Incidence and impact of anemia in radiation oncology
About 45 years ago, Thomlinson and Gray (1955) demonstrated the presence of radioresistant hypoxic cells in experimental cancers. Their work stimulated much clinical and experimental research work on hypoxia in tumors. In subsequent investigations, a marked impact of hemoglobin levels on treatment outcome was found by Evans and Bergsjö in 1965. They found a stage-dependent linear relationship between hemoglobin 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 most radiotherapists did not focus on the prognostic impact of anemia in daily work. The main question over the recent years has concentrated on whether or not the well-known association between anemia and survival reflects a causal relationship or represents only an epiphenomemon (Fyles et al. 2000).
KeywordsCervical Cancer Hemoglobin Level Radiation Oncology Prognostic Impact Radiation Therapy Oncology Group
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- 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: 37–42CrossRefGoogle Scholar
- 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: 1069–1075PubMedCrossRefGoogle Scholar
- Oehler W, Fischer J, Merkle K (1990) Beeinflußt der initiale Hämoglobinwert die Primärtumorreaktion? Eine Untersuchung an 264 bestrahlten Bronchialkarzinomen. Radiobiol Radiother 31: 325–331Google Scholar
- Overgaard J (1988) The influence of hemoglobin concentrations on the response to radiotherapy. Scand J Clin Lab Invest 48: 49–53Google Scholar
- 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 head and neck cancer after concomitant boost radiochemotherapy. Radiother Oncol 53: 119–125PubMedCrossRefGoogle Scholar
- 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: 1475–1482PubMedCrossRefGoogle Scholar