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