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. 2025 Mar 27;20(1):45.
doi: 10.1186/s13014-025-02614-x.

Smoking increases breast toxicity despite adjuvant hypofractionated IMRT in early breast cancer

Ana A Díaz-Gavela  1   2   3 , E Del Cerro  4   5   6 , S Sanchez-Garcia  6 , C Andreu-Vázquez  7   8 , I J Thuissard-Vasallo  8 , D Sanz-Rosa  5 , M Pena-Huertas  4   5 , C Ruiz-Morales  9 , L L Guerrero-Gomez  6 , V Duque-Santana  4   5 , G Hernandez-Cortés  5   10 , L Gonzalez-Cortijo  5   11 , F Counago  5   12
Affiliations

Smoking increases breast toxicity despite adjuvant hypofractionated IMRT in early breast cancer

Ana A Díaz-Gavela et al. Radiat Oncol. .

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Breast cancer; Long term adverse effects; Radiation dose hypofractionation; Radiotherapy-intensity-modulated; Smoking.

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Conflict of interest statement

Declarations. Ethical approval: The research protocol for this descriptive, retrospective, longitudinal study was approved by the Jiménez Díaz Foundation’s Ethics and Research Committee with Medicines (Madrid, Spain) on March 5, 2020. Given the retrospective nature of the study, and the possibility that some patients included in the study may no longer attend the hospital or may have passed away, a waiver for individualized informed consent was requested, which was granted. The investigators strictly adhered to the approved protocol established by the ethical research committee, ensuring accurate completion of data collection forms. The study was conducted in accordance with the recommendations outlined in the Declaration of Helsinki, as revised in successive World Medical Assemblies, and in compliance with Good Clinical Practice Guidelines. Consent to participate: Not applicable. Competing interests: The authors declare no competing interests.

References

    1. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005. 10.1016/S0140-6736(05)67887-7. - PubMed
    1. Donovan E, Bleakley N, Denholm E, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007. 10.1016/j.radonc.2006.12.008. - PubMed
    1. Gu L, Dai W, Fu R, et al. Comparing hypofractionated with conventional fractionated radiotherapy after breast-Conserving surgery for early breast cancer: A Meta-Analysis of randomized controlled trials. Front Oncol 2021; Published. 2021 Oct;1. 10.3389/fonc.2021.753209. - PMC - PubMed
    1. Singareeka Raghavendra A, Kypriotakis G, Karam-Hage M, Kim S, Jizzini M, Seoudy KS, Robinson JD, Barcenas CH, Cinciripini PM, Tripathy D, Ibrahim NK. The impact of treatment for smoking on breast Cancer patients’ survival. Cancers (Basel). 2022. 10.3390/cancers14061464. - PMC - PubMed
    1. Bergman M, Fountoukidis G, Smith D, Ahlgren J, Lambe M, Valachis A. Effect of smoking on treatment efficacy and toxicity in patients with cancer: A systematic review and Meta-Analysis. Cancers (Basel). 2022. 10.3390/cancers14174117. - PMC - PubMed

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