College of Medicine and Dentistry, James Cook University, Townsville, Australia.
The Townsville Health Library, Australia.
Radiother Oncol. 2019 Jun;135:51-57. doi: 10.1016/j.radonc.2019.02.021. Epub 2019 Mar 11.
To determine the effects of continued smoking in head and neck cancer (HNC) patients undergoing radiotherapy on overall survival (OS), locoregional control (LRC), quality of life (QoL) and acute and late toxicities.
Articles from January 1990 to August 14, 2018 were searched in PubMed, MEDLINE (Ovid), Embase, Scopus, The Cochrane Library, CINAHL and AUSThealth. Articles were included if majority of patients were treated with radiotherapy and smokers were defined as those who continued to smoke during or after radiotherapy. Data extraction and risk of bias assessment was performed by three independent co-authors using summary data of original studies. A meta-analysis using a random effects model was conducted for OS and LRC. In addition, a qualitative synthesis was performed for toxicities and quality of life as only a limited number of articles were available.
The initial search identified 2217 studies, with 24 articles comprising 6332 patients eligible for inclusion. Analysis demonstrated that continued smoking was associated with approximately two times the risk of mortality (RR = 1.85, 95% CI 1.55-2.21, p < 0.0001, I = 43%) in HNC patients. Similarly, the risk of locoregional failure was more than two times greater in HNC patients who continued smoking (RR = 2.24, CI 1.42-3.52, p = 0.0005, I = 64%). The qualitative synthesis indicates that continued smoking may contribute to an elevated incidence of late but not acute toxicities.
This review provides evidence that continued smoking is associated with a lower OS and LRC and a higher incidence of late toxicities. Therefore, clinicians should strongly encourage smoking cessation amongst all head and neck cancer patients.
确定头颈部癌症（HNC）患者在接受放疗期间继续吸烟对总生存（OS）、局部区域控制（LRC）、生活质量（QoL）以及急性和晚期毒性的影响。
检索了 1990 年 1 月至 2018 年 8 月 14 日在 PubMed、MEDLINE（Ovid）、Embase、Scopus、The Cochrane Library、CINAHL 和 AUSThealth 中的文章。如果大多数患者接受放疗治疗，且吸烟者被定义为在放疗期间或之后继续吸烟的患者，则将其纳入研究。三位独立的合著者使用原始研究的汇总数据进行了数据提取和偏倚风险评估。使用随机效应模型对 OS 和 LRC 进行了荟萃分析。此外，由于可用的文章数量有限，仅对毒性和生活质量进行了定性综合分析。
最初的搜索确定了 2217 项研究，其中 24 项研究包含 6332 名符合纳入条件的患者。分析表明，继续吸烟与 HNC 患者的死亡风险增加约两倍相关（RR=1.85，95%CI 1.55-2.21，p<0.0001，I=43%）。同样，继续吸烟的 HNC 患者局部区域失败的风险增加了两倍多（RR=2.24，CI 1.42-3.52，p=0.0005，I=64%）。定性综合分析表明，继续吸烟可能会导致晚期毒性的发生率增加，但不会导致急性毒性的发生率增加。
本综述提供了证据表明，继续吸烟与 OS 和 LRC 降低以及晚期毒性发生率增加有关。因此，临床医生应强烈鼓励所有头颈部癌症患者戒烟。
