Anemia may be marker for poor cancer outcomes.(Gynecology)

DENVER -- Anemia is probably a symptom rather than a cause of radiation-therapy failure in women with cervical cancer, Dr. Patricia J. Eifel asserted at the annual meeting of the American Society for Therapeutic Radiology and Oncology.

"In the past, I think the hypothesis that many have held is that anemia causes radiobiologically significant hypoxia. We would argue that, more likely, anemia is simply a surrogate for bad disease that's more advanced, biologically aggressive, or poorly responsive," said Dr. Eifel, a radiation oncologist at the University of Texas M.D. Anderson Cancer Center, in Houston.

"Putting it differently," she continued, "in the clinic we often conclude that severe anemia may cause a poor radiation response, and this for years has caused us to transfuse patients to keep their hemoglobin up. But one must also look at the question the other way--that a poor radiation response leads to continuous bleeding and severe anemia.... Bad tumors bleed."

She presented a massive retrospective study involving 2,988 patients with FIGO stage I or II squamous cell carcinoma of the cervix treated with radiation therapy (RT) alone at M.D. Anderson. Median follow-up was 14 years.

Dr. Eifel analyzed the impact of seven clinical variables on key patient outcomes. Four variables were anemia-related: pre-RT hemoglobin (Hb) level, lowest Hb during RT, the occurrence of transfusion before RT, and transfusion during RT. The other three were descriptive tumor variables: FIGO stage, clinical tumor diameter, and clinical lymph node status. Tumor size was categorized both as a continuous variable and by placing the tumor into one of five size groups.

Each of the seven variables proved strongly associated with the risk of central disease recurrence, pelvic recurrence, distant metastasis, disease-free survival, and overall survival. However, patients with large tumors, positive nodes, or Stage IIb disease were significantly more likely ...