Thomas Gillian M
Department of Radiation Oncology, Obstetrics & Gynecology, University of Toronto, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Canada.
Oncology. 2002;63 Suppl 2:19-28. doi: 10.1159/000067148.
Although the association between low hemoglobin levels and poorer outcomes in radiation oncology has long been recognized, anemia is often overlooked and untreated. However, a growing body of clinical evidence now indicates that low hemoglobin levels during radiation treatment are associated with decreased response and survival following radiotherapy. For example, a large Canadian retrospective study in patients receiving radical radiotherapy for cervical cancer showed that the 5-year survival rate was 19% higher in those whose hemoglobin during radiation treatment was =12 g/dl compared to those with levels <12 g/dl. The data suggest that clinical trials need to be performed to determine whether increasing hemoglobin levels leads to improved local control and survival. The mechanism by which low hemoglobin levels could cause poorer outcomes is not well understood and needs further elucidation. It is postulated that lower hemoglobin levels resulting in decreased oxygen carrying capacity may lead to increased tumor hypoxia, radiation resistance and increased tumor angiogenesis. The interrelationship of low hemoglobin levels, hypoxia, tumor angiogenesis and survival is explored in this article.
尽管长期以来人们已经认识到低血红蛋白水平与放射肿瘤学中较差的治疗结果之间存在关联，但贫血常常被忽视且未得到治疗。然而，越来越多的临床证据表明，放射治疗期间的低血红蛋白水平与放疗后反应降低和生存率降低有关。例如，一项针对接受宫颈癌根治性放疗患者的大型加拿大回顾性研究表明，放疗期间血红蛋白≥12 g/dl的患者5年生存率比血红蛋白水平<12 g/dl的患者高19%。数据表明需要进行临床试验以确定提高血红蛋白水平是否会改善局部控制和生存率。低血红蛋白水平导致较差治疗结果的机制尚不清楚，需要进一步阐明。据推测，较低的血红蛋白水平导致氧携带能力下降，可能会导致肿瘤缺氧增加、放射抗性增加以及肿瘤血管生成增加。本文探讨了低血红蛋白水平、缺氧、肿瘤血管生成与生存率之间的相互关系。
