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.