Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy

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ABSTRACT

Introduction. The objetive was to investigate thepossible prognostic value of blood hemoglobin concentrationin the outcome of radical treatment forlocally advanced esophageal carcinoma.Materials and method. This was a retrospectiveanalysis of data for 85 patients treated for locallyadvanced esophageal carcinoma between January1991 and January 1997 with chemoradiotherapyalone or as neoadjuvant therapy. All patients receivedchemotherapy (4 cycles of cisplatin 100mg/m2 on day 1, and continuous infusion 5-fluorouracil1 g/m2 per day on days 1-5) with concomitantradiotherapy (40 Gy at 2 Gy/session to theesophageal tumor and mediastinum). The responsewas evaluated after 4 weeks. 69 patients continuedto receive chemoradiotherapy only to a total dose of60-64 Gy to the esophageal tumor with a 2-cm margin.Sixteen patients underwent radical surgery. Hemoglobinlevels were measured before combinedtreatment in all patients. The prognostic value ofhemoglobin concentration was analyzed statistically,along with other patient-, tumor- and treatmentrelatedfactors.Results. Mean follow-up time 82 months (range 60-99 months). Chemoradiotherapy was followed byan overall clinical response of 69.4%, with completeclinical response in 24.7% of the patients. Mean survivaltime was 12 months, and overall likelihood ofsurvival after 3 years was 13%. Mean time to progression5 months. Median survival time was 12months in the 69 patients who underwent chemoradiotherapyalone, and 26 months in patients whounderwent radical surgery. Univariate analysisshowed a hemoglobin value of > 13 g/dl to be a prognosticfactor for better survival, along with performancestatus according to the ECOG classification,weight loss < 10%, tumor stage, tumor length, andcomplete response to chemoradiotherapy. Multivariateanalysis showed that only hemoglobin concentrationwas an independent prognostic factorfor each unit increase in hemoglobin level, the riskof death from esophageal carcinoma decreased by5%. In the subgroup of patients who did not undergosurgery, hemoglobin concentration was also anindependent prognostic factor along with completeclinical response.Conclusions. As found for other solid tumors, hemoglobinlevel was a determining factor in theprognosis for treatment outcome in patients withesophageal carcinoma. Our findings require confirmationin randomized studies and further documentationof the probable benefits of correcting hemoglobinlevels