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Year : 2018  |  Volume : 43  |  Issue : 1  |  Page : 19-24

The impact of pretreatment anemia on response to neoadjuvant concurrent chemoradiotherapy in locally advanced carcinoma rectum: a single-institute prospective study

1 Army Hospital R&R, Delhi, India
2 Command Hospital, Pune, India

Correspondence Address:
Neelam Sharma
Deparment of Radiotherapy, Army Hospital R&R, New Delhi, 110010
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejh.ejh_32_17

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Background Rectal cancer is one of the most frequent human malignant neoplasms and the second most common cancer in the large intestine. Neoadjuvant concurrent chemoradiotherapy along with surgery has been strongly recommended for locally advanced cancers located in the middle or the distal rectum. Anemia is reported to have adverse effects on survival in cancer patients. The aim of this study was to evaluate the influence of anemia on radiochemotherapy treatment outcome in these patients. Patients and methods A total of 50 consecutive patients with histologically confirmed adenocarcinoma of the rectum were treated radically with three-dimensional conformal radiation therapy with concurrent 5-fluorouracil or 5-fluorouracil derivatives-based concurrent chemotherapy. The influence on the pathological response of hemoglobin concentrations at presentation before neoadjuvant concurrent chemoradiotherapy was studied. Results Out of 50 patients 22 were anemic at presentation. There was a statistically significant difference, P value of 0.001, in anemic and nonanemic groups for tumor downstaging, whereas nodal downstaging did not reach statistical significance (P=0.201). In the multivariate analysis, the circumferential resection margin was found to be the most important risk feature, with a local control rate of 95.7% in patients with a negative margin and a 25% local control rate in the patients with a positive margin, with a significant P value of 0.002. Conclusion Pretreatment anemia had negative effects on pathological response and local control among patients who underwent neoadjuvant chemoradiotherapy and surgery for rectal cancer. Strategies maintaining hemoglobin levels within the normal range could potentially be used to improve local control in rectal cancer patients.

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