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Researchers discover how to overcome poor response to radiotherapy caused by low haemoglobin levels
Date:5/11/2012

e survival, so that the differences between them and patients with normal Hb levels were no longer significant," says Professor Kaanders' colleague Dr. Geert Janssens. The difference in local control between this low Hb group and the normal Hb accelerated radiotherapy (AR) alone group was only 1% (81% in the ARCON group versus 82% in the AR-only group); for disease-free survival, the difference was 77% (ARCON) as opposed to 70% (AR); and for metastasis-free survival 93% (ARCON) versus 89% (AR).

However, patients in both groups with low Hb levels pre-treatment still had a worse overall survival irrespective of which treatment they received. This is most likely due the fact that many patients with head and neck cancer also have other health problems that cannot be treated by radiotherapy, the researchers say.

"In the past, a number of investigators have tried to improve the outcome for patients with low Hb levels by giving erythropoietin, which stimulates red blood cell production, and red cell blood transfusion before and during treatment, but without success. ARCON is the first treatment to be found to correct for low Hb and therefore to improve prognosis in these patients," says Dr. Janssens. "We know that a decrease in Hb levels is associated with a reduced sensitivity to radiotherapy, and that this can switch the tumour microenvironment into a more aggressive subtype with a higher risk of loco-regional failure and of the development of distant metastases."

The lack of success with transfusion of red blood cells or erythropoietin suggests underlying adaptive mechanisms. Accelerated radiotherapy to counteract tumour cell repopulation during radiotherapy, combined with carbogen and nicotinamide, administered immediately before irradiation to increase the oxygen level, ensures that adaptive mechanisms cannot erode the effect, and this is probably the key to success of the ARCON regime in patients with low HB levels at presentation, the re
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Contact: Mary Rice
mary.rice@riceconseil.eu
European Society for Radiotherapy and Oncology (ESTRO)
Source:Eurekalert

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