1
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Lee JJW, Kunaratnam V, Kim CJH, Pienkowski M, Hueniken K, Sahovaler A, Lam ACL, Davies JC, Brown CM, De Almeida JR, Huang SH, Waldron JN, Spreafico A, Hung RJ, Xu W, Goldstein DP, Liu G. Cigarette smoking cessation, duration of smoking abstinence, and head and neck squamous cell carcinoma prognosis. Cancer 2023; 129:867-877. [PMID: 36653915 DOI: 10.1002/cncr.34620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Tobacco use is a major risk factor for developing head and neck squamous cell carcinoma (HNSCC). However, the prognostic associations with smoking cessation are limited. The authors assessed whether smoking cessation and increased duration of abstinence were associated with improved overall (OS) and HNSCC-specific survival. METHODS Clinicodemographic and smoking data from patients with HNSCC at Princess Margaret Cancer Center (2006-2019) were prospectively collected. Multivariable Cox and Fine and Gray competing-risk models were used to assess the impact of smoking cessation and duration of abstinence on overall mortality and HNSCC-specific/noncancer mortality, respectively. RESULTS Among 2482 patients who had HNSCC, former smokers (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.58-0.87; p = .001; N = 841) had a reduced risk of overall mortality compared with current smokers (N = 931). Compared with current smokers, former smokers who quit >10 years before diagnosis (long-term abstinence; n = 615) had the most improved OS (aHR, 0.72; 95% CI, 0.56-0.93; p = .001). The 5-year actuarial rates of HNSCC-specific and noncancer deaths were 16.8% and 9.4%, respectively. Former smokers (aHR, 0.71; 95% CI, 0.54-0.95; p = .019) had reduced HNSCC-specific mortality compared with current smokers, but there was no difference in noncancer mortality. Abstinence for >10 years was associated with decreased HNSCC-specific death compared with current smoking (aHR, 0.64; 95% CI, 0.46-0.91; p = .012). Smoking cessation with a longer duration of quitting was significantly associated with reduced overall and HNSCC-specific mortality in patients who received primary radiation. CONCLUSIONS Smoking cessation before the time of diagnosis reduced overall mortality and cancer-specific mortality among patients with HNSCC, but no difference was observed in noncancer mortality. Long-term abstinence (>10 pack-years) had a significant OS and HNSCC-specific survival benefit.
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Affiliation(s)
- John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Kunaratnam
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Christina J H Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martha Pienkowski
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Head and Neck Surgery, University College London Hospitals, London, UK
| | - Andrew C L Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel C Davies
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Catherine M Brown
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - John R De Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - John N Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Rayjean J Hung
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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2
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The clinical impact of continued smoking in patients with breast and other hormone-dependent cancer: A systematic literature review. Crit Rev Oncol Hematol 2023; 184:103951. [PMID: 36805551 DOI: 10.1016/j.critrevonc.2023.103951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
We conducted a systematic review of studies that investigated whether quitting smoking at or around diagnosis improves survival of patients with hormone-dependent cancers (HDC). Nine studies published in 2013-2022 were included. Studies were very diverse in terms of design, definition of quitters and continued smokers, and prevalence of prognostic factors other than smoking cessation (e.g. patients' demographics, tumour characteristic, and treatments). For breast, ovarian, and endometrial cancer, all included studies found that quitters had better overall, disease specific, and disease-free survival than continued smokers. For prostate cancer, there was no evidence of an association of smoking cessation with improved survival. This literature review provided suggestive evidence that female smokers diagnosed with cancer of the breast, ovary, or endometrium may improve their chances of surviving by stopping smoking. Smoking cessation counselling should become part of standard oncological care for these patients and integrated into breast cancer screening programs.
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3
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Caini S, Del Riccio M, Vettori V, D'Ecclesiis O, Bonomo P, Locatello LG, Salvestrini V, Gallo O, Tagliabue M, Raimondi S, Saieva C, Cozzolino F, Bendinelli B, Gandini S. Post-diagnosis smoking cessation and survival of patients with head and neck cancer: a systematic review and meta-analysis. Br J Cancer 2022; 127:1907-1915. [PMID: 35999273 PMCID: PMC9681856 DOI: 10.1038/s41416-022-01945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Cigarette smoking is the main risk factor for head and neck cancer (HNC) and many HNC patients are active smokers at diagnosis. We conducted a systematic literature review and meta-analysis to quantify the survival impact of smoking cessation at or around the time of HNC diagnosis. We searched studies published until December 31, 2021, and used random-effects meta-analysis to pool study-specific estimates into summary hazard ratio (SHR) and corresponding 95% confidence intervals (CI). Sixteen studies were published between 1983 and 2021, and over 2300 HNC patients were included. Studies were diverse in terms of design, patients, tumours and treatment characteristics, and criteria used to discriminate quitters from continued smokers. HNC patients who quit smoking at or around diagnosis had significantly better overall survival than continued smokers (SHR 0.80, 95% CI 0.70-0.91, n studies = 10). A beneficial effect of post-diagnosis smoking cessation was suggested for other survival endpoints as well, but the results were based on fewer studies (n = 5) and affected by publication bias. Cessation counselling should be offered to all smokers who start a diagnostic workup for HNC and should be considered standard multidisciplinary oncological care for HNC patients. PROSPERO registration number CRD42021245560.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Virginia Vettori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Careggi University Hospital, Florence, Italy
| | | | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Tagliabue
- Department of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Flavia Cozzolino
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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4
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Campbell G, Glazer TA, Kimple RJ, Bruce JY. Advances in Organ Preservation for Laryngeal Cancer. Curr Treat Options Oncol 2022; 23:594-608. [PMID: 35303749 PMCID: PMC9405127 DOI: 10.1007/s11864-022-00945-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT At the University of Wisconsin, all treatment of head and neck cancer patients begins with discussion at our multi-disciplinary tumor board. Most patients with T4 disease, with existing laryngeal dysfunction, considered unlikely to complete definitive CRT or who have a high risk of persistent aspiration after non-operative management undergo total laryngectomy. A laryngeal sparing approach is attempted on most other patients. Radiotherapy is delivered over 6.5 weeks, preferably with concurrent weekly cisplatin. If the patient is hesitant of chemotherapy or has contraindications to cisplatin, concurrent cetuximab may be offered. Patients treated with RT alone are often treated to the same dose, but via an accelerated schedule by adding a 6th fraction per week. The 6th fraction is given by delivering two treatments at least 6 h apart on a weekday of the patient's choosing. We consider the following to be major risk factors for clinically significant weight loss during treatment: a 10% or greater loss of weight in the 6 months prior to starting treatment, delivery of concurrent cisplatin, and treatment of the bilateral neck with radiation. Patients who have 2-3 of these characteristics are often given gastrostomy tubes prophylactically. Patients are seen 2 weeks after completion of therapy, and then every 3 months after completion for 2 years. A CT neck and PET-CT are performed at the first 3-month visit. They are seen twice in year three, and then yearly until years 5-7. At each of these visits, we have a low threshold to present the patient at our multidisciplinary tumor board for consideration of salvage laryngectomy if there are signs of progression.
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Affiliation(s)
- Graham Campbell
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tiffany A Glazer
- Department of Surgery - Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Justine Yang Bruce
- Department of Medicine - Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA. .,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, USA.
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5
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Fazel A, Quabius ES, Fabian A, Gonzales Donate M, Schleicher T, Kress K, Laudien M, Huber K, Hoffmann M. [The impact of smoking habit alteration on prognosis of head and neck cancer patients]. Laryngorhinootologie 2021; 100:634-643. [PMID: 34139775 DOI: 10.1055/a-1509-8851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The influence of smoking on survival in patients with HNSCC is well documented in the literature. There is little data on changes in smoking habits after diagnosis. Here, the effect on survival of the reduction of smoking compared to full smoking cessation is investigated. PATIENTS AND METHODS Patient records and tumor documentation of 643 consecutive HNSCC cases of the Head and Neck Tumor Center of the University Hospital Kiel are evaluated retrospectively: smoking habits before and after treatment and survival are evaluated. RESULTS Change in smoking behavior at the initial diagnosis of HNSCC leads to a significant positive effect on the prognosis compared to continued smoking. There is no difference between smoke reduction and weaning. This effect is based solely on those patients who are treated exclusively by surgery. Lifelong non-smokers have a significant survival advantage over active and ex-smokers, with no difference between the latter two groups. CONCLUSIONS The positive influence of changed smoking habits on the prognosis runs parallel to the negative direct effect of active smoking on therapy, which is attributed to peritumoral hypoxia with a negative effect on the effectiveness of R(C)T. The positive effect of the change in smoking behaviour during surgery alone is most likely due to reduced peri-operative complications. Patients should be encouraged to at least minimize smoking with the cancer diagnosis. In addition, former smokers should be considered active smokers for survival estimates and therapy planning.
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Affiliation(s)
- Asita Fazel
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Alexander Fabian
- Klinik für Strahlentherapie, Christian-Albrechts-Universität zu Kiel, Germany
| | - Mireia Gonzales Donate
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Thilo Schleicher
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Konstantin Kress
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Martin Laudien
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karen Huber
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Markus Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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6
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Karri J, Lachman L, Hanania A, Marathe A, Singh M, Zacharias N, Orhurhu V, Gulati A, Abd-Elsayed A. Radiotherapy-Specific Chronic Pain Syndromes in the Cancer Population: An Evidence-Based Narrative Review. Adv Ther 2021; 38:1425-1446. [PMID: 33570737 DOI: 10.1007/s12325-021-01640-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/27/2021] [Indexed: 12/25/2022]
Abstract
While radiation therapy is increasingly utilized in the treatment paradigm of many solid cancers, the chronic effects of radiation therapies are poorly characterized. Notably, understanding radiation-specific chronic pain syndromes is paramount given that the diagnosis and management of these conditions can serve to prevent long-standing functional impairments, optimize quality of life, and even allow for continued radiotherapy candidacy. These radiation-specific chronic pain phenomena include dermatitis, mucositis, enteritis, connective tissue fibrosis, lymphedema, and neuropathic pain syndromes. It is necessary to maintain a low threshold of suspicion for appropriately diagnosing these conditions as there exists a variance in when these symptoms arise after radiation. However, we present key epidemiological data delineating vulnerable cancer populations for each pain syndrome along with the available evidence for the management for each specific condition.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Laura Lachman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alex Hanania
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Anuj Marathe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Mani Singh
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Nicholas Zacharias
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Vwaire Orhurhu
- Division of Pain Medicine, Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
| | - Amitabh Gulati
- Division of Pain Medicine, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alaa Abd-Elsayed
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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7
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Knitschke M, Sonnabend S, Bäcker C, Schmermund D, Böttger S, Howaldt HP, Attia S. Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years. Cancers (Basel) 2021; 13:cancers13040865. [PMID: 33670721 PMCID: PMC7922890 DOI: 10.3390/cancers13040865] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022] Open
Abstract
Fibula free flap (FFF) is widely used in head and neck reconstructive surgery and is considered as a standard and therapy of choice after ablative cancer surgery. The aim of this retrospective monocenter study was to determine the success rates of fibula free flaps for jaw reconstruction after ablative tumor surgery. The disease course of patients who underwent jaw reconstructive surgery with FFF from January 2002 to June 2020 was evaluated regarding the flap success rate. Flap failure was analyzed in detail and categorized into two groups: partial flap failure (PFF) and total flap failure (TFF). A total of 180 free fibular flaps were performed over the last 19 years and a total of 36 flap failures were recorded. TFF occurred in n = 20 (56.6%) and PFF in n = 16 cases (44.4%) cases. No statistically significant differences were found concerning patients' age at flap transfer, sex, BMI, ASA-Score, preoperative non-virtual or virtual surgical planning (non-VSP vs. VSP), and time of reconstruction (immediately vs. delayed). Duration of hospitalization shows statistically significant differences between both groups (p = 0.038), but no differences concerning operating time and duration on Intensive Care Unit (ICU). Partial flap failure appears to be underreported in literature. Sub- and complete failure of the skin paddle leads to clinical complaints like uncovered bone segments and plate exposure. Partial or complete FFF failure lead to infections on the recipient site and prolonged wound healing and therefore may cause a delay of the beginning of adjuvant radiation therapy (RT). PFF of hard tissue can be induced by RT.
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8
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Fazel A, Quabius ES, Gonzales-Donate M, Laudien M, Herzog A, Kress K, Schleicher T, Fabian A, Huber K, Hoffmann M. Alteration of smoking habit at time of first diagnosis influences survival of patients with HNSCC. Mol Clin Oncol 2020; 13:50. [PMID: 32874580 PMCID: PMC7453390 DOI: 10.3892/mco.2020.2120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
The impact of smoking on survival in patients with squamous cell carcinoma of the head and neck is well established, despite some conflicting data in the literature. However, data on alterations of smoking habit following cancer diagnosis is sparse. In the present study, the effect of reduction of smoking compared with cessation on the course of disease was studied. Data from 643 patients with HNSCC from the tumor documentation registry of the Department of Otorhinolaryngology, Head and Neck Surgery of the Christian-Albrechts-University Kiel were collected and statistically analyzed, looking at pre- and post-treatment smoking habit and survival. Alteration of smoking at the first diagnosis of HNSCC led to a significantly beneficial effect on survival outcomes compared with continued smoking, without significant differences between reduction and cessation of smoking. Detailed analysis revealed that this effect was solely dependent on patients treated by surgery only. Lifelong non-smokers exhibited a significant survival advantage compared with active and former smokers, with no difference in survival between these last two groups. The positive influence of altered smoking habit following first time diagnosis on disease-specific survival paralleled the negative direct effect of active smoking on therapy, which is predominantly attributed to peritumoral tissue hypoxia leading to impaired efficacy of radiochemotherapy (RCT). In the present study cohort, the positive effect of smoking habit alterations were primarily observed in patients treated by surgery only instead of RCT, possibly due to fewer perioperative complications. These findings indicated that patients should be encouraged to at least minimize smoking following cancer diagnosis. Furthermore, for survival estimates and therapy planning, former smokers should be considered as active smokers.
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Affiliation(s)
- Asita Fazel
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Elgar Susanne Quabius
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany.,Institute of Immunology, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Mireia Gonzales-Donate
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Martin Laudien
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Arved Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Konstantin Kress
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Thilo Schleicher
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Alexander Fabian
- Department of Radiooncology, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Karen Huber
- Department of Radiooncology, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
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9
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Zhang B, Du W, Gan K, Fang Q, Zhang X. Significance of the neutrophil-to-lymphocyte ratio in young patients with oral squamous cell carcinoma. Cancer Manag Res 2019; 11:7597-7603. [PMID: 31496814 PMCID: PMC6691951 DOI: 10.2147/cmar.s211847] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
Background The main goal of this study was to evaluate the prognosis of young patients with oral squamous cell carcinoma (SCC) with a focus on the value of the pretreatment neutrophil-to-lymphocyte ratio (NLR). Materials and methods Young (≤40 years old) patients with oral SCC were retrospectively enrolled, and each young patient was matched with an old (≥60 years old) oral SCC patient. Associations between the NLR and clinicopathological variables were analyzed by the chi-square test, and the Kaplan–Meier method was used to analyze recurrence-free survival (RFS) and disease-specific survival (DSS) rates. Results A total of 103 young patients were enrolled, and compared to the old group, the young group had a significantly lower NLR value (p=0.012). In the young group, the 5-year RFS and DSS rates were 82% and 85%, respectively. In the old group, the 5-year RFS and DSS rates were 65% and 71%, respectively, and the differences between the groups were significant (both p<0.05). In the young patients with an NLR≤2.56, the 5-year DSS rate was 93%, while in the young patients with an NLR >2.56, the 5-year DSS rate was 76%. This difference was significant (p=0.020). A further Cox model analysis confirmed that the NLR was an independent prognostic factor for DSS. Conclusion Young patients with oral SCC have a better prognosis than old oral SCC patients, and the NLR is significantly associated with DSS in young patients.
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Affiliation(s)
- Baixia Zhang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Wei Du
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Kang Gan
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Xu Zhang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
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10
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Lazarev S, Gupta V, Ghiassi-Nejad Z, Miles B, Scarborough B, Misiukiewicz KJ, Reckson B, Sheu RD, Bakst RL. Premature discontinuation of curative radiation therapy: Insights from head and neck irradiation. Adv Radiat Oncol 2017; 3:62-69. [PMID: 29556582 PMCID: PMC5856974 DOI: 10.1016/j.adro.2017.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/19/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose Factors related to premature discontinuation of curative radiation therapy (PDCRT) are understudied. This study aimed to examine causes and clinical outcomes of PDCRT at our institution by investigating the most common anatomical site associated with PDCRT. Methods and materials Among the 161 patients with PDCRT of various anatomic sites at our institution between 2010 and 2017, 36% received radiation to the head and neck region. Pertinent demographic, clinical, and treatment-related data on these 58 patients were collected. Survival was examined using the life-table method and log-rank test. Results The majority of patients were male (81%), white (67%), ≥60 years old (59%), living ≥10 miles away from the hospital (60%), single (57%), with Eastern Cooperative Oncology Group score ≥1 (86%), experiencing significant pain issues (67%), and had treatment interruptions in radiation therapy (RT; 66%). The most common reasons for PDCRT were discontinuation against medical advice (33%), medical comorbidity (24%), and RT toxicity (17%). Of the comorbidities leading to PDCRT, 50% was acute cardiopulmonary issues and 43% was infection. The mean follow-up time was 15.9 months, and the 2-year overall survival and disease-specific survival rates were 61% and 78%, respectively. Patients with illicit substance abuse, cardiovascular disease, and Eastern Cooperative Oncology Group score ≥2 had worse survival. A trend toward improved survival with total completed dose ≥50 Gy versus <50 Gy existed (74% versus 44%, respectively; P = .07). Conclusions In this largest-to-date, modern analysis of PDCRT, the most common cause of discontinuation was discontinuation against medical advice, which underscores the importance of patient education, optimization of RT symptoms, involvement of social work, and integration of other supportive services early in treatment. Survival remains suboptimal after PDCRT for H&N tumors, with a 2-year overall survival rate of 61%. Completing >50 Gy appears to confer a relative therapeutic benefit.
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Affiliation(s)
- Stanislav Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahra Ghiassi-Nejad
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bethann Scarborough
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Krzysztof J Misiukiewicz
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Batya Reckson
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
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11
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Loeffelbein D, Ritschl L, Güll F, Roth M, Wolff KD, Mücke T. Influence of possible predictor variables on the outcome of primary oral squamous cell carcinoma: a retrospective study of 392 consecutive cases at a single centre. Int J Oral Maxillofac Surg 2017; 46:413-421. [DOI: 10.1016/j.ijom.2016.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/11/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022]
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12
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Choi SH, Terrell JE, Bradford CR, Ghanem T, Spector ME, Wolf GT, Lipkus IM, Duffy SA. Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients? Nicotine Tob Res 2016; 18:2216-2224. [PMID: 27613928 DOI: 10.1093/ntr/ntw189] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Abstract
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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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Michigan State University, East Lansing, MI
| | | | | | | | | | | | | | - Sonia A Duffy
- College of Nursing, Ohio State University, Columbus, OH; .,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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13
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Systématiser l’accompagnement à l’arrêt du tabac dans la prise en charge du patient atteint de cancer. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2618-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gaillot-de-Saintignon J, Deutsch A. [Systematizing support in cessation smoking to improve care for cancer patients]. Bull Cancer 2016; 103:584-93. [PMID: 27233368 DOI: 10.1016/j.bulcan.2016.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 01/18/2023]
Abstract
Approximately 20% of cancer patients smoke at diagnosis (all localizations included), and over two thirds continue despite the therapeutic management of their cancer, especially when cancer is not associated with tobacco. The impact of smoking on quality of care for patients is actually not enough considered. A literature review conducted by the French National Cancer Institute emphasizes the importance of tobacco cessation to improve the prognosis (decreased mortality from all causes and specific); to reduce the risk of second primary cancers; to reduce per- and post-surgical risks as long as some toxicities related to treatments and to improve the quality of physical and mental life of patients. It is important that a communication with the patient takes place at the beginning of the treatment to impact the smoking behavior. All oncology health professionals should deliver a clearly and personalized cessation advice in the light of scientific data and ensure that smoking cessation help will be offered to the patient.
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Affiliation(s)
- Julie Gaillot-de-Saintignon
- Institut national du cancer, département prévention, 52, avenue André-Morizet, 92513 Boulogne-Billancourt cedex, France.
| | - Antoine Deutsch
- Institut national du cancer, département prévention, 52, avenue André-Morizet, 92513 Boulogne-Billancourt cedex, France
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Abstract
This article discusses risk factors, incidence trends, and prognostic considerations for head and neck cancer (HNC). The primary causes of HNC are tobacco and alcohol use, and human papillomavirus (HPV). Tobacco-related HNC incidence rates are decreasing in countries where tobacco use has declined. HPV-HNC, which occurs primarily in the oropharynx and is associated with sexual behaviors, has been increasing over the past several decades, among white men in particular. The prognosis for HNC overall has improved slightly since the 1990s, and is influenced by site, stage, and HPV status. Prognosis for HPV-HNC is significantly better than for HPV-negative disease.
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Affiliation(s)
- Eleni M Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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16
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Shaw SM, Flowers H, O'Sullivan B, Hope A, Liu LWC, Martino R. The effect of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement on swallowing and swallow-related outcomes in patients undergoing radiotherapy for head and neck cancer: a systematic review. Dysphagia 2015; 30:152-75. [PMID: 25737196 DOI: 10.1007/s00455-014-9592-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Abstract
Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.
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Affiliation(s)
- Stephanie M Shaw
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada,
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Chen C, Shen LJ, Li BF, Gao J, Xia YF. Smoking is a poor prognostic factor for male nasopharyngeal carcinoma treated with radiotherapy. Radiother Oncol 2013; 110:409-15. [PMID: 24021341 DOI: 10.1016/j.radonc.2013.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 05/14/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effect of smoking on prognosis of male nasopharyngeal carcinoma by comparing the treatment outcomes between smokers and non-smokers. MATERIALS AND METHODS A total of 2450 nasopharyngeal carcinoma patients were enrolled, including 1865 male patients. Matching was performed between smokers and non-smokers in male patients according to age, UICC clinical stage, T stage, N stage and treatment. Survival outcomes were compared using Kaplan-Meier analysis and Cox regression. Smoking index was calculated by multiplying cigarette packs per day and smoked time (year). RESULTS In male patients, smokers had significantly lower 5-year overall survival (70.1% vs. 77.5%, P<0.001) and locoregional recurrent free survival (76.8% vs.82.4%, P = 0.002) compared with non-smokers. Matched-pair analysis showed that smokers kept a high risk of death compared with non-smokers (HR = 2.316, P<0.001). High degree of smoking index (>15 pack-years) had a poor effect on overall survival (HR = 1.225, P = 0.016). When smoking index was more than 45 and 60 pack-years, the risk for death increased to 1.498 and 1.899 fold compared with non-smokers (P = 0.040, 0.001), respectively. CONCLUSIONS Smoking was a poor prognostic factor for male nasopharyngeal carcinoma. The heavier the patients smoked, the poorer prognosis they suffered.
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Affiliation(s)
- Chen Chen
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; Zhongshan School of Medcine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lu-Jun Shen
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; Zhongshan School of Medcine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Bo-Fei Li
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; Zhongshan School of Medcine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jin Gao
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in Southern China, Cancer Center, , Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yun-Fei Xia
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in Southern China, Cancer Center, , Sun Yat-Sen University, Guangzhou, People's Republic of China.
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O'Sullivan B, Huang SH, Siu LL, Waldron J, Zhao H, Perez-Ordonez B, Weinreb I, Kim J, Ringash J, Bayley A, Dawson LA, Hope A, Cho J, Irish J, Gilbert R, Gullane P, Hui A, Liu FF, Chen E, Xu W. Deintensification candidate subgroups in human papillomavirus-related oropharyngeal cancer according to minimal risk of distant metastasis. J Clin Oncol 2013; 31:543-50. [PMID: 23295795 DOI: 10.1200/jco.2012.44.0164] [Citation(s) in RCA: 464] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To define human papillomavirus (HPV) -positive oropharyngeal cancers (OPC) suitable for treatment deintensification according to low risk of distant metastasis (DM). PATIENTS AND METHODS OPC treated with radiotherapy (RT) or chemoradiotherapy (CRT) from 2001 to 2009 were included. Outcomes were compared for HPV-positive versus HPV-negative patients. Univariate and multivariate analyses identified outcome predictors. Recursive partitioning analysis (RPA) stratified the DM risk. RESULTS HPV status was ascertained in 505 (56%) of 899 consecutive OPCs. Median follow-up was 3.9 years. HPV-positive patients (n = 382), compared with HPV-negative patients (n = 123), had higher local (94% v 80%, respectively, at 3 years; P < .01) and regional control (95% v 82%, respectively; P < .01) but similar distant control (DC; 90% v 86%, respectively; P = .53). Multivariate analysis identified that HPV negativity (hazard ratio [HR], 2.9; 95% CI, 2.0 to 5.0), N2b-N3 (HR, 2.9; 95% CI, 1.8 to 4.9), T4 (HR, 1.8; 95% CI, 1.2 to 2.9), and RT alone (HR, 1.8; 95% CI, 1.1 to 2.5) predicted a lower recurrence-free survival (RFS; all P < .01). Smoking pack-years > 10 reduced overall survival (HR, 1.72; 95% CI, 1.1 to 2.7; P = .03) but did not impact RFS (HR, 1.1; 95% CI, 0.7 to 1.9; P = .65). RPA segregated HPV-positive patients into low (T1-3N0-2c; DC, 93%) and high DM risk (N3 or T4; DC, 76%) groups and HPV-negative patients into different low (T1-2N0-2c; DC, 93%) and high DM risk (T3-4N3; DC, 72%) groups. The DC rates for HPV-positive, low-risk N0-2a or less than 10 pack-year N2b patients were similar for RT alone and CRT, but the rate was lower in the N2c subset managed by RT alone (73% v 92% for CRT; P = .02). CONCLUSION HPV-positive T1-3N0-2c patients have a low DM risk, but N2c patients from this group have a reduced DC when treated with RT alone and seem less suited for deintensification strategies that omit chemotherapy.
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Affiliation(s)
- Brian O'Sullivan
- Room 5-624, Princess Margaret Hospital, 610 University Ave, Toronto, Ontario, Canada M5G 2M9.
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Hoff CM. Importance of hemoglobin concentration and its modification for the outcome of head and neck cancer patients treated with radiotherapy. Acta Oncol 2012; 51:419-32. [PMID: 22313317 DOI: 10.3109/0284186x.2011.653438] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hypoxia induced radioresistance has been acknowledged for decades. One of the indirect evidences of the influence of hypoxia on radiation response comes from the observations of a correlation between tumor control and hemoglobin level. This review examines the clinical data on the prognostic and predictive role of hemoglobin level and hemoglobin manipulation in radiotherapy of squamous cell carcinomas of the head and neck, a tumor type where hypoxic radioresistance have been previously documented. THE INFLUENCE OF HEMOGLOBIN CONCENTRATION ON TUMOR OXYGENATION AND OUTCOME The aim is to evaluate the existing literature for information of the influence of hemoglobin concentration and hemoglobin modifications on tumor oxygenation and outcome in head and neck squamous cell cancer patients. The data from several randomized trials show that while most studies have confirmed the prognostic value of hemoglobin, increasing the hemoglobin level through transfusion or erythropoietin stimulation did not result in improved outcome for patients with low initial hemoglobin levels. Clinical studies showed that smoking reduced the oxygen carrying capacity of the blood through formation of carboxyhemoglobin, and lead to poorer response to radiotherapy in smokers compared to non-smokers. Smoking also increased the risk of the development of secondary cancers. CONCLUSION AND FUTURE PERSPECTIVES In conclusion, low hemoglobin is a significant negative prognostic factor for radiotherapy of head and neck cancer. Correction of pre-treatment low hemoglobin by blood transfusion and/or erythropoietin stimulating agents does, however, not improve the outcome. Smoking leads to a decrease in effective hemoglobin and poorer treatment outcome. Smoking should be avoided in order to improve the therapeutic efficacy of radiotherapy and development of other smoking-related diseases and/or secondary cancers.
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Affiliation(s)
- Camilla Molich Hoff
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
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Hoff CM, Grau C, Overgaard J. Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma--a prospective study. Radiother Oncol 2012; 103:38-44. [PMID: 22385797 DOI: 10.1016/j.radonc.2012.01.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/25/2012] [Accepted: 01/25/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Head and neck cancer patients with high hemoglobin respond better to irradiation compared to patients with low hemoglobin possibly due to hypoxia induced radioresistance. The hemoglobin level is, however, a crude indicator of the amount of oxygen available to the tissue and may be influenced by a number of factors, smoking being of potential importance. The aim of the present study was to examine the effect of smoking on available oxygen to tumors and the effect on outcome in head and neck cancer patients treated with radiotherapy in a prospective study. MATERIALS AND METHODS A total of 232 consecutive patients with squamous cell carcinoma of the larynx, pharynx and oral cavity completed questionnaires on smoking habits prior to treatment. Venous blood samples were collected before and/or during treatment to determine the hemoglobin and carboxyhemoglobin level. Patients were treated with primary curative radiotherapy 62-68 Gy, 2 Gy/fx, 5 fx/week. RESULTS All but 12 patients had a history of smoking, 35 were long term quitters, 23 recent quitters, 54 moderate smokers and 108 heavy smokers (>1 pack/day). There was no relationship between total hemoglobin and carboxyhemoglobin, but effective hemoglobin and carboxyhemoglobin were linearly correlated. The amount of carboxyhemoglobin increased with increasing smoking status. Actuarial 5-year univariate analysis showed that heavy smokers had a significantly reduced probability of loco-regional control (44% vs. 65%, p = 0.001), disease-specific (56% vs. 77%, p = 0.003) and overall survival (39% vs. 66%, p = 0.0004) compared to non-smoking patients. Multivariate analyses showed that patients characterized as non-smokers, with low T and N classifications and high hemoglobin level had the best outcome measurements. A rise in carboxyhemoglobin significantly decreased the probability of loco-regional control and each additional pack year increased the risk of death. Smokers and former smokers develop secondary cancers. CONCLUSION The study showed a significant negative impact of smoking during radiotherapy for head and neck cancer and the risk of death was increased with each additional pack year of smoking. The effect on loco-regional control could be explained by a rise in carboxyhemoglobin level in smokers, e.g. a reduced oxygen supply to tumors. The data strongly advocate that smoking should be avoided in order to improve the therapeutic efficacy of radiotherapy and development of other smoking-related diseases and/or secondary cancers.
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Affiliation(s)
- Camilla Molich Hoff
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
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