Treatment of irradiation-induced mucositis with growth factors (rhGM-CSF) in patients with head and neck cancer

Abstract

Background: Mucositis is a frequent side-effect of radiotherapy which often causes interruption of therapy and consequently decreases the probability of remission or cure, rhGM-CSF may ameliorate symptoms of mucositis by increasing the immune response via macrophage activation and stimulation of secondary cytokines.

Patients and methods: 32 patients with locally advanced head and neck cancer were treated with adjuvant local radiotherapy after surgery (60 Gy in 30 dose fractions). In a pilot study, 16 patients received rhGM-CSF for five days, starting after a radiation dose of 20 Gy. These patients were compared retrospectively with a control group of 16 matching patients. Patients were assessed according to the Oral Assessment Guide (OAG), the Composite Mucositis Score (CMS) and the Common Toxicity Criteria (CTC) for severity of mucositis and pain.

Results: When compared with controls, patients on rhGM-CSF treatment showed decreased OAG, CMS and CTC scores. During the following irradiation courses mucositis was less severe in patients previously treated with rhGM-CSF. With regard to pain relief, rhGM-CSF-treated patients demonstrated a statistically significant improvement (p = 0.011), compared with controls.

Conclusion: rhGM-CSF affected the severity of oral mucositis and reduced the related pain. As rhGM-CSF was well tolerated, this effect will be further investigated in prospective, controlled study.