You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Radiation Treatment Interruptions Greater Than One Week and Low Hemoglobin Levels (12 g/dL) are Predictors of Local Regional Failure After Definitive Concurrent Chemotherapy and Intensity-Modulated Radiation Therapy for Squamous Cell Carcinoma of the Head and Neck

McCloskey, Susan A. MD*; Jaggernauth, Wainwright MD*; Rigual, Nestor R. MD†; Hicks, Wesley L. Jr MD, DDS†; Popat, Saurin R. MD†; Sullivan, Maureen DDS§; Mashtare, Terry L. Jr MS‡; Khan, Mohamed K. MD, PhD*; Loree, Thom R. MD†; Singh, Anurag K. MD*

American Journal of Clinical Oncology:
doi: 10.1097/COC.0b013e3181967dd0
Original Article: Head & Neck

Purpose: To determine whether baseline hemoglobin level and radiation treatment interruptions predict for loco-regional failure after intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy for definitive treatment of squamous cell carcinoma of the head and neck (SCCHN).

Methods: This retrospective review identified 78 consecutive patients treated with definitive concurrent chemoradiation for SCCHN. Patients were treated with IMRT to 70 Gy in 35 daily fractions to the high-dose target volume and 56 Gy to the elective target volume.

Results: Median age of the cohort was 62 (37–81). Median follow-up was 12 months. Tumor sites included: oropharynx (54%), larynx (36%), oral cavity (5%), and hypopharynx (5%). Fifteen of 78 patients (19%) experienced loco-regional failure. These included: 6 primary site failures, 5 regional failures, and 4 failures in both the primary site and regional lymph nodes. All but one failure occurred in the high-dose target volume. Only duration of radiation treatment and baseline hemoglobin levels were significant predictors of local control. Loco-regional failure occurred in 6 of 13 patients (46%) with radiation treatment interruptions (>1 week) versus 9 of 65 patients (14%) completing radiation therapy without interruption (P = 0.0148). Loco-regional failure occurred in 7 of 19 patients (37%) whose pretreatment hemoglobin level was <12 g/dL compared with 8 of 59 patients (14%) with hemoglobin levels ≥12 (P = 0.042).

Conclusion: Overall radiation treatment time and pretreatment hemoglobin level were significant predictors for loco-regional failure after definitive concurrent chemotherapy and IMRT for SCCHN.

Author Information

From the *Department of Radiation Medicine, †Department of Head and Neck Surgery, ‡Department of Biostatics, §Department of Dentistry, Roswell Park Cancer Institute, Buffalo, New York.

Reprints: Anurag K. Singh, MD, Department of Radiation Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo NY 14263. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.