Abstract
Cancer-related anemia is a complex disease (for review see: Birgegaard et al. 2005; Nowrousian 2007) and is a well-known prognostic factor in patients treated with radiotherapy (for review see: Grau and Overgaard 1998; Caro et al. 2001; Knight et al. 2004; Dunst and Molls 2007). Its impact on local control and survival is mainly explained by the fact that anemia may worsen tumor oxygenation and thereby decreases the radiation sensitivity of a tumor (so-called oxygen effect). Improving tumor tissue oxygenation by avoiding or correcting anemia during radiotherapy is therefore an attractive approach to increase radiation efficacy. Tumor hypoxia, on the other hand, is a complex phenomenom which may be caused by a variety of mechanisms of which anemia is only one.
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References
Acs G, Zhang PJ, McGrath CM, et al (2003) Hypoxia-inducible erythropoietin signaling in squamous dysplasia and squamous cell carcinoma of the uterine cervix and its potential role in cervical carcinogenesis and tumor progression. Am J Pathol 162: 1789–1806
Ahmed RS, Kim RY, Duan J, Meleth S, De Los Santos JF, Fiveash JB (2004) IMRT dose escalation for positive paraaortic lymph nodes in patients with locally advanced cervical cancer while reducing dose to bone marrow and other organs at risk. Int J Radiat Oncol Biol Phys 60: 505–512
Arcasoy MO, Amin K, Chou SC, Haroon ZA, Varia M, Raleigh JA (2005) Erythropoietin and erythropoietin receptor expression in head and neck cancer: relationship to tumor hypoxia. Clin Cancer Res 11: 20–27
Batra S, Perelman N, Lori R, et al (2003) Pediatric tumor cells express erythropoietin and a functional erythropoietin receptor that promotes angiogenesis and tumor cell survival. Lab Invest 83: 1477–1487
Becker A, Stadler P, Lavey R, Haensgen G, Kuhnt T, Lautenschlaeger C, Feldmann HJ, Molls M, Dunst J (2000) Severe anemia is associated with poor tumor oxygenation in head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 46: 459–466
Belenkov AI, Shenouda G, Rizhevskaya E, Cournoyer D, Belzile JP, Souhami L, Devic S, Chow TY (2004) Erythropoietin induces cancer cell resistance to ionizing radiation and cisplatin. Mol Cancer Ther 3: 1525–1532
Birgegard G, Aapro MS, Bokemeyer C, Dicato M, Drings P, Hornedo J, Krzakowski M, Ludwig L, Pecorelli S, Schmoll H, Schneider M, Schrijvers D, Shasha D, Van Belle S (2005) Cancer-related anemia: pathogenesis, prevalence and treatment. Oncology 68 [Suppl 1]: 3–11
Blohmer JU, von Minckwitz G, Paepke, et al (2002) Sequential adjuvant chemoradiotherapy with vs. without erythropoietin for patients with high-risk cervical cancer — second analysis of a prospective, randomized, open and controlled AGOand NOGGO-intergroup study. Proc ASCO 21: 206a
Blumberg N, Heal JM (1996) The transfusion modulation theory: the th1/th2 paradigm and an analogy with pregnancy as a unifying mechanism. Semin Hematol 33: 329–340
Bohlius JF, Langensiepen S, Schwarzer G, Bennet CL, Engert A (2003) Does erythropoietin improve survival in the treatment of patients with malignant diseases? Results of a comprehensive meta-analysis. Blood 102, [Suppl] Abstract_709
Bokemeyer C, Aapro MS, Courdi A, Foubert J, Link H, Osterborg A, Repetto L, Soubeyran P (2004) EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer. Eur J Cancer 40: 2201–2216
Boogaerts M, Coiffier B, Kainz C and the Epoietin beta QoL Working Group (2003) Impact of epoietin beta on quality of life in patients with malignant disease. Br J Cancer 88: 988–995
Boogaerts M, Mittelman M, Vaupel P (2005) Beyond anaemia management: evolving role of erythropoietin therapy in neurological disorders, multiple myeloma and tumour hypoxia models. Oncology 69 [Suppl 2]: 22–30
Bush RS (1986) The significance of anemia in clinical radiation therapy. Int J Radiat Oncol Biol Phys 12: 2047–2050
Caro JJ, Salas M, Ward A, Goss G (2001) Anemia as an independent prognostic factor for survival in patients with cancer: a systematic, quantitative review. Cancer 91: 2214–2221 C
Cerami A (2001) Beyond erythropoiesis: novel applications for recombinant erythropoietin. Semin Hematol 38 [Suppl 7]: 33–39
Cerami A, Brins M, Ghezzi P, Cerami C, Itri LM (2002) Neuroprotective properties of epoietin alfa. Nephrol Dial Transplant 17 [Suppl 1]: 8–12
Dellinger EP, Anaya DA (2004) Infectious and immunological consequences of blood transfusions. Critical Care 8 [Suppl 2]: S18–S23
Dunst J, Feldmann HJ, Becker A, Stadler P, Haensgen G, Molls M (1999) Oxygenation of human tumors: the Halle/Munich experience. In: Vaupel P, Kelleher D (eds) Tumor hypoxia. Wissenschaftliche Verlagsgesellschaft mbH, Stuttgart
Dunst J (2004) Erythropoietin and radiotherapy: a dangerous combination? Strahlenther Onkol 180: 133–135
Dunst J, Molls M (2006) Incidence and impact of anemia in radiation oncology. In: Nowrousian MR (ed) Recombinant human erythropoietin (rhEPO) in clinical oncology. Springer, Wien New York
Dusenbery KE, McGuie WA, Holt PJ, et al (1994) Erythropoietin increases Hb during radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 29: 1079–1084
Fyles AW, Milosevic M, Pintilie M, Syed A, Hill RP (2000) Anemia, hypoxia and transfusion in patients with cervical cancer: a review. Radiother Oncol 57: 13–19
Glaser CM, Millesi W, Kornek GV, et al (2001) Impact of Hb level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx. Int J Radiat Oncol Biol Phys 50: 705–715
Grau C, Overgaard J (1998) Significance of Hb concentrations for treatment outcome. In: Molls M, Vaupel P (eds) Blood perfusion and microenvironment of human tumors. Implications for clinical radiooncology. Springer, Berlin, pp 101–112
Grogan M, Thomas GM, Melamed I, Wong FL (1999) The importance of maintaining high Hb levels during radiation treatment of carcinoma of the cervix. Cancer 86: 1531–1536
Henke M, Guttenberger R, Barke A, Pajonk F, Pötter R, Frommhold H (1999) Erythropoietin for patients undergoing radiotherapy: a pilot study. Radiother Oncol 50: 185–190
Henke M, Laszig R, Rübe C, Schaefer U, Haase KD, Schilcher D, Mose S, Beer KT, Burger U, Dougherty C, Frommhold H (2003) Erythropoietin to treat head and neck cancer patients with aneamia undergoing radiotherapy: randomized, double-blind, placebo-controlled trial. Lancet 362: 1255–1260
Henke M, Mattern D, Pepe M, Bézay C, Weissenberger C, Werner M, Pajonk F (2006) Do erythropoietin receptors on cancer cells explain unexpected clinical findings? J Clin Oncol 24: 4708–4713
Höckel M, Schlenger K, Aral B, Mitze M, Schaffer U, Vaupel P (1996) Association between tumor hypoxia and malignant progression in advanced cancer of the uterine cervix. Cancer Res 56: 4509–4515
Kapp KS, Poschauko J, Geyer E, Berghold A, Oechs AC, Petru E, Lahousen M, Kapp DS (2002) Evaluation of the effect of routine packed blood cell transfusion in anemic cervix cancer patients treated with radical radiotherapy. Int J Radiat Oncol Biol Phys 54: 58–66
Kelleher DK, Matthiensen U, Thews O, Vaupel P (1995) Tumor oxygenation in anemic rats: effects of erythropoietin treatment versus red blood cell transfusion. Acta Oncol 34: 379–384
Kelleher DK, Matthiesen U, Thews O, Vaupel P (1996) Blood flow, oxygenation and bioenergetic status of tumors after erythropoietin treatment in normal and anemic rats. Cancer Res 56: 4728–4734
Knight K, Wade S, Balducci L (2004) Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med 116: 11S–26S
Lavey RS, Dempsey WH (1993) Erythropoietin increases Hb in cancer patients during radiation therapy. Int J Radiat Oncol Biol Phys 27: 1147–1152
Lavey RS, Liu PY, Greer BF, Robinson WRD, Chang PC, Wynn RB, Conrad ME, Jiang C, Markman M, Alberts DS (2004) Recombinant human erythropoietin as an adjunct to radiation therapy and cisplatin for stage IIB-IVA carcinoma of the cervix: a Southwest Oncology Group study. Gyn Oncol 95: 145–151
Leyland-Jones B, Semiglazov V, Pawlicki M, Pienkowski T, Tjulandin S, Manikhas G, Makhson A, Roth A, Dodwell D, Baselga J, Biakhov M, Valuckas K, Voznyi E, Liu X, Vercammen E (2005) Maintaining normal Hb levels with epoetin alfa in mainly nonanemic patients with metastatic breast cancer receiving first-line chemotherapy: a survival study. J Clin Oncol 23: 5960–5972
Leyland-Jones B, BEST Investigators and Study Group (2003) Breast cancer trial with erythropoietin terminated unexpectedly. Lancet Oncol 5: 206–207
Machtay M, Pajak T, Suntharalingam M, Hershock D, Stripp DC, Cmelak A, Shenouda G, Schulsinger A, Fu K (2004) Definitive radiotherapy ± erythropoietin for squamous cell carcinoma of the head and neck: preliminary report of RTOG 99-03. Int J Radiat Oncol Biol Phys 60 [Suppl 1]: 132
Mueller-Klieser W, Vaupel P, Manz R, Schmidseder R (1981) Intracapillary oxyHb saturation in malignant tumors in humans. Int J Radiat Oncol Biol Phys 7: 1397–1404
Ning S, Hartley C, Molineux G, Knox SJ (2005) Darbepoietin alfa potentiates the efficacy of radiation therapy in mice with corrected or uncorrected anemia. Cancer Res 65: 284–290
Nordsmark M, Overgaard M, Overgaard J (1996) Pretreatment oxygenation predicts radiation response in advanced squamous cell carcinoma of the head and neck. Radiother Oncol 41: 31–39
Nordsmark M, Bentzen SM, Rudat V, Brizel D, Lartigau E, Stadler P, Becker A, Adam M, Molls M, Dunst J, Terris DJ, Overgaard J (2005) Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multicenter study. Radiother Oncol 77: 18–24
Nowrousian MR (2006) Pathophysiology of cancer-related anemia. In: Nowrousian MR (ed) Recombinant human erythropoietin (rhEPO) in clinical oncology. Springer, Wien New York
Pinel S, Barberi-Heyob M, Cohen-Jonathan E, Merlin JL, Delmas C, Plenat F, Chastagner P (2004) Erythropoietin-induced reduction of hypoxia before and during fractionated irradiation contributes to improvement of radioresponse in human glioma xenografts. Int J Radiat Oncol Biol Phys 59: 250–259
Rades D, Schild SE, Yekebas EF, Job H, Schwarz R, Rudat V (2005) Epoetinalpha during radiotherapy for stage III esophageal carcinoma. Cancer 103: 2274–2279
Rizzo JD, Lichtin AE, Woolf SH, et al (2002) Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. J Clin Oncol 20: 4083–4107
Rosen FR, Haraf DJ, Kies MS, Stenson K, Portugal L, List MA, Brockstein BE, Mittal BB, Rademaker AW, Witt ME, Pelzer H, Weichselbaum RR, Vokes EE (2003) Multicenter randomized phase II study of paclitaxel (1hour infusion), fluorouracil, hydroxyurea, and concomitant twice daily radiation with or without erythropoietin for advanced head and neck cancer. Clin Cancer Res 9: 1689–1697
Santin AD, Bellone S, Palmieri M, et al (2002) Effect of blood transfusions during radiotherapy on the immune fanction of patients with cancer of the uterine cervix: role of interleukin-10. Int J Radiat Oncol Biol Phys 54: 1345–1355
Shasha D, George MJ, Harrison LB (2003) Once-weekly dosing of epoetin-alfa increases Hb and improves quality of life in anemic cancer patients receiving radiation therapy either concomitantly or sequentially with chemotherapy. Cancer 98: 1072–1079
Selzer E, Wachek V, Kodym R, et al (2000) Erythropoietin receptor expression in human melanoma cells. Melanoma Res 10: 421–426
Strauss HG, Haensgen G, Dunst J, Hayward CRW, Burger HU, Koelbl H (2006) Effects of anaemia correction with epoetin beta in patients receiving radiochemotherapy for advanced cervical cancer. Clin Cancer Res (in press)
Stueben G, Thews O, Poettgen C, et al (2001) Recombinant human erythropoietin increases the radiosensitivity of xenografted human tumours in anaemic nude mice. J Cancer Res Clin Oncol 127: 346–350
Stueben G, Thews O, Poetttgen C, et al (2003) Impact of anemia prevention by recombinant erythropoietin on the sensitivity of xenografted glioblastomas to fractionated irradiation. Strahlenther Onkol 179: 620–625
Sundfor K, Lyng H, Rofstad EK (1998) Tumor hypoxia and vascular density as predictors of metastasis in squamous cell carcinoma of the uterine cervix. Br J Cancer 78: 822–827
Sweeney PJ, Nicolae D, Ignacio L, Chen L, Roach M, Wara W, Marcus KC, Vijayakumar S (1998) Effect of subcutaneous recombinant human erythropoietin in cancer patients reciving radiotherapy: final report of a randomized, openlabelled phase II trial. Br J Cancer 77: 1996–2002
Thews O, König R, Kelleher DK, et al (1998) Enhanced radiosensitivity in experimental tumours following erythropoietin treatment of chemotherapy-induced anaemia. Br J Cancer 78: 752–766
Thews O, Kelleher DK, Vaupel P (2001) Erythropoietin restores the anemiainduced reduction in cyclophosphamide cytotoxicity in rat tumors. Cancer Res 61: 1358–61
Throuvalas N, Antonadou D, Lavey R, Boufi M, Malamos N (2004) Final results of a randomized phase II study evaluating the role of erythropoietin during radiochemotherapy for pelvic tumors. Int J Radiat Oncol Biol Phys 60 [Suppl 1]: 300
Vaupel P, Kallinowski F, Okunieff P (1989) Blood flow, oxygen and nutrient supply, and metabolic environment of human tumors: a review. Cancer Res 49: 6449–6465
Vaupel P, Thews O, Mayer A, et al (2002) Oxygenation status of gynecological tumors: what is the optimal Hb level? Strahlenther Onkol 178: 727–731
Westenfelder C, Baranowski RL (2000) Erythropoietin stimulates proliferation of human renal carcinoma cells. Kidney Int 58: 647–657
Westphal G, Niederberger L, Blum C, Wollman Y, Knoch TA, Rebel W, Debus J, Friedrich E (2002) Erythropoietin and G-CSF receptors in human tumor cells: expression and aspects regarding functionality. Tumori 88: 150–159
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Dunst, J. (2008). Treatment of anemia with rhEPO in radiation oncology. In: Nowrousian, M.R. (eds) Recombinant Human Erythropoietin (rhEPO) in Clinical Oncology. Springer, Vienna. https://doi.org/10.1007/978-3-211-69459-6_23
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DOI: https://doi.org/10.1007/978-3-211-69459-6_23
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