Radiotherapy for T1a glottic cancer: the influence of smoking cessation and fractionation schedule of radiotherapy

Abstract

The objective of the presented study is to report on retrospectively collected data on long-term outcome and toxicity and prospective assessment of quality of life (QoL) and Voice-Handicap Index (VHI) of patients with T1a glottic cancer treated with radiotherapy. Between 1985 and 2011, 549 patients were treated. Endpoints were local control (LC), toxicity, QoL and VHI. After a median follow-up of 93 months, the actuarial rates of LC were 91, and 90 % at 5- and 10-years, respectively. Continuing smoking (p < 0.001) and anaemia (p = 0.02) were significantly correlated with poor LC on univariate analysis and fractionation schedule did not show significant correlation (p = 0.08). On multivariate analysis, only continuing smoking retained significance (p = 0.001). These patients had also significantly increased incidence of second primary tumour and lower overall survival rates. The incidence of grade ≥2 late xerostomia and dysphagia were 10 and 6 %, respectively. Slight and temporary deterioration of QoL-scores was reported. The scores on the EROTC-QOL-H&N35 dysphagia and xerostomia at 24 months were -2 and -3, compared to baseline, respectively. VHI improved significantly from 34 at baseline to 21 at 24 months. Patients who continued smoking had significantly worse VHI. In conclusion, excellent outcome with good QoL and VHI were reported. Patients who continued smoking after radiotherapy had significantly poor LC and worse VHI. The current study emphasizes the importance of smoking cessation and the non-inferiority of hypofractionated schemes in terms of outcome and VHI. At our institution, phase II study is going to evaluate the role of single vocal cord irradiation with high fraction dose.

Prognostic value of continued smoking on survival and recurrence rates in patients with head and neck cancer: A systematic review

“…No articles were excluded based on language. One study was excluded because the results were described in another study . The study that included the largest study population of the 2 was included for further analysis .…”

Attributable Failure of First-line Cancer Treatment and Incremental Costs Associated With Smoking by Patients With Cancer

“…6 Smoking cessation in the general population is known to improve health outcomes and create significant reductions in health expenditures. 6 , 7 Whereas many studies found that smoking cessation after a cancer diagnosis can improve survival, 8 , 9 , 10 , 11 , 12 , 13 to our knowledge, there have been no evaluations of the association between continued smoking among patients with cancer and the costs of cancer treatment. Understanding the financial effects of smoking among patients with cancer is needed to develop value-based approaches that could lead to improved cancer treatment outcomes.…”

Impact of smoking cessation on clinical outcomes in patients with head and neck squamous cell carcinoma receiving curative chemoradiotherapy: A prospective study

“…18 Al-Mamgani et al retrospectively demonstrated that patients with early stage glottis cancer who continued smoking after radiotherapy had significantly poor local control and low voice quality; however, the acute adverse effects during radiotherapy were not addressed. 19 Peppone et al retrospectively demonstrated association between smoking and increased symptom burden, during and following the treatments for cancer. 20 Hoff et al prospectively showed that heavy smokers had significantly reduced probability of locoregional control, disease-specific survival, and OS, compared to non-smoking patients, while not addressing the acute adverse effects during radiotherapy.…”