Recombinant human granulocyte macrophage colony-stimulating factor for the prevention and treatment of oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma

Abstract

Objective To observe the effect of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on the prevention and treatment of oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma. Methods A total of 64 patients with locally advanced nasopharyngeal carcinoma from April 2015 to April 2017 in the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled. The patients were randomly divided into the observation group (32 cases) and the control group (32 cases) according to the random number table method. Both groups were treated with intensity modulated radiotherapy (IMRT) and synchronized with TP regimen (docetaxel + cisplatin) chemotherapy for 2 cycles. Both groups were treated with mouthwash at the beginning of radiotherapy to prevent oral mucositis. The observation group was given rhGM-CSF mouthwash, and the control group was given compound borax mouthwash. The oral mucositis and the oral pain during the treatment and the end of the treatment were evaluated by using American Radiation Oncology Group (RTOG)grading criteria and visual analogue scoring method (VAS) grading criteria. The time of onset of oral mucositis and the total time of radiotherapy in both groups was also recorded. Results All the patients were treated with concurrent chemoradiotherapy. The total radiotherapy time in the observation group was less than that in the control group [(46.4±1.6) vs. (48.2±3.2) d, t=-2.720, P=0.009]. The clinical total effective rate was 93.8% (30/32) in the observation group and 96.9% (31/32) in the control group respectively (χ 2=0.35, P = 0.554). The occurrence of grade 1, 2 and 3 oral mucositis in the observation group was (20.9±2.5), (29.3±2.4), and (34.5±1.8) d respectively, which was latter than that in the control group [(16.3±2.0), (24.2±2.2) and (31.0±2.2) d] respectively (t = 8.125, P = 0.000; t = 8.840, P = 0.000; t = 6.944, P = 0.001). During concurrent chemoradiotherapy, the incidence of grade 3 oral mucositis in the observation group was lower than that in the control group [31.2% (10/32) vs. 56.2% (18/32); Z = -2.197, P = 0.028]. At the end of concurrent chemoradiotherapy, the total incidence of grade 2 and grade 3 oral mucositis in the observation group was lower than that in the control group [53.1% (17/32) vs. 81.2% (26/32); Z = -2.708, P = 0.007]. The incidence of moderate and severe oral pain caused by oral mucositis in the observation group was lower than that in the control group [46.9% (15/32) and 6.2% (2/32) vs. 59.4% (19/32) and 15.6% (5/32), respectively; Z = -2.009, P = 0.045]. Conclusion rhGM-CSF mouthwash can delay the occurrence of oral mucositis, reduce the incidence of oral mucositis and oral pain to effectively prevent and treat oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma, which is worthy of clinical application. Key words: Nasopharyngeal neoplasms; Radiotherapy; Antineoplastic combined chemotherapy protocols; Stomatitis; Granulocyte macrophage colony-stimulating factors, recombinant