Effective prevention of postoperative recurrence of a granulocyte colony-stimulating factor-producing fallopian tube carcinoma by using concurrent chemoradiotherapy

Abstract

Granulocyte colony-stimulating factor (G-CSF)-producing tumors are very rare in the field of gynecology and generally tend to have poor prognoses. We report a case of platinum-refractory G-CSF-producing fallopian tube cancer that was successfully treated with concurrent chemotherapy and TomoTherapy®. A 76-year-old woman with an abnormally high white blood cell (WBC) count was referred to our hospital by a local clinic. Comprehensive laboratory testing excluded a possible hematological disorder; however, on the basis of imaging findings, surgery was scheduled for a suspected fallopian tube cancer. The results of blood tests performed after the patient arrived at our hospital revealed a WBC count of 67000 cells/µL and a maximum neutrophil percentage of 96.6 %. Total hysterectomy and bilateral salpingo-oophorectomy were performed, and the histopathological analysis revealed a poorly differentiated serous adenocarcinoma of the fallopian tube. However, the postoperative blood tests revealed a G-CSF level of 183 pg/mL (normal range is <39 pg/mL). Because the preoperative WBC count and neutrophil percentage were high and the pathological specimens stained positive for G-CSF on immunohistochemical analysis, a diagnosis of a G-CSF-producing tumor was made. The tumor enlarged even though combination chemotherapy of paclitaxel and carboplatin was administered and concurrent chemoradiotherapy (CCRT) with TomoTherapy® and nedaplatin was administered. The G-CSF level increased to 852 pg/mL, after which the tumor subsequently reduced in size and the G-CSF level normalized; currently, a complete response has been maintained for 1.5 years post-surgery. This case suggests that primary TomoTherapy®-based CCRT might be effective for the treatment of G-CSF-producing tumors.