title: Impact of exposure to tobacco smoke, arsenic, and phthalates on locally advanced cervical cancer treatment-preliminary results.
abstract: BACKGROUND
  Cancer research is a national and international priority, with the efficiency and effectiveness of current anti-tumor therapies being one of the major challenges with which physicians are faced.
  
  
  OBJECTIVE
  To assess the impact of exposure to tobacco smoke, arsenic, and phthalates on cervical cancer treatment.
  
  
  METHODS
  We investigated 37 patients with locally advanced cervical carcinoma who underwent chemotherapy and radiotherapy. We determined cotinine and five phthalate metabolites in urine samples collected prior to cancer treatment, by gas chromatography coupled to mass spectrometry, and urinary total arsenic by atomic absorption spectrometry with hydride generation. We used linear regression to evaluate the effects of cotinine, arsenic, and phthalates on the change in tumor size after treatment, adjusted for confounding variables.
  
  
  RESULTS
  We detected no significant associations between urinary cotinine, arsenic, or phthalate monoesters on change in tumor size after treatment, adjusted for urine creatinine, age, baseline tumor size, and cotinine (for arsenic and phthalates). However, higher %mono-ethylhexyl phthalate (%MEHP), a putative indicator of phthalate diester metabolism, was associated with a larger change in tumor size (β = 0.015, 95% CI [0.003-0.03], P = 0.019).
  
  
  CONCLUSIONS
  We found no statistically significant association between the urinary levels of arsenic, cotinine, and phthalates metabolites and the response to cervical cancer treatment as measured by the change in tumor size. Still, our results suggested that phthalates metabolism may be associated with response to treatment for locally advanced cervical cancer. However, these observations are preliminary and will require confirmation in a larger, more definitive investigation.
authors.affiliation: Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institut, Cluj-Napoca, Romania.
authors.forename: Iulia A
authors.initials: IA
authors.lastname: Neamtiu
authors.affiliation: Health Department, Environmental Health Center, Cluj-Napoca, Romania; Departments of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, United States of America.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Bloom
authors.affiliation: Physico-chemical and Biotoxicological Analysis Laboratory, Environmental Health Center, Cluj-Napoca, Romania; Cluj School of Public Health - College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.
authors.forename: Irina
authors.initials: I
authors.lastname: Dumitrascu
authors.affiliation: Faculty of Environmental Science and Engineering, Babes-Bolyai University , Cluj-Napoca , Romania.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Roba
authors.affiliation: Physico-chemical and Biotoxicological Analysis Laboratory, Environmental Health Center, Cluj-Napoca, Romania; Cluj School of Public Health - College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania; Faculty of Environmental Science and Engineering, Babes-Bolyai University, Cluj-Napoca, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Pop
authors.affiliation: Radiotherapy II Department, The Oncology Institute "Prof. Dr. Ion Chiricuta" , Cluj-Napoca , Romania.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ordeanu
authors.affiliation: Functional Genomics, Proteomics and Experimental Pathology Laboratory, The Oncology Institute "Prof. Dr. Ion Chiricuta" , Cluj-Napoca , Romania.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Balacescu
authors.affiliation: Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institut, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Eugen S
authors.initials: ES
authors.lastname: Gurzau
keywords: Arsenic; Exposure; Locally advanced cervical cancer; Phthalates; Tobacco smoke; Treatment response