The effect of low hemoglobin levels on outcomes of radiotherapy following microscopically complete resection of locally advanced SCCHN: Implications for the future

This study investigated the prognostic implications of pre-radiotherapy hemoglobin levels after microscopically complete (R0) resection of locally advanced squamous cell carcinoma of the head-and-neck (SCCHN) and reviewed the question “should anemia be corrected?”. A total of 225 patients receiving R0-resection and postoperative irradiation were retrospectively evaluated. Pre-radiotherapy hemoglobin levels (<12 vs. ≥12 g/dl) plus eight factors (T-/N-category, AJCC-stage, performance score, gender, age, tumor site, and histologic grading) were analyzed for locoregional control and survival. Hemoglobin levels of <12 and ≥12 g/dl were associated with 3-year locoregional control rates of 67% and 84%, respectively, and 5-year locoregional control rates of 63% and 74%, respectively (p = 0.029). On multivariate analysis of locoregional control, hemoglobin levels achieved significance (hazard ratio [HR] 1.97; 95%-confidence interval [95%-CI] 1.02–3.81; p = 0.043). Hemoglobin levels of <12 and ≥12 g/dl were associated with 3-year survival rates of 55% and 87%, respectively, and 5-year survival rates of 25% and 71%, respectively (p < 0.001). On multivariate analysis of survival, hemoglobin levels were significant (HR 2.91; 95%-CI 1.67–5.22; p < 0.001). Thus, pre-radiotherapy hemoglobin is an independent predictor for outcomes after R0-resection of SCCHN. Levels <12 g/dl were associated with worse outcomes than ≥12 g/dl. Tumor cell oxygenation and correction of anemia appear important also after R0-resection.