Amifostine-related fever-rash during fractionated radiotherapy: diagnostic and predictive role of C-reactive protein.
Am J Clin Oncol
; 34(3): 281-5, 2011 Jun.
Article
em En
| MEDLINE
| ID: mdl-20838325
ABSTRACT
INTRODUCTION:
Fever/rash is a side-effect of amifostine that demands immediate interruption of the drug. Here, we focus on the role of C-reactive protein (CRP) as a putative marker linked with amifostine fever/rash. MATERIALS ANDMETHODS:
The CRP serum values were analyzed in 496 patients receiving radiotherapy supported with amifostine (500-1000 mg/d). CRP levels were recorded before the onset of radiotherapy (day 0), on day 15 and when the fever/rash appeared. For 121 out of 496 patients, CRP values on day 7 were also available. About 79 patients (15.9%) developed fever/rash symptoms.RESULTS:
The CRP levels before the onset of therapy were 0 to 20.7 mg/dL (normal, ≤0.5 mg/dL). For patients who did not develop fever/rash, the CRP levels increased from a median of 0.30 to 0.50 on day 15; P = 0.001. Patients who developed fever/rash showed a more than 7-fold increase of the median CRP levels (median, 3.50; P < 0.0001). This sharp CRP rise was specific for amifostine-related fever/rash. Initially abnormal CRP levels were linked with a 2-fold risk for fever/rash (P = 0.01), while abnormal levels on day 7 were linked with a 3-fold higher risk (P = 0.08). The occurrence of fever/rash was independent of the amifostine dose level.CONCLUSIONS:
Sharp rise of CRP levels on the day after the fever/rash development suggest amifostine-related etiology of fever/rash. Abnormal initial CRP levels and/or high CRP levels on day 7 should be considered as an alert signal as the probability to develop fever/rash reaches the 30%.
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Base de dados:
MEDLINE
Assunto principal:
Protetores contra Radiação
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Radioterapia
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Proteína C-Reativa
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Toxidermias
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Amifostina
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Fracionamento da Dose de Radiação
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Febre
Idioma:
En
Ano de publicação:
2011
Tipo de documento:
Article