To determine how smoking intensity impacts the prognosis of patients with human papillomavirus (HPV)-positive oropharyngeal cancer treated by chemoradiation. The medical records of 32 patients with histologically proven squamous cell carcinoma of the oropharynx and a prior smoking history were retrospectively reviewed. All patients were treated with intensity-modulated radiotherapy to a median dose of 70Gy (range 63 to 72Gy) with concurrent cisplatin. Seventeen patients (53%) had stage II disease; and 15 patients (47%) had stage III disease. Distribution of T-classification was: T1 8 (25%); T2 4 (13%); T3 10 (31%); and T4 10 (31%). Smoking history was categorized as follows: ≤10 pack-years (10 patients); 10-20 pack-years (6 patients); 20-30 pack-years (7 patients); >30 pack-years (9 patients). With a median follow-up of 40months (range, 6 to 121months), the 3-year overall survival for the entire population was 79%. Significant differences in 3-year overall survival (83% vs 54%, p=0.01), local-regional control (86% vs 62%, p<0.001), and progression-free survival (75% vs 52%, p=0.02) were observed when comparing patients with ≤30 pack-year versus those with >30 pack-year smoking histories. The deleterious effect of smoking seemed to be most impactful in those with heavy consumption (i.e., >30 pack-year history).
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