Haemoglobin level as the prognostic factor for patients with carcinoma of the cervix receiving radiation therapy

Objective. The primary objective was to assess the influence of the pre-treatment and mid-treatment haemoglobin (Hb) level on local control and pelvic disease-free and overall disease-free survival in patients with carcinoma of the cervix receiving radiation therapy. Material and methods. Seventy-two patients referred for radiation therapy for carcinoma of the cervix between January and December 2002 were entered into this prospective study. Forty-three patients (60%) had stage II and 29 (40%) stage III disease. Hb levels were checked before starting treatment and in the middle of treatment. The mean Hb levels at the start and mid-treatment were 12.8 g/dl and 12.1 g/dl, respectively. Results. Treatment failed in 13 patients (pelvic disease 9, distant 3 and pelvic and distant 1). Patients with mid-treatment Hb levels ≥12 g/dl had significantly lower rates of pelvic failure (p=0.05) as well as overall failure (p=0.03) than patients with levels <12 g/dl. The patients with mid-treatment Hb levels ≥12 g/dl had 5-year pelvic disease-free survival and overall disease-free survival rates of 83% and 81%, as opposed to 66% and 58% for patients with Hb levels <12 g/dl (p=0.04 and p=0.02). The 5-year pelvic disease-free survival rate for stage II disease was 89% compared with 45% for stage III (p=0.006). Conclusion. A mid-treatment Hb level of ≥12 g/dl was associated with significantly improved control of pelvic disease and improved 5-year pelvic disease-free and overall survival. Disease stage was an independent prognostic factor.