Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma - A prospective study
Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma - A prospective study
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DOI：
10.1016/j.radonc.2012.01.011
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发表时间：
2012-04-01
影响因子：
5.7
通讯作者：
Overgaard, Jens
中科院分区：
文献类型：
--
作者：
Hoff, Camilla Molich;Grau, Cai;Overgaard, Jens
背景资料：与低血红蛋白患者相比，高血红蛋白的头颈癌患者对辐射的反应更好，这可能是由于缺氧诱导的辐射抗性。然而，血红蛋白水平是组织可获得的氧气量的粗略指标，并且可能受到许多因素的影响，吸烟具有潜在的重要性。本研究的目的是探讨吸烟对肿瘤的可用氧的影响和对头颈部癌症患者的治疗结果与放射治疗在前瞻性study.Materials和方法：共232例连续的喉，咽和口腔鳞状细胞癌患者完成了问卷调查，吸烟习惯治疗前。在治疗前和/或治疗期间采集静脉血样，以测定血红蛋白和碳氧血红蛋白水平。患者接受初次根治性放疗62-68戈伊，2戈伊/次，5次/周。结果：除12例患者外，所有患者均有吸烟史，其中35例为长期戒烟者，23例为近期戒烟者，54例中度吸烟者和108例重度吸烟者（>1包/天）。总血红蛋白与碳氧血红蛋白无相关性，有效血红蛋白与碳氧血红蛋白呈线性相关。碳氧血红蛋白的量随着吸烟状态的增加而增加。精算5年单变量分析显示，与非吸烟患者相比，重度吸烟者的局部区域控制（44% vs. 65%，p = 0.001）、疾病特异性（56% vs. 77%，p = 0.003）和总生存率（39% vs. 66%，p = 0.0004）的概率显著降低。多变量分析表明，患者的特点是不吸烟，与低地N分类和高血红蛋白水平有最好的结果测量。碳氧血红蛋白的增加显著降低了局部控制的可能性，每增加一包年就会增加死亡的风险。吸烟者和前吸烟者发展继发cancer.Conclusion：研究表明，在头颈部癌症放射治疗期间吸烟的显着负面影响，死亡的风险增加，每增加一包年的吸烟。对局部区域控制的影响可以通过吸烟者中碳氧血红蛋白水平的升高来解释，例如，对肿瘤的氧气供应减少。这些数据强烈主张，应避免吸烟，以提高放射治疗的疗效和其他吸烟相关疾病和/或继发性癌症的发展。(C)2012爱思唯尔爱尔兰有限公司保留所有权利。放射治疗和肿瘤学103（2012）38-44
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 lowland 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. (C) 2012 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 103 (2012) 38-44