my personal edition > cervical cancer > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Smoking During Chemoradiation For Cervical Cancer Adversely Affects Outcome: Presented at SGO

By Charlene Laino
Special to DG News

NEW ORLEANS, LA -- February 10, 2003 -- Women who smoke and are undergoing treatment for locally advanced cervical cancer are less likely to survive compared with those who do not light up, a new study suggests.

The findings were reported here on February 2^nd at the 34^th Annual Meeting of the Society of Gynecologic Oncologists by Steven E. Waggoner, MD, a professor of obstetrics and gynecology at the University Hospitals of Cleveland, Ohio, United States.

The study group comprised 315 patients with previously untreated Stage II-B, III-B or IV-A cervical cancer who participated in Gynecologic Oncology Group Protocol 165. This was a Phase III study comparing the effectiveness of cisplatin-based chemoradiation and chemoradiation with a prolonged venous infusion of fluorouracil.

As part of that study, the women prospectively recorded their smoking behaviour using a self-administered questionnaire. Urine cotinine testing was used to confirm the patients" smoking status both before and during treatment.

Of the 315 participants, 42% were smokers at the start of treatment, and fewer than 5% stopped smoking during treatment, Dr. Waggoner said.

Women who smoked were more likely to be younger than 40 (p < 0.01), have a higher tumour stage (p=0.01) and have squamous histology (p=0.002), compared with non-smokers. "An association between smoking and worse outcomes was found when survival analysis was performed using the Kaplan-Meier method and confirmed using univariate and multivariate models," he said.

Univariate analysis revealed that current smoking was associated with a 44% increase in the relative risk of progression (p=0.04) and a 59% increase in the relative risk of death (p=0.02), compared with non-smoking.

After adjusting for factors that affect survival, including patient age, performance status, treatment arm, pelvic node status, tumour size, stage and grade, and cell type, in the multivariate analysis, smoking was still a significant independent predictor of poor outcome, the study showed. Specifically, the analysis showed smoking was associated with a 44% increase in the relative risk of progression (p=0.04) and a 69% increase in the risk of dying (p=0.02), Dr. Waggoner said.

While the study was not designed to find out how smoking adversely affects survival, he hypothesized that quitting may induce tumour hypoxia, thus positively influencing clinical outcome.

The next step, he said, is to develop intervention trials to test the hypothesis that kicking the habit during chemoradiation treatment for locally advanced cervical cancer may favorably alter the adverse effects of smoking and improve a woman"s chance of survival.

E-Mail this DGDispatch to a colleague

To print, use this version