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G-CSF bei Radiochemotherapie

G-CSF in radiochemotherapy

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Zusammenfassung

Hintergrund

G-CSF (granulocyte-colony-stimulating-factor) beschleunigt die Teilung, Reifung und Freisetzung von Vorläuferzellen der Granulozyten. Die Verkürzung von chemotherapieinduzierten Leukopenien durch G-CSF-Gabe ist in der Literatur hinreichend beschrieben, unter alleiniger fraktionierter Radiotherapie zeigt sich ein meist deutliches Ansteigen der Granulozytenwerte. Für die simultane Radiochemotherapie gibt es bisher nur Einzelergebnisse.

Patienten und Methode

Seit 1992 wurden in der Strahlentherapeutischen Universitätsklinik Erlangen 101 Patienten mit G-CSF behandelt. 28 Patienten (31 Anwendungen) bekamen G-CSF interventionell täglich bei alleiniger Radiotherapie (n=4) oder simultaner Radiochemotherapie (n=27); diese Ergebnisse werden vorgestellt und diskutiert. Indikationen für G-CSF waren ausgeprägte Leukopenien unter 1000/mm3 (Grad 4 nach WHO) oder schnell absinkende Leukozytenzahlen unter Therapie. Unter Chemotherapie wurde G-CSF nicht gegeben, vielmehr mindestens 24 Stunden vor dem nächsten Zyklus abgesetzt. Verwendet wurde r-metHuG-CSF (Filgrastim, Neupogen®) subkutan. Dokumentiert wurden die Anzahl der Tage bis zum Anstieg der Leukozyten, die Werte der neutrophilen Granulozyten und Thrombozyten, Unterbrechungen der Radiotherapie, febrile Episoden und Nebenwirkungen.

Ergebnisse

Bei ausgeprägten Leukopenien (<1000/mm3, n=16) erfolgte der Leukozytenanstieg erst nach durchschnittlich dreitägiger Gabe von G-CSF, die Radiotherapie mußte in zwei Fällen unterbrochen und einmal abgebrochen werden. Vier Patienten hatten vorher bereits Fieber, unter G-CSF trat Fieber in weiteren vier Fällen auf. Der Beginn der G-CSF-Gabe bei Leukozytenzahlen zwischen 1000 und 1500/mm3 bewirkte in neun von elf Fällen nach einem Tag einen Anstieg der Werte über den Ausgangswert. Eine Unterbrechung der Radiotherapie war nicht erforderlich. Febrile Episoden (1/11) waren seltener als in der Vergleichsgruppe. Relevante Nebenwirkungen von G-CSF traten nicht auf.

Schlußfolgerungen

Schnell auftretende oder ausgeprägte Leukopenien unter Radiochemotherapie sind Indikationen für eine interventionelle Gabe von G-CSF. Die Grenzwerte sollten so gewählt werden, daß ohne G-CSF ein Therapieabbruch oder eine Leukopenie Grad 4 nach WHO unvermeidbar scheint. Eine standardisierte Prophylaxe ist nicht erforderlich.

Abstract

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 literatur, with fractionated radiotherapy alone one finds a distinct increase of the granulocyte level. There are only few results for combined simultaneous radiochemotherapy.

Patients and 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 fever 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.

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  1. Strahlentherapeutische Klinik und Poliklinik der Universität Erlangen-Nürnberg, Universitätsstraße 27, D-91054, Erlangen

    M. Riepl, R. Fietkau & R. Sauer

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  1. M. Riepl
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  2. R. Fietkau
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  3. R. Sauer
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Riepl, M., Fietkau, R. & Sauer, R. G-CSF bei Radiochemotherapie. Strahlenther. Onkol. 173, 76–82 (1997). https://doi.org/10.1007/BF03038926

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