Effect of alterations in smoking habit before or during the therapy of squamous cell carcinoma of the head and neck (HNSCC)

Introduction:

A positive smoking history has negative consequences on the survival of HPV-negative and -positive HNSCC-patients. Smoking cessation leads to a decrease in smoking associated diseases. The files of HNSCC-patients were analyzed to elucidate the consequences of altering smoking behavior before or during therapy.

Methods:

Files of 643 patients (treated between 2013 and 2016 at the head and neck tumor center Kiel) were analyzed; follow-up: 0.01 – 4.4yrs; mean: 1.62yrs. age: 64.5 ± 10.2yrs. Kaplan-Meyer-analyses were stratified according to smoking habit, chance of the latter, over all- (OS) and progression free survival (PFS).

Results:

Nonsmoker show better OS when compared to active or ex-smoker (smoking cessation before diagnosis; both p < 0.001). Active and ex-smoker show no differences in OS (p> 0.05). Altering smoking habit at time of diagnosis leads to better OS when compared to active smoker, with no differences whether smoking was ceased or reduced (p> 0.05). PFS shows no differences in all groups analyzed (p> 0.05).

Conclusion:

Interestingly Ex-smoker with HNSCC show no better OS than patients with active smoking habit at time of diagnosis. The advantage of chancing smoking habit before diagnosis results in a decreased incidence of smoking associated diseases. Smoking reduction or cessation at time of diagnosis positively affects OS, this might be due to the tobacco associated peri-tumoral hypoxia during RCT, this effect can also be seen after surgical treatment only. Reduction of tobacco consumption at time of diagnosis should be advised.

Publication History

Publication Date:
23 April 2019 (online)