To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: DG DISPATCH - SGO: Hemoglobin Levels During Chemoradiation Predict Cervical Cancer Treatment Outcome URL: http://www.pslgroup.com/dg/1F422E.htm Doctor's Guide March 6, 2001
By Cameron Johnston Special to DG News
NASHVILLE, TN -- March 6, 2001 -- A patient's hemoglobin level during chemoradiation therapy may be the most significant indicator of response to treatment, it was reported yesterday at the 32nd annual meeting of the Society of Gynecologic Oncology here.
According to Dr. Andreas Obermair, who is doing a fellowship in gynecology at the Queensland Center for Gynaecologic Oncology, in Brisbane, Australia, hemoglobin (Hb) might be the only truly prognostic indicator when other factors such as age, tumor histology, tumor grading and parametrial involvement are considered.
In a study among 57 women with cervical cancer ranging from stage 1B to IVA, Dr. Obermair and colleagues measured Hb levels and full blood counts before and every week during the chemoradiation cycle.
Mean hemoglobin levels were 12.9 g/dL at presentation among those patients who had a complete clinical response, but 12.1 g/dL among those who had persistent disease.
In the women whose Hb was 12.9 g/dL at the start of radiation, this dropped to a mean of 11.5 at week four and remained there throughout the fifth week of therapy. Overall, the mean Hb for this group was 11.1 g/dL.
For those with persistent disease, the mean Hb level at the start of therapy was 12.1, and fell to 10.7 at the third week, then increased again to 11.7 at the fourth week, and 11.9 at the fifth week. Their mean over the five-week cycle was 9.8 g/dL.
A univariate logistic regression model demonstrated that the mean Hb nadir was the most predictive factor for treatment failure (relative risk 1.92), followed by disease stage (relative risk 0.51). In a multivariate model the nadir Hb was the only prognostically relevant factor predicting the response to chemoradiation.
"Local failure following chemoradiation therapy with cervical carcinoma was significantly more likely in patients whose Hb [level] dropped during radiation. Only those patients whose Hb was greater than 11 throughout all cycles of chemoradiation were likely to have a 90 percent likelihood of complete local response," Dr Obermair said.
In an interview with Doctor's Guide, he said that as many as half of the women with cervical or other gynecological cancers are already anemic at the time of presentation. Irregular bleeding is quite common among women with cervical cancer, he said, while for those with ovarian cancer, one-third are already anemic because there is so much internal bleeding.
There is also a well-known phenomenon in the medical literature called "cancer related anemia syndrome", which is poorly understood, but describes the extent to which women with gynecologic cancers develop anemia which can affect their treatment outcomes.
He added that unfortunately, erythropoietin is seldom used in Australia to boost hemoglobin levels during treatment, largely because of the cost.
This data suggests that other clinical trials are warranted to determine whether erythropoietin will increase Hb during chemoradiation, and whether this increase -- if there is one -- would have any meaningful clinical impact on patient outcomes. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.