Avaliação da resposta à quimiorradioterapia neoadjuvante em pacientes com adenocarcinomas retais
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Data
2012-04-26
Autores
Castro, Rafael Amaral de [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O câncer colorretal é o segundo câncer mais comum com 2,4 milhões de pessoas diagnosticadas. Desses casos, 27% são neoplasias retais (NR). Quimiorradioterapia neoadjuvante (QRTN) tornou-se padrão nestes casos, mas trouxe controvérsia no tratamento adjuvante. O objetivo foi avaliar o impacto da resposta patológica completa (RPC). Além disso, investigamos a influência da quimioterapia adjuvante (QADJ) após QRTN, biópsia, tempo entre QRTN e cirurgia e ausência de cirurgia após QRTN. Métodos: Entre mar/96 e Out/2010, 84 pacientes receberam QRTN, 58 foram submetidos à ressecção retal (RR). A QRTN consistiu de 5-FU em bolus, na primeira e na quinta semana das 25 sessões de radioterapia (RT) no acelerador linear (total 45 - 50 Gy). A biópsia foi feita de acordo com a opção do cirurgião após a RT. A cirurgia (excisão mesorretal total - TME), foi realizada idealmente 8 semanas após a QRTN. Aqueles não submetidos à cirurgia, também foram seguidos. Quando realizada, a QADJ consistiu de 5-FU no D1-D5 por 4 ciclos. Avaliação da sobrevida global (SG) e sobrevida livre de doença (SLD) foi realizada com uso da curva de Kaplan-Meier. Resultados: Dos 58 pacientes submetidos à cirurgia, 90% eram estágio II, 51% ocorreram no reto inferior e 66% eram ECOG 1. RPC foi obtida em 25,8% (15) dos casos. Destes, 20% (3) receberam QADJ. Pacientes sem RPC receberam QADJ em 51% dos casos (22). O tempo médio de seguimento foi de 41 meses. Tanto o SLD (p = 0,024) e SG (p = 0,0488) foram maiores em pacientes com RPC independente do uso de QADJ. Por outro lado, o uso de QADJ vs sem QADJ, independente da presença de RPC, não alterou significativamente a SLD (p = 0,74) ou SG (p = 0,32). Em pacientes com RPC, QADJ não interferiu nos desfechos (SLD, p = 0,76; SG, p = 0,73). No grupo dos pacientes sem RPC, o subgrupo com QADJ...
Colorectal cancer is the second most common cancer with 2,4 million people diagnosed. The rectal cancer (RC) is 27% of these cases. Neoadjuvant chemoradiotherapy (NCRT) has become standard but brought controversy in the adjuvant treatment. The objective was to assess the impact of Pathologic Complete Response (pCR). Furthermore, we investigated the influence of adjuvant chemotherapy (ADJC) after NCRT, biopsy and time between NCRT and surgery, and the absence of surgery after NCRT. Methods: Between mar/96 and Oct/2010, 84 patients received NCRT, and 58 patients underwent resection of the rectum. The NCRT consisted of 5- Fluorouracil (5-FU) and Leucovorin (LV) bolus in the 1st and 5th week of the 25 sessions of radiotherapy (RT) in linear accelerator (total 45 - 50 Gy). Biopsy was made according to the surgeon option after RT. Ideally surgery (Total mesorretal excision - TME) was performed after 8 weeks NCRT ends. Those not undergoing surgery, were followed too. When performed, Adjuvant Chemotherapy (ADJC) consisted of 5-FU and LV bolus on D1-D5 for 4 cycles. Evaluation of Overall Survival (O.S) and Disease-Free Survival (DFS) performed using Kaplan-Meier curve. Results: Of the 58 patients who underwent surgery, 90% were stage II, 51% occurred in the lower rectum, 66% were ECOG 1 and pCR was obtained in 25.8% (15) of patients (group 1). Of these, 20% (3) received ADJC. Patients without PCR (group 2) received ADJC in 51% of the cases (22). The mean follow-up was 41 months. Both the DFS (p = 0.024) and OS (p = 0.0488) were higher in patients with pPCR independent of the use of ADJC. Patients treated with ADJC vs without ADJC, independent of presence of pCR, did not alter DFS (p = 0.74) or OS (p = 0.32). In pCR patients, ADJC do not interfere in the outcome... (Complete abstract click electronic access below)
Colorectal cancer is the second most common cancer with 2,4 million people diagnosed. The rectal cancer (RC) is 27% of these cases. Neoadjuvant chemoradiotherapy (NCRT) has become standard but brought controversy in the adjuvant treatment. The objective was to assess the impact of Pathologic Complete Response (pCR). Furthermore, we investigated the influence of adjuvant chemotherapy (ADJC) after NCRT, biopsy and time between NCRT and surgery, and the absence of surgery after NCRT. Methods: Between mar/96 and Oct/2010, 84 patients received NCRT, and 58 patients underwent resection of the rectum. The NCRT consisted of 5- Fluorouracil (5-FU) and Leucovorin (LV) bolus in the 1st and 5th week of the 25 sessions of radiotherapy (RT) in linear accelerator (total 45 - 50 Gy). Biopsy was made according to the surgeon option after RT. Ideally surgery (Total mesorretal excision - TME) was performed after 8 weeks NCRT ends. Those not undergoing surgery, were followed too. When performed, Adjuvant Chemotherapy (ADJC) consisted of 5-FU and LV bolus on D1-D5 for 4 cycles. Evaluation of Overall Survival (O.S) and Disease-Free Survival (DFS) performed using Kaplan-Meier curve. Results: Of the 58 patients who underwent surgery, 90% were stage II, 51% occurred in the lower rectum, 66% were ECOG 1 and pCR was obtained in 25.8% (15) of patients (group 1). Of these, 20% (3) received ADJC. Patients without PCR (group 2) received ADJC in 51% of the cases (22). The mean follow-up was 41 months. Both the DFS (p = 0.024) and OS (p = 0.0488) were higher in patients with pPCR independent of the use of ADJC. Patients treated with ADJC vs without ADJC, independent of presence of pCR, did not alter DFS (p = 0.74) or OS (p = 0.32). In pCR patients, ADJC do not interfere in the outcome... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Quimioterapia, Radioterapia, Reto - Câncer, Intestino grosso - Câncer, Adenocarcinoma, Colorectal cancer - Chemoradiotherapy
Como citar
CASTRO, Rafael Amaral de. Avaliação da resposta à quimiorradioterapia neoadjuvante em pacientes com adenocarcinomas retais. 2012. 39 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2012.