The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix

BACKGROUND It is unclear whether blood transfusion can overcome the negative impact of anemia before or during radiotherapy (RT) in patients with carcinoma of the cervix. The objective of this retrospective study was to examine the impact of anemia and blood transfusion on 605 patients with carcinoma of the cervix treated with radical RT at 7 centers across Canada in 1989, 1990, and 1992. METHODS The data collected included hemoglobin (Hgb) levels from the time of diagnosis to the end of therapy; blood transfusions administered; and identifiable patient‐, tumor‐, and treatment‐related factors. Survival, disease free survival, and pelvic control analyses were evaluated by univariate and multivariate analysis. RESULTS The median follow‐up was 41 months (range, 0–92 months). Presenting Hgb level, average weekly nadir Hgb (AWNH) during RT, and blood transfusion were correlated significantly with local control, disease free survival, and overall survival on univariate analysis. However, the AWNH remained significant on multivariate analysis, whereas Hgb at presentation and blood transfusion did not. The 5‐year survival was 74% for patients with an AWNH ≥ 120 g/L, 52% for patients with AWNH levels 110–119 g/L inclusive, and 45% for patients with AWNH levels < 110 g/L (P < 0.0001). At each Hgb level, patients who were transfused and maintained a specific Hgb level had a survival rate that was not significantly different from patients who were at that level spontaneously. There was a significant reduction in both pelvic and distant recurrence (P < 0.0001 and P < 0.0006, respectively) in patients whose AWNH level during RT was ≥ 120 g/L compared with < 120 g/L. A reduction in the rate of distant recurrence was observed in patients with and without pelvic recurrence. CONCLUSIONS AWNH is highly predictive of outcome for patients treated with RT for carcinoma of the cervix. Blood transfusion appears to overcome the negative prognostic effects of low presenting Hgb levels and AWNH levels. Cancer 1999;86:1528–36. © 1999 American Cancer Society. Hemoglobin level during radiation is the most significant independent prognostic factor other than stage of disease for patients with carcinoma of the cervix who are treated with radiotherapy. The authors hypothesized that the negative impact of a low hemoglobin level at presentation can be overcome by blood transfusions to maintain the patient's hemoglobin level at ≥ 120 g/L during radiotherapy.