Effects of smoking cessation on hypoxia and its potential impact on radiation treatment effects in lung cancer patients.

BACKGROUND AND PURPOSE

Smoking cessation is often attempted in the context of a lung cancer diagnosis. If cessation causes slowly continuing changes of total lung capacity and vital capacity, this may have consequences for lung volume, results of dose-volume histogram (DVH) analysis and targeting precision, in addition to changes in oxygenation, tumor biology (gene expression) and prognosis.

METHODS

To address the impact of smoking cessation on radiation treatment of lung cancer, a literature review was performed.

RESULTS

Smoking cessation is associated with important benefits such as improved lung function and a better general health and performance status. In surgically and radiation treated patients, smoking cessation might lead to longer survival and reduced complications. Early data indicate that hypoxia in non-small cell lung cancer should be considered a poor prognostic factor. Yet, specific human data on how hypoxia is influenced by smoking status are not available. The influence of smoking history on the pneumonitis risk is not entirely clear. However, it appears that other factors outweigh the influence of smoking. The short-term effects of smoking cessation on lung function do not appear to cause relevant errors in treatment planning or targeting precision. Yet, no prospective study formally addressing this question was identified.

CONCLUSION

Smoking cessation appears to be prognostically beneficial. The role of hypoxia in this context requires more detailed evaluation.