Prognostic value of low hemoglobin concentration in adjuvant radiotherapy after total laryngectomy in group of patients with laryngeal cancer
Objective: To investigate the impact of hemoglobin concentration (Hb) at the start and end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy on the loco-regional control in postoperative radiotherapy for patients with advanced laryngeal cancer.
Methods: Between January 1993 and December 1996, 254 patients with pT3 or pT4 and pN0-pN2 laryngeal cancer were treated with a total laryngectomy and adjuvant radiotherapy (RT). The median age of patients was 56.3 years (range: 30-70 years). The analyzed group consisted of 236 males (92%) and 18 females (8%). In all cases a total laryngectomy was performed. 196 out of 254 patients underwent homolateral neck dissection and 58 out of 254 underwent bilateral neck dissection. The primary tumor bed was irradiated to the median total dose of 61.2 Gy (range: 57 - 64 Gy) and all regional lymph nodes were treated in all patients to a dose of 50 Gy. Indications for postoperative RT were close postoperative margins at the tumor site or pathological status of lymph nodes described as pN1 or pN2. Univariate analyses were used to determine the predictors for locoregional failure. The following factors were studied for prognostic importance of loco-regional outcome: the hemoglobim concentration at the start of radiotherapy, at the end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy, age, sex, pT and pN categories.
Results: The actuarial 5-year overall survival was 49%, the actuarial loco-regional control rate was 70%. Univariate analysis, using log-rank test indicated that pN +, Hb level at the end of RT (p = 0.004) and drop during RT (p = 0.038) were predicted for the loco-regional control of postoperative radiotherapy.
Conclusions: Analysis showed that the low level of Hb at the end of radiotherapy and the drop during radiotherapy were correlated with decreasing of the loco-regional control of adjuvant radiotherapy for patients with advanced laryngeal cancer.