Díaz-Gavela Ana A, Del Cerro E, Sanchez-Garcia S, Andreu-Vázquez C, Thuissard-Vasallo I J, Sanz-Rosa D, Pena-Huertas M, Ruiz-Morales C, Guerrero-Gomez L L, Duque-Santana V, Hernandez-Cortés G, Gonzalez-Cortijo L, Counago F
Radiation Therapy Department, Quironsalud Madrid University Hospital, Diego de Velázquez 1, Pozuelo de Alarcón, Madrid, 28223, Spain.
Department of Medicine, Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, C. Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain.
Radiat Oncol. 2025 Mar 27;20(1):45. doi: 10.1186/s13014-025-02614-x.
To evaluate the impact of smoking on acute and chronic toxicity in early breast cancer patients treated with hypofractionated intensity-modulated radiation therapy (IMRT) and a brachytherapy boost following breast-conserving surgery.
A retrospective study of 638 patients treated between 2009 and 2017, with 566 having recorded smoking status. Acute toxicity was assessed at treatment end and chronic toxicity at least one-year post-treatment, using Common Terminology Criteria for Adverse Events v4.0. Statistical analyses included chi-square tests and relative risk (RR) calculations.
A total of 566 patients were included in the study, with 31.3% being smokers. The cohort was followed for a median of 6 years (range: 1-11 years). Acute toxicity was primarily characterized by radiodermatitis, with 87.6% of patients developing grade 1 and 5.5% experiencing grade 2. No cases of grade ≥ 3 were observed, and 6.9% of patients did not experience radiodermatitis. Bleeding was rare (1.1%) and infections occurred in 2.0% of patients. Regarding chronic toxicity, 67.1% of patients had no fibrosis, while 27.4% had grade 1 fibrosis. Grade 2 and grade 3 fibrosis were observed in 4.9% and 0.6% of patients, respectively, with no cases of grade 4 fibrosis. Edema was present in 8.0%, and 4.4% of patients reported chronic pain. When comparing smokers and nonsmokers, acute toxicity incidence, particularly radiodermatitis, was similar between the two groups. Smokers had a significantly higher incidence of chronic fibrosis (35.6% vs. 24.7%, p = 0.013) and chronic pain (7.9% vs. 3.3%, p = 0.024) compared to nonsmokers. However, there were no significant differences in the occurrence of edema between smokers and nonsmokers (7.9% vs. 8.0%, p = 0.879).
While advanced radiation techniques such as hypofractionated IMRT improve overall toxicity profiles, smoking significantly exacerbates chronic toxicity in breast cancer patients. This study underscores the urgent need for comprehensive smoking cessation programs as part of cancer care, addressing lifestyle factors to improve patient outcomes and quality of life.
评估吸烟对保乳手术后接受短疗程调强放射治疗（IMRT）及近距离放射治疗补充的早期乳腺癌患者急慢性毒性的影响。
对2009年至2017年间接受治疗的638例患者进行回顾性研究，其中566例记录了吸烟状况。使用不良事件通用术语标准v4.0在治疗结束时评估急性毒性，在治疗后至少一年评估慢性毒性。统计分析包括卡方检验和相对风险（RR）计算。
共有566例患者纳入研究，其中31.3%为吸烟者。队列随访时间中位数为6年（范围：1 - 11年）。急性毒性主要表现为放射性皮炎，87.6%的患者出现1级，5.5%的患者出现2级。未观察到≥3级病例，6.9%的患者未出现放射性皮炎。出血罕见（1.1%），2.0%的患者发生感染。关于慢性毒性，67.1%的患者无纤维化，27.4%的患者有1级纤维化。2级和3级纤维化分别在4.9%和0.6%的患者中观察到，无4级纤维化病例。8.0%的患者出现水肿，4.4%的患者报告有慢性疼痛。比较吸烟者和非吸烟者时，两组急性毒性发生率，尤其是放射性皮炎发生率相似。与非吸烟者相比，吸烟者慢性纤维化发生率显著更高（35.6%对24.7%，p = 0.013），慢性疼痛发生率也显著更高（7.9%对3.3%，p = 0.024）。然而，吸烟者和非吸烟者水肿发生率无显著差异（7.9%对8.0%，p = 0.879）。
虽然短疗程IMRT等先进放疗技术改善了总体毒性情况，但吸烟会显著加剧乳腺癌患者的慢性毒性。本研究强调迫切需要将全面戒烟计划作为癌症护理的一部分，解决生活方式因素以改善患者预后和生活质量。
