PROGNOSTIC SIGNIFICANCE OF DECLINE IN PLASMA HEMOGLOBIN CONCENTRATION WITH NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH NASOPHARYNGEAL CARCINOMA

The purpose of this article is to assess the value of plasma hemoglobin (hb) concentration in predicting treatment outcomes in patients with nasopharyngeal carcinoma (NPC) treated with neoadjuvant chemotherapy (CT) and conventional radiotherapy (RT). From 1989 to 1996, 98 NPC patients treated with three courses of platinum-based neoadjuvant CT and conventional RT consisting of 70 Gy to the primary tumor and the clinically positive cervical nodes; and 50 Gy to all of the cervical lymphatic bearing areas were grouped as normal (>=12.0 g/dl in females and >=13g/dl in males), mild anemic (13.0 g/dl >hb >=11 g/dl in men, 12.0g/dl>=11 g/dl in female) and anemic (hb<11 g/dl). The patients were also grouped as having >=1.5 g/dl decrease in hb concentration with neoadjuvant CT (defined as "massive decrease in hb concentration" (MDH), or not. The prognostic value of anemia before RT and MDH with neoadjuvant CT were analysed together with other known risk factors (gender, age (<=30 vs. >30), histopathology (WHO1 vs. WHO2.3), T(1-3 vs. T4) and N (NO-2 vs. N3) stages, bilateral cervical involvement, cranial nerve palsy and elongation in total RT time (planned vs. >1 week elongation). The mean value of plasma hemoglobin concentration declined from 13.1 g/dl to 11.5 g/dl with neoadjuvant CT (p < .0001). Anemia increased from 7,1% (7/98) to 32,7% (32/98) with neoadjuvant CT (p< .0001). Patients with anemia after neoadjuvant CT had a worse 5-year locoregional control (LRC), disease-free survival (DPS) and overall survival (OS) than patients without anemia (5-year LRC 49% vs. 73%; p=.03, 5-year DPS 42% vs 68%; p=.01 and 5-year OS 43% vs. 69%; p=.01). Similarly patients with MDH after neoadjuvant CT had lower 5-year LRC, DPS and OS rates than patients without MDH (5-year LRC 51% vs. 82%; p=.002, 5-year DPS 47% vs. 74%; p=.001 and 5-year OS 52% vs. 74%: p=.02). In multivariate analyses, the effect of MDH with neoadjuvant CT was pronounced for LRC and the effect of anemia before RT was pronounced for survival. The adverse affect on treatment outcome of MDH and anemia caused by neoadjuvant CT suggests that this unfavorable condition should be corrected before RT.

Keywords: anemia, nasopharyngeal carcinoma, radiotherapy, survival, chemotherapy, locoregional control