[G-CSF in radiochemotherapy].
BACKGROUND
G-CSF enhances the division, maturation and release of granulocyte precursor cells. The shortening of chemotherapy-induced leukopenia via G-CSF is well documented in literature, with fractionated radiotherapy alone one finds a distinct increase of the granulocyte level. There are only few results for combined simultaneous radiochemotherapy.


METHODS
In the Department of Radiotherapy of the University of Erlangen 102 patients were treated with G-CSF since 1992. Twenty-eight patients (31 applications) undergoing radiotherapy only (n = 4) or combined simultaneous radiochemotherapy (n = 27) received G-CSF interventional daily. These results are presented and discussed. Indications for the application of G-CSF were severe leukopenia below 1000/mm3 (level IV according to WHO) or rapid decreasing leukocytes during therapy. G-CSF was not applied during chemotherapy and terminated at least 24 h before the next chemotherapy cycle. r-metHuG-CSF (Filgrastim, Neupogen) was used subcutaneously. Documented were the duration until the leukocyte increase, neutrophil granulocytes, thrombocytes, interruption of radiotherapy, febrile episodes and side effects.


RESULTS
In case of severe leukopenia (< 1000/mm3 n = 16) the leukocytes increased after 3 days of G-CSF application, the radiotherapy was interrupted in 2 cases, terminated in 1 case. Four patients had lever before during G-CSF 4 additional febrile episodes occurred. If G-CSF application was started between leukocyte levels of 1000 and 1500/mm3 after 1 day the leukocytes increased in 9 of 10 cases beyond the starting level. Interruption of radiotherapy was not necessary. Only 1 febrile episode occurred (1/11). There were no relevant side effects of G-CSF.


CONCLUSIONS
Rapidly developing or severe leukopenia during radio(chemo)therapy are indications for an interventional application of G-CSF. The leukocyte level for the start of G-CSF should be chosen so that without G-CSF an interruption of therapy or a level IV leukopenia seems to be unavoidable.
Riepl
M
M
Strahlentherapeutische Klinik und Poliklinik, Universität Erlangen-Nürnberg.
Fietkau
R
R
Sauer
R
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000532:radiotherapy*; D010976:Platelet Count / Q000187:drug effects; D011994:Recombinant Proteins; D013997:Time Factors
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor
G-CSF bei Radiochemotherapie.