Locally advanced stage IV squamous cell carcinoma of the head and neck: Impact of pre-radiotherapy hemoglobin level and interruptions during radiotherapy

Purpose: Stage IV head and neck cancer patients carry a poor prognosis. Clear understanding of prognostic factors can help to optimize care for the individual patient. This study investigated 11 potential prognostic factors including pre-radiotherapy hemoglobin level and interruptions during radiotherapy for overall survival (OS), metastases-free survival (MFS), and locoregional control (LC) after radiochemotherapy. Methods and Materials: Eleven factors were investigated in 153 patients receiving radiochemotherapy for Stage IV squamous cell-head and neck cancer: age, gender, Karnofsky performance score (KPS), tumor site, grading, T stage, N stage, pre-radiotherapy hemoglobin level, surgery, chemotherapy type, and interruptions during radiotherapy > 1 week. Results: On multivariate analysis, improved OS was associated with KPS 90 - 100 (relative risk [RR], 2.36; 95% confidence interval [CI], 1.20 - 4.93; p=.012), hemoglobin >= 12 g/dL (RR, 1.88; 95% CI, 1.01 - 3.53;p=.048), and no radiotherapy interruptions (RR, 2.59; 95 % CI, 1.15 - 5.78; p=.021). Improved LC was significantly associated with lower T stage (RR, 2.17; 95 % CI, 1.16 - 4.63; p=.013), hemoglobin >= 12 g/dL (RR, 4.12; 95 % CI, 1.92 - 9.09; p <.001), surgery (RR, 2.67; 95% CI, 1.28 - 5.88; p=.008), and no radiotherapy interruptions (RR, 3.32; 95% CI, 1.26 - 8.79; p=.015). Improved MFS was associated with KPS 90 - 100 (RR, 3.41; 95% CI, 1.46 - 8.85; p=.012). Conclusions: Significant predictors for outcome in Stage IV head and neck cancer were performance status, stage, surgery, pre-radiotherapy hemoglobin level, and interruptions during radiotherapy > 1 week. It appears important to avoid anemia and radiotherapy interruptions to achieve the best treatment results. (c) 2008 Elsevier Inc.