The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix

BACKGROUND. It is unclear whether blood transfusion can overcome the negati ve impact of anemia before or during radiotherapy (RT) in patients with car cinoma of the cervix. The objective of this retrospective study was to exam ine the impact of anemia and blood transfusion on 605 patients with carcino ma of the cenix treated with radical RT at 7 centers across Canada in 1989, 1990, and 1992. METHODS. The data collected included hemoglobin (Hgb) levels from the time of diagnosis to the end of therapy; blood transfusions administered; and id entifiable patient-, tumor-, and treatment-related factors. Survival, disea se free survival, and pelvic control analyses were evaluated by univariate and multivariate analysis. RESULTS. The median follow-up was 41 months (range, 0-92 months). Presentin g Hgb level, average weekly nadir Hgb (AWNH) during RT, and blood transfusi on were correlated significantly with local control, disease free survival, and overall survival on univariate analysis. However, the AWNH remained si gnificant on multivariate analysis, whereas Hgb at presentation and blood t ransfusion did not. The 5-year survival was 74% for patients with an AWNH g reater than or equal to 120 g/L, 52% for patients with AWNH levels 110-119 g/L inclusive, and 45% for patients with AWNH levels < 110 g/L (P < 0.0001) . At each Hgb level, patients who were transfused and maintained a specific Hgb level had a survival rate that was not significantly different from pa tients who were at that level spontaneously. There was a significant reduct ion in both pelvic and distant recurrence (P < 0.0001 and P < 0.0006, respe ctively) in patients whose AWNH level during RT was greater than or equal t o 120 g/L compared with < 120 g/L. A reduction in the rate of distant recur rence was observed in patients with and without pelvic recurrence. CONCLUSIONS, AWNH is highly predictive of outcome for patients treated with RT for carcinoma of the cervix. Blood transfusion appears to overcome the negative prognostic effects of low presenting Hgb levels and AWNH levels. ( C) 1999 American Cancer Society.