Introduction/Background Anaemia is common in patients with cervical cancer. Existing guidelines emphasise the importance of maintaining haemoglobin levels above 120 g/L in cervical cancer patients undergoing chemoradiation. The aim of the study is to evaluate the impact of anaemia on the clinical outcomes in patients with cervical cancer referred for chemoradiation.

Methodology 135 patients (median age was 48 years) with cervical cancer (squamous= 79.3%, Adenocarcinoma= 12.6%, Adenosquamous= 8.1%) referred for radical chemoradiartion between January 2013 and December 2017 were reviewed retrospectively. The FIGO stages for the group were: Ib2 = 11%; II = 42%; III = 39%; IVa =8%. Patients underwent chemoradiation with external beam radiotherapy with concurrent weekly cisplatin for five cycles followed by high-dose-rate brachytherapy. Factors included in the analysis were age, histology, FIGO stage, nodal status, pre-treatment haemoglobin, pre-brachytherapy haemoglobin and post treatment haemoglobin.

Results After a median follow-up of 42 months, the 3 year local failure rate for the whole group, pre-treatment Hb < 120 g/L and pre-brachytherapy Hb < 120 g/L was 9%, 15% and 22% respectively. The 3 year overall survival rate was 72%, 65% and 49% respectively. 52 patients (38.5%) had anaemia at presentation (Hb < 120 g/L). There was significant association between anaemia and younger age, more advanced stage and lymph node involvement. Anaemia was corrected by blood transfusion and/or ferric carboxymaltose. The pre-brachytherapy Hb level had the strongest impact on both local failure and survival. The post-treatment Hb level did not have an impact on the outcomes.

Conclusion Anaemia in patients with cervical cancer undergoing chemoradiation was a strong prognostic factor for local control and survival. The pre-brachytherapy Hb level had the strongest impact indicating the benefit from correcting the anaemia before treatment and maintaining the Hb level above 120 g/L during the treatment.