Effect of smoking during radiotherapy, respiratory insufficiency, and hemoglobin levels on outcome in patients irradiated for non-small-cell lung cancer.
OBJECTIVE
To investigate the effect of smoking during radiotherapy (RT), respiratory insufficiency before RT, hemoglobin levels during RT, and additional factors on overall survival, locoregional control (LRC), and metastasis-free survival in non-small-cell lung cancer patients.


METHODS
The following factors were investigated in 181 patients who underwent RT for non-small-cell lung cancer: age, gender, Karnofsky performance score, histologic type, grade, T/N stage, American Joint Committee on Cancer stage, surgery, chemotherapy, respiratory insufficiency before RT, pack-years, smoking during RT, and hemoglobin levels during RT. Additionally, in the 129 patients who did not undergo surgery, the effect of the equivalent dose in 2-Gy fractions (EQD2) (<60 Gy vs. 60 Gy vs. >60 Gy) on outcome was investigated.


RESULTS
On multivariate analysis, improved overall survival was associated with a lower T stage (p = 0.004), lower N stage (p = 0.040), surgery (p = 0.010), and no respiratory insufficiency (p = 0.023). A Karnofsky performance score >70 achieved borderline significance (p = 0.056). Improved LRC was associated with a lower T stage (p = 0.007) and no smoking during RT (p = 0.029). Improved metastasis-free survival was associated with lower T stage (p < 0.001) and lower N stage (p < 0.001). In those patients who did not undergo surgery, an EQD2 of > or =60 Gy was associated with a better outcome than an EQD2 of <60 Gy. Furthermore, an EQD2 >60 Gy resulted in better LRC than did an EQD2 of < or =60 Gy.


CONCLUSIONS
Smoking during RT had a significant effect on LRC, but we did not find that hemoglobin levels or respiratory insufficiency significantly affected LRC or metastasis-free survival in our patient population. Furthermore, our data suggest a dose-effect relationship in those patients who did not undergo surgery.
Rades
Dirk
D
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. Rades.Dirk@gmx.net
Setter
Cornelia
C
Schild
Steven E
SE
Dunst
Juergen
J
D000328:Adult; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000401:mortality* / Q000532:radiotherapy*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000097:blood / Q000401:mortality* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D012131:Respiratory Insufficiency / Q000097:blood* / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012907:Smoking / Q000097:blood / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D006454:Hemoglobins