• Dirk Rades, Cornelia Setter, Steven E Schild, and Juergen Dunst.
• Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. Rades.Dirk@gmx.net
• Int. J. Radiat. Oncol. Biol. Phys. 2008 Jul 15; 71 (4): 1134-42.

PurposeTo investigate the effect of smoking during radiotherapy (RT), respiratory insufficiency before RT, hemoglobin levels during RT, and additional factors on overall survival, locoregional control (LRC), and metastasis-free survival in non-small-cell lung cancer patients.Methods And MaterialsThe following factors were investigated in 181 patients who underwent RT for non-small-cell lung cancer: age, gender, Karnofsky performance score, histologic type, grade, T/N stage, American Joint Committee on Cancer stage, surgery, chemotherapy, respiratory insufficiency before RT, pack-years, smoking during RT, and hemoglobin levels during RT. Additionally, in the 129 patients who did not undergo surgery, the effect of the equivalent dose in 2-Gy fractions (EQD2) (<60 Gy vs. 60 Gy vs. >60 Gy) on outcome was investigated.ResultsOn multivariate analysis, improved overall survival was associated with a lower T stage (p = 0.004), lower N stage (p = 0.040), surgery (p = 0.010), and no respiratory insufficiency (p = 0.023). A Karnofsky performance score >70 achieved borderline significance (p = 0.056). Improved LRC was associated with a lower T stage (p = 0.007) and no smoking during RT (p = 0.029). Improved metastasis-free survival was associated with lower T stage (p < 0.001) and lower N stage (p < 0.001). In those patients who did not undergo surgery, an EQD2 of > or =60 Gy was associated with a better outcome than an EQD2 of <60 Gy. Furthermore, an EQD2 >60 Gy resulted in better LRC than did an EQD2 of < or =60 Gy.ConclusionsSmoking during RT had a significant effect on LRC, but we did not find that hemoglobin levels or respiratory insufficiency significantly affected LRC or metastasis-free survival in our patient population. Furthermore, our data suggest a dose-effect relationship in those patients who did not undergo surgery.

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