title: The Effects of smoking status and smoking history on patients with brain metastases from lung cancer.
abstract: There is limited data on the effects of smoking on lung cancer patients with brain metastases. This single institution retrospective study of patients with brain metastases from lung cancer who received stereotactic radiosurgery assessed whether smoking history is associated with overall survival, local control, rate of new brain metastases (brain metastasis velocity), and likelihood of neurologic death after brain metastases. Patients were stratified by adenocarcinoma versus nonadenocarcinoma histologies. Kaplan-Meier analysis was performed for survival endpoints. Competing risk analysis was performed for neurologic death analysis to account for risk of nonneurologic death. Separate linear regression and multivariate analyses were performed to estimate the brain metastasis velocity. Of 366 patients included in the analysis, the median age was 63, 54% were male and, 60% were diagnosed with adenocarcinoma. Current smoking was reported by 37% and 91% had a smoking history. Current smoking status and pack-year history of smoking had no effect on overall survival. There was a trend for an increased risk of neurologic death in nonadenocarcinoma patients who continued to smoke (14%, 35%, and 46% at 6/12/24 months) compared with patients who did not smoke (12%, 23%, and 30%, P = 0.053). Cumulative pack years smoking was associated with an increase in neurologic death for nonadenocarcinoma patients (HR = 1.01, CI: 1.00-1.02, P = 0.046). Increased pack-year history increased brain metastasis velocity in multivariate analysis for overall patients (P = 0.026). Current smokers with nonadenocarcinoma lung cancers had a trend toward greater neurologic death than nonsmokers. Cumulative pack years smoking is associated with a greater brain metastasis velocity.
authors.affiliation: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Rachel F
authors.identifier: http://orcid.org/0000-0001-6552-6255
authors.initials: RF
authors.lastname: Shenker
authors.affiliation: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Emory R
authors.initials: ER
authors.lastname: McTyre
authors.affiliation: Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Kathryn E
authors.identifier: http://orcid.org/0000-0001-9006-4064
authors.initials: KE
authors.lastname: Weaver
authors.affiliation: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Christina
authors.initials: C
authors.lastname: Cramer
authors.affiliation: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Natalie K
authors.initials: NK
authors.lastname: Alphonse-Sullivan
authors.affiliation: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Farris
authors.affiliation: Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: William J
authors.initials: WJ
authors.lastname: Petty
authors.affiliation: Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Marcelo R
authors.initials: MR
authors.lastname: Bonomi
authors.affiliation: Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Kounosuke
authors.initials: K
authors.lastname: Watabe
authors.affiliation: Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Adrian W
authors.initials: AW
authors.lastname: Laxton
authors.affiliation: Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Tatter
authors.affiliation: Department of Radiation Oncology, Medical College of South Carolina, Charleston, 29425, South Carolina.|Department of Cell and Molecular Pharmacology, MUSC, Charleston, 29425, South Carolina.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Warren
authors.affiliation: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, 27157, North Carolina.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Chan
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Brain metastases; brain metastasis velocity; lung cancer; smoking cessation; stereotactic radiosurgery