Early hematological effects of chemo-radiation therapy in cancer patients and their pattern of recovery - a prospective single institution study

ABSTRACT

The purpose of this prospective study is to understand the early hematological effects of chemo-radiation therapy in cancer patients, their pattern of recovery and to ascertain their prognostic value. 255 diagnosed cancer patients planned for definitive treatment with radiation therapy alone or with chemotherapy were included in this two year prospective study. A complete blood count was done at baseline, weekly during the course of therapy and thereafter, monthly for a period of 6 months. For the purpose of grading clinical toxicity, the Common Toxicity Criteria, CTCAE v2.0 was used while RECIST criteria was used to define the tumor response rates. This study was statistically analyzed using SPSS software. 255 patients were included in the study wherein head and neck cancers comprised the major patient population [28.6%] followed by cervix [18.8%] and breast [15.7%]. Out of these, 37% in head-and-neck cancer subgroup, and 58.3% in cervix had anemia at start of treatment. 92.2% cases with chemoradiation developed anemia during treatment, while with radiation alone it was 95.5%. This was statistically significant in patients with cancer uterine cervix [p < 0.01]. At the end of treatment 65% patients with normal hemoglobin had complete responses [CR], while 58.3% with mild anemia and 33.3% with moderate anemia had CR [p=0.1]. Severe anemia during treatment is a poor prognostic indicator and is usually a sign of advanced disease. Leucopenia and thrombocytopenia occur more commonly during chemoradiotherapy as against radiotherapy alone, but improves with supportive management