Comparison of Effects of Hemoglobin Levels Upon Tumor Response among Cervical Carcinoma Patients Undergoing Accelerated Hyperfractionated Radiotherapy versus Cisplatin Chemoradiotherapy

Purpose: Blood hemoglobin levels are known to influence response to radiotherapy. This retrospectiveanalysis compared the effect of hemoglobin levels upon response to radiation among patients treated withradiation alone (by accelerated hyperfractionated radiotherapy) versus those treated with concurrent cisplatinchemoradiotherapy. Materials and
Methods: Among patients treated for locally advanced carcinoma of thecervix (LACC) during 2009-10, a total of 60 fulfilled the eligibility criteria. In this time frame, external beamradiotherapy was delivered with either concurrent chemoradiotherapy (CRT, n=31) (45Gy over 25 fractions,with weekly cisplatin at 40mg/m2), or with accelerated hyperfractionated radiotherapy (AHRT, n=29) (20Gyover 10 daily fractions over the first two weeks, followed by 30Gy over 20 fractions over the next two weeks,with two fractions of 1.5Gy per day, without the use of chemotherapy). Mean weekly hemoglobin (MWH) levelsof all patients were calculated as the arithmetic means of weekly recorded blood hemoglobin levels. As perMWH, patients in both of the AHRT or the CRT groups were classified into two subgroups- those with MWHbetween 10-10.9g/dL, or with MWH>11g/dL. Complete response (CR) to external beam RT phase (prior tobrachytherapy) was declared after clinical examinations and computed tomography. The CR rate was noted forboth MWH sub-groups within each of the AHRT and CRT groups.
Results: Within the AHRT group, patientswith MWH>11g/dL had a much better CR rate in comparison to those with MWH:10-10.9g/dL (80% vs. 21.1%)which was statistically significant (p 0.0045). Within the CRT group, there was no significant difference in theoutcomes within the MWH>11g/dL and MWH:10-10.9g/dL sub-groups ( CR rates of 80% vs. 61.9%, p=0.4285).
Conclusions: The importance of maintaining a minimum hemoglobin level of 11g/dL during RT is much greaterfor patients treated with RT alone, than for patients treated with concurrent chemoradiotherapy. Enhancedhaemoglobin levels during RT may to an extent negate the ill-effects that may otherwise arise due to non-use ofconcurrent chemotherapy.