[Supportive therapy during radiochemotherapy--prevention and therapy of infections]

In current radiooncology the consistent use of best supportive care during aggressive combined treatment protocols is indispensible. Presently the optimal management of fever in granulocytopenic patients is controversially discussed.

Based on own clinical experiences and a literature review we report about empiric antibiotic and antifungal therapy in febrile patients with granulocytopenia. Particular consideration is given to the new antifungal agent fluconazole (compared to amphotericin B) and the beta-lactamase inhibitor sulbactam. We also discuss the use of hematopoietic growth factors and selective gastrointestinal decontamination.

In fever of unknown origin the use of a two drug antibiotic combination containing an ureidopenicillin (acyl-penicillin) and an aminoglycoside is recommended. After five days of persisting fever additional antimycotic therapy is initiated. Fluconazole shows a high response rate with only few side effects in the treatment of infections with candida albicans and cryptococcus neoformans. In the early empiric antifungal therapy it is more and more replacing amphotericin B. With encouraging results sulbactam can be combined with piperacillin or mezlocillin during radiochemotherapy. Concerning G-CSF there are no general recommendations allowed. We prefer a calculated prophylaxis for patients who receive a myelotoxic chemotherapy and have a high individual risk for severe neutropenia. During the second day of reverse isolation we start a selective decontamination of the digestive tract until white-blood-cell-count increases to more than 1000 to 1500 granulocytes/mm3.

The radiooncologist should be able to completely manage prevention and treatment of infectious diseases to provide an optimal use of all new options in combined modality treatment in radiooncology.