Effect of smoking during radiotherapy, respiratory insufficiency, and hemoglobin levels on outcome in patients irradiated for non-small-cell lung cancer

Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1134-42. doi: 10.1016/j.ijrobp.2007.11.006. Epub 2008 Feb 6.


Purpose: 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 and materials: 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.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Carcinoma, Non-Small-Cell Lung / blood
  • Carcinoma, Non-Small-Cell Lung / mortality*
  • Carcinoma, Non-Small-Cell Lung / radiotherapy*
  • Comorbidity
  • Female
  • Germany / epidemiology
  • Hemoglobins / analysis*
  • Humans
  • Incidence
  • Lung Neoplasms / blood
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / radiotherapy*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods
  • Respiratory Insufficiency / blood*
  • Respiratory Insufficiency / mortality*
  • Risk Assessment / methods
  • Risk Factors
  • Smoking / blood
  • Smoking / mortality*
  • Survival Analysis
  • Survival Rate
  • Treatment Outcome


  • Hemoglobins