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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: December 2009 - Volume 32 - Issue 6 - p 587-591
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.

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.