Effect of Smoking During Radiotherapy, Respiratory Insufficiency, and Hemoglobin Levels on Outcome in Patients Irradiated for Non–Small-Cell Lung Cancer

Rades, Dirk; Setter, Cornelia; Schild, Steven E.; Dunst, Juergen

doi:10.1016/j.ijrobp.2007.11.006

Cited by 38 publications

(31 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The importance of an upfront TURBT in achieving optimal results has been previously reported (2). The prognostic impact of the number of pack years and smoking during the period of irradiation has also already been demonstrated for other tumours such as lung and headand-neck cancer (12)(13)(14)(15). The fact that the findings of the present study agree with the results of previous studies demonstrates consistency of the data obtained from the present analyses.…”

Section: Discussionsupporting

confidence: 90%

Factors Impacting the Overall Survival of Patients Irradiated for Invasive Carcinoma of the Urinary Bladder

Rades

Manig

Schild

2017

View full text Add to dashboard Cite

Abstract. Background A considerable number of patients with carcinoma of the urinary bladder are treated with an organ-preserving approach, mostly consisting of transurethral resection of the bladder tumour (TURBT) followed by irradiation with or without concurrent chemotherapy (1-3). Since many of these patients present with significant comorbidities, a personalised treatment program is often required. Such a program should ideally consider several patient-related factors, including the patient's social situation, patient treatment preference, additional diseases, general condition and remaining life-span. It has been reported for other situations of patients with carcinoma of the urinary bladder, such as metastatic or recurrent disease, that those patients with a poor survival prognosis should receive shorter-course and less aggressive treatments, since low treatment-related toxicity not impairing the patient's quality of life is very important for this group (4-7). Those patients with a much better prognosis should benefit from more aggressive longer-course treatments including systemic therapies leading to better control of the malignant disease and significant prolongation of the patient's survival time.In order to tailor the treatment regimen to the patient's individual situation, the ability to estimate their survival time is desirable. This goal could be achieved with a clear understanding of the independent predictors of survival identified specifically for patients with carcinoma of the urinary bladder. This study aimed to identify such predictors in a cohort of patients who received organ-preserving treatment including local irradiation. Patients and MethodsThis retrospective study included 61 patients treated with definitive irradiation for carcinoma of the urinary bladder cancer. Irradiation was performed as computed tomography-based conformal radiotherapy with 6-18 MV photons. The median dose was 59.4 Gy (range=50.4 to 63.0 Gy), which was delivered with conventional fractionation of 1.8 to 2.0 Gy on five consecutive days per week. In two-thirds of the patients (N=40), the total dose was 59.4 Gy given with 1.8 Gy per fraction. In 45 patients, irradiation was supplemented with simultaneous chemotherapy, which was mainly cisplatin-or carboplatin-based (N=27). The characteristics of the 61 patients are summarized in Table I. For the 61 patients, a total of 11 potential predictive factors were analysed with respect to an association with overall survival. These factors were gender, age (≤77 vs. >77 years; median age=77 years), T-stage (T1-2 vs. T>2a vs. T3-4), N-stage (N0 vs. N1/2), histological grading (G2 vs. G3), pack years smoked prior to irradiation (<40 vs. ≥40 years), smoking during irradiation (no vs. yes), transurethral resection of the bladder tumour prior to irradiation (TURBT; no vs. 741

show abstract

Section: Discussionsupporting

confidence: 90%

Factors Impacting the Overall Survival of Patients Irradiated for Invasive Carcinoma of the Urinary Bladder

Rades

Manig

Schild

2017

View full text Add to dashboard Cite

show abstract

“…These patients are a subgroup with available tissue samples and successful staining for VEGF and/or FLT1 of our preceding study of prognostic factors in NSCLC [21]. All patients were smokers at the time when the diagnosis of NSCLC was made.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Impact of VEGF and VEGF Receptor 1 (FLT1) Expression in Patients Irradiated for Stage II/III Non-Small Cell Lung Cancer (NSCLC)

et al. 2010

Self Cite

View full text Add to dashboard Cite

show abstract

“…Th is has been shown in particular for non-small cell lung cancer and headand-neck cancer [7,[22][23][24]. In a retrospective study of 181 patients with non-small cell lung cancer, loco-regional control at 2 years was better in patients who did not smoke than in patients who did smoke during radiotherapy (58% vs. 41%, p < 0.001) [7]. In another retrospective study of 151 patients with non-small cell lung cancer, patients who had stopped smoking at the time of initial consultation (prior to surgery and postoperative radiotherapy) had a signifi cantly better loco-regional control at 5 years (77% vs. 52%, p = 0.002) than patients who continued to smoke [22].…”

Section: Erythropoietin Stimulating Agents (Esas)mentioning

confidence: 97%

“…Furthermore, the results of the previously mentioned studies and meta-analyses might have been infl uenced by the patients' smoking habit, as smoking during radiotherapy has been shown to impair tumour oxygenation. Th is has been shown in particular for non-small cell lung cancer and headand-neck cancer [7,[22][23][24]. In a retrospective study of 181 patients with non-small cell lung cancer, loco-regional control at 2 years was better in patients who did not smoke than in patients who did smoke during radiotherapy (58% vs. 41%, p < 0.001) [7].…”

Section: Erythropoietin Stimulating Agents (Esas)mentioning

confidence: 97%

“…Th ese data have been confi rmed in a retrospective study of 108 oesophageal cancer patients, where haemoglobin levels during radiotherapy of 12-14 g/dl resulted in better 2-year loco-regional control than levels <12 g/dl or >14 g/dl (58% vs. 19% and 44%, p < 0.001) [6]. In another retrospective study of 181 patients with non-small cell lung cancer, haemoglobin levels during radiotherapy of <12 g/dl were associated with signifi cantly lower 2-year loco-regional control (29 vs. 41%, p = 0.004) and 2-year overall survival rates (41 vs. 58%, p = 0.013) when compared to haemoglobin levels during radiotherapy of ≥12 g/dl [7].…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Challenges of anemia correction during radiotherapy and chemoradiation

Rades

Schild

2012

memo

View full text Add to dashboard Cite

Th e eff ect of radiotherapy depends on optimal tumour oxygenation, as tumour hypoxia impairs the production of radiation-induced cytotoxic free radicals resulting in less tumour cell kill. Th e range of haemoglobin levels optimal for tumour oxygenation is 12-14 g/dl in women and 13-15 g/dl in men. It appears reasonable to elevate the haemoglobin level in anaemic cancer patients into this optimal range. Th is may be achieved with red blood cell transfusions (RBCT) or erythropoiesis stimulating agents (ESAs). However, RBCT have had negligible or even negative eff ect on patient outcome, possibly because RBCT induce immunosuppression or result in haemoglobin levels too high for optimal tumour oxygenation. Several randomized trials have demonstrated that patients irradiated for head-and-neck cancer had worse outcomes with ESAs than the control group. However, in the majority of these trials, over-treatment with ESAs resulted in haemoglobin levels above the optimal range. Tumour oxygenation is impaired by inappropriately high haemoglobin levels due to increased blood viscosity and decreased tumour cell perfusion. Th is concept is supported by the fi ndings of prospective studies in cervix cancer and esophageal cancer patients. In these studies the ESA administration was withheld at a haemoglobin level of 14 g/dl resulting in a positive eff ect of ESAs on treatment outcome. In summary, the eff ect of RBCT and particularly of ESAs during radiotherapy remains unclear. Further randomized trials are required. Until such trials are available, one should follow the ASCO and ESMO guidelines that are very conservative regarding the administration of ESAs during radiotherapy and chemoradiation.

show abstract

Effect of Smoking During Radiotherapy, Respiratory Insufficiency, and Hemoglobin Levels on Outcome in Patients Irradiated for Non–Small-Cell Lung Cancer

Cited by 38 publications

References 32 publications

Factors Impacting the Overall Survival of Patients Irradiated for Invasive Carcinoma of the Urinary Bladder

Factors Impacting the Overall Survival of Patients Irradiated for Invasive Carcinoma of the Urinary Bladder

Prognostic Impact of VEGF and VEGF Receptor 1 (FLT1) Expression in Patients Irradiated for Stage II/III Non-Small Cell Lung Cancer (NSCLC)

Challenges of anemia correction during radiotherapy and chemoradiation

Contact Info

Product

Resources

About