局部晚期宫颈癌的预后与近距离放疗前的血红蛋白值和输血实践有关吗？一项观察性研究比较了两个临床指南不同的大型学术中心。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-11-01 DOI:10.1016/j.brachy.2024.07.006

Taylor Dear , Jodi Chiu , Harley Meirovich , Amie Malkin , Razan Amjad , David D'Souza , Jeannie Callum , Eric Leung , Kate Kelly , Alejandro Lazo-Langner , Ziad Solh

{"title":"局部晚期宫颈癌的预后与近距离放疗前的血红蛋白值和输血实践有关吗？一项观察性研究比较了两个临床指南不同的大型学术中心。","authors":"Taylor Dear , Jodi Chiu , Harley Meirovich , Amie Malkin , Razan Amjad , David D'Souza , Jeannie Callum , Eric Leung , Kate Kelly , Alejandro Lazo-Langner , Ziad Solh","doi":"10.1016/j.brachy.2024.07.006","DOIUrl":null,"url":null,"abstract":"<div><h3>BACKGROUND AND PURPOSE</h3><div>Anemia is common in locally advanced cervical cancer. Clinical practice varies greatly for management of anemia during brachytherapy, with some centres providing red cell transfusion to increase hemoglobin levels above 100 g/L.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This is a retrospective observational cohort study of adult patients with cervical cancer treated with brachytherapy at two academic hospitals. One hospital (H1) uses a liberal transfusion strategy with hemoglobin threshold of 100 g/L during brachytherapy and the other uses a restrictive target of 70 g/L (H2).</div></div><div><h3>RESULTS</h3><div>Overall, 336 patients met inclusion criteria (H1: 150 patients, H2: 186 patients). 11 patients were excluded (2 at H1, 9 at H2). Demographics at both sites were comparable, except for cancer stage and smoking history. External beam radiation and chemotherapy provided was similar. Hemoglobin values were compared at baseline (within 4 weeks of oncology consult), and prior to the first and second brachytherapy treatments. In total, 101red blood cell (RBC) units were transfused to patients at H1 and 19 units to patients at H2. Patients were followed for a median of 37.0 months (0.6-80.5) at H1, and 33.3 months (1.6-82.0) at H2. There was no significant difference in progression-free or overall survival. Multivariable logistic regression analysis showed that FIGO stage was a predictor for both overall survival and cancer progression. Age, tumor size, chemotherapy, and hemoglobin levels were not predictors of disease progression or mortality.</div></div><div><h3>CONCLUSIONS</h3><div>The practice of liberal transfusion should be re-evaluated in the absence of robust data to support its use.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 660-667"},"PeriodicalIF":1.7000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Are outcomes of locally advanced cervical cancer associated with prebrachytherapy hemoglobin values and transfusion practice? An observational study comparing two large academic centres with divergent clinical guidelines\",\"authors\":\"Taylor Dear , Jodi Chiu , Harley Meirovich , Amie Malkin , Razan Amjad , David D'Souza , Jeannie Callum , Eric Leung , Kate Kelly , Alejandro Lazo-Langner , Ziad Solh\",\"doi\":\"10.1016/j.brachy.2024.07.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>BACKGROUND AND PURPOSE</h3><div>Anemia is common in locally advanced cervical cancer. Clinical practice varies greatly for management of anemia during brachytherapy, with some centres providing red cell transfusion to increase hemoglobin levels above 100 g/L.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This is a retrospective observational cohort study of adult patients with cervical cancer treated with brachytherapy at two academic hospitals. One hospital (H1) uses a liberal transfusion strategy with hemoglobin threshold of 100 g/L during brachytherapy and the other uses a restrictive target of 70 g/L (H2).</div></div><div><h3>RESULTS</h3><div>Overall, 336 patients met inclusion criteria (H1: 150 patients, H2: 186 patients). 11 patients were excluded (2 at H1, 9 at H2). Demographics at both sites were comparable, except for cancer stage and smoking history. External beam radiation and chemotherapy provided was similar. Hemoglobin values were compared at baseline (within 4 weeks of oncology consult), and prior to the first and second brachytherapy treatments. In total, 101red blood cell (RBC) units were transfused to patients at H1 and 19 units to patients at H2. Patients were followed for a median of 37.0 months (0.6-80.5) at H1, and 33.3 months (1.6-82.0) at H2. There was no significant difference in progression-free or overall survival. Multivariable logistic regression analysis showed that FIGO stage was a predictor for both overall survival and cancer progression. Age, tumor size, chemotherapy, and hemoglobin levels were not predictors of disease progression or mortality.</div></div><div><h3>CONCLUSIONS</h3><div>The practice of liberal transfusion should be re-evaluated in the absence of robust data to support its use.</div></div>\",\"PeriodicalId\":55334,\"journal\":{\"name\":\"Brachytherapy\",\"volume\":\"23 6\",\"pages\":\"Pages 660-667\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brachytherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1538472124001193\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brachytherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1538472124001193","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景和目的：贫血在局部晚期宫颈癌中很常见。在近距离放射治疗期间，临床上对贫血的处理方法大相径庭，有些中心提供红细胞输注，以将血红蛋白水平提高到 100 g/L 以上：这是一项回顾性观察队列研究，研究对象是在两家学术医院接受近距离放射治疗的成年宫颈癌患者。一家医院（H1）在近距离治疗期间采用自由输血策略，血红蛋白阈值为 100 g/L，另一家医院（H2）采用限制性目标，血红蛋白阈值为 70 g/L：共有 336 例患者符合纳入标准（H1：150 例；H2：186 例）。11名患者被排除在外（H1：2名，H2：9名）。除癌症分期和吸烟史外，两地患者的人口统计学特征相当。提供的体外放射治疗和化疗相似。比较了基线（肿瘤科会诊后 4 周内）、第一次和第二次近距离放射治疗前的血红蛋白值。H1 期患者共输注了 101 个红细胞 (RBC)单位，H2 期患者输注了 19 个单位。H1 期患者的随访时间中位数为 37.0 个月（0.6-80.5 个月），H2 期患者的随访时间中位数为 33.3 个月（1.6-82.0 个月）。无进展生存期和总生存期无明显差异。多变量逻辑回归分析显示，FIGO分期是总生存期和癌症进展的预测因素。年龄、肿瘤大小、化疗和血红蛋白水平不是疾病进展或死亡率的预测因素：结论：在缺乏有力数据支持的情况下，应重新评估自由输血的做法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Are outcomes of locally advanced cervical cancer associated with prebrachytherapy hemoglobin values and transfusion practice? An observational study comparing two large academic centres with divergent clinical guidelines

BACKGROUND AND PURPOSE

Anemia is common in locally advanced cervical cancer. Clinical practice varies greatly for management of anemia during brachytherapy, with some centres providing red cell transfusion to increase hemoglobin levels above 100 g/L.

MATERIALS AND METHODS

This is a retrospective observational cohort study of adult patients with cervical cancer treated with brachytherapy at two academic hospitals. One hospital (H1) uses a liberal transfusion strategy with hemoglobin threshold of 100 g/L during brachytherapy and the other uses a restrictive target of 70 g/L (H2).

RESULTS

Overall, 336 patients met inclusion criteria (H1: 150 patients, H2: 186 patients). 11 patients were excluded (2 at H1, 9 at H2). Demographics at both sites were comparable, except for cancer stage and smoking history. External beam radiation and chemotherapy provided was similar. Hemoglobin values were compared at baseline (within 4 weeks of oncology consult), and prior to the first and second brachytherapy treatments. In total, 101red blood cell (RBC) units were transfused to patients at H1 and 19 units to patients at H2. Patients were followed for a median of 37.0 months (0.6-80.5) at H1, and 33.3 months (1.6-82.0) at H2. There was no significant difference in progression-free or overall survival. Multivariable logistic regression analysis showed that FIGO stage was a predictor for both overall survival and cancer progression. Age, tumor size, chemotherapy, and hemoglobin levels were not predictors of disease progression or mortality.

CONCLUSIONS

The practice of liberal transfusion should be re-evaluated in the absence of robust data to support its use.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.