The recent introduction of chemotherapy in the treatment of gynecological malignancies has gained wide acceptance along with preoperative and postoperative adjuvant therapy and with preradiation and concurrent chemoradiation therapy. But, the
side
effects of chemotherapy including bleeding and infection due to bone marrow suppression have resulted in delayed treatment and a reduction in the chemotherapeutic agent used. Recent efforts to overcome this bone marrow suppression have led to
deyelopment of the various human colony-stimulating factor including recombinant granulocyte colony-stimulating factor. The author investigated the clinical benefits and toxicity of G-CSF used during chemotherapy of various gynecological
malignancies at
the Department of Obstertrics & Gynecology Hanyang University between August, 1991 and July, 1992.
@ES The results were as follows:
@EN 1. An increase in the number of neutrophils following a single injection of G-CSF was noted in 19 out of 21 cases(600∼1,000/㎣ before injection, 4,500∼12,000/㎣ after injection). The remaining 2 cases showed an increase after 3∼5
continuous
injections.
2. To assess the increase in neutrophils according to the dosage of G-CSF given, 100 and 300㎍/m* of G-CSF were injected in each trial of chemotherapy in a single case of ovarian cancer. The results were a 1.5 time increase when injected when
injected
with 300㎍/m*.
3. After injecting into a patient with recurrent endometrial cancer who was managed with 15gm of ifosfamide, 50gm of cis-platinum, 50gm of adriamycin and 3gm of mesna following surgery, no evidence of neutropenia could be found after 4days of
prophylactic G-CSF injections.
4. Patients with cervix cancer with metastasis to the lung were first treated with GM-CSF in one trial and G-CSF in the nest. Patients treated with Gm-CSF for a period of 7 days showed leukocytosis(3,600/㎣) but the number was reduced to 1,400/㎣
after
7 days. On the other hand, patients treated with G-CSF showed an increase of 5,700/㎣ within one day and this figure did not decrease until 20 days later.
5. The toxic effects of G-CSF included on case of severe back pain was easily managed by administration acetaminophen. Others were headache, chills, general weakness and redness of the oral mucosa and injection area. Most of these symptoms
disappeared
within 2 days.
The G-CSF is effective in neutropenia during chemotherapy thereby decreasing the incidence of treatment delay or dose reduction. It also increases the amount of chemotherapeutic agent administered and its toxicity is more tolerable making a rigid
systemic chemotherapeutic regime possible.
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