Skip to main content
SpringerLink
Log in
Book cover

Recombinant Human Erythropoietin (rhEPO) in Clinical Oncology pp 249–263Cite as

Incidence and impact of anemia in radiation oncology

  • Chapter

Abstract

About 45 years ago, (1955) demonstrated the presence of radioresistant hypoxic cells in experimental cancers.Their work stimulated numerous clinical and experimental investigations on hypoxia in tumors. In subsequent investigations, a marked impact of hemoglobin (Hb) levels on treatment outcome was found by Evans and Bergsjö in 1965. They found a stage-depenodent linear relationship between Hb levels and local control as well as survival after radiotherapy. Evans and Bergsjö interpreted their findings as a result of anemia-induced tumor hypoxia. Although numerous other studies have further supported an association between anemia and decreased local control and survival in radiotherapy patients, some controversies have remained and a major issue of current research is whether or not the wellknown association between anemia and survival reflects a causal relationship or represents only an epi-phenomemon (Fyles et al. 2000).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 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

    PubMed  Google Scholar 

  2. 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

    Google Scholar 

  3. Bush RS (1986) The significance of anemia in clinical radiation therapy. Int J Radiat Oncol Biol Phys 12: 2047–2050

    CAS  PubMed  Google Scholar 

  4. Canaday DJ, Regine WF, Mohiuddin M, Zollinger W, Machtay M, Schultz D, Rudoltz MS (1999) Significance of pretreatment hemoglobin levels in patients with T1 glottic cancer. Radiat Oncol Investig 7: 42–48

    Article  CAS  PubMed  Google Scholar 

  5. Dunst J, Hintner A, Haensgen G, Becker A (1999) Low hemoglobin is associated with increased serum levels of vascular endothelial growth factor (VEGF) in cancer patients. Does anemia stimulate angiogenesis? Strahlenther Onkol 175: 93–96

    Article  CAS  PubMed  Google Scholar 

  6. Dunst J, Becker A, Lautenschlaeger C, Markau S, Becker H, Fischer K, Haensgen G (2002) Anemia and elevated systemic levels of vascular endothelial growth factor. Strahlenther Onkol 178: 436–441

    Article  PubMed  Google Scholar 

  7. Dunst J, Kuhnt T, Pelz T, Strauss HG, Koelbl H, Haensgen G (2003) Anemia in cervical cancers: patterns of relapse and association with tumor hypoxia and angiogenesis. Int J Radiat Oncol Biol Phys 56: 778–787

    PubMed  Google Scholar 

  8. Evans IC, Bergsjø P (1965) The influence of anemia on the results of radiotherapy in carcinoma of the cervix. Radiology 84: 709–717

    CAS  PubMed  Google Scholar 

  9. Fein DA, Lee WR, Hanlon AL, Ridge JA, Langer CJ, Curran WJ Jr, Coia LR (1995) Pretreatment hemoglobin level influences local control and survival of T1-T2 squamous cell carcinomas of the glottic larynx. J Clin Oncol 13: 2077–2083

    CAS  PubMed  Google Scholar 

  10. Frommhold H, Guttenberger R, Henke M (1998) The impact of blood hemoglobin content on the outcome of radiotherapy. The Freiburg experience. Strahlenther Onkol 174 [Suppl IV]: 31–34

    PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. Girinksi T, Pejovic-Lenfant MH, Bourhis J, Campana F, Cosset JM, Petit C, Malaise EP, Haie C, Gerbaulet A, Chassagne D (1989) Prognostic value of hemoglobin concentrations and blood transfusions in advanced carcinoma of the cervix treated by radiation therapy: results of a retrospective study of 386 patients. Int J Radiat Oncol Biol Phys 16: 37–42

    Google Scholar 

  13. Grau C, Overgaard J (1998) Significance of hemoglobin 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

    Google Scholar 

  14. Grogan M, Thomas GM, Melamed I, Wong FL (1999) The importance of maintaining high hemoglobin levels during radiation treatment of carcinoma of the cervix. Cancer 86: 1531–1536

    Article  Google Scholar 

  15. Hannisdal E, Fossa SD, Host H (1993) Blood tests and prognosis in bladder carcinomas treated with definitive radiotherapy. Radiother Oncol 27: 117–122

    Article  CAS  PubMed  Google Scholar 

  16. Harrison L, Shasha D, Homel P (2002) Prevalence of anemia in cancer patients undergoing radiotherapy: prognostic significance and treatment. Oncology 63 [Suppl 2]: 11–18

    Article  CAS  PubMed  Google Scholar 

  17. Hasenclever D, Diehl V (1998) A prognostic score for advanced Hodgkin’s disease: International prognostic factors project on advanced Hodgkin’s disease. N Engl J Med 339: 1506–1514

    Article  CAS  PubMed  Google Scholar 

  18. Kapp DS, Fisher D, Gutierrez E, Kohorn IE, Schwartz PE (1983) Pretreatment prognostic factors in carcinoma of the uterine cervix: a multivariate analysis of the effect of age, stage, histology, and blood counts on survival. Int J Radiat Oncol Biol Phys 9: 445–455

    CAS  PubMed  Google Scholar 

  19. Lee WR, Berkey B, Marcial V, Fu KK, Cooper JS, Vikram B, Coia L, Rotman M, Ortiz H (1998) Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: a secondary analysis of RTOG 85-27. Int J Radiat Oncol Biol Phys 42: 1069–1075

    CAS  PubMed  Google Scholar 

  20. Lutterbach J, Guttenberger R (2001) Anemia is associated with decreased local control of surgically treated squamous cell carcinomas of the glottic larynx. Int J Radiat Oncol Biol Phys 48: 1345–1350

    Google Scholar 

  21. Logsdon MD, Eifel PJ (1999) FIGO IIIB squamous cell carcinoma of the cervix: an analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy. Int J Radiat Oncol Biol Phys 43: 763–775

    CAS  PubMed  Google Scholar 

  22. Miller CB, Jones RJ, Piantadosi S, Abeloff MD, Spivak JL (1990) Decreased erythropietin response in patients with the anemia of cancer. N Engl J Med 322: 1689–1692

    CAS  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. Nowrousian MR (2007) Pathophysiology of anemia in cancer. In: Nowrousian MR (ed) Recombinant human erythropoietin (rhEPO) in clinical oncology, 2nd edn. Springer, Wien New York, 149–188

    Google Scholar 

  25. Oehler W, Fischer J, Merkle K (1990) Beeinflusst der initiale Hämoglobinwert die Primärtumorreaktion ? Eine Untersuchung an 264 bestrahlten Bronchialkarzinomen. Radiobiol Radiother 31: 325–331

    CAS  Google Scholar 

  26. Overgaard J (1988) The influence of hemoglobin concentrations on the response to radiotherapy. Scand J Clin Lab Invest 48: 49–53

    Google Scholar 

  27. Pedersen D, Sogaard H, Overgaard J, Bentzen SM (1995) Prognostic value of pretreatment factors in patients with locally advanced carcinoma of the uterine cervix treated by radiotherapy alone. Acta Oncol 34: 787–795

    Article  CAS  PubMed  Google Scholar 

  28. Quilty PM, Duncan W (1986) The influence of the hemoglobin level on the regression and long term local control of transitional cell carcinoma of the bladder following photon irradiation. Int J Radiat Oncol Biol Phys 12: 1735–1742

    CAS  PubMed  Google Scholar 

  29. Rudat V, Dietz A, Schramm O, Conradt C, Maier H, Flentje M, Wannenmacher M (1999) Prognostic impact of total tumor volume and hemoglobin concentration on the outcome of patients with advanced nead and neck cancer after concomitant boost radiochemotherapy. Radiother Oncol 53: 119–125

    Article  CAS  PubMed  Google Scholar 

  30. Stadler P, Becker A, Feldmann HJ, Dunst J, Molls M (1999) Influence of the hypoxic subvolume on the survival of patients with head and neck cancer. Int J Radiat Oncol Biol Phys 44: 749–754

    CAS  PubMed  Google Scholar 

  31. Tarnawski R, Skladowski K, Maciejewski B (1997) Prognostic value of hemoglobin concentration in radiotherapy for cancer of the supraglottic larynx. Int J Radiat Oncol Biol Phys 38: 1007–1011

    CAS  PubMed  Google Scholar 

  32. Thomlinson RH, Gray LH (1955) The histological structure of some human lung cancers and the possible implications for radiotherapy. Br J Cancer 9: 539–549

    CAS  PubMed  Google Scholar 

  33. Van Acht MJ, Hermans J, Boks DE, Leer JW (1992) The prognostic value of hemoglobin and a decrease in hemoglobin during radiotherapy in laryngeal carcinoma. Radiother Oncol 23: 229–235

    Article  PubMed  Google Scholar 

  34. Vaupel P, Thews O, Mayer A, et al (2002) Oxygenation status of gynecological tumors: what is the optimal hemoglobin level? Strahlenther Onkol

    Google Scholar 

  35. Wagner W, Hermann R, Hartlapp J, Esser E, Christoph B, Müller M, Krech R, Koch O (2000) Prognostic value of hemoglobin concentrations in patients with advanced head and neck cancer treated with combined radio-chemotherapy and surgery. Strahlenther Onkol 176: 73–80

    Article  CAS  PubMed  Google Scholar 

  36. Werner-Wasik M, Scott C, Cox JD, Sause WT, Byhardt RW, Asbell Russell A, Komaki R, Lee JS (2000) Recursive partitioning analysis of 1999 Radiation Therapy Oncology Group (RTOG) patients with locally-advanced non-small-cell lung cancer (LA-NSCLC): identification of five groups with different survival. Int J Radiat Oncol Biol Phys 48: 1475–1482

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Prof. Dr. Jürgen Dunst

  2. Department of Radiation Oncology, Technical University Munich, Ismaninger Straße 22, 81675, München, Germany

    Univ.-Prof. Dr. med. M. Molls

Authors
  1. Prof. Dr. Jürgen Dunst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Univ.-Prof. Dr. med. M. Molls
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jürgen Dunst .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine (Cancer Research), West German Cancer Center, University Hospital of Essen, Essen, Germany

    Mohammad Resa Nowrousian

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag/Wien

About this chapter

Cite this chapter

Dunst, J., Molls, M. (2008). Incidence and impact of anemia 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_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-211-69459-6_9

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-25223-9

  • Online ISBN: 978-3-211-69459-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation