The Impact of Blood Hemoglobin Content on the Outcome of Radiotherapy. The Freiburg Experience

Background: Numerous publications have reported an impaired radiocurability when anemia is present. Tissue hypoxia and consecutive radioresistance are speculated to be the underlying causes.

Own Experience: Our own retrospective data impressively confirm these observations: in an analysis of 889 patients homogeneously irradiated for head and neck cancer for locoregional tumor control and survival, anemia has proven to be a highly significant risk factor. Furthermore, hemoglobin content is an independent and, at least equally powerful predictor for outcome when compared to the known risk factors of site, treatment modality, resection status, T-, and N-stage.

Treatment: In an attempt to improve therapeutic outcome, 50 anemic patients undergoing radiotherapy were treated with erythropoietin (rhEPO). A weekly increment in hemoglobin content of 0.7 g/dl was documented without any major side effects. Additionally, it seems that patients reacting sufficiently to rhEPO stimulation can expect better locoregional tumor control within the irradiation volume. This, however, awaits confirmation in an ongoing trial.