Will Your Breast Cancer Patient’s Mortality Go Up in Smoke?

Dedicated smokers who receive breast radiation may pay an unexpected price[1]in both recurrence risk and in mortality. Smoking during radiation therapy (RT) noticeably increases (and accelerates) the recurrence risk, but it also increases long-term risks of lung and heart mortality. The recurrence risk probably derives from (temporary) smoking - caused hypoxia. On the other hand, concurrent RT and smoking produces synergistic and permanent heart and lung damage. Tumor cell hypoxia can be exogenous (via smoking) or endogenous (inadequate capillary perfusion) or possibly even environmental (at high altitudes). However it occurs, though, it is a major contributor to treatment failure. Techniques for addressing hypoxia - both currently in the clinic, and on the technological horizon - are briefly reviewed here. These include photoacoustics, FLASH radiotherapy, and Cherenkov - Excited Luminescence Imaging (CELI).