Primary prophylaxis with pegylated G-CSF is associated with improved treatment completion and progression-free survival in locally advanced cervical cancer undergoing concurrent chemoradiotherapy: a retrospective cohort study.

BACKGROUND

Concurrent cisplatin-based chemoradiotherapy (CCRT) for locally advanced cervical cancer is often limited by severe neutropenia. This study evaluated whether primary prophylaxis with pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) improves outcomes.

METHODS

240 patients were categorized into a prophylactic PEG-rhG-CSF group (n = 80) and a control group (n = 160). The cohort included patients on various platinum-based regimens to reflect real-world practice; regimen heterogeneity was addressed as a covariate in adjusted analyses. Endpoints included grade 3-4 neutropenia, treatment delivery, and survival.

RESULTS

Prophylactic PEG-rhG-CSF significantly reduced grade 3-4 neutropenia (22.5% vs. 42.5%, p = 0.002) and febrile neutropenia. It was also associated with improved treatment delivery, specifically fewer radiotherapy interruptions (>5 consecutive days; 6.3% vs. 16.9%, p = 0.022) and a higher rate of planned chemotherapy cycle completion. With a median follow-up of 53.5 months, the PEG group showed significantly better progression-free survival (HR, 0.660; 95% CI, 0.508-0.857; p = 0.002) and a trend toward improved overall survival (HR, 0.788; 95% CI, 0.600-1.034; p = 0.094).

CONCLUSIONS

In this retrospective analysis, primary prophylaxis with PEG-rhG-CSF was associated with reduced severe neutropenia, better adherence to planned CCRT, and longer progression-free survival. These findings support its consideration within standard supportive care for this population and warrant prospective validation.