Author(s)

Dina Ragab Diab Ibrahim^1*, Mohamed Saad Hasaballah², Marwa Mohamed El-Begermy², Ahmed Abdel Aziz Ahmed², Soha Ahmed Abuelela³

¹Clinical Oncology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
²Ear Nose Throat ENT Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
³Clinical Pathology Department, Ain-Shams University, Cairo, Egypt.

Background: Anemia is reported by many studies as an important risk factor for poor locoregional disease control and survival in head and neck carcinoma. We aimed to study the frequency and prognostic effect of low hemoglobin (Hb) level in head and neck squamous cell carcinoma (HNSCC) before radiotherapy (RT) and/or chemoradiotherapy (CRT). Material and Methods: We retrospectively studied the charts of 86 patients diagnosed with laryngeal and hypopharyngeal SCC in a university hospital in Cairo, Egypt. Based on the World Health Organization (WHO), anemia was diagnosed in males at Hb levels < 13 g/dl and <12 g/dl in females. We examined the Hb levels before radiotherapy alone or combined with chemotherapy and its impact on re-sponse to treatment and survival. Results: The median age was 56 years. 75/86 (87.2%) patients were males with performance status1 in 73/86 (84.9%) patients. The median Hb level was 13.1 g/dl. The pre-RT/CRT Hb level in female patients (n = 11) was <12g/dl in 4/11 (36.4%) and >12 g/dl in 7/11 (63.6%) patients. Pre-RT/CRT Hb level in male patients was <13 g/dl in 31/75 (41.3%) and >13 g/dl in 44/75 (58.7%). Tumor sites were larynx in 77 (89.5%) and hypopharynx in 9 (10.5%) patients. Disease stage 3, 4 was common in 59/86 (68.6%) patients. Thirty-six (41.8%) patients had surgery. 13/86 (15.1%) patients received induction chemotherapy, while 31/86 (36.0%) had concomitant chemoradiotherapy. Radiotherapy was given in 65/86 (75.58%) patients. The mean RT dose was 66 Gy. Non-anemic patients had significant higher inci-dence of complete response (CR) to treatment (p = 0.034). 25.8% of male pa-tients with Hb < 13 g/dl had higher incidence of recurrence (p = 0.036) com-pared to recurrence in 39.5% of male patients with Hb > 13 g/dl (p = 0.403). Female patients whether anemic or non-anemic had no recurrence (p = 0.036 and p = 0.403 respectively). The median duration of DFS and OS was 6.52 and 9.33 months respectively. Pretreatment Hb level had statistical significant effect on response to treatment and overall survival, but not disease free survival. Conclusion: Nutritional anemia is common in developing countries. Our results support the positive prognostic effect of Hb level > 12 g/dl and >13 g/dl before radiation therapy and/or chemoradiotherapy on response to treatment and overall survival but not the disease free survival.

Hemoglobin, Radiotherapy, Chemotherapy, Tumor Hypoxia, Local Control, Survival

Ibrahim, D. , Hasaballah, M. , El-Begermy, M. , Ahmed, A. and Abuelela, S. (2018) Impact of Pre-Radiotherapy and/or Chemoradiotherapy Hemoglobin Level on Response to Treatment in Laryngeal and Hypophayrngeal Squamous Cell Carcinoma. Journal of Cancer Therapy, 9, 362-381. doi: 10.4236/jct.2018.94033.