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Cigarette smoking during external beam radiation therapy for prostate cancer is associated with an increased risk of prostate cancer‐specific mortality and treatment‐related toxicity
Author(s) -
Steinberger Emily,
Kollmeier Marisa,
McBride Sean,
Novak Caroline,
Pei Xin,
Zelefsky Michael J.
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12969
Subject(s) - medicine , prostate cancer , common terminology criteria for adverse events , cancer , oncology , genitourinary system , prostate , radiation therapy , hazard ratio , toxicity , confidence interval
Objective To evaluate whether a history of smoking or smoking during therapy after external beam radiotherapy ( EBRT ) for clinically localised prostate cancer is associated with increased treatment‐related toxicity or disease progression. Patients and Methods Of 2358 patients receiving EBRT for prostate cancer between 1988 and 2005, 2156 had chart‐recorded smoking histories. Patients were classified as ‘never smokers’, ‘current smokers’, ‘former smokers’, and ‘current smoking unknown’. Variables considered included quantity of tobacco use in pack‐years, duration of smoking, and, for former smokers, how long before initiation of RT the patient quit smoking, when available. The median EBRT dose was 8100 Gy and the median follow‐up was 95 months. Toxicity was graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Results Current smoking significantly increased the risks of both prostate‐specific antigen relapse [hazard ratio ( HR ) 1.4, P = 0.02] and distant metastases ( HR 2.37, P < 0.001), as well as prostate cancer‐specific death ( HR 2.25, P < 0.001). Multivariate analysis showed that smoking was also associated with increased risk of EBRT ‐related genitourinary toxicities (current smoker, HR 1.8, P = 0.02; former smoker, HR 1.45, P = 0.01). Smoking did not increase gastrointestinal toxicity. Conclusions Current smokers with prostate cancer are at increased risk of biochemical recurrence, distant metastasis, and prostate cancer‐related mortality after definitive RT to the prostate. Current and former smokers, regardless of duration and quantity of exposure, are at an increased risk of long‐term genitourinary toxicity after EBRT . Oncologists should encourage patients to participate in smoking‐cessation programmes before therapy to potentially lower their risk of relapsing disease and post‐treatment toxicities.