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

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.
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.
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).
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.
This study investigated the clinical impact of primary prophylaxis with a long-acting supportive medication, pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF), in patients receiving definitive concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer. CCRT, while standard curative treatment, is frequently complicated by severe neutropenia, which can lead to treatment delays, dose reductions, and increased risk of infections.In this retrospective analysis of 240 patients, those who received prophylactic PEG-rhG-CSF from the first chemotherapy cycle experienced significantly lower rates of severe neutropenia and its complications compared to those managed with short-acting G-CSF only after complications occurred. This effective mitigation of a key hematological toxicity was associated with better adherence to the planned curative therapy. Specifically, the PEG-rhG-CSF group had fewer prolonged interruptions to radiotherapy, a higher likelihood of receiving the full planned dose of chemotherapy, and a greater proportion of patients completing all treatment cycles.With a median follow-up exceeding four years, the analysis found that patients receiving prophylactic PEG-rhG-CSF had a longer time without cancer progression (progression-free survival). A positive trend toward longer overall survival was also observed, though not statistically significant in this cohort.In conclusion, the findings suggest that integrating primary prophylaxis with long-acting G-CSF into the management of locally advanced cervical cancer patients undergoing CCRT is associated with enhanced treatment delivery and more favorable survival outcomes, supporting its consideration within comprehensive supportive care strategies for this curative-intent setting.