Log in Register Subscribe Claim

Advanced
Articles Publish Topics Multimedia CME About Contact Search for...  search

CLINICAL INVESTIGATION | VOLUME 84, ISSUE 1, P183-188, SEPTEMBER 01, 2012      

Purchase Subscribe Save Share Reprints Request

Active Tobacco Smoking and Distant Metastasis in

 Patients With Oropharyngeal Cancer 
Sean M. McBride, M.D. • Nawal N. Ali, B.S. • Danielle N. Margalit, M.D., M.P.H. • Annie W. Chan, M.D.  

Published: February 13, 2012 • DOI: https://doi.org/10.1016/j.ijrobp.2011.11.044 PlumX Metrics

Purpose
Keywords
Distant metastasis is the site of first relapse in approximately one-third of patients with locally advanced oropharyngeal
References carcinoma, irrespective of human papillomavirus status. Yet the risk factors associated with distant metastasis are not well
characterized. We sought to characterize the relationship between smoking status and distant metastasis.
Article info

Related Articles
Methods and Materials
We evaluated the association between tobacco smoking status and distant metastasis in a retrospective cohort study of 132
Comments
patients who underwent definitive radiation therapy and chemotherapy for Stage III–IVA/B oropharyngeal cancer.
Information on tobacco smoking was prospectively collected by patient questionnaires and physician notes at the time of
diagnosis. Thirty-three percent of the patients were nonsmokers, 51% were former smokers, 16% were active smokers. The
cumulative lifetime tobacco smoking in pack-years was 20 (range, 0–150).

Results
With a median follow-up time of 52 months, the overall rate of distant metastasis at 4 years was 8%. Distant metastasis was
the most common first site of relapse, occurring in 56% of the patients with recurrences. Active smokers had higher rates of
distant metastasis than non-active smokers (including never- and former smokers; 31% vs. 4%, p < 0.001) and former
smokers (31% vs. 3%, p < 0.001). There was no statistically significant difference in the risk of distant metastasis for
patients with lifetime cumulative pack-years >20 and ≤20 (10% vs. 4%, p = 0.19). In univariate analysis, active smoking (p =
0.0004) and N category (p = 0.009) were predictive of increased risk of distant metastasis. In multivariate analysis, active
smoking was the most significant predictive factor for increased risk of distant metastasis (hazard ratio, 12.7, p < 0.0001).

Conclusions
This study identified a strong association between active smoking and distant metastasis in patients with oropharyngeal
cancer.

Keywords
Cigarette • Distant metastasis • HPV • Human papillomavirus • Oropharyngeal carcinoma • Radiation • Smoking • Tobacco

To read this article in full you will need to make a payment

ASTRO Member Login Subscribe:

Subscribe to International Journal of Radiation Oncology, Biology,

ASTRO Members, full access to the journal is a member benefit. Physics
Use your society credentials to access all journal content and
features.
Purchase one-time access:
One-time access price info Academic & Personal: 24 hour online access

Corporate R&D Professionals: 24 hour online access

Already a print subscriber? Claim online access

Already an online subscriber? Sign in

Register: Create an account

Institutional Access: Sign in to ScienceDirect

References
1. Brown L.M. • Check D.P. • Devesa S.S.
Oropharyngeal cancer incidence trends: Diminishing racial disparities.
Cancer Causes Control. 2011; 22: 753-763

View in Article  Scopus (64) • PubMed • Crossref • Google Scholar

2. Pang E. • Delic N.C. • Hong A. • et al.

Radiosensitization of oropharyngeal squamous cell carcinoma cells by human papillomavirus 16 oncoprotein
E6 ∗I.
Int J Radiat Oncol Biol Phys. 2011; 79: 860-865

View in Article  Scopus (49) • Abstract • Full Text • Full Text PDF • Google Scholar

3. Setton J. • Caria N. • Romanyshyn J. • et al.

Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: An update of the Memorial Sloan-
Kettering Cancer Center experience.
Int J Radiat Oncol Biol Phys. 2012; 82: 291-298

View in Article  Scopus (159) • PubMed • Abstract • Full Text • Full Text PDF • Google Scholar

4. Huang K. • Xia P. • Chuang C. • et al.

Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma: The University
of California-San Francisco experience.
Cancer. 2008; 113: 497-507

View in Article  Scopus (116) • PubMed • Crossref • Google Scholar

5. Mendenhall W.M. • Amdur R.J. • Morris C.G. • et al.

Intensity-modulated radiotherapy for oropharyngeal squamous cell carcinoma.
Laryngoscope. 2010; 120: 2218-2222

View in Article  Scopus (61) • PubMed • Crossref • Google Scholar

6. Daly ME. • Le QT. • Maxim PG. • et al.

Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: Clinical outcomes and patterns of
failure.
Int J Radiat Oncol Biol Phys. 2010; 76: 1339-1346

View in Article  Scopus (99) • PubMed • Abstract • Full Text • Full Text PDF • Google Scholar

7. Taneja C. • Allen H. • Koness R.J. • et al.

Changing patterns of failure of head and neck cancer.
Arch Otolaryngol Head Neck Surg. 2002; 128: 324-327

View in Article  Scopus (56) • Crossref • Google Scholar

8. Ang K.K. • Harris J. • Wheeler R. • et al.

Human papillomavirus and survival of patients with oropharyngeal cancer.
N Engl J Med. 2010; 363: 24-35

View in Article  Scopus (5052) • PubMed • Crossref • Google Scholar

9. Lim Y.C. • Koo B.S. • Choi E.C.

Bilateral neck node metastasis: A predictor of isolated distant metastasis in patients with oral and
oropharyngeal squamous cell carcinoma after primary curative surgery.
Laryngoscope. 2007; 117: 1576-1580

View in Article  Scopus (20) • Crossref • Google Scholar

10. Rischin D. • Young R.J. • Fisher R. • et al.

Prognostic significance of p16INK4A and human papillomavirus in patients with oropharyngeal cancer treated
on TROG 02.02 phase III trial.
J Clin Oncol. 2010; 28: 4142-4148

View in Article  Scopus (627) • PubMed • Crossref • Google Scholar

11. Maxwell J.H. • Kumar B. • Feng F.Y. • et al.

Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk
of distant metastases and tumor recurrence.
Clin Cancer Res. 2010; 16: 1226-1235

View in Article  Scopus (254) • Crossref • Google Scholar

12. Hafkamp H.C. • Manni J.J. • Haesevoets A. • et al.

Marked differences in survival rate between smokers and nonsmokers with HPV 16-associated tonsillar
carcinomas.
Int J Cancer. 2008; 122: 2656-2664

View in Article  Scopus (287) • Crossref • Google Scholar

13. Wood D.M. • Mould M.G. • Ong S.B. • et al.

“Pack year” smoking histories: What about the patients who use loose tobacco?.
Tob Control. 2005; 14: 141-142

View in Article  Scopus (54) • Crossref • Google Scholar

14. Jeremic B. • Milicic B.

Pretreatment prognostic factors influencing distant metastasis-free survival in locally advanced squamous cell
carcinoma of the head and neck treated with radiation therapy with or without concurrent chemotherapy.
Am J Clin Oncol. 2009; 32: 483-487

View in Article  Scopus (5) • Crossref • Google Scholar

15. Kowalski L.P. • Carvalho A.L. • Martins Priante A.V. • et al.

Predictive factors for distant metastasis from oral and oropharyngeal squamous cell carcinoma.
Oral Oncol. 2005; 41: 534-541

View in Article  Scopus (88) • Abstract • Full Text • Full Text PDF • Google Scholar

16. Yao M. • Dornfeld K.J. • Buatti J.M. • et al.

Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma: The University of Iowa
experience.
Int J Radiat Oncol Biol Phys. 2005; 63: 410-421

View in Article  Scopus (172) • Abstract • Full Text • Full Text PDF • Google Scholar

17. Fujita K.
Cytochrome P450 and anticancer drugs.
Curr Drug Metab. 2006; 7: 23-37

View in Article  Scopus (79) • Crossref • Google Scholar

18. Van der Bol J.M. • Mathijssen R.H. • Loos W.J. • et al.
Cigarette smoking and irinotecan treatment: Pharmacokinetic interaction and effects on neutropenia.
J Clin Oncol. 2007; 25: 2719-2726

View in Article  Scopus (120) • PubMed • Crossref • Google Scholar

19. Dasgupta P. • Rizwani W. • Pillai S. • et al.

Nicotine induces cell proliferation, invasion and epithelial-mesenchymal transition in a variety of human cancer
cell lines.
Int J Cancer. 2009; 124: 36-45

View in Article  Scopus (316) • PubMed • Crossref • Google Scholar

20. Davis R. • Rizwani W. • Banerjee S. • et al.

Nicotine promotes tumor growth and metastasis in mouse models of lung cancer.
PLoS One. 2009; 4: e7524

View in Article  Scopus (163) • PubMed • Crossref • Google Scholar

Article info
Publication history
Published online: February 13, 2012
Accepted: November 13, 2011
Received in revised form: November 8, 2011
Received: June 22, 2011

Footnotes
Funding: This project was supported in part by the Flight Attendant Medical Research Institute (FAMRI) through a Clinical
Innovator Award to A.W. Chan.

Conflict of interest: none.

Identification
DOI: https://doi.org/10.1016/j.ijrobp.2011.11.044

Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

ScienceDirect
Access this article on ScienceDirect

Related Articles

Comments

Commenting Guidelines

To submit a comment for a journal article, please use the space above and note the following:

We will review submitted comments as soon as possible, striving for within two business days.
This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to
specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise
inappropriate will not be posted.
We require that commenters identify themselves with names and affiliations.
Comments must be in compliance with our Terms & Conditions.
Comments are not peer-reviewed.

View full text

Home Contouring Atlases FOR AUTHORS Contact Information ASTRO

Access for Developing Countries Cover Art Gallery Call for Papers Editorial Board ASTRO Online

ARTICLES & ISSUES COVID-19 Author Instructions Editorial Board COI Disclosures ASTRO Guidelines

Articles In Press Critical Reviews Researcher Academy Editorial Board COI Policy RT Answers

Current Issue Gray Zone Submit a Manuscript Info for Advertisers Advances

List of Issues Issue Highlights Submit a Review Journal Access Information PRO

Special Topics Multidisciplinary Symposia JOURNAL INFO New Content Alerts MORE PERIODICALS

Supplements Oncology Scan About Open Access Permissions Find a Periodical

ASTRO Abstracts PENTEC: Pediatric Normal Tissue Effects in the Clinic About the Journal Pricing Go to Product Catalog

COLLECTIONS Podcasts Abstracting/Indexing Reprints FOLLOW US

Around the Globe Red Journal Outtakes Activate Online Access Reviewer Training Twitter

ASTRO Abstracts Statistics for the People CME Subscribe Facebook

The content on this site is intended for healthcare professionals.

We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Configuración de cookies for this site.
All content on this site: Copyright © 2024 Elsevier Inc., its licensors, and contributors.
All rights are reserved, including those for text and data mining, AI training, and similar technologies.
For all open access content, the Creative Commons licensing terms apply.

Privacy Policy Terms and Conditions Accessibility Help & Contact