Efficiency and toxicity of the USE of granulocyte colony stimulating factor in the process of chemoradiotherapy in patients diagnosed with locally advanced lung cancer

Introduction and Objective: Lung cancer is basically divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). 85% of all lung cancers are NSCLC, and approximately one third of these are diagnosed at locally advanced stage. In addition, approximately 30-40% of SCLC cases are in the limited stage at the time of diagnosis. If surgery is not suitable in both patint groups, the standard treatment is concurrent chemoradiotherapy (CRT). In our study, we aimed to examine the efficacy and toxicity of the use of granulocyte-colony stimulating factor (G-CSF) during concurrent CRT in patients with locally advanced lung cancer. Material and Methods: 209 patients with locally advanced lung caner who applied to the Medical Oncology outpatient clinic of Dicle University Medical Faculty Hospital between January 2007-January 2022 and received concurrent CRT were included in this study. Patient files were reviewed retrospectively. Demographic characteristics of the patients, disease stage at the time of diagnosis, chemotherapy protocol, RT dose, hemogram examinations, radiography reports, treatment response, progression status and last control time were examined in accordance with patient data. The patients were divided into two groups according to the use of G-CSF. Overall survival was calculated according to the date of death or last control of the patients. Results: Of the patients in our study, 19 were diagnosed with SCLC and 190 with NSCLC. In the SCLC group, 5 patients did not use G-CSF, and 14 patients used it as secondary prophylaxis. There was no significant difference between the group that using and not using G-CSF in terms of radiation pneumonia (50% vs. 20%; p=0.338). Of the patients with NSCLC, 177 (93.2%) were male and 13 (6.8%) were female. The median age of the patients at the time of diagnosis was 62 years (39-83). Considering the stages at the time of diagnosis, it was seen that the majority of the patients were stage 3B (52.6%). 171 (90%) of the patients received RT at a dose of 60 Gy or more. Considering the use of G-CSF, it was seen that 112 (59%) patients had never used G-CSF, and 78 (41%) patients used G-CSF as secondary prophylaxis. There was no significant difference in overall survival between patients using and not using G-CSF (median 26.44 and 23.06 months; p=0.844). On the other hand, it was observed that the need for CRT dose reduction developed less in the group using G-CSF (6.4% vs. 17%; p=0.031). However, grade 2 and higher anemia and thrombocytopenia (37.2% and 19.2%) developed more in the group using G-CSF compared to the group that did not use (20.6% and 3.6%). Also, the frequency of neutropenic fever was higher in the group using G-CSF (9% vs. 0). Finally, radiation pneumonitis was found to be more common in patients using G-CSF in the following periods (20.5% vs. 39.7%; p=0.004). Conclusion: The use of G-CSF during concurrent CRT does not make any difference in disease-free and overall survival. However, it reduces the frequency of neutropenic fever and the need for chemotherapy dose reduction. In addition, the use of G-CSF during the concurrent CRT may increase the risk of developing radiation pneumonitis. Keywords: Lung cancer, chemoradiotherapy, granulocyte-colony stimulating factor, radiation pneumonitis