Adjuvant radiotherapy in carcinomas of the uterine cervix: the prognostic value of hemoglobin levels

• Published in: International journal of gynecological cancer Vol. 15; no. 2; pp. 285 - 291
• Main Authors: Münstedt, K., Johnson, P., Bohlmann, M.K., Zygmunt, M., Von Georgi, R., Vahrson, H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Blackwell Science Inc 01.03.2005; Copyright Blackwell Publishing Ltd
• Subjects: Adult; Aged; Anemia - complications; Carcinoma - complications; Carcinoma - pathology; Carcinoma - radiotherapy; cervical cancer; Disease-Free Survival; Female; hemoglobin; Hemoglobins - analysis; Humans; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Prognosis; radiotherapy; Radiotherapy, Adjuvant; Retrospective Studies; Treatment Outcome; Uterine Cervical Neoplasms - complications; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1111/j.1525-1438.2005.15217.x

.  Münstedt K, Johnson P, Bohlmann MK, Zygmunt M, von Georgi R, Vahrson H. Adjuvant radiotherapy in carcinomas of the uterine cervix: the prognostic value of hemoglobin levels. Int J Gynecol Cancer 2005;15:285–291. Anemia has been associated with a poorer treatment response and reduced survival in women undergoing primary radiotherapy (RT) or radiochemotherapy for advanced cervical carcinoma. This study aimed to determine the influence of anemia on outcome in patients with cervical carcinoma undergoing adjuvant RT. Medical records were reviewed for 183 cervical cancer patients who had received adjuvant RT because of risk factors after radical surgery (n= 109) or inadequate primary surgery (simple hysterectomy; n= 74). Kaplan–Meier and Cox regression analyses were used to study hemoglobin levels before and during adjuvant RT in relation to recurrence‐free and overall survival. Hemoglobin values ≥11 g/dL were considered normal, while those <11 g/dL indicated anemia. Hemoglobin levels before RT influenced significantly overall survival and recurrence‐free survival across the whole group (overall survival—log rankall patients= 7.5; df = 1; P= 0.006). However, subgroup analysis showed that the observed difference was mainly due to the group of women who had undergone inadequate primary surgery (overall survival—log rankinadequate surgery= 10.8; df = 1; P= 0.001). Multifactorial regression analyses comparing hemoglobin before RT with grading and tumor stage confirmed the prognostic value of hemoglobin values. Maintaining normal hemoglobin values before and during adjuvant RT seems to be important, especially in patients who have had inappropriate simple hysterectomy, which may resemble a therapeutic situation.