Influence of smoking status on treatment outcomes after post-operative radiation therapy for non-small-cell lung cancer

Radiother Oncol. 2010 Jul;96(1):89-93. doi: 10.1016/j.radonc.2010.05.008. Epub 2010 Jun 10.


Background and purpose: The role of post-operative radiotherapy in patients with resected non-small-cell lung cancer (NSCLC) is unclear. Modifiable factors, like smoking, may help guide therapy. We retrospectively evaluated the impact of smoking on control in patients undergoing post-operative radiation therapy (PORT) for NSCLC.

Materials and methods: Between 1995 and 2007, 152 patients who underwent surgery for NSCLC were analyzed (median follow-up 26 months). Non-smokers were defined as patients who never smoked or who had stopped smoking at the time of initial consultation. Sixty seven percent were non-smokers; 5% never smoked, 40% of the non-smokers had ceased smoking for a year or less, while 55% had stopped for more than a year.

Results: On univariate analysis, smokers had worse 5-year local control than non-smokers (70% versus 90%, p=0.001) and locoregional control (52% versus 77%, p=0.002). The 5-year survival rate was 21% for smokers and 31% for non-smokers (p=0.2). On multivariate analysis, smokers maintained a detrimental effect on locoregional control (HR 3.6, p=0.0006).

Conclusions: Smokers at initial consultation have poorer local and locoregional control after PORT than non-smokers. In patients being considered for PORT for NSCLC, quitting smoking before treatment confers additional treatment advantage.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Carcinoma, Non-Small-Cell Lung / mortality*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / radiotherapy*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Confidence Intervals
  • Databases, Factual
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Pneumonectomy / methods
  • Radiotherapy Dosage
  • Radiotherapy, Adjuvant
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Smoking / adverse effects*
  • Smoking / epidemiology
  • Survival Analysis
  • Treatment Outcome