Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma – A prospective study

Hoff, Camilla Molich; Grau, Cai; Overgaard, Jens

doi:10.1016/j.radonc.2012.01.011

Cited by 110 publications

(101 citation statements)

References 39 publications

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“…Moreover, evidence indicates that smoking exacerbates tissue hypoxia and can lead to smoking-induced tissue hypoxia in healthy human smokers (33), and inhalation of carbon monoxide-one component of cigarette smoke-can reduce the control of tumors by radiotherapy in animal models (34). In addition, patients with head and neck cancer (including nasopharyngeal carcinoma) with a higher smoking status have higher venous blood levels of carboxyhemoglobin, which results in reduced oxygen supply to the tumors (35). It is known that hypoxia induces the expression of a variety of genes associated with an aggressive malignant phenotype, including genes involved in stem cell maintenance, invasion, angiogenesis, and extravasation (36).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Cigarette Smoking on the Survival of Patients with Established Nasopharyngeal Carcinoma

OuYang

Mao

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Cigarette smoking is associated with the etiology of nasopharyngeal carcinoma; however, the influence of smoking on survival in patients with established nasopharyngeal carcinoma remains unknown.Methods: We retrospectively analyzed 1,849 patients with nasopharyngeal carcinoma who were categorized as never, former, and current smokers. Cumulative effect of smoking was defined in terms of pack-years. Associations between cigarette exposure and survival were estimated by Cox proportional hazards model.Results: The risks of death, progression, locoregional relapse, and distant metastasis were significantly higher for former and current smokers (all P 0.002) than never smokers. Heavy smokers with high pack-years had HRs for death of 3.31 [95% confidence interval (CI), 2.58-4.26; P < 0.001], for progression of 2.53 (95% CI, 2.03-3.16; P < 0.001), and for distant metastasis of 2.65 (95% CI, 1.89-3.70; P < 0.001). Specifically, in the cohort of 495 patients treated with intensity-modulated radiotherapy/three-dimensional conformal radiotherapy, we obtained similarly significant results. All of the survival outcomes remained significant in multivariate analyses.Conclusions: Pretreatment cigarette smoking is an independent, poor prognostic factor for patients with nasopharyngeal carcinoma, which is associated with increased risk of death, progression, locoregional relapse, and distant metastasis, with the risk increasing with pack-years.Impact: It is clear that cigarette smoking not only promotes carcinogenesis in the normal nasopharyngeal epithelium, but also affects the survival of patients with nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev; 22(12); 2285-94. Ó2013 AACR.

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Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Cigarette Smoking on the Survival of Patients with Established Nasopharyngeal Carcinoma

OuYang

Mao

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…The other main treatment modality for head and neck cancer is radiotherapy and a few studies have reported that smoking before and/or during treatment is associated with poorer survival following radiotherapy (7,10,34,35). However, these studies did not include patients who had not had radiotherapy so could not investigate whether the smoking effect was modified by radiotherapy receipt.…”

Section: Smoking and Treatmentmentioning

confidence: 99%

Smoking at Diagnosis Is an Independent Prognostic Factor for Cancer-Specific Survival in Head and Neck Cancer: Findings from a Large, Population-Based Study

Sharp

McDevitt

Carsin

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Some studies suggest smoking may result in poorer clinical outcomes in head and neck cancer, but the evidence is heterogeneous and some of it is poor quality. In a large, population-based, study we investigated: (i) whether smoking at diagnosis is an independent prognostic factor for cancer-specific survival in head and neck cancer; and (ii) whether the association varies by site and treatment.Methods: Head and neck cancers (ICD10 C01-C14, and C30-32) diagnosed from 1994 to 2009 were abstracted from the National Cancer Registry Ireland, and classified by smoking status at diagnosis. Follow-up was for 5 years or until December 31, 2010. Multivariate Cox proportional hazards models were used to compare cancerspecific death rates in current, ex-, and never smokers. Subgroup analyses by site and treatment were conducted.Results: In total, 5,652 head and neck cancers were included. At diagnosis, 24% were never smokers, 20% exsmokers, and 56% current smokers. Compared with never smokers, current smokers had a significantly raised death rate from cancer [multivariate HR, 1.36; 95% confidence interval (CI), 1.21-1.53]. The association was similar after restriction to squamous cell tumors. A significantly increased cancer-related death rate was seen for current smokers with oral cavity, pharyngeal, and laryngeal cancers. The association was stronger in surgically treated patients [HR, 1.49; 95% CI, 1.25-1.79; P(interaction) ¼ 0.01]. Neither radiotherapy nor chemotherapy modified the effect of smoking.Conclusions: Patients with head and neck cancer who smoke at diagnosis have a significantly increased cancer death rate.Impact: Greater efforts are needed to encourage and support smoking cessation in those at risk of, and diagnosed with, head and neck cancer. Cancer Epidemiol Biomarkers Prev; 23(11); 2579-90. Ó2014 AACR.

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“…14 Many studies have examined the relationship between smoking and mortality among cancer patients. A history of ever smoking compared with never smoking was associated with an increase in overall mortality [15][16][17][18][19][20][21][22][23] and cancer-specific mortality. 15,16,24 However, other studies fail to show a significant difference in mortality based on smoking status after controlling for covariates.…”

Section: Introductionmentioning

confidence: 99%

“…15,16,24 However, other studies fail to show a significant difference in mortality based on smoking status after controlling for covariates. [25][26][27][28] In the head and neck cancer literature, smoking significantly increases overall mortality and cancer-specific mortality, 10,21,23,[29][30][31][32][33][34] and pack-years of smoking has a dose-response positive relationship with mortality, 23,30,35 yet some studies reported nonsignificant differences in overall mortality [36][37][38][39] and cancer-specific mortality 37,40 between smokers and nonsmokers. However, previous studies are limited by a one-time smoking assessment at or after diagnosis (mostly at diagnosis), their retrospective nature, inability to control for covariates, and short follow-up periods.…”

Section: Introductionmentioning

confidence: 99%

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

Choi

Terrell

Bradford

et al. 2016

NICTOB

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Introduction: To determine if smoking after a cancer diagnosis makes a difference in mortality among newly diagnosed head and neck cancer patients. Methods: Longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 1627 days (N = 590). Mortality was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into four groups: continuing smokers, quitters, former smokers, or never-smokers. A broad range of covariates were included in the analyses. Kaplan-Meier curves, bivariate and multivariate Cox proportional hazards models were constructed. Results: Eight-year overall mortality and cancer-specific mortality were 40.5% (239/590) and 25.4% (150/590), respectively. Smoking status after a cancer diagnosis predicted overall mortality and cancer-specific mortality. Compared to never-smokers, continuing smokers had the highest hazard ratio (HR) of dying from all causes (HR = 2.71, 95% confidence interval [CI] = 1.48-4.98). Those who smoked at diagnosis, but quit and did not relapse-quitters-had an improved hazard ratio of dying (HR = 2.38, 95% CI = 1.29-4.36) and former smokers at diagnosis with no relapse after diagnosis-former smokers-had the lowest hazard ratio of dying from all causes (HR = 1.68, 95% CI = 1.12-2.56). Similarly, quitters had a slightly higher hazard ratio of dying from cancer-specific reasons (HR = 2.38, 95% CI = 1.13-5.01) than never-smokers, which was similar to current smokers (HR = 2.07, 95% CI = 0.96-4.47), followed by former smokers (HR = 1.70, 95% CI = 1.00-2.89). Conclusions: Compared to never-smokers, continuing smokers have the highest HR of overall mortality followed by quitters and former smokers, which indicates that smoking cessation, even after a cancer diagnosis, may improve overall mortality among newly diagnosed head and neck cancer patients. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population. Implications: Using prospective observational longitudinal data from 590 head and neck cancer patients, this study showed that continuing smokers have the highest overall mortality relative to never-smokers, which indicates that smoking cessation, even after a cancer diagnosis, may have beneficial effects on long-term overall mortality. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.

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Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma – A prospective study

Cited by 110 publications

References 39 publications

Prognostic Impact of Cigarette Smoking on the Survival of Patients with Established Nasopharyngeal Carcinoma

Prognostic Impact of Cigarette Smoking on the Survival of Patients with Established Nasopharyngeal Carcinoma

Smoking at Diagnosis Is an Independent Prognostic Factor for Cancer-Specific Survival in Head and Neck Cancer: Findings from a Large, Population-Based Study

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

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