Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck

Liam Welsh; Rafal Panek; Angela Riddell; Kee Wong; Martin O. Leach; Mahvash Tavassoli; Durdana Rahman; Maria Schmidt; Tara Hurley; Lorna Grove; Thomas Richards; Dow Mu Koh; Christopher Nutting; Kevin Harrington; Kate Newbold; Shreerang Bhide

doi:10.1038/bjc.2016.386

Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck

Liam Welsh, Rafal Panek, Angela Riddell, Kee Wong, Martin O. Leach, Mahvash Tavassoli^*, Durdana Rahman, Maria Schmidt, Tara Hurley, Lorna Grove, Thomas Richards, Dow Mu Koh, Christopher Nutting, Kevin Harrington, Kate Newbold, Shreerang Bhide

^*Corresponding author for this work

Centre for Host Microbiome Interactions

Research output: Contribution to journal › Article › peer-review

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Abstract

Background:Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radical chemo-radiation (CRT) frequently receive transfusion with packed red cells (PRCT) during radiotherapy on the basis that PRCT increases tumour oxygenation and overcomes hypoxia-induced radio-resistance. This is likely to be a significant oversimplification given the fact that tumour hypoxia is the result of several intrinsic and extrinsic factors, including many that are not directly related to serum haemoglobin (Hb). Therefore, we have studied the effect of PRCT on tumour oxygenation in a prospective cohort of patients who developed low Hb during radical CRT for HNSCC.Methods:This was a prospective study of 20 patients with HNSCC receiving radical CRT undergoing PRCT for Hb-1. Patients underwent pretransfusion and posttransfusion intrinsic susceptibility-weighted (SWI) MRI and dynamic contrast-enhanced (DCE) MRI. Blood samples were obtained at the time of MRI scanning and two further time points for measuring Hb and a panel of serum cytokine markers of tumour hypoxia. 3D T₂* and K^trans maps were calculated from the MRI data for primary tumours and cervical lymph node metastases.Results:PRCT produced no change (11 patients) or reduced (1 patient) T₂* (tumour oxygenation) in 12 of the 16 (75%) evaluable primary tumours. Three of the four patients with improved tumour oxygenation progressed or had partial response following treatment completion. There were variable changes in K^trans (tumour perfusion or vessel permeability) following PRCT that were of small magnitude for most tumours. Pre- and Post-PRCT levels of measured cytokines were not significantly different.Conclusions:This study suggests that PRCT during radical CRT for HNSCC does not improve tumour oxygenation. Therefore, oncologists should consider changing practice according to NICE and American Association of Blood Banks guidelines on PRCT for anaemia.British Journal of Canceradvance online publication, 24 November 2016; doi:10.1038/bjc.2016.386 www.bjcancer.com.

Original language	English
Journal	BJC: British Journal of Cancer
Early online date	24 Nov 2016
DOIs	https://doi.org/10.1038/bjc.2016.386
Publication status	E-pub ahead of print - 24 Nov 2016

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10.1038/bjc.2016.386

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Welsh, L., Panek, R., Riddell, A., Wong, K., Leach, M. O., Tavassoli, M., Rahman, D., Schmidt, M., Hurley, T., Grove, L., Richards, T., Koh, D. M., Nutting, C., Harrington, K., Newbold, K., & Bhide, S. (2016). Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck. BJC: British Journal of Cancer. Advance online publication. https://doi.org/10.1038/bjc.2016.386

@article{02e3e271deaa4596b22f545e03106bc2,

title = "Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck",

abstract = "Background:Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radical chemo-radiation (CRT) frequently receive transfusion with packed red cells (PRCT) during radiotherapy on the basis that PRCT increases tumour oxygenation and overcomes hypoxia-induced radio-resistance. This is likely to be a significant oversimplification given the fact that tumour hypoxia is the result of several intrinsic and extrinsic factors, including many that are not directly related to serum haemoglobin (Hb). Therefore, we have studied the effect of PRCT on tumour oxygenation in a prospective cohort of patients who developed low Hb during radical CRT for HNSCC.Methods:This was a prospective study of 20 patients with HNSCC receiving radical CRT undergoing PRCT for Hb-1. Patients underwent pretransfusion and posttransfusion intrinsic susceptibility-weighted (SWI) MRI and dynamic contrast-enhanced (DCE) MRI. Blood samples were obtained at the time of MRI scanning and two further time points for measuring Hb and a panel of serum cytokine markers of tumour hypoxia. 3D T2* and Ktrans maps were calculated from the MRI data for primary tumours and cervical lymph node metastases.Results:PRCT produced no change (11 patients) or reduced (1 patient) T2* (tumour oxygenation) in 12 of the 16 (75%) evaluable primary tumours. Three of the four patients with improved tumour oxygenation progressed or had partial response following treatment completion. There were variable changes in Ktrans (tumour perfusion or vessel permeability) following PRCT that were of small magnitude for most tumours. Pre- and Post-PRCT levels of measured cytokines were not significantly different.Conclusions:This study suggests that PRCT during radical CRT for HNSCC does not improve tumour oxygenation. Therefore, oncologists should consider changing practice according to NICE and American Association of Blood Banks guidelines on PRCT for anaemia.British Journal of Canceradvance online publication, 24 November 2016; doi:10.1038/bjc.2016.386 www.bjcancer.com.",

author = "Liam Welsh and Rafal Panek and Angela Riddell and Kee Wong and Leach, {Martin O.} and Mahvash Tavassoli and Durdana Rahman and Maria Schmidt and Tara Hurley and Lorna Grove and Thomas Richards and Koh, {Dow Mu} and Christopher Nutting and Kevin Harrington and Kate Newbold and Shreerang Bhide",

year = "2016",

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doi = "10.1038/bjc.2016.386",

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journal = "BJC: British Journal of Cancer",

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Welsh, L, Panek, R, Riddell, A, Wong, K, Leach, MO, Tavassoli, M, Rahman, D, Schmidt, M, Hurley, T, Grove, L, Richards, T, Koh, DM, Nutting, C, Harrington, K, Newbold, K & Bhide, S 2016, 'Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck', BJC: British Journal of Cancer. https://doi.org/10.1038/bjc.2016.386

TY - JOUR

T1 - Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck

AU - Welsh, Liam

AU - Panek, Rafal

AU - Riddell, Angela

AU - Wong, Kee

AU - Leach, Martin O.

AU - Tavassoli, Mahvash

AU - Rahman, Durdana

AU - Schmidt, Maria

AU - Hurley, Tara

AU - Grove, Lorna

AU - Richards, Thomas

AU - Koh, Dow Mu

AU - Nutting, Christopher

AU - Harrington, Kevin

AU - Newbold, Kate

AU - Bhide, Shreerang

PY - 2016/11/24

Y1 - 2016/11/24

N2 - Background:Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radical chemo-radiation (CRT) frequently receive transfusion with packed red cells (PRCT) during radiotherapy on the basis that PRCT increases tumour oxygenation and overcomes hypoxia-induced radio-resistance. This is likely to be a significant oversimplification given the fact that tumour hypoxia is the result of several intrinsic and extrinsic factors, including many that are not directly related to serum haemoglobin (Hb). Therefore, we have studied the effect of PRCT on tumour oxygenation in a prospective cohort of patients who developed low Hb during radical CRT for HNSCC.Methods:This was a prospective study of 20 patients with HNSCC receiving radical CRT undergoing PRCT for Hb-1. Patients underwent pretransfusion and posttransfusion intrinsic susceptibility-weighted (SWI) MRI and dynamic contrast-enhanced (DCE) MRI. Blood samples were obtained at the time of MRI scanning and two further time points for measuring Hb and a panel of serum cytokine markers of tumour hypoxia. 3D T2* and Ktrans maps were calculated from the MRI data for primary tumours and cervical lymph node metastases.Results:PRCT produced no change (11 patients) or reduced (1 patient) T2* (tumour oxygenation) in 12 of the 16 (75%) evaluable primary tumours. Three of the four patients with improved tumour oxygenation progressed or had partial response following treatment completion. There were variable changes in Ktrans (tumour perfusion or vessel permeability) following PRCT that were of small magnitude for most tumours. Pre- and Post-PRCT levels of measured cytokines were not significantly different.Conclusions:This study suggests that PRCT during radical CRT for HNSCC does not improve tumour oxygenation. Therefore, oncologists should consider changing practice according to NICE and American Association of Blood Banks guidelines on PRCT for anaemia.British Journal of Canceradvance online publication, 24 November 2016; doi:10.1038/bjc.2016.386 www.bjcancer.com.

AB - Background:Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radical chemo-radiation (CRT) frequently receive transfusion with packed red cells (PRCT) during radiotherapy on the basis that PRCT increases tumour oxygenation and overcomes hypoxia-induced radio-resistance. This is likely to be a significant oversimplification given the fact that tumour hypoxia is the result of several intrinsic and extrinsic factors, including many that are not directly related to serum haemoglobin (Hb). Therefore, we have studied the effect of PRCT on tumour oxygenation in a prospective cohort of patients who developed low Hb during radical CRT for HNSCC.Methods:This was a prospective study of 20 patients with HNSCC receiving radical CRT undergoing PRCT for Hb-1. Patients underwent pretransfusion and posttransfusion intrinsic susceptibility-weighted (SWI) MRI and dynamic contrast-enhanced (DCE) MRI. Blood samples were obtained at the time of MRI scanning and two further time points for measuring Hb and a panel of serum cytokine markers of tumour hypoxia. 3D T2* and Ktrans maps were calculated from the MRI data for primary tumours and cervical lymph node metastases.Results:PRCT produced no change (11 patients) or reduced (1 patient) T2* (tumour oxygenation) in 12 of the 16 (75%) evaluable primary tumours. Three of the four patients with improved tumour oxygenation progressed or had partial response following treatment completion. There were variable changes in Ktrans (tumour perfusion or vessel permeability) following PRCT that were of small magnitude for most tumours. Pre- and Post-PRCT levels of measured cytokines were not significantly different.Conclusions:This study suggests that PRCT during radical CRT for HNSCC does not improve tumour oxygenation. Therefore, oncologists should consider changing practice according to NICE and American Association of Blood Banks guidelines on PRCT for anaemia.British Journal of Canceradvance online publication, 24 November 2016; doi:10.1038/bjc.2016.386 www.bjcancer.com.

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U2 - 10.1038/bjc.2016.386

DO - 10.1038/bjc.2016.386

M3 - Article

AN - SCOPUS:84996969483

SN - 0007-0920

JO - BJC: British Journal of Cancer

JF - BJC: British Journal of Cancer

ER -

Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck

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