title: Continued cigarette smoking by patients receiving concurrent chemoradiotherapy for limited-stage small-cell lung cancer is associated with decreased survival.
abstract: OBJECTIVE
  To determine the impact of continued smoking by patients receiving chemotherapy (CHT) and radiotherapy (RT) for limited-stage small-cell lung cancer (LSCLC) on toxicity and survival.
  
  
  METHODS
  A retrospective review was carried out on 215 patients with LSCLC treated between 1989 and 1999. Treatment consisted of six cycles of alternating cyclophosphamide, doxorubicin, vincristine and etoposide, cisplatin (EP). Thoracic RT was concurrent with EP (cycle 2 or 3) only. Patients were known smokers, with their smoking status recorded at the start of chemoradiotherapy (CHT/RT). RT interruption during concurrent CHT/RT was used as the marker for treatment toxicity.
  
  
  RESULTS
  Of 215 patients, smoking status was recorded for 186 patients (86.5%), with 79 (42%) continuing to smoke and 107 (58%) abstaining during CHT/RT. RT interruptions were recorded in 38 patients (20.5%), with a median duration of 5 days (range, 1 to 18 days). Median survival for former smokers was greater than for continuing smokers (18 v 13.6 months), with 5-year actuarial overall survival of 8.9% versus 4%, respectively (log-rank P =.0017). Proportion of noncancer deaths was comparable between the two cohorts. Continuing smokers did not have a greater incidence of toxicity-related treatment breaks (P =.49), but those who continued to smoke and also experienced a treatment break had the poorest overall survival (median, 13.4 months; log-rank P =.0014).
  
  
  CONCLUSIONS
  LSCLC patients who continue to smoke during CHT/RT have poorer survival rates than those who do not. Smoking did not have an impact on the rate of treatment interruptions attributed to toxicity.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St, ASBI, L2, Boston, MA 02115, USA. gvidetic@lroc.harvard.edu
authors.forename: Gregory M M
authors.initials: GM
authors.lastname: Videtic
authors.forename: Larry W
authors.initials: LW
authors.lastname: Stitt
authors.forename: A Rashid
authors.initials: AR
authors.lastname: Dar
authors.forename: Walter I
authors.initials: WI
authors.lastname: Kocha
authors.forename: Anna T
authors.initials: AT
authors.lastname: Tomiak
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.forename: Mark D
authors.initials: MD
authors.lastname: Vincent
authors.forename: Edward W
authors.initials: EW
authors.lastname: Yu
mesh_terms: D000206:Actuarial Analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome