nach oben

Supportive Care in Cancer

Erschienen in:

01.03.2013 | Original Article

Analysis of the risk factors for myelosuppression after concurrent chemoradiotherapy for patients with advanced non-small cell lung cancer

verfasst von: Nan Jiang, Xiao-Cen Chen, Yue Zhao

Erschienen in: Supportive Care in Cancer | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Myelosuppression induced by concurrent chemotherapy and radiotherapy can be a significant problem in patients with non-small cell lung cancer (NSCLC), but its risk factors remain largely unknown. The objective of this study was to retrospectively evaluate clinical data obtained before chemoradiotherapy (CRT) to identify the risk factors for myelosuppression in patients with advanced NSCLC.

Methods

Between January 2007 and January 2012, 141 patients with advanced NSCLC were treated with curative intent according to the CRT protocol (50–70 Gy at 2 Gy/day with paclitaxel 135–175 mg/m² and carboplatin 100 mg/m² on days 1, 22, and 43). The endpoint of this survey was the occurrence of grade 3 or higher myelosuppression (neutropenia, leukopenia, thrombocytopenia, or anemia). Risk factors significantly related to myelosuppression were extracted using logistic regression analysis.

Results

Grade 3 or higher neutropenia, leukopenia, thrombocytopenia, or anemia occurred in 19.9, 16.3, 14.9, and 0 % of the patients, respectively. According to the multivariate analysis, the risk factors included age, albumin, and body surface area (BSA) for neutropenia; performance status and bone metastases for leukopenia; and age, gender, and serum creatinine concentration for thrombocytopenia (p < 0.05).

Conclusions

It was found that age, BSA, creatinine level, and female gender were the most important factors for CRT-induced myelosuppression in advanced NSCLC. By identifying these risk factors, medical staff can improve application of appropriate medical care to reduce the myelosuppression in advanced NSCLC patients treated by CRT.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96PubMedCrossRef

Dillman RO, Herndon J, Seagren SL, Eaton WJ, Green MR (1996) Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst 88:1210–1215PubMedCrossRef

Fournel P, Robinet G, Thomas P, Souquet PJ, Lena H, Vergnenegre A et al (2005) Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95-01 Study. J Clin Oncol 23:5910–5917PubMedCrossRef

Rakovitch E, Tsao M, Ung Y, Pignol JP, Cheung P, Chow E (2004) Comparison of the efficacy and acute toxicity of weekly versus daily chemoradiotherapy for non-small-cell lung cancer: a meta-analysis. Int J Radiat Oncol Biol Phys 58:196–203PubMedCrossRef

Pritchard RS, Anthony SP (1996) Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, non-small-cell lung cancer: a meta-analysis. Ann Intern Med 125:723–729PubMed

Zatloukal P, Petruzelka L, Zemanova M, Havel L, Janku F, Judas L et al (2004) Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer 46:87–98PubMedCrossRef

Li J, Dai CH, Shi SB, Bao QL, Yu LC, Wu JR (2010) Induction concurrent chemoradiotherapy compared with induction radiotherapy for superior sulcus non-small cell lung cancer: a retrospective study. Asia Pac J Clin Oncol 6:57–65PubMedCrossRef

Abdelwahab S, Abdulla H, Azmy A, Abdelfatah A, Abdel-Aziz H, Margerges M et al (2009) Integration of irinotecan and cisplatin with early concurrent conventional radiotherapy for limited-disease SCLC (LD-SCLC). Int J Clin Oncol 14:230–236PubMedCrossRef

Sunpaweravong P, Magree L, Rabinovitch R, Bunn P, Kelly K (2006) A phase I/II study of docetaxel, etoposide, and carboplatin before concurrent chemoradiotherapy with cisplatin and etoposide in limited-stage small cell lung cancer. Invest New Drugs 24:213–221PubMedCrossRef

10.

Belani CP, Choy H, Bonomi P, Scott C, Travis P, Haluschak J, Curran WJ (2005) Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol 23:5883–5891PubMedCrossRef

11.

Cox JD, Pajak TF, Asbell S, Russell AH, Pederson J, Byhardt RW et al (1993) Interruptions of high-dose radiation therapy decrease long-term survival of favorable patients with unresectable non-small cell carcinoma of the lung: analysis of 1244 cases from 3 Radiation Therapy Oncology Group (RTOG) trials. Int J Radiat Oncol Biol Phys 27:493–498PubMedCrossRef

12.

Herrmann T (1994) Interruptions of high-dose radiation therapy decrease the long-term survival of favorable patients with unresectable non-small-cell carcinoma of the lung. Analysis of 1244 cases from radio-oncology (RTOG) studies. Radiation Therapy Oncology Group. Strahlenther Onkol 170:551–552PubMed

13.

Choi CW, Sung HJ, Park KH, Yoon SY, Kim SJ, Oh SC et al (2003) Early lymphopenia as a risk factor for chemotherapy-induced febrile neutropenia. Am J Hematol 73:263–266PubMedCrossRef

14.

Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106:2258–2266PubMedCrossRef

15.

Hui EP, Leung LK, Poon TC, Mo F, Chan VT, Ma AT et al (2011) Prediction of outcome in cancer patients with febrile neutropenia: a prospective validation of the Multinational Association for Supportive Care in Cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network. Support Care Cancer 19:1625–1635PubMedCrossRef

16.

Morrison VMV, Picozzi VPV, Scott SSS, Pohlman BPB, Dickman EDE, Lee MLM et al (2001) The impact of age on delivered dose intensity and hospitalizations for febrile neutropenia in patients with intermediate-grade non-Hodgkin's lymphoma receiving initial CHOP chemotherapy: a risk factor analysis. Clin Lymphoma 2:47–56PubMedCrossRef

17.

Lyman GLG, Lyman CLC, Agboola OAO (2005) Risk models for predicting chemotherapy-induced neutropenia. Oncologist 10:427–437PubMedCrossRef

18.

Arrieta O, Michel OR, Villanueva-Rodriguez G, Serna-Thome MG, Flores-Estrada D, Diaz-Romero C et al (2010) Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer 10:1–7CrossRef

19.

Ishizuka M, Fujimoto Y, Itoh Y, Kitagawa K, Sano M, Miyagawa Y et al (2011) Relationship between hematotoxicity and serum albumin level in the treatment of head and neck cancers with concurrent chemoradiotherapy using cisplatin. Jpn J Clin Oncol 41:973–979PubMedCrossRef

20.

Alexandre J, Gross-Goupil M, Falissard B, Nguyen ML, Gornet JM, Misset JL et al (2003) Evaluation of the nutritional and inflammatory status in cancer patients for the risk assessment of severe haematological toxicity following chemotherapy. Ann Oncol 14:36–41PubMedCrossRef

21.

Intragumtornchai TIT, Sutheesophon JSJ, Sutcharitchan PSP, Swasdikul DSD (2000) A predictive model for life-threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non-Hodgkin's lymphoma. Leuk Lymphoma 37:351–360PubMed

22.

Kratz F, Ehling G, Kauffmann HM, Unger C (2007) Acute and repeat-dose toxicity studies of the (6-maleimidocaproyl)hydrazone derivative of doxorubicin (DOXO-EMCH), an albumin-binding prodrug of the anticancer agent doxorubicin. Hum Exp Toxicol 26:19–35PubMedCrossRef

23.

Singh S, Parulekar W, Murray N, Feld R, Evans WK, Tu D et al (2005) Influence of sex on toxicity and treatment outcome in small-cell lung cancer. J Clin Oncol 23:850–856PubMedCrossRef

24.

Bruno RBR, Hille DHD, Riva ARA, Vivier NVN, Huinnink WHW et al (1998) Population pharmacokinetics/pharmacodynamics of docetaxel in phase II studies in patients with cancer. J Clin Oncol 16:187–196PubMed

25.

Lambert LA, Armstrong TS, Lee JJ, Liu S, Katz MH, Eng C et al (2009) Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C. Ann Surg Oncol 16:2181–2187PubMedCrossRef

26.

Kantarjian H, Giles F, List A, Lyons R, Sekeres MA, Pierce S et al (2007) The incidence and impact of thrombocytopenia in myelodysplastic syndromes. Cancer 109(9):1705–1714PubMedCrossRef

27.

Liou SY, Stephens JM, Carpiuc KT, Feng W, Botteman MF, Hay JW (2007) Economic burden of haematological adverse effects in cancer patients: a systematic review. Clin Drug Investig 27:381–396PubMedCrossRef

28.

Stinchcombe TE, Choi J, Schell MJ, Mears A, Jones PE, Nachtsheim RV et al (2006) Carboplatin-based chemotherapy in patients with advanced non-small cell lung cancer and a poor performance status. Lung Cancer 2:237–243CrossRef

29.

Gridelli C, Ardizzoni A, Le Chevalier T, Manegold C, Perrone F, Thatcher N et al (2004) Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European Experts Panel. Ann Oncol 15:419–426PubMedCrossRef

30.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655PubMedCrossRef

31.

Armstrong TS, Cao Y, Scheurer ME, Vera-Bolanos E, Manning R, Okcu MF et al (2009) Risk analysis of severe myelotoxicity with temozolomide: the effects of clinical and genetic factors. Neuro Oncol 11:825–832PubMedCrossRef

32.

Kogo M, Watahiki M, Sunaga T, Kaneko K, Yoneyama K, Imawari M et al (2011) Analysis of the risk factors for myelosuppression after chemoradiotherapy involving 5-fluorouracil and platinum for patients with esophageal cancer. Hepatogastroenterology 58:802–808PubMed

33.

Holoye PY, Kalbfleisch J (1984) The influence of myelosuppression on the response to chemotherapy in small cell bronchogenic carcinoma. Cancer 54:411–415PubMedCrossRef

34.

Nalesnik JG, Mysliwiec AG, Canby-Hagino E (2004) Anemia in men with advanced prostate cancer: incidence, etiology, and treatment. Rev Urol 6:1–4PubMed

35.

Khafagy R, Shackley D, Samuel J, O’Flynn K, Betts C, Clarke N (2007) Complications arising in the final year of life in men dying from advanced prostate cancer. J Palliat Med 10:705–711PubMedCrossRef

36.

Elting LS, Rubenstein EB, Martin CG, Kurtin D, Rodriguez S, Laiho E et al (2001) Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thrombocytopenia. J Clin Oncol 19:1137–1146PubMed

37.

Mac MM, Lamborn K, Khan W, Varghese A, Graef L, Knox S (1997) Radiotherapy-associated neutropenia and thrombocytopenia: analysis of risk factors and development of a predictive model. Blood 89:2303–2310

38.

Hefti FF, Bales R (2006) Regulatory issues in aging pharmacology. Aging Cell 5:3–8PubMedCrossRef

39.

Massacesi C, Marcucci F, Rocchi MB, Mazzanti P, Pilone A, Bonsignori M (2004) Factors predicting docetaxel-related toxicity: experience at a single institution. J Chemother 16:86–93PubMed

40.

Matsui K, Masuda N, Uchida Y, Fukuoka M, Negoro S, Yana T et al (1996) Determinants of myelosuppression in the treatment of non-small cell lung cancer with cisplatin-containing chemotherapy. Jpn J Cancer Res 87:781–786PubMedCrossRef

41.

Sloan JA, Goldberg RM, Sargent DJ, Vargas-Chanes D, Nair S, Cha SS et al (2002) Women experience greater toxicity with fluorouracil-based chemotherapy for colorectal cancer. J Clin Oncol 20:1491–1498PubMedCrossRef

42.

43.

Anderson GD (2008) Gender differences in pharmacological response. Int Rev Neurobiol 83:1–10PubMedCrossRef

44.

Kloft C, Wallin J, Henningsson A, Chatelut E, Karlsson MO (2006) Population pharmacokinetic pharmacodynamic model for neutropenia with patient subgroup identification: comparison across anticancer drugs. Clin Cancer Res 12:5481–5490PubMedCrossRef

45.

Hurria A, Hurria A, Brogan K, Panageas KS, Pearce C, Norton L et al (2005) Effect of creatinine clearance on patterns of toxicity in older patients receiving adjuvant chemotherapy for breast cancer. Drugs Aging 22:785–791PubMedCrossRef

Titel: Analysis of the risk factors for myelosuppression after concurrent chemoradiotherapy for patients with advanced non-small cell lung cancer
verfasst von: Nan Jiang
Xiao-Cen Chen
Yue Zhao
Publikationsdatum: 01.03.2013
Verlag: Springer-Verlag
Erschienen in: Supportive Care in Cancer / Ausgabe 3/2013
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-012-1580-y

Neu im Fachgebiet Onkologie

24.04.2024 | DGIM 2024 | Nachrichten

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Analysis of the risk factors for myelosuppression after concurrent chemoradiotherapy for patients with advanced non-small cell lung cancer

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet Onkologie

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Krebspatienten impfen: Was? Wen? Und wann nicht?

Müde im Alter? Auch an die Nebenniere denken

Update Onkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2013

Cancer caregivers’ perceptions of an exercise and nutrition program

Does fear of cancer recurrence predict cancer survivors' health care use?

Implementation of modified early-goal directed therapy for sepsis in the emergency center of a comprehensive cancer center

Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks

Supportive care and not only palliative care in the route of cancer patients

The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer

Neu im Fachgebiet Onkologie

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Krebspatienten impfen: Was? Wen? Und wann nicht?

Müde im Alter? Auch an die Nebenniere denken

Update Onkologie