Epoetin‐α during radiotherapy for stage III esophageal carcinoma

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Abstract
BACKGROUND It has been suggested that hemoglobin levels of 12–14 g/dL are optimal for tumor oxygenation, radiosensitivity, and prognosis. In this prospective study, the authors evaluated the effectiveness of epoetin‐α to maintain hemoglobin levels at 12–14 g/dL during radiotherapy (RT) for patients with UICC Stage III esophageal carcinoma, and they examined the impact of erythropoetin on overall survival (OS), metastatic‐free survival (MFS), and local control (LC). METHODS Sixty patients who received RT between March, 2001 and September, 2004, were included in this prospective, nonrandomized study. Thirty patients received epoetin‐α (150 IU/kg 3 times per week) during RT (Group A), and 30 patients did not receive epoetin‐α (Group B). Epoetin‐α was started at hemoglobin levels < 13 g/dL and was stopped at hemoglobin levels ≥ 14 g/dL. Hemoglobin was measured before RT and once weekly during RT. RESULTS Both patient groups were balanced for age, gender, performance status, tumor location/length, histology, grading, tumor classification, lymph node status, chemotherapy, treatment (45–50.4 grays [Gy] plus resection vs. 45.0–50.4 Gy vs. 59.4–66.0 Gy), and hemoglobin level before RT. In 20 of 30 patients (67%) from Group A and in 3 of 30 patients (10%) from Group B, ≥ 60% of hemoglobin levels during RT were 12–14 g/dL (P = 0.003). The median change in hemoglobin was + 0.4 g/dL per week in Group A and − 0.4 g/dL per week in Group B. LC was significantly better in Group A (66% vs. 38% at 1 year, respectively; P = 0.012), a trend was observed for OS (59% vs. 33%, respectively; P = 0.08), and MFS did not differ significantly (43% vs. 38%, respectively; P = 0.34). No epoetin‐α‐related toxicity was observed. CONCLUSIONS Epoetin‐α was effective in maintaining the hemoglobin levels at 12–14 g/dL during RT. The application of epoetin‐α significantly improved LC, and a trend was observed for OS. Cancer 2005. © 2005 American Cancer Society.