Radiotherapy With or Without Erythropoietin for Anemic Patients With Head and Neck Cancer: A Randomized Trial of the Radiation Therapy Oncology Group (RTOG 99-03)

Mitchell Machtay, Thomas F. Pajak, Mohan Suntharalingam, George Shenouda, Diane Hershock, Diana C. Stripp, Anthony J. Cmelak, Alan Schulsinger, Karen K. Fu

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine whether the addition of recombinant human erythropoietin (Epo) could improve the outcomes of anemic patients receiving definitive radiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Methods and Materials: Eligible patients had SCCHN, with a plan for continuous-course definitive radiotherapy (66-72 Gy) with or without chemotherapy. Patients with Stage III or IV SCCHN were required to undergo concurrent chemoradiotherapy and/or accelerated fractionation radiotherapy. Preradiotherapy hemoglobin was required to be between 9.0 g/dL and 13.5 g/dL (12.5 g/dL for women). Patients randomized to Epo received 40,000 U once weekly, starting 7-10 days before start of radiotherapy. Results: A total of 148 patients were enrolled; 141 were evaluable. Median pretreatment hemoglobin was 12.1 g/dL. Hemoglobin levels at 4 weeks rose by an average of 1.66 g/dL in the Epo arm, compared with an average 0.24 g/dL decrease in the control arm (p = 0.0001). Median follow-up was 2.5 years (3.1 years for surviving patients). There was no statistically significant difference in the primary endpoint of local-regional failure (LRF) rate between the treatment arms. The 3-year LRF rate was 36% for control and 44% for Epo (p = 0.56). There were also no significant differences in local-regional progression-free survival (LRPFS), patterns of failure, overall survival, or toxicity. The 3-year LRPFS rate was 52% for control and 47% for Epo. The overall survival rate was 57% and 56%, respectively. Conclusions: The addition of Epo to definitive radiotherapy for SCCHN did not improve outcomes. The study was not specifically designed to detect a potential negative association between Epo and tumor progression/survival.

Original languageEnglish (US)
Pages (from-to)1008-1017
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume69
Issue number4
DOIs
StatePublished - Nov 15 2007

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Radiation Oncology
Head and Neck Neoplasms
Erythropoietin
radiation therapy
Radiotherapy
cancer
hemoglobin
progressions
Hemoglobins
Disease-Free Survival
Survival Rate
chemotherapy
Survival
fractionation
toxicity
pretreatment
Chemoradiotherapy
tumors
Drug Therapy
Carcinoma, squamous cell of head and neck

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Machtay, Mitchell ; Pajak, Thomas F. ; Suntharalingam, Mohan ; Shenouda, George ; Hershock, Diane ; Stripp, Diana C. ; Cmelak, Anthony J. ; Schulsinger, Alan ; Fu, Karen K. / Radiotherapy With or Without Erythropoietin for Anemic Patients With Head and Neck Cancer : A Randomized Trial of the Radiation Therapy Oncology Group (RTOG 99-03). In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 69, No. 4. pp. 1008-1017.
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abstract = "Purpose: To determine whether the addition of recombinant human erythropoietin (Epo) could improve the outcomes of anemic patients receiving definitive radiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Methods and Materials: Eligible patients had SCCHN, with a plan for continuous-course definitive radiotherapy (66-72 Gy) with or without chemotherapy. Patients with Stage III or IV SCCHN were required to undergo concurrent chemoradiotherapy and/or accelerated fractionation radiotherapy. Preradiotherapy hemoglobin was required to be between 9.0 g/dL and 13.5 g/dL (12.5 g/dL for women). Patients randomized to Epo received 40,000 U once weekly, starting 7-10 days before start of radiotherapy. Results: A total of 148 patients were enrolled; 141 were evaluable. Median pretreatment hemoglobin was 12.1 g/dL. Hemoglobin levels at 4 weeks rose by an average of 1.66 g/dL in the Epo arm, compared with an average 0.24 g/dL decrease in the control arm (p = 0.0001). Median follow-up was 2.5 years (3.1 years for surviving patients). There was no statistically significant difference in the primary endpoint of local-regional failure (LRF) rate between the treatment arms. The 3-year LRF rate was 36{\%} for control and 44{\%} for Epo (p = 0.56). There were also no significant differences in local-regional progression-free survival (LRPFS), patterns of failure, overall survival, or toxicity. The 3-year LRPFS rate was 52{\%} for control and 47{\%} for Epo. The overall survival rate was 57{\%} and 56{\%}, respectively. Conclusions: The addition of Epo to definitive radiotherapy for SCCHN did not improve outcomes. The study was not specifically designed to detect a potential negative association between Epo and tumor progression/survival.",
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Radiotherapy With or Without Erythropoietin for Anemic Patients With Head and Neck Cancer : A Randomized Trial of the Radiation Therapy Oncology Group (RTOG 99-03). / Machtay, Mitchell; Pajak, Thomas F.; Suntharalingam, Mohan; Shenouda, George; Hershock, Diane; Stripp, Diana C.; Cmelak, Anthony J.; Schulsinger, Alan; Fu, Karen K.

In: International Journal of Radiation Oncology Biology Physics, Vol. 69, No. 4, 15.11.2007, p. 1008-1017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiotherapy With or Without Erythropoietin for Anemic Patients With Head and Neck Cancer

T2 - A Randomized Trial of the Radiation Therapy Oncology Group (RTOG 99-03)

AU - Machtay, Mitchell

AU - Pajak, Thomas F.

AU - Suntharalingam, Mohan

AU - Shenouda, George

AU - Hershock, Diane

AU - Stripp, Diana C.

AU - Cmelak, Anthony J.

AU - Schulsinger, Alan

AU - Fu, Karen K.

PY - 2007/11/15

Y1 - 2007/11/15

N2 - Purpose: To determine whether the addition of recombinant human erythropoietin (Epo) could improve the outcomes of anemic patients receiving definitive radiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Methods and Materials: Eligible patients had SCCHN, with a plan for continuous-course definitive radiotherapy (66-72 Gy) with or without chemotherapy. Patients with Stage III or IV SCCHN were required to undergo concurrent chemoradiotherapy and/or accelerated fractionation radiotherapy. Preradiotherapy hemoglobin was required to be between 9.0 g/dL and 13.5 g/dL (12.5 g/dL for women). Patients randomized to Epo received 40,000 U once weekly, starting 7-10 days before start of radiotherapy. Results: A total of 148 patients were enrolled; 141 were evaluable. Median pretreatment hemoglobin was 12.1 g/dL. Hemoglobin levels at 4 weeks rose by an average of 1.66 g/dL in the Epo arm, compared with an average 0.24 g/dL decrease in the control arm (p = 0.0001). Median follow-up was 2.5 years (3.1 years for surviving patients). There was no statistically significant difference in the primary endpoint of local-regional failure (LRF) rate between the treatment arms. The 3-year LRF rate was 36% for control and 44% for Epo (p = 0.56). There were also no significant differences in local-regional progression-free survival (LRPFS), patterns of failure, overall survival, or toxicity. The 3-year LRPFS rate was 52% for control and 47% for Epo. The overall survival rate was 57% and 56%, respectively. Conclusions: The addition of Epo to definitive radiotherapy for SCCHN did not improve outcomes. The study was not specifically designed to detect a potential negative association between Epo and tumor progression/survival.

AB - Purpose: To determine whether the addition of recombinant human erythropoietin (Epo) could improve the outcomes of anemic patients receiving definitive radiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Methods and Materials: Eligible patients had SCCHN, with a plan for continuous-course definitive radiotherapy (66-72 Gy) with or without chemotherapy. Patients with Stage III or IV SCCHN were required to undergo concurrent chemoradiotherapy and/or accelerated fractionation radiotherapy. Preradiotherapy hemoglobin was required to be between 9.0 g/dL and 13.5 g/dL (12.5 g/dL for women). Patients randomized to Epo received 40,000 U once weekly, starting 7-10 days before start of radiotherapy. Results: A total of 148 patients were enrolled; 141 were evaluable. Median pretreatment hemoglobin was 12.1 g/dL. Hemoglobin levels at 4 weeks rose by an average of 1.66 g/dL in the Epo arm, compared with an average 0.24 g/dL decrease in the control arm (p = 0.0001). Median follow-up was 2.5 years (3.1 years for surviving patients). There was no statistically significant difference in the primary endpoint of local-regional failure (LRF) rate between the treatment arms. The 3-year LRF rate was 36% for control and 44% for Epo (p = 0.56). There were also no significant differences in local-regional progression-free survival (LRPFS), patterns of failure, overall survival, or toxicity. The 3-year LRPFS rate was 52% for control and 47% for Epo. The overall survival rate was 57% and 56%, respectively. Conclusions: The addition of Epo to definitive radiotherapy for SCCHN did not improve outcomes. The study was not specifically designed to detect a potential negative association between Epo and tumor progression/survival.

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