同步放化疗期间应用聚乙二醇化重组人粒细胞刺激因子中国专家共识（2023版）

doi:10.3760/cma.j.cn371439-20230227-00039

摘要/Abstract

摘要：

中性粒细胞减少症是恶性肿瘤患者同步放化疗期间最常见的血液学毒性，导致后续治疗延迟和（或）剂量减少，易引发中性粒细胞减少性发热及严重感染，影响患者预后及安全。合理预防和管理恶性肿瘤患者同步放化疗期间的中性粒细胞减少症至关重要。聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）作为重组人粒细胞刺激因子的长效制剂，可预防和治疗中性粒细胞减少症，临床使用更加便捷。为促进临床合理用药，中国医师协会放射肿瘤治疗医师分会、中华医学会放射肿瘤治疗学分会、中国抗癌协会肿瘤放射治疗专业委员会参考PEG-rhG-CSF相关指南及最新循证证据，评估其在同步放化疗期间应用的有效性及安全性，明确预防与治疗的临床路径及给药方式，形成同步放化疗期间应用PEG-rhG-CSF中国专家共识。

关键词: 化放疗, 中性粒细胞减少, PEG-rhG-CSF, 临床共识

Abstract:

Neutropenia is the most common hematologic toxicity of concurrent chemoradiotherapy for malignant tumor patients， which can lead to follow-up treatment delay and/or dose reduction， induce febrile neutropenia and severe infection easily， thus affecting prognosis and safety of patients. It is important to prevent and manage neutropenia in patients with malignant tumors during concurrent chemoradiotherapy reasonably. As a long-acting preparation of recombinant human granulocyte colony-stimulating factor， pegylated recombinant human granulocyte colony-stimulating factor （PEG-rhG-CSF） can prevent and treat neutropenia， which is more convenient for clinical practice. In order to promote clinical rational administration of drugs， Radiation Oncology Treatment Physician Branch of Chinese Medical Doctor Association， Radiation Oncology Therapy Branch of Chinese Medical Association， Chinese Association of Radiation Therapy of China Anti-Cancer Association consulted guidelines and the latest evidence-based evidences related to PEG-rhG-CSF， evaluated the effectiveness and safety of the application of PEG-rhG-CSF during concurrent chemoradiotherapy， clarified the clinical pathway and administration route of prevention and treatment and then formed a Chinese experts' consensus on the application of PEG-rhG-CSF during concurrent chemoradiotherapy.

Key words: Chemoradiotherapy, Neutropenia, PEG-rhG-CSF, Clinical consensus

中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 同步放化疗期间应用聚乙二醇化重组人粒细胞刺激因子中国专家共识（2023版）[J]. 国际肿瘤学杂志, 2023, 50(4): 193-201.

Radiation Oncology Treatment Physician Branch, Chinese Medical Doctor Association, Radiation Oncology Therapy Branch, Chinese Medical Association, Chinese Association of Radiation Therapy, China Anti-Cancer Association. Chinese experts' consensus on the application of pegylated recombinant human granulocyte colony-stimulating factor during concurrent chemoradiotherapy （2023 version）[J]. Journal of International Oncology, 2023, 50(4): 193-201.

图/表 4

表1

表2

常用同步放化疗方案的FN发生风险及3~4级中性粒细胞减少症发生率"

肿瘤类型	放化疗方案	放化疗剂量				FN发生风险	3~4级中性粒细胞减少症发生率
头颈部肿瘤	顺铂+同步放疗^[16]	顺铂		100 mg/m²，d1，q3w		低危	—
		同步放疗		72 Gy，1.8或1.5 Gy/次
小细胞肺癌^a	依托泊苷+顺铂+同步放疗^[17-18]	依托泊苷		100 mg/（m²·d），d1~3		高危	75%~95%
		顺铂		75~80 mg/m²，d1或25 mg/（m²·d），d1~3，q3w
		同步放疗		45 Gy，1.5 Gy/次，bid/3w
	依托泊苷+顺铂+同步放疗^[17]	依托泊苷		100 mg/（m²·d），d1~3		中危	64%
		顺铂		75 mg/m²，d1或25 mg/（m²·d），d1~3，q3w
		同步放疗		60~70 Gy，1.8~2.0 Gy/次
非小细胞肺癌	顺铂+多西他赛+同步放疗^[19]	顺铂		40 mg/m²，d1、8、29、36		高危	62%
		多西他赛		40 mg/m²，d1、8、29、36
		同步放疗		60 Gy/30次
	顺铂+长春瑞滨+同步放疗^[10,20]	顺铂		80 mg/m²，d1		中危	52%~77%
		长春瑞滨		20 mg/m²，d1、8，q4w
		同步放疗		60~72 Gy/30次
	顺铂+依托泊苷+同步放疗^[21]	顺铂		50 mg/m²，d1、8、29、36		低危	28.7%
		依托泊苷		50 mg/m²，d1~5，d29~33
		同步放疗		60~66 Gy/30~33次
	顺铂+培美曲塞+同步放疗^[21]	顺铂		75 mg/m²，d1		低危	18.4%
		培美曲塞		500 mg/m²，d1，q3w
		同步放疗		60~66 Gy/30~33次
食管癌	多西他赛+顺铂+氟尿嘧啶+同步放疗^[22]	多西他赛		35 mg/m²，d1		高危	56.6%
		顺铂		40 mg/m²，d1
		氟尿嘧啶		400 mg/（m²·d），d1~5，q2w
		同步放疗		50.4 Gy/28次
	顺铂+氟尿嘧啶+同步放疗^[12]	顺铂		75 mg/m²，d1、29		中危	41%
		氟尿嘧啶		1 000 mg/m²，d1~4，d29~33
		同步放疗		50.4 Gy/28次
	卡铂+紫杉醇+同步放疗^[23]b	卡铂		AUC=2，d1，qw		中危	27%
		紫杉醇		50 mg/m²，d1，qw
		同步放疗		50 Gy/25次
	卡铂+紫杉醇+同步放疗^[24]b	卡铂		AUC=2，d1，qw		低危	9%
		紫杉醇		50 mg/m²，d1，qw
		同步放疗		41.4 Gy/23次
	顺铂+替吉奥+同步放疗^[25]	替吉奥		80~100 mg/（m²·d），d1~14		低危	37.9%
		顺铂		70 mg/m²，d8，q3w
		同步放疗		30 Gy/15次
	顺铂+长春瑞滨+同步放疗^[26]	长春瑞滨		25 mg/m²，d1、8		未报道	45.7%
		顺铂		75 mg/m²，d1或25 mg/（m²·d），d1~4，q3w
		同步放疗		40 Gy/20次
	顺铂+紫杉醇+同步放疗^[27]	紫杉醇		50 mg/m²，d1、8、15、22、29		未报道	29%
		顺铂		30 mg/m²，d1、8、15、22、29
		同步放疗		45 Gy/25次
结直肠癌	卡培他滨+伊立替康+同步放疗^[28]		卡培他滨		625 mg/m²，bid，每周5天	低危		20%
			伊立替康		80或65 mg/（m²·w）
			同步放疗		50 Gy/25次
	卡培他滨+同步放疗^[28]		卡培他滨		825 mg/m²，bid，每周5天	低危		2%
			同步放疗		50 Gy/25次
宫颈癌	顺铂+紫杉醇+同步放疗^[29]		紫杉醇		150 mg/m²，d1	中危		77.78%
			顺铂		35 mg/（m²·d），d1~2，q3w
			同步放疗		45 Gy/25次
	顺铂+同步放疗^[30]		顺铂		40 mg/m²，d1，qw	低危		3.80%
			同步放疗		1.8 Gy/（次·d），25~28次

表2

图1

图2

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推荐级别	代表意义
1类	基于高级别临床研究证据，专家意见高度一致
2A类	基于低级别临床研究证据，专家意见高度一致；或基于高级别证据，专家意见基本一致
2B类	基于低级别临床研究证据，专家意见基本一致
3类	不论基于何种级别临床证据，专家意见明显分歧