236 Radiation Oncology, Biology, Physics Volume 30, Supplement 1

Results: Various demographic, pre-treatment CBC and other blood profiles as well as other oncological parameters between the two arms were well balanced. The mean increment in hemoglobin for weeks 3-6 was significantly higher in the treatment arm than the control arm (p values 0.012, 0.0017, 0.006, and 0.003). Similar results were seen for RBC and hematocrit values. More interestingly, a beneficial effect on platelets was seen. The treatment arm patients had higher platelet values than the control arm patients (p values for weeks 3-6: 0.056, 0.025, 0.009, and 0.140, respec- tively). Vital signs recorded every day in these patients showed no adverse effects. No hypertensive episodes have been noted. The administration of subcutaneous doses of 200 units per/kg/day is well tolerated.

Conclusion: Beneficial effects of r-KuEPC on hemoglobin, hematocrit and RBC have been reported; however, increased levels of platelets in cancer patients have not been documented in a randomized study until now. Our results may be related to the higher doses of r-HuEPO being administered in this study. It is lcnown that patients with iron deficiency anemia-with resultant increased serum erythropoietin levels~develop thrombocytosis. Laboratory studies show dose-response effect of EPO on early Burst Forming Units. Wide field RT (e.g.. hemibodv RT) and radioactive Strontium administration are complicated by significani lowering of platelet cot&~ the effects on platelets suggest that administration of r-HuFPO in patients receiving such therapies may be beneficial.

144 AN ANALYSIS OF WEEKLY COMPLETE BLOOD COUNTS (CBC) IN 158 PATIEXTS RECEIVING RADI- AND GUIDELINES FOR OBTAINING CBCs DURING RADIOTHEMPY

Ignacio, Lani; Yang, Farley; Vijayakumar, Srinivasan; Houghton, Alan; Nautiyal, Jaishanker; Halpem, Howard; Sutton, Harold Michael Reese/University of Chicago Center for Radiation Therapy, Michael Reese Hospital & Medical Ctr., Chicago, IL Purpose/Objective: Weekly CBCs are considered standard of practice in patients receiving radiotherapy. Whether all patients receiving radiotherapy need weekly blood counts is not known. To develop guidelines, ~3 nnalycis of weekly blood counts obtained in patients receiving radiotherapy is reported here. Material & Methods: In the calendar year 1993, 412 new patients were seen at Michael Reese Hospital and Medical Center; of these only patients with a diagnosis of carcinoma of lung, breast, prostate, head and neck or gynecological malig- nancies were included in this study; only patients who received radiotherapy with an intent to cure are included except lung cancer patients in whom those who received more than 5 weeks of radiotherapy are not excluded. In this retro- spective study, an acceptable initial CBC prior to radiotherapy was considered as the one obtained within four weeks from the day of starting of radiotherapy.

Results: A total of 158 patients were identified; the breakdown in terms of disease sites is as follows: lung cancer - 33; breast - 49; prostate - 52; head and neck - 9; gynecological malignancies - 15. Of these, 10 patients received concomitant chemotherapy. One hundred eighteen patients had initial CBC by criteria described above. The number of patients with CBC results on week 1, 2, 3, 4, 5, and 6, 7, are week 1 - 155, week 2 - 153, week 3 - 149, week 4 - 147, week 5 - 130, week 6 - 198, week 7 L 38, respectively.~ Ten patients had initial hemoglobin less than 16 gm/dl. Only one patient had less than l,OOO/dl WBC count. None had less than lOO,OOO/dl platelet count. During radiotherapy, hemoglobin levels declined below 10 gm/dl in 32 patients; the disease-site breakdown for these patients are as follows: lung - 13 (39%); breast and prostate - 5 each, (10X), respectively; head and neck - 2 (22%); gyne - 7 (47%). The number of patients with less than 1,000 WBC count was 4 (lung - 3; prostate - 1). the number of patients with less than 100,000 platelet count was 5 (prostate - 3; breast - 2).

Conclusions: (a) Routine weekly CBCs may not be warranted in patients receiving curative RT. (b) However, almost 50% of patients receiving RT to the pelvis for gynecological malignancies had a decrease in hemoglobin to less than 10. Since it has been shown that hemoglobin is an important prognostic factor in carcinoma of cervix and transfusion also has shown to improve outcome, routine weekly CBC should be obtained in these patients. (c) The majority of our head and neck patients received chemotherapy with radiotherapy, thus accounting for our results in them. Patients receiving concomitant chemotherapy should have close monitoring of CBCs during chemoradiotherapy. (d) Our prostate cancer patients did not receive whole pelvic RT; hence, our results may not be extrapolated to institutions treating pelvic lymph nodes in these patients. However, routine weekly CBC in patients with limited field radiation therapy is not indicated. (e) Stage I/II breast cancer patients receiving radiotherapy alone after lumpectomy do not require weekly CBCs, unless their initial levels are low or are receiving concomitant chemotherapy. (f) A cost analysis and national health care cost reduction with streamlined CBC determinations will be presented.