Impact of anemia in patients with head and neck cancer

Head and neck squamous cell carcinoma, which is comprised of a heterogeneous group of tumors arising from the epithelial lining of the oral cavity, pharynx, and larynx, is a locoregional disease. Tumor hypoxia and anemia are known to adversely effect the efficacy of radiation therapy, a local treatment modality. Therefore, head and neck cancers represent an ideal model for assessing the impact of anemia following treatment with radiation therapy. Various treatment strategies aimed at increasing tumor oxygenation in head and neck cancer patients (including hyperbaric oxygen and hypoxic cell radiosensitizers) have been studied. These studies have been fueled by evidence that hypoxia adversely effects the radiosensitivity of cells. Although the exact mechanism of action of the oxygen effect is not known, in vitro studies with conventional photon radiation therapy under normoxic conditions have shown an effectiveness of 2.5-3.0 times greater than that achieved under anoxic conditions. Recent studies, including large retrospective analyses, have demonstrated the dramatic adverse impact of anemia upon locoregional tumor control and survival. These studies, which have revealed hemoglobin levels as a powerful prognostic factor, provide compelling evidence for the value of reversing anemia and hence tumor hypoxia in head and neck cancer patients.