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Amifostine-related Fever-rash during fractionated radiotherapy: diagnostic and predictive role of C-reactive protein.
MedLine Citation:
PMID:  20838325     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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 AND METHODS: : 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%.
Authors:
Michael I Koukourakis; Dimitra Pitsiava; Alexandra Giatromanolaki; Georgia Kambouromiti; Efthimios Sivridis; George Kartalis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of clinical oncology     Volume:  34     ISSN:  1537-453X     ISO Abbreviation:  Am. J. Clin. Oncol.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8207754     Medline TA:  Am J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  281-5     Citation Subset:  IM    
Affiliation:
From the Departments of *Radiotherapy/Oncology, †Internal Medicine, ‡Pathology, and §Biochemistry, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
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