Cigarette and Alcohol Use Associated with Poor Outcomes for Patients With Squamous Cell Carcinomas of the Head and Neck

In a study of more than 1,800 patients treated for head and neck squamous cell cancer with radiation therapy alone, post-operative radiation therapy and chemoradiotherapy, cigarette and alcohol use was associated with poor outcomes.

Of the 1,871 patients in the study, 973 were treated with radiation therapy alone; 469 with post-operative radiation; and 429 with chemotherapy and radiation. Subjects were included in the study when complete information was available on baseline smoking and alcohol behavior—never, former or active—disease stage, primary site, radiation dose, gender and age.

Andre Fortin, M.D., et al, reported that 9 percent of the patients had never smoked; 40 percent were former smokers; and 51 percent were active smokers. Twenty percent had never consumed alcohol; 25 percent were former drinkers; and 55 percent were active drinkers.

The authors found that smoking was associated with inferior local control and survival. The hazard ratio (HR) associated with local control for active smokers versus former smokers was 1.5 (p = 0.0001). The hazard ratios of former smokers and active smokers versus those who never smoked were also statistically significant (1.3 and 1.7, respectively, p = 0.000001). The HRs for survival of the former and active drinkers was 1.1, compared to 1.28 for those who never drank. The adjusted five-year local control and survival rates of those who never smoked and never drank were 87 percent and 77 percent, respectively. The patients who were active smokers and drinkers had survival rates of 72 percent (p = 0.007) and 52 percent (p = 0.0009), respectively.

The study titled “Influence of Smoking and Alcohol Drinking Behaviors on Treatment Outcomes of Patients With Squamous Cell Carcinomas of the Head and Neck,” by Andre Fortin, M.D., M.Sc., Chang Shu Wang, M.D., Ph.D., and Eric Vigneault, M.D., M.Sc, was published July 15, 2009, in the Red Journal.