Changes in hemoglobin concentration during chemoradiation of locally advanced head and neck tumors

Background: Despite multimodality treatment strategies of locally advanced head and neck cancers long-term results leave much to be desired. There is evidence that oxygenation status of head and neck tumors is directly influe nced by the hemoglobin concentration. The aim of this study was to verify c hanges in the hemoglobin level during combined radio-chemotherapy of locall y advanced head and neck tumors. Patients and Methods: Sixty-eight patients with locally advanced head and n eck cancer had primary or adjuvant radiotherapy with doses of 60 to 74 Gy i n combination with cisplatin- (+/-5-FU) or carboplatin chemotherapy in the first and fifth week of treatment. Hemoglobin levels were analyzed before a nd at the end of radiotherapy. Results: In 41% of all patients the initial hemoglobin concentration was be low normal levels. The mean hemoglobin values in all patients dropped signi ficantly from 12.9 +/- 1.7 g/dl before to 11.6 +/- 1.6 g/dl at the end of t reatment. In 12 cases (18%) allogeneic erythrocytes had to be transfused du ring treatment. At the end of treatment 76% of all patients had anemic hemo globin levels. In the groups of patients with cisplatin and carboplatin che motherapy a significant decrease in hemoglobin levels was seen without mean ingful statistical difference between these 2 groups. Conclusions: In patients with locally advanced head and neck cancer a high initial rate of anemia was registered (41%): This rate was nearly doubled d uring chemoradiation (76%). Since several studies have shown a correlation between hemoglobin levels and local tumor control, there is evidence, that this group might benefit from correcting anemia before combined radio-chemo therapy.