Severe anemia is associated with poor tumor oxygenation in head and neck squamous cell carcinomas

Purpose: To investigate the relationship between tumor oxygenation and the blood hemoglobin (Hb) concentration in patients with squamous cell carcinom a of the head and neck (SCCHN). Methods and Materials: A total of 133 patients with SCCHN underwent pretrea tment polarographic pO(2) measurements of their tumors, In 66 patients meas urements were also made in sternocleidomastoid muscles. The patients were d ivided into three groups according to their Hb concentration-severe anemia (Hb < 11.0 g/dl), mild anemia (female: Hb 11.0-11.9 g/dl; male: Hb 11.0-12. 9 g/dl), and normal Hb concentration (female: Hb greater than or equal to 1 2.0 g/dl; male: greater than or equal to 13.0 g/dl). Results: No significant difference in tumor oxygenation could be detected b etween mildly anemic patients and patients with a normal Hb level. However, the tumor oxygenation in the severely anemic group was significantly below that of each of the other two groups (p < 0.0001). There was no significan t difference between the Hb groups in oxygenation of sternocleidomastoid mu scles, In a multivariate analysis including Hb group, tumor volume, smoking habits, gender, T-stage, N-stage, and histologic grade a Hb level < 11 g/d l was found to be the strongest predictor for a poor tumor oxygenation. Smo king also had a marginal influence on median pO(2). Conclusion: Our data suggest that a low Hb concentration and cigarette smok ing contribute to inadequate oxygenation of SCCHN and thus for increased ra dioresistance. Consequently, Hb correction and abstinence from smoking may significantly improve tumor oxygenation. (C) 2000 Elsevier Science Inc.