Abstract
IntroductionTo investigate whether current or prior smoking history had any impact on prostate cancer outcomes and toxicity in our predominantly minority population of males receiving dose-escalated external beam radiation therapy (EBRT).MethodsOf the 500 patients treated with EBRT between 2003-2011, 444 had smoking histories recorded. Patients were classified as current smoker, former smoker, or never smoker. Biochemical failure-free survival (BFFS) and distant metastatic-free survival (DMFS) endpoints were analyzed. Multivariate Cox regression and multivariate logistic regression were used to assess whether smoking had an impact on outcomes and toxicity respectively.Results There were 176 males (39.6%) classified as never smokers, 169 (38.1%) as prior smokers, and 99 (22.3%) as current smokers. The median follow-up was 76 months (range nine-146) and 61.9% of patients were African American. The eight-year BFFS for never smokers, prior smokers and current smokers was 73.6%, 80.2%, and 73.4% respectively, p=0.38. Similarly, the eight-year DMFS was 92.8%, 96.8%, and 95.3% respectively, p=0.54. On multivariate analysis, prior smoking (HR 0.72, p=0.19) and current smoking (HR 1.02, p=0.93) were not associated with increased biochemical failure. Similarly, smoking use was not associated with increased distant metastatic disease (hormone receptor (HR) 0.71, p=0.51 for prior smokers, HR 1.41, p=0.52 for current smokers). The presence of intermediate-risk disease (HR 2.87, p=0.002) was associated with an increased likelihood of biochemical failure. The high-risk disease was associated with both a higher risk of biochemical failure (HR 8.02, p <0.001) as well as distant metastatic disease (HR 17.61, p=0.01). On multivariate regression, prior or current smoking use was not associated with an increased likelihood of late grade two genitourinary or gastrointestinal toxicity.ConclusionCurrent or prior smoking use was not associated with inferior outcomes or increased toxicity in this study comprising a predominantly minority population undergoing dose escalated radiation therapy for prostate cancer.
Highlights
To investigate whether current or prior smoking history had any impact on prostate cancer outcomes and toxicity in our predominantly minority population of males receiving doseescalated external beam radiation therapy (EBRT)
We found that current or prior smoking use during dose escalated radiotherapy for prostate cancer had no impact on outcomes or toxicity in our predominantly minority patient cohort of United States Veterans
Several prior studies have suggested that tobacco use is associated with worse outcomes and/or toxicity in males receiving radiation therapy for prostate cancer
Summary
Of the 500 patients treated with EBRT between 2003-2011, 444 had smoking histories recorded. After the approval by our institutional review board, we reviewed the charts of all patients who were diagnosed with prostate cancer and were treated at the Brooklyn Veterans Hospital with external beam radiation to a dose of 7560cGy or higher, during 2003-2011. Smoking usage was classified as current smokers, former smokers (quit before consultation or treatment started), or nonsmokers. Treatments were delivered via three-dimensional conformal radiation from 2003-2006 This typically involved a four-field box technique for the initial 4500cGy followed by a six-field oblique plan for subsequent boost fields. The radiation fields varied based on the National Cancer Care Network (NCCN) risk group but typically included treatment of the pelvic lymph nodes for high-risk disease and prostate/seminal vesicles for those with intermediate- or low-risk disease
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