Incidence of Neutropenia in Locally Advanced Esophageal Carcinoma treated with concurrent chemoradiation

Abstract

Objective: To analyse incidence of neutropenia in locally advanced esophageal carcinoma treated with cisplatin & 5 flurouracil based chemo radiation. Methods: This descriptive case series study was conducted in the Department of Clinical Oncology LINAR Cancer Hospital Larkana from January 2016 to August 2017 ,on histological proven squamous cell carcinoma of esophagus with Inclusion criteria locally advanced stage, good performance status (ECOG-0,01,02),normal blood counts, normal hepatic & renal profiles. Exclusion criteria with carcinoma of cervical esophagus, infiltration of tumor in tracheobronchial tree, distant metastasis. We planned our patients with EBRT have total dose of radiation 50.4Gy in 28 fractions. Inj Cisplatin 75mg/m2 IV D1 & Inj 5- Flurouracil 1000mg/m2 IV D1 to D4 were infused during 1st & 5th week of external beam radiotherapy & 8th & 11th weeks. Neutropenia was assessed on weekly basis through complete blood counts(CBC ) during course of con current chemoradiation & later on during two cycles of adjuvant chemotherapy infused after chemoradiation. Neutropenia grading were performed on basis of common Terminology Criteria for Adverse Events (CTC AE).The data was statistically analyzed. Results: Majority of patients have age above 40 years. The average age of patients & duration of disease were 46.45+/- 10.59 years(95%CI :46.45+/- 10.59) and 3.5 +/-1.17 months(95%CI:3.20 to 3.80) respectively.out of 62 cases 27(43.5%) were male & 35(56.5%) were female. Chemoradiation induced neutropenia was assessed on complete blood counts on weekly basis. Neutropenia grading were performed. Neutropenia grading from grade 1 to 4 were 2%,34%,48%,16% cases respectively. Conclusion: Chemotherapy induced neutropenia is most common oncological emergency. It increases morbidity and mortality if not assessed timely during cancer treatment.