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Título

ANEMIA IS ASSOCIATED WITH TOXICITY OF RADIOTHERAPY PROSTATE CANCER

Resumo

Introduction: Radiotherapy is one of the fundamental pillars of current oncological treatment, together with surgery and chemotherapy. Technological improvements, modifications in dose fractionation, and the introduction of radioprotectors have led to improvements in radiotherapy. Nevertheless, many tumors remain highly radioresistant, and one of the factors involved in such resistance is the degree of tumor oxygenation. Several experimental studies have shown that low levels of hemoglobin (Hb) correlate with diminished partial oxygen pressure in the tumor. Objective: To analyze the possible correlation between hb concentration and the appearance of acute radiotherapy-induced toxicity. Methods: The participants in this prospective study were 86 consecutive patients with a histological diagnosis of carcinoma of the prostate treated by radiotherapy with a radical intent (70 Gy in 28 fractions). Hb measurement was performed before radiotherapy and after the end of treatment. No patient received corrective treatment for Hb levels. Acute gastrointestinal (GI) toxicity was analyzed weekly during radiotherapy and 7-10 days after therapy ended. To analyze acute GI toxicity, we used RTOG criteria. Results: 86 patients were evaluated with the measurement of Hb levels before radiotherapy treatment. The mean age was 67 years (55-79 / 95%CI 65-69 / SD ± 5.4). The mean hb levels were 13.3 g/dL (SD ± 1,1). Hb concentration was < 12 g/dL in 24 patients (27 .9%) with mean hemoglobin levels were 11,3 d/dL (SD ± 0,9). At the end of radiotherapy, 28 patients (32,6%) had Hb values < 12 g/dL and mean concentration for patients with anemia was 10.9 g/dL (SD ± 0.8). No acute toxicity attributable to radiotherapy was seen in 21 patients (24.4%). Grade 1 toxicity was seen in 49 patients (57%), grade 2 in 14 (16.3%), and grade 3 in 2 (2.3%). The incidence of toxicity was analyzed in patients with and without anemia in table 1
Anemia
Degree of toxicity Yes No
G0 1 (4,8%) 20 (95,2%)
G1 14 (28,6%) 35 (71,4%)
G2 11 (78,6%) 3 (21,4%)
G3 2 (100%) 0 (0%)
p < 0,001
Conclusion: Greater awareness of the prevalence and impact of anemia in patients with cancer is an important goal for all clinicians. Prostate cancer patients undergoing radiotherapy with low Hb were more likely to experience Grade 2–3 acute gastrointestinal toxicity.