The severity and optimal management of iron deficiency and anaemia before radiation for cervical cancer at the University of Pretoria Academic Hospitals

Abstract

BACKGROUND : In patients with locally advanced cervical cancer who receive radiotherapy, outcomes correlate significantly with haemoglobin level before and during therapy. These patients often have severe anaemia and require repeated transfusions to achieve and maintain optimal haemoglobin levels. METHODS : Women with anaemia and cervical cancer needing primary radiation treatment were randomised to two groups: the study group received limited transfusion with intravenous and oral iron therapy; the control group received transfusion and oral iron. Haemoglobin (Hb) levels, transfusion and markers of iron status were recorded initially and during follow up. RESULTS : Forty-three participants were randomised; data for 39 were available for analysis: 19 received limited transfusion with parenteral and then oral iron (Fe group); 20 had allogenic transfusion and oral iron (Tf group). Average Hb levels in the Fe group displayed a steady rise over a 12-week follow-up while levels in the Tf group declined at about 0.5 g/dl per week. At week 12 pretreatment levels were again reached despite intermittent transfusions. CONCLUSIONS : Anaemic patients with late-stage cervical cancer in this setting have severe iron deficiency that necessitates aggressive correction before radiation. While patients with severe or critical anaemia and those who require radiation without delay need immediate transfusion, sufficient iron is critical to help replenish stores and sustain Hb levels. Patients with longer waiting times before radiation or less severe anaemia should have parenteral iron supplementation at the time of diagnosis and transfusion can be delayed until the time of radiation treatment.