Gastrointestinal Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_2_2018 - The Impact of Hemoglobin on Outcomes in Anal Canal Cancer Treated with Definitive Chemoradiation

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

The Impact of Hemoglobin on Outcomes in Anal Canal Cancer Treated with Definitive Chemoradiation
S. E. Kelm, J. M. Longo, M. Bedi, M. L. Siker, J. Thomas, B. George, K. Ludwig, C. Peterson, T. Ridolfi, and B. A. Erickson; Medical College of Wisconsin, Milwaukee, WI

Purpose/Objective(s): Squamous cell carcinomas (SCC) of the anal canal and cervix share many characteristics. Both are initiated by human papilloma virus (HPV) infection and share other risk factors including high risk sexual practices, chronic immunosuppression, and smoking. Definitive chemoradiation (CRT) is the mainstay of treatment for anal canal and locally advanced cervical cancers. Pretreatment hemoglobin (Hgb) of ≤ 10 g/dL has been shown to have a negative impact on survival in cervical cancer. The relationship between Hgb and outcomes is less well-characterized in SCC of the anal canal. This study aims to determine if pre-treatment Hgb of ≤ 10 g/dL and treatment-related anemia are associated with decreased progression free survival (PFS) and overall survival (OS) in SCC of the anal canal.

Materials/Methods: From September 2005 to June 2017, 61 patients with localized SCC of the anal canal received CRT with helical 3DCRT and intensity modulated radiation therapy (IMRT) planned in parallel to the RTOG 0529. Pre-treatment Hgb levels were recorded within two weeks prior to the start of radiation. Treatment-related anemia during or within 3 months of CRT was classified using CTCAEv4.0. Clinical outcomes including PFS and OS were calculated using Kaplan-Meier survival analysis. Prognostic variables were determined by univariate analysis (UVA) using the log-rank test and multivariate analysis (MVA) using the Cox proportional hazards model. Other analyzed variables included age, diabetes, smoking, neutropenia, thrombocytopenia, leukopenia, gender, transplant status, and HIV status.

Results: The median pre-treatment Hgb was 13 g/dL and ranged from 8.5 g/dL to 16.2 g/dL. Ten patients had a pre-treatment Hgb of ≤ 10 g/dL. Pre-treatment Hgb ≤ 10 g/dL was associated with inferior PFS and OS, 14 months vs >80 months (p<0.0001) and 51 months versus >110 months in (p=0.0035), respectively. This was confirmed on MVA for both PFS (p=0.009, 95% CI 1.93-97.29) and OS (p=0.035, 95% CI 1.22-57.58). Ten patients had ≥ grade 3 treatment-related anemia. PFS was inferior for patients with ≥ grade 3 anemia on UVA (p = 0.0033) but there was no difference in OS (p = 0.884). In addition, age > 56 years was associated with decreased PFS (p = 0.0493) and diabetes led to a decreased OS (p = 0.0402).

Conclusion: In this study, pre-treatment hemoglobin levels of ≤ 10 g/dL are associated with poorer PFS and OS in patients with SCC of the anal canal treated with CRT. Similarly, PFS is worse in patients who experience ≥ grade 3 treatment-related anemia. As in cervical cancer, these findings demonstrate that pre-treatment Hgb and treatment-related anemia are prognostic in SCC of the anal canal. Future studies are warranted to assess the benefit of aggressively treating anemia in this patient population.

Author Disclosure: S.E. Kelm: None. J.M. Longo: None. M. Bedi: None. B. George: Honoraria; Celgene, Cook Medical, Ipsen, Foundation Medicine, Merrimack, Bristol Myers Squibb. Consultant; Celgene, Cook Medical, Ipsen, Foundation Medicine, Merrimack, Bristol Myers Squibb. C. Peterson: None. B.A. Erickson: Employee; ProHealth Care, Waukesha, WI. Steering committee; American Brachytherapy Society.

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