Quantitation of the Early Effects of Radiation and Hormonal Therapy on Hemoglobin Levels in Men Treated for Prostate Cancer
Ryan Smith, MD
University of Pennsylvania Cancer Center
Last Modified: November 4, 2001
Presenter: J. Wilson
Affiliation: University of Pennsylvania
Anemia has been shown to be a prognostic factor in head and neck and cervical cancer. However, unless hemoglobin falls to values <8 mg/dl, it is rarely treated, even though it is associated with hypoxia and poorer outcome. There are limited studies evaluating radiation's effect on erythropoiesis in prostate cancer. Radiation effects the bone marrow directly and hormones may block androgen's stimulation of erythropoiesis. Therefore, the effect of radiation and hormones may be additive.
Methods This is a retrospective study of 198 men with stage T1-4N0M0 prostate cancer.
Hemoglobin levels were measured before and after treatment and compared to determine the effect of radiation and hormonal ablation on the development of anemia
54 patients were treated with prostate irradiation alone (less than a 12x12 cm field or brachytherapy)
46 patients were treated with prostate irradiation with 4-6 months of androgen ablation
55 patients were treated with whole pelvis irradiation alone
43 patients were treated with whole pelvis irradiation with 4-6 months of androgen ablation.
Hormonal ablation consisted of leuprolide +/- anti-androgen therapy
There was a trend toward more T1-T2 patients that had prostate irradiation and more patients with T3-T4 disease that had pelvic irradiation
Results Median hemoglobin values decreased in each group, though there was a broad range
Prostate XRT alone had a mean decrease of 0.29 g/dl
Whole pelvis XRT alone had a mean decrease of 0.78 g/dl
Prostate XRT + hormones and a mean decrease of 0.90 g/dl
Whole pelvis XRT + hormones had a mean decrease of 1.43 g/dl
Severe hemoglobin drops (>2g/dl) occurred in 2% of the prostate XRT alone group, but in 13-23% of the other groups. The most severe was the whole pelvis + hormone population
Author's Conclusions Minor changes in hemoglobin often occur
Significance decrease in hemoglobin occurs in a minority of patients, up to 23% of patients in the whole pelvis + hormone group
Radiation and hormones both supress hemoglobin levels, though the effect seems to be additive
It remains unclear whether this translates into a clinically significant detrimental effect on treatment
Both radiation and hormonal ablation seem to decrease hemoglobin levels. However, except in the whole pelvis + hormone group, this drop is somewhat minor. The drop in this group is likely due to a combination of radiation and hormones, though comparing this population to the prostate radiation + hormones group, it appears this difference is due mainly to the pelvic radiation. As stated, it is unclear whether this translated into a clinically significant effect. Prospective studies looking at hemoglobin's effect on local control and the use of hematopoietic growth factors in combatting anemia should be done.
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