The impact of blood hemoglobin content on the outcome of radiotherapy - The Freiburg experience

Background: Numerous publications have reported an impaired radiocurability when anemia is present. Tissue hypoxia and consecutive radioresistance are speculated to be the underlying causes. Own Experience: Our own retrospective data impressively confirm these obser vations: in an analysis of 889 patients homogeneously irradiated for head a nd neck cancer for locoregional tumor control and survival, anemia has prov en to be a highly significant risk factor. Furthermore, hemoglobin content is an independent and, at least equally powerful predictor for outcome when compared to the known risk factors of site, treatment modality, resection status, T-, and N-stage. Treatment: In an attempt to improve therapeutic outcome, 50 anemic patients undergoing radiotherapy were treated with erythropoietin (rhEPO). A weekly increment in hemoglobin content of 0.7 g/dl was documented without any maj or side effects. Additionally, it seems that patients reacting sufficiently to rhEPO stimulation can expect batter locoregional tumor control within t he irradiation volume. This, however, awaits confirmation in an ongoing tri al.