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Lower pretreatment hemoglobin status and treatment breaks in locally advanced head and neck squamous cell carcinoma during concurrent chemoradiation
Rajesh Kar Narayanasamy1, RM Muthusekar2, Sathiamoorthy Pattanam Nagalingam1, Sendil Thyagarajan1, Balasubramaniam Ramakrishnan3, Karthikeyan Perumal1
1 Consultant Oncologist, Dr. Rai - Comprehensive Blood and Cancer Center Oncology Services, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
2 Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
3 Consultant Bio-Statistician, Dr. Rai - Comprehensive Blood and Cancer Center Oncology Services, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
Correspondence Address:
Karthikeyan Perumal,
Consultant Oncologist, Dr. Rai - Comprehensive Blood and Cancer Center Oncology Services, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/ijc.IJC_656_18 PMID: 33402593
Background: Treatment breaks during radiation for locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) is one of the important factors affecting the loco-regional control rate. We prospectively analysed the role lower pre-treatment hemoglobin (pre-T Hb) status and its influence on treatment breaks amongst patients undergoing concurrent chemoradiation (CRT).
Methods: One hundred and twenty HNSCC (T3-T4a, N1-N2c) patients treated by CRT were prospectively analysed for influence of pre-T Hb on treatment breaks. Sub-sites included oral cavity, oropharynx, hypopharynx & larynx. All patients received radiation to a total dose of 66Gy to PTV along with weekly Inj. Cisplatin 40 mg/m2. All patients were evaluated weekly and at the end of 6 weeks by hemogram, physician and radiological examination.
Results: Our study population had a mean age (±standard deviation) of 55 (± 10.7) years (range: 27 - 69 years), 85 men and 35 women with a performance status of the Eastern Cooperative Oncology Group (ECOG) 1-2. The mean pre-T Hb calculated (using receiver operating characteristic curve [ROC]) was 10.3 g/dL. Among 120 patients, in the pre-T Hb of ≤10.3 g/dL group, 44 (75.9%) patients had treatment breaks of ≥5 days and 11 (17.7%) patients had treatment breaks < 5 days; in the pre-T Hb of >10.3 g/dL group, 14 (24.1%) patients had treatment breaks of ≥5 days and 51 (82.3%) patients had treatment breaks < 5 days (P = 0.001).
Conclusion: Lower pre-T Hb level of ≤ 10.3 g/dL is statistically significantly associated with higher treatment breaks of ≥ 5 days.
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