Influence of anaemia in patients with head and neck cancer receiving adjuvant postoperative radiotherapy in the Grampian region

Aims: To assess the impact of haemoglobin on local recurrence and overall survival in patients receiving postoperative radiotherapy for squamous cell carcinoma of the head and neck. Materials and methods: A retrospective study identified all patients with head and neck carcinoma treated with primary surgery followed by adjuvant radiotherapy from 1994-2000. Data were collected on host-related, tumour-related and treatment-related factors, and outcome was measured in terms of time to local recurrence and overall survival. Results: Ninety-five patients were identified for analysis. The median age was 58.5 years; 31% were women. Mean pre-treatment haemoglobin was 128 g/l. The primary site of tumour was in the oral cavity in 35% of patients, oropharynx in 20%, larynx in 20% and hypopharynx in 5%. of patients. Nodal involvement was seen in 48% of patients. A median biologically effective dose (BED) of 62.5 Gy(10) was delivered, with a median overall treatment time of 26 days. After a median follow-up of 3.1 years, 23% of patients had local recurrence and 48% had died, with an estimated median survival time of 5.6 years. Actuarial 2-year and 5-year local control rates were both 75%, and actuarial 2-year and 5-year survival rates were 67% and 51%, respectively. Multivariate analysis revealed T stage, margin status, BED and anaemia to be independent prognostic factors, and T stage, N stage, tumour site, BED and anaemia to be independent predictors for local recurrence. Conclusion: The data from this study are consistent with the hypothesis that pre-treatment anaemia is an independent prognostic factor for survival and predictive factor for local recurrence in postoperative radiotherapy for head and neck cancer. (C) 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.