Impact of maintaining adequate haemoglobin level on the treatment outcome of stage III cervical carcinoma a prospective, nonrandomized study

ABSTRACT

It has been suggested that hemoglobin levels of 12-14 g/dL are optimal for tumor oxygenation, radiosensitivity, and prognosis. in this prospective study, we evaluated the effectiveness of epoetin-alpha to maintain hemoglobin levels at 12-14 g/dL during radiotherapy [RT] for patients with FIGO Stage III cervical carcinoma, and we examined the impact of erythropoetin on overall survival [OS], metastatic-free survival [MFS], and local control [LC]. Forty patients, who received RT between January 2002 and June 2004, were included in this prospective, nonrandomized study. Twenty patients received epoetin-alpha [150 lU/kg 3 times per week] during RT [Group A], and 20 patients did not receive epoetin-alpha [Group B]. Epoetin-alpha was started at hemoglobin levels < 13 g/dL and was stopped at hemoglobin levels >/= 14 g/dL. Hemoglobin was measured before RT and once weekly during RT. Both groups were balanced for age, performance status, histology, grading and hemoglobin level before RT. in 11 of 20 patients [55%]from Group A and in 13 out of 20 patients [65%]from Group B had Haemoglobin level < 12 mg/dl prior to radiotherapy. The median change in hemoglobin was + 0.4 g/dL per week in Group A and - 0.4 g/dL per week in Group B. Local Control [LC] was significantly better in Group A [66% vs. 38% at 1 year, respectively P=0.012], a trend was observed for Overall Survival [OS] [59% VS. 33%, respectively; P = 0.08] and Metastatic Free Survival [MFS] did not differ significantly [43% vs. 38%, respectively; P = 0.34]. No epoetin-alpha related toxicity was observed. Epoetin-alpha was effective in maintaining the hemoglobin levels at 12-14 g/dL during RT. The application of epoetin-alpha significantly improved LC, and a trend was observed for OS