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Influencing factors and prognostic values of hemoglobin changes in prostate cancer patient during radiotherapy combined with androgen-deprivation therapy
Li Xiaoying, Gao Xianshu, Li Hongzhen, Qin Shangbin, Li Xiaomei, Zhang Min, Ma Mingwei, Qi Xin, Bai Yun
Department of Radiation Onclogy,Peking University First Hospital,Beijing 100034,China
AbstractObjective To analyze the influencing factors of hemoglobin changes in prostate cancer patients during radiotherapy combined with androgen-deprivation therapy (ADT) and analyze the relationship between the hemoglobin changes and long-term prognosis. Methods The changes of hemoglobin levels in 145 prostate cancer patients treated with radiotherapy combined with ADT in Department of Radiation Oncology of Peking University First Hospital from November 2011 to May 2015 were retrospectively analyzed. Intensity-modulated radiotherapy (IMRT) was employed for conventionally fractionated radiotherapy. Luteinizing hormone-releasing hormone agonist was utilized for endocrine therapy. Results The median hemoglobin reduction during radiotherapy combined with ADT was 8 g/L. The higher the baseline level of hemoglobin, pelvic irradiation and GS score before radiotherapy, the more obvious the decrease of hemoglobin during treatment (all P<0.001). Pelvic radiotherapy significantly increased the decline tendency of hemoglobin throughout the combined treatment (86.8% vs. 72.8%, P=0.05). The duration of endocrine therapy before radiotherapy and the hemoglobin changes during endocrine therapy alone were not significantly correlated with the degree of hemoglobin decline during subsequent radiotherapy (P=0.53 and 0.837). The biochemical failure-free survival did not significantly differ between patients with significant and mild hemoglobin reduction (P=0.686). Conclusions The baseline level of hemoglobin before radiotherapy is negatively correlated with the decrease of hemoglobin during combined therapy. Pelvic radiotherapy is positively correlated with hemoglobin reduction during combined therapy. Hemoglobin reduction during combined therapy is not associated with the long-term biochemical failure-free survival of patients.
Fund:Scientific Research Seed Fund Project of Peking University First Hospital (2018SF084); Research Foundation of Peking University First Hospital(2017QN05)
Li Xiaoying,Gao Xianshu,Li Hongzhen et al. Influencing factors and prognostic values of hemoglobin changes in prostate cancer patient during radiotherapy combined with androgen-deprivation therapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(12): 1043-1047.
Li Xiaoying,Gao Xianshu,Li Hongzhen et al. Influencing factors and prognostic values of hemoglobin changes in prostate cancer patient during radiotherapy combined with androgen-deprivation therapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(12): 1043-1047.
[1] Bolla M, Gonzalez D, Warde P, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin[J]. N Engl J Med, 1997, 337(5):295-300. DOI:10.1056/NEJM199707313370502. [2] Choo R, Chander S, Danjoux C, et al. How are hemoglobin levels affected by androgen deprivation in non-metastatic prostate cancer patients?[J]. Can J Urol, 2005, 12(1):2547-2552. [3] Asbell SO, Leon SA, Tester WJ, et al. Development of anemia and recovery in prostate cancer patients treated with combined androgen blockade and radiotherapy[J]. Prostate, 1996, 29(4):243-248. DOI:10.1002/(SICI)1097-0045(199610)29:4<243::AID-PROS5>3.0. CO, 2-C. [4] Chander S, Choo R, Danjoux C, et al. Effect of androgen suppression on hemoglobin in prostate cancer patients undergoing salvage radiotherapy plus 2-year buserelin acetate for rising PSA after surgery[J]. Int J Radiat Oncol Biol Phys, 2005, 62(3):719-724. DOI:10.1016/j.ijrobp.2004.11.008. [5] Nishiyama T, Ishizaki F, Anraku T, et al. The influence of androgen deprivation therapy on metabolism in patients with prostate cancer[J]. J Clin Endocrinol Metab, 2005, 90(2):657-660. DOI:10.1210/jc.2004-1611. [6] Besa EC. Hematologic effects of androgens revisited:an alternative therapy in various hematologic conditions[J]. Semin Hematol, 1994, 31(2):134-145. [7] Sykes MP, Chu FC, Wilkerson WG. Local bone-marrow changes secondary to therapeutic irradiation[J]. Radiology, 1960, 75:919-924. DOI:10.1148/75.6.919. [8] Sykes MP, Chu F, Gee TS, et al. Follow-up on the long-term effects of therapeutic irradiation on bone marrow[J]. Radiology, 1974, 113(1):179-180. DOI:10.1148/113.1.179. [9] Brixey CJ, Roeske JC, Lujan AE, et al. Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies[J]. Int J Radiat Oncol Biol Phys, 2002, 54(5):1388-1396. DOI:10.1016/s0360-3016(02)03801-4. [10] Golfam M, Samant R, Eapen L, et al. Effects of radiation and total androgen blockade on serum hemoglobin, testosterone, and erythropoietin in patients with localized prostate cancer[J]. Curr Oncol, 2012, 19(4):e258-e263. DOI:10.3747/co.19.963. [11] Harrison LB, Shasha D, Homel P. Prevalence of anemia in cancer patients undergoing radiotherapy:prognostic significance and treatment[J]. Oncology, 2002, 63(Suppl 2):11-18. DOI:10.1159/000067147. [12] Caro JJ, Salas M, Ward A, et al. Anemia as an independent prognostic factor for survival in patients with cancer:a systemic, quantitative review[J]. Cancer, 2001, 91(12):2214-2221. [13] D'Amico AV, Saegaert T, Chen MH, et al. Initial decline in hemoglobin during neoadjuvant hormonal therapy predicts for early prostate specific antigen failure following radiation and hormonal therapy for patients with intermediate and high-risk prostate cancer[J]. Cancer, 2002, 95(2):275-280. DOI:10.1002/cncr.10673. [14] Pai HH, Ludgate C, Pickles T, et al. Hemoglobin levels do not predict biochemical outcome for localized prostate cancer treated with neoadjuvant androgen-suppression therapy and external-beam radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2006, 65(4):990-998. DOI:10.1016/j.ijrobp.2006.02.008. [15] Timilshina N, Hussain S, Breunis H, et al. Predictors of hemoglobin decline in non-metastatic prostate cancer patients on androgen deprivation therapy:a matched cohort study[J]. Support Care Cancer, 2011, 19(11):1815-1821. DOI:10.1007/s00520-010-1023-6. [16] Beer TM, Tangen CM, Bland LB, et al. The prognostic value of hemoglobin change after initiating androgen-deprivation therapy for newly diagnosed metastatic prostate cancer:a multivariate analysis of Southwest Oncology Group Study 8894[J]. Cancer, 2006, 107(3):489-496. DOI:10.1002/cncr.22029. [17] Ellis RE. The distribution of active bone marrow in the adult[J]. Phys Med Biol, 1961, 5:255-258. DOI:10.1088/0031-9155/5/3/302. [18] Sykes MP, Chu FC, Savel H, et al. The effects of varying dosages of irradiation upon sternal-marrow regeneration[J]. Radiology, 1964, 83:1084-1088. DOI:10.1148/83.6.1084. [19] Rose BS, Liang Y, Lau SK, et al. Correlation between radiation dose to 18F-FDG-PET defined active bone marrow subregions and acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2012, 83(4):1185-1191. DOI:10.1016/j.ijrobp.2011.09.048. [20] Pinkawa M, Djukic V, Klotz J, et al. Hematologic changes during prostate cancer radiation therapy are dependent on the treatment volume[J]. Future Oncol, 2014, 10(5):835-843. DOI:10.2217/fon.13.237. [21] Strum SB, McDermed JE, Scholz MC, et al. Anaemia associated with androgen deprivation in patients with prostate cancer receiving combined hormone blockade[J]. Br J Urol, 1997, 79(6):933-941. DOI:10.1046/j.1464-410x.1997.00234.x. [22] Parker C, Warde P, Norman A, et al. The role of hemoglobin concentration in clinically localized prostate cancer treated with radical radiotherapy+/-neoadjuvant androgen deprivation[J]. Int J Radiat Oncol Biol Phys, 2004, 58(1):53-58. DOI:10.1016/s0360-3016(03)00821-6.
2020, Vol. 29 
