Hemoglobin levels during radiation therapy and their influence on local control and survival of patients with endometrial carcinoma.

Anemia is a common complication of cancer that has been associated with poor response to treatment and decreased survival in a number of malignancies. By chart review the effects of prognostic factors (e.g. age, body mass index, tumor stage) and hemoglobin levels, measured prior to and during adjuvant (724/996; 72.7%) and primary radiotherapy (185/996; 18.6%) in 996 endometrial cancer patients treated between 1986 and 1998 were investigated using Kaplan-Meier survival on disease-free and overall survival. Preoperative hemoglobin levels were of no prognostic value. Patients with normal hemoglobin had an improved survival during primary radiotherapy (p<0.05). Anemia and course of hemoglobin during adjuvant radiotherapy were significantly associated with poor survival in patients undergoing adjuvant radiotherapy (p=0.001). Cox regression analysis confirmed these findings for adjuvant treatment. Local recurrences were also less frequently observed in patients with normal hemoglobin levels (p=0.044). Hemoglobin levels prior to and during radiotherapy seem to be important with respect to treatment outcome for endometrial cancer. This finding supports the use of measures to maintain adequate hemoglobin levels (transfusions, erythropoietin) to improve local control and patient survival.