Vol. 13 Núm 3

Quimioradioterapia neoadyuvante en cáncer de recto localmente avanzado

Ocanto A, Rodríguez I, Belinchón B, Glaría L, Morera M. 

 

Texto completo [PDF]

Resumen (ES)

El tratamiento neoadyuvante con radioterapia y quimioterapia radiosensibilizante es el estándar de tratamiento para el cáncer de recto localmente avanzado (CRLA). El objetivo de este estudio es analizar la respuesta patológica tras el tratamiento neoadyuvante. Se realizó un estudio observacional descriptivo y retrospectivo en pacientes con diagnóstico de adenocarcinoma de recto desde enero 2018 a diciembre 2018 en el Servicio de Oncología-Radioterápica del Hospital Universitario La Paz. Se incluyeron 51 pacientes. Un grupo de pacientes (82,4%) se trató con radioterapia tridimensional conformada (3D-CRT)con una dosis de 45 Gray (Gy) sobre pelvis y una sobreimpresión de 5,4 Gy sobre tumor primario y otro grupo (17,6%) se trató con radioterapia con técnica de arcoterapia volumétrica de intensidad modulada (VMAT) y verificación diaria con radioterapia guiada por imágenes (IGRT) con una dosis de 53,7 Gy en pelvis con sobreimpresión concurrente al tumor. La dosis de capecitabina oral fue de 850 mg/m2 dos veces al día durante el tratamiento. Todos los pacientes fueron reevaluados con resonancia magnética (RM) post-neoadyuvancia. Los pacientes se operaron entre 6-8 semanas tras quimioradioterapia. La respuesta patológica completa fue de 15,6% y la respuesta patológica parcial de 80,5% con una tasa global de downstaging de 33%. Se concluye que la quimioradioterapia neoadyuvante es un tratamiento seguro con aceptables tasas de control local en los pacientes con CRLA con escasa toxicidad aguda.

Palabras clave: Quimioradioterapia; cáncer; recto; respuesta patológica.

Resumen (EN)

Neoadjuvant treatment with radiotherapy and radiosensitizing chemotherapy is the standard of treatment for locally advanced rectal cancer (LARC). The objective of this study is to analyze the pathological response after neoadjuvant treatment. This is a descriptive and retrospective observational study in patients diagnosed with rectal adenocarcinoma from January 2018 to December 2018 at the Radiation Oncology Department of Hospital Universitario La Paz. 51 patients were included. One group of patients (82.4%) was treated with three-dimensional conformal radiotherapy (3D-CRT) with a dose of 45 Gray (Gy) on the pelvis and an boost of 5.4 Gy on the primary tumor and another group (17.6 %) was treated with radiotherapy with volumetric arcotherapy technique (VMAT) and daily verification with image-guided radiotherapy (IGRT) with a dose of 53.7 Gy in the pelvis with concurrent tumor boost. The oral capecitabine dose was 850 mg/m2 twice daily during treatment. All patients were reevaluated with post-neoadjuvant magnetic resonance imaging (MRI). The patients underwent surgery 6-8 weeks after chemoradiotherapy. Complete pathological response was of 15.6% and partial pathological response of 80.5% with an overall downstaging rate of 33%. It is concluded that neoadjuvant chemoradiotherapy is a safe treatment with acceptable local control rates in patients with LARC with little acute toxicity.

Keywords: Chemoradiotherapy; cancer; rectum; pathological response

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