Prognostic value of hemoglobin concentrations in patients with advanced head and neck cancer treated with combined radio-chemotherapy and surgery

Purpose: Hemoglobin levels are currently the focus of interest as prognosti c factors in patients with head and neck cancer. Most published clinical tr ials have confirmed hemoglobin to possess a significant influence on surviv al in patients treated with radiotherapy. In our study we have investigated the prognostic value of hemoglobin in a combined modality schedule. Patients and Methods: Forty-three patients with advanced head and neck tumo rs were treated with combined radiochemotherapy. The therapy comprised 2 co urses of induction chemotherapy with ifosfamide (1,500 mg/m(2), day 1 to 5) and cisplatin (60 mg/m(2), day 5) followed by hyperfractionated accelerate d radiotherapy with a total dose of only 30 Gy. Surgery involved tumor rese ction and neck dissection. Results: The 1-year overall survival rate and the 2-year survival rate were 79% and 56%,respectively. The 1- and 2-year recurrence-free survival rates were 68% and 49%, respectively. Prognostic factors with an impact on survi val were seen in tumor size (T3 vs T4, p = 0.0088), response to radio-chemo therapy at the primary site (no vital tumor rest vs vital tumor rest, p = 0 .045). response to lymph node radio-chemotherapy (no vital tumor cells vs v ital tumor cells, p = 0.013) and level of hemoglobin after radio-chemothera py (Hb greater than or equal to 11.5 g/dl vs < 11.5 g/dl, p = 0.0084). Conclusion: In our study hemoglobin level after radio-chemotherapy was iden tified for the first time to be also a significant prognostic factor (univa riate analysis) in head and neck cancer patients who underwent combined rad io-chemotherapy. Besides chemotherapy plus low-dose irradiation achieved si milar results in comparison with radical resection and high-dose radiothera py at least for the first 2 years after therapy. Relapsing disease could be treated with 1 additional course of radiotherapy which is supposed to be w ell tolerated.