Haemoglobin monitoring in endometrial cancer patients undergoing radiotherapy

To evaluate the level of anaemia monitoring and to determine the prevalence of anaemia in patients with endometrial carcinoma (EC) undergoing postoperative pelvic radiotherapy (RT).

We evaluated 233 consecutive patients diagnosed with EC receiving RT in our institution between January 2011 and December 2015. One hundred and fifty-two patients (65.2%) received a combination of external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDR-BT) (mean dose 53.4 Gy, range 21-75), and 71 patients (30.5%) were exclusively treated with HDR-BT (mean dose 10.2 Gy, range 7-20). Blood test results with haemoglobin (Hb) levels were collected at three specific time points were: pre-RT (Hb1), during RT (Hb2) and post-RT (Hb3). Anaemia was defined as Hb <12 g/dL.

Anaemia was detected in 54% of patients (67 patients) in the pre-RT analysis. Only 53.7% (n = 36) of the patients with anaemia detected pre-RT underwent subsequent Hb controls (during or post-RT). Blood tests were performed in 124 patients (53.20%) pre-RT, in 51 (17.59%) during RT and in 90 patients (38.62%) post-RT. Significant differences were observed between the mean Hb levels at Hb1-Hb3 (p = 0.001) and Hb2-Hb3 (p = 0.004). Patients with a pre-RT Hb level <12 g/dL presented a worse overall survival (OS) (p = 0.021, χ ² 5.3) with a mean OS of 53.39 months (range 45.5-61.3) vs. 61.4 (range 58.4-64.4) in patients with Hb ≥12 g/dL.

Although the presence of anaemia is frequent in patients with EC (53.2% of patients affected at cancer diagnosis) and influences the OS, Hb monitoring in patients receiving RT remains suboptimal (no controls during RT in 46.3%). There is a strong need to pay attention to blood test prescription for all the patients during and after RT.