EFFICACY OF GRANULOCYTE MACROPHAGE-COLONY STIMULATING FACTOR ON ORAL MUCOSITIS

Purpose: Investigating the efficacy of granulocyte-macrophage colony stimulating factor as a mouthwash solution on radiotherapy-induced high-grade mucositis. Patients and Method: Patients with head and neck cancer who were planned to receive radiotherapy, with a Karnofsky performance status of 70 and above were included in the study. Oral cavity was evaluated and microbiological examination was performed before treatment. Nine patients received concomitant boost radiotherapy while 23 patients received conventional fractionation. Evaluation of mucosal toxicity was done according to the RTOG mucosal reaction scoring system and photographs of oral mucosal reactions were taken. Patients having grade 3-4 mucositis used 400 ug of GM-CSF in 250 cc of water as a mouthwash solution for 5 days. Results: Of the 32 patients who received radiotherapy for head and neck cancer 22 (68%) had high-grade (grade 3-4) mucosal toxicity. The influence of gender, stage, smoking, surgery and RT volume on mucosal toxicity was investigated. Only the correlation between the development of high-grade mucositis and smoking was statistically significant (p=0.04). After five days of GM-CSF application partial response was achieved in 64% of the patients and 32% of the patients had complete response. Subjective evaluation revealed that 68% of the patients had partial response and 23% of them had complete response. Results of objective and subjective evaluations were consistent. Overall treatment time was not increased in any of the patients and no correlation was found between application of GM-CSF and hematological values. Conclusion: In our study, topical application of GM-CSF in radiotherapy-induced high-grade oral mucositis in head and neck cancer patients was found to be effective according to objective and subjective criteria, but still comparative studies on symptomatic treatment of mucositis are needed.

Keywords: head and neck cancer, mucositis, gm-csf