Prognostic significance of initial hemoglobin in head and neck cancer treated by primary chemoradiation

The pretherapeutic hemoglobin level (Hb) has been postulated to constitute a prognostic marker for outcome after primary chemoradiation of patients wi th advanced cancer of the head and neck. However, this hypothesis has not b een tested systematically in large study samples. In the years 1992-1997, 125 patients with advanced head and neck cancer (st ages III-IV UICC) were treated with primarychemoradiation in two different prospective multicentric trials, 62 patients in trial A (phase II,1992-1995 ), and 63 in trial B (phase III, 1995-1997). Beside initial Hb, other preth erapeutic parameters with potential prognostic relevance were assessed and correlated with clinical outcome after 43-months follow-up: total tumor vol ume (TTV; calculated in initial CT scans), tumor oxygenation (polarographic measurements with Eppendorf histography),TNM, tumor localization, age, and performance status. The evaluation of the clinical end points (progression-free and overall sur vival and local tumor control) revealed that Hb and TTV were independent pa rameters with strong predictive character of outcome after primary chemorad iation in both trials (n=125). Bivariate analysis showed < median (13.5 g/d l) a hazard ratio of 2.1 (P=0.002) for Hb: and > median (98 ml) a Hazard ra tio of 2.0 (P=0.006) for TTV. Severe anemia (Hb<10 g/dl) was an adverse fac tor in three patients. Hypoxia was associated with poorer initial therapeut ical response but was not predictive of clinical outcome. Furthermore, tumo r oxygenation showed no correlation with Hb. The other parameters examined failed to show prognostic significance. Our results indicate a high prognostic value of initial Hb for outcome afte r primary chemoradiation in advanced head and neck cancer and imply a thera peutic benefit of Hb substitution or erythropoietin administration. We prop ose to test this in randomized clinical trials.