Head and Neck Cancer

SS 31 - H&N 3 - Strategies to Improve Outcomes and Minimize Toxicity in Oropharyngeal Cancer

228 - Smoking Cessation Had Good Impact on Clinical Outcomes in Patients With Head and Neck Squamous Cell Carcinoma Receiving Curative Chemoradiotherapy

Tuesday, October 23
5:35 PM - 5:45 PM
Location: Room 214 A/B

Smoking Cessation Had Good Impact on Clinical Outcomes in Patients With Head and Neck Squamous Cell Carcinoma Receiving Curative Chemoradiotherapy
J. L. Y. Chen1, C. W. Shen2, C. C. Wang1, Y. S. Huang1, J. P. Chen2, S. H. Kuo3, and C. W. Wang1; 1National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 2National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, 3Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan

Purpose/Objective(s): Smoking during curative chemoradiation (CRT) caused rising carboxyhemoglobin concentrations and reduced oxygen supply to radiation therapy sites. Few studies have prospectively examined the effect of smoking cessation on clinical outcomes of radiation therapy. We hypothesized that patients with head and neck squamous cell carcinoma (HNSCC) who achieved smoking cessation during curative CRT would have lesser complications and lower risks of tumor recurrence.

Materials/Methods: Patients with non-metastatic HNSCC who were smokers at the time of diagnosis (confirmed by carbon monoxide breath test concentrations of ≥ 3 ppm) undergoing curative CRT were prospectively enrolled. Patients were treated with primary curative radiation therapy to a total dose 60-70 Gy in 30-35 fractions. Patients were referred to smoking cessation program before CRT. Successful smoking cessation throughout CRT was confirmed by CO breath test concentrations of < 3 ppm at the end of CRT. Associations between smoking and grade ≥ 3 acute or late toxicities, or permanent tracheostomy were evaluated by Pearson's chi-squared test. Associations between smoking and clinical survivals were evaluated by Kaplan–Meier log-rank tests and Cox proportional hazards regression model.

Results: Sixty-three HNSCC patients (stage IV disease, 68%) were prospectively included. The primary sites were oropharynx (41%), oral cavity (25%), hypopharynx (21%), larynx (6%), and others (7%). Forty-one patients (65%) reached successful smoking cessation throughout CRT. Patients who achieved successful smoking cessation during CRT had a significantly lesser probability of grade ≥ 3 acute toxicities (22% vs. 55%, p = 0.009), compared to patients who continued smoking throughout CRT. With a median follow-up of 33 months, patients who reached successful smoking cessation throughout CRT had a significantly greater probability of recurrence-free survival (3-year RFS 61% vs. 34%, p = 0.026), compared to patients who continued smoking during CRT. Patients who reached successful smoking cessation throughout CRT had a significantly lower rate of permanent tracheostomy (5% vs. 23%, p = 0.032), compared to patients who continued smoking during CRT. In multivariate analysis, despite age, histological grade, primary site, or radiation therapy total dose, initial T4 stage remained significantly poor prognostic factor for tumor recurrence (hazard ratio: 2.7, 95% confidence interval: 1.3-5.6, p = 0.008), while smoking cessation during CRT significantly reduced the risk of tumor recurrence (hazard ratio: 0.4, 95% confidence interval: 0.2-0.9, p = 0.026).

Conclusion: The study showed that smoking cessation during curative CRT reduced treatment-related toxicities and risks of tumor recurrence for HNSCC patients. Efforts should be made to reach smoking cessation during curative CRT, in order to improve the therapeutic efficacy of curative CRT.

Author Disclosure: J. Chen: None. Y. Huang: None. S. Kuo: None.

Jenny Ling-Yu Chen, MD, PhD

Disclosure:
No relationships to disclose.

Biography:
Dr Jenny Ling-Yu Chen completed residency of radiation oncology in National Taiwan University Hospital and became staff radiation oncologist since 2013. Her major clinical expertises are radiotherpy in lung cancer, radiotherpy in gyenecology cancer, radiotherpy in head and ceck cancer, radiobiology, radiosensitization, and onco-immunology. She has been involved in several multidisciplinary projects using novel radiation therapy to treat patients with cancers.

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