Importance of hemoglobin concentration and its modification for the outcome of head and neck cancer patients treated with radiotherapy

Abstract

In conclusion, low hemoglobin is a significant negative prognostic factor for radiotherapy of head and neck cancer. Correction of pre-treatment low hemoglobin by blood transfusion and/or erythropoietin stimulating agents does, however, not improve the outcome. Smoking leads to a decrease in effective hemoglobin and poorer treatment outcome. Smoking should be avoided in order to improve the therapeutic efficacy of radiotherapy and development of other smoking-related diseases and/or secondary cancers.

Smoking is a poor prognostic factor for male nasopharyngeal carcinoma treated with radiotherapy

“…One of the possible mechanisms involves hypoxia [13,[22][23][24]. Cigarette smoking is associated with increased blood carboxyhemoglobin concentrations, which will cause a leftward shift of the hemoglobin-oxygen dissociation curve [25]. A study in 2008 by Fortin A et al [24] reported that combined exposure of smoking during the radiation and antioxidant vitamin would increase the rate of long-term mortality and recurrence among HNC.…”

The DAHANCA 6 randomized trial: Effect of 6 vs 5 weekly fractions of radiotherapy in patients with glottic squamous cell carcinoma

“…Evaluation of the study outcome was limited by the absence of smoking data since smoking affects the efficacy of radiotherapy, and the risk of recurrence [17,33]. The problem was modest, though, since the randomized study setup was likely to have allocated smokers evenly in the two treatment groups.…”

Predictors of Postoperative Complications, Prolonged Length of Hospital Stay, and Short-Term Mortality in Elderly Patients with Malignant Head and Neck Neoplasm

“…Hoff [24], studying the response to radiotherapy in head and neck cancer, considered normal hemoglobin levels to be 12-15 g/dl for women and 13-16 g/dl for men. The optimal hemoglobin level as a prognostic factor has not been definitely established [25].…”

“…In our study, smoking was associated with the development of complications only in bivariate analysis, which may be due to the small number of cases analyzed. However, it is worth emphasizing that smoking leads to a reduction in effective hemoglobin and to poorer treatment outcome [24]. …”