EFFECT OF FILGRASTIM (G-CSF) DURING CHEMOTHERAPY AND ABDOMINOPELVIC RADIATION-THERAPY IN PATIENTS WITH OVARIAN-CARCINOMA

Purpose: To evaluate the safety and effectiveness of filgrastim (granu locyte colony-stimulating factor, G-CSF) in reducing neutropenia and t reatment interruptions during whole abdominal radiotherapy for ovarian canter. Methods and Materials: Sixteen patients with ovarian cancer t reated with 2 to 6 courses of cisplatin-containing chemotherapy and ab domino-pelvic radiation therapy received filgrastim for neutrophil cou nts <2 x 10(9)L. Endpoints for analysis included the ability to mainta in the neutrophil count in the target range, number of treatment inter ruptions due to neutropenia, and toxicity attributed to filgrastim. Re sults: Fourteen patients received a mean of 2.9 courses of filgrastim (each with a mean duration of 4.1 days), with no treatment interruptio ns due to neutropenia. The majority of neutrophil counts were maintain ed above the target range of 2 x 10(9)/L during treatment. Thrombocyto penia requiring treatment interruption was seen in sis patients and ne cessitated platelet transfusions in one. Thrombocytopenia occurred at a mean abdominal radiation dose of 2207 cGy and in all but one patient was preceded by one or more episodes of neutropenia. In comparison wi th a control group of 31 patients treated without filgrastim there was no reduction in treatment interruptions. Four patients did not comple te treatment because of persistent thrombocytopenia get received a mea n of 94% of the planned abdominal radiation dose and 69% of the planne d pelvic dose. Filgrastim toxicity was limited to mild skeletal pains in six patients and a Grade 1 skin rash in two patients. Conclusions: Filgrastim is safe and effective in preventing neutropenia and reducin g neutropenic treatment interruptions during abdominal radiotherapy in patients with ovarian cancer, However, there was no clear benefit to the use of filgrastim as thrombocytopenia became the dose-limiting tox icity resulting in a risk of treatment interruptions and early termina tion of radiotherapy. (C) 1998 Elsevier Science Inc.