Definitive chemo-radiotherapy for squamous cell carcinoma of the pharynx: impact of baseline low hemoglobin level (<12 g/dL) and post-radiation therapy F-18 FDG-PET/CT

Objective To identify reliable predictors of overall survival (OS), locoregional control (LC), and metastasis-free survival (MFS) after definitive concurrent chemo-radiotherapy (CCRT) for squamous cell carcinoma (SCC) of the pharynx (nasopharynx, oropharynx and hypopharynx), we examined 16 potential prognostic factors, including pre-treatment hemoglobin level and pre- and post-treatment [ 18 F]fluorodeoxyglucose positron emission tomography CT (F-18 FDG-PET/CT) maximum standardized up-take values (SUV max ) of primary sites and lymph node (LN) regions. Methods We retrospectively reviewed records of 70 patients treated with definitive CCRT for pharyngeal cancer in our institution during July 2006–April 2012, with particular regard to 16 prognostic factors: age, sex, T stage, N stage, retropharyngeal LN (RPLN) involvement, existence of multiple primary cancer, treatment interruptions, overall treatment time, chemotherapy type, pre-treatment hemoglobin level, pre-treatment body mass index, enteral feeding period, and pre- and post-treatment F-18 FDG-PET/CT SUV max of primary site and LN region. All patients in our cohort underwent pre- and post-treatment F-18 FDG-PET/CT. Results Multivariate analysis associated improved OS with pre-treatment hemoglobin level (≥12 g/dL; hazard ratio [HR] 3.902; 95 % confidence interval [CI] 1.244–12.236; P = 0.020) and post-treatment SUV max (primary site) (SUV max