Resultados oncológicos del manejo neoadyuvante con quimiorradioterapia seguido de cirugía en cáncer de recto localmente avanzado: en el Instituto Oncológico Nacional de Panamá
[Oncologic results of neoadjuvant management with chemoradiotherapy followed by surgery in locally advanced rectal cancer: at the Oncology Institute of Panama]Iván Alberto Díaz Dubarrán1
, César Gonzalo Díaz Selles11. Departamento de Cirugía Oncológica del Instituto Oncológico Nacional. Panamá, Rep. de Panamá.
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Resumen
Antecedentes y objetivos: Se reportan 720 000 nuevos casos cada año de cáncer de recto. En la etapa localmente avanzada (LARC), la terapia multimodal seguido de cirugía con escisión total del mesorrecto (TME) es el estándar de tratamiento con potenciales beneficios en toxicidad aguda, valoración de respuesta y resecabilidad. El objetivo es describir las características clínico-patológicas y resultados oncológicos en pacientes tratados con quimiorradioterapia neoadyuvante seguido de cirugía radical.
Materiales y métodos: Estudio descriptivo, no experimental, transversal y retrospectivo en donde se analizaron 141 pacientes con diagnóstico de LARC definido como cT3T4N0 o cTXN+M0 programados para tratamiento con quimiorradioterapia neoadyuvante en el Instituto Oncológico Nacional durante el período de enero 2014 a diciembre 2019.
Resultados: Un total de 119 pacientes completaron quimiorradioterapia neoadyuvante seguido de cirugía radical resultando en una resecabilidad de 90.1%. La tasa global de complicaciones posoperatorias fue de 17.4%. La tasa de pCR (La respuesta patológica completa) y desvalorización fue 19.6% y 70.6% respectivamente. La categoría N preoperatoria fue la única variable con un impacto estadísticamente significativo con respecto a la pCR vs no pCR (p = 0.04). La mediana de seguimiento fue de 39 meses, obteniendo una supervivencia global a 5 años de 69% y una supervivencia libre de enfermedad a 5 años de 74.4%.
Conclusiones: En el Instituto Oncológico Nacional de Panamá, el tratamiento del LARC con curso largo de quimiorradioterapia seguido de cirugía radical demostró una alta adherencia al tratamiento con una tasa de respuesta patológica completa y control local en concordancia con lo reportado a nivel internacional.
Abstract
Background and objectives: 720,000 new cases of rectal cancer are reported each year. In the locally advanced stage (LARC), multimodal therapy followed by surgery with total mesorectal excision (TME) is the standard of care with potential benefits in acute toxicity, response assessment and resectability. The objective is to describe the clinicopathological characteristics and oncological results in patients treated with neoadjuvant chemoradiation therapy followed by radical surgery.
Methods: A descriptive, non-experimental, cross-sectional and retrospective study in which the clinical records of 141 patients diagnosed with LARC defined as cT3T4N0 or cTXN+M0 scheduled for treatment with neoadjuvant chemoradiation therapy at the National Oncology Institute during the period from January 2014 to December 2019 were analyzed.
Results: A total of 119 patients completed neoadjuvant chemoradiotherapy followed by radical surgery, resulting in a resectability of 90.1%. The overall rate of postoperative complications was 17.4%. The pCR and downstaging rate was 19.6% and 70.6%, respectively. Preoperative N category was the only variable with a statistically significant impact regarding pCR vs no pCR (p = 0.04). The median follow-up was 39 months, obtaining a 5-year overall survival of 69% and a 5-year disease-free survival of 74.4%.
Conclusion: At the National Oncology Institute of Panama, the treatment of LARC with a long course of chemoradiation therapy followed by surgery with curative intent demonstrated high adherence to treatment with a rate of complete pathological response and local control in accordance with international reports.
Citas
[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209–49.
[2] Kuipers EJ, Grady WM, Lieberman D, Sifferlin T, Sung JJ, Boelens PG, et al. Colorectal cancer. Nat Rev Dis Primers. 2015 Nov 5;1.
[3] Díaz Beveridge R, Akhoundova D, Bruixola G, Aparicio J. Controversies in the multimodality management of locally advanced rectal cancer. Vol. 34, Medical Oncology. Humana Press Inc.; 2017.
[4] Gately L, Wong HL, Tie J, Wong R, Lee M, Lee B, et al. Emerging strategies in the initial management of locally advanced rectal cancer. Future Oncology. 2019;15(25):2955–65.
[5] Brenner H, Kloor M, Pox CP. Colorectal cancer. In: The Lancet. Elsevier B.V.; 2014. p. 1490–502.
[6] Benson AB, Venook AP, Al-Hawara MM, Arain MA, Chen YJ, Ciombor KK, et al. Rectal cancer, version 6.2020: Featured updates to the NCCN guidelines. Vol. 18, JNCCN Journal of the National Comprehensive Cancer Network. Harborside Press; 2020. p. 807–15.
[7] Oronsky B, Reid T, Larson C, Knox SJ. Locally advanced rectal cancer: The past, present, and future. Vol. 47, Seminars in Oncology. W.B. Saunders; 2020. p. 85–92.
[8] Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer [Internet]. Vol. 17, n Engl j med. 2004.
[9] Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: Results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. Journal of Clinical Oncology. 2012 Jun 1;30(16):1926–33.
[10] Calata J, Perterson CY. Disparities in rectal cancer care: A call to action for all. The American Journal of Surgery. 2021 May 1;223(5).
[11] Al-Sukhni E, Attwood K, Mattson DM, Gabriel E, Nurkin SJ. Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer. Ann Surg Oncol. 2016 Apr 1;23(4):1177–86.
[12] Body A, Prenen H, Lam M, Davies A, Tipping-Smith S, Lum C, et al. Neoadjuvant Therapy for Locally Advanced Rectal Cancer: Recent Advances and Ongoing Challenges. Vol. 20, Clinical Colorectal Cancer. Elsevier Inc.; 2021. p. 29–41.
[13] Taylor FGM, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-Year follow-up results of the MERCURY Study. Journal of Clinical Oncology. 2014 Jan 1;32(1):34–43.
[14] Gersak MM, Badea R, Graur F, al Hajjar N, Furcea L, Dudea SM. Endoscopic ultrasound for the characterization and staging of rectal cancer. Current state of the method. Technological advances and perspectives. Vol. 17, Medical Ultrasonography. Societatea Romana de Ultrasonografie in Medicina si Biologie; 2015. p. 227–34.
[15] Santiago I, Rodrigues B, Barata M, Figueiredo N, Fernandez L, Galzerano A, et al. Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide. Vol. 12, Insights into Imaging. Springer Science and Business Media Deutschland GmbH; 2021.
[16] Feeney G, Sehgal R, Sheehan M, Hogan A, Regan M, Joyce M, et al. Neoadjuvant radiotherapy for rectal cancer management. World J Gastroenterol. 2019 Sep 7;25(33):4850–69.
[17] Lefevre JH, Mineur L, Cachanado M, Denost Q, Rouanet P, de Chaisemartin C, et al. Does A Longer Waiting Period After Neoadjuvant Radio-chemotherapy Improve the Oncological Prognosis of Rectal Cancer? Three Years’ Follow-up Results of the Greccar-6 Randomized Multicenter Trial. Ann Surg. 2019 Nov 1;270(5):747–54.
[18] Wolf JH, Hung YC, Cox S, Aghedo B, Mavanur A, Svoboda S, et al. Pathologic complete response is associated with decreased morbidity following rectal cancer resection. The American Journal of Surgery. 2021 Aug 27;222(2):390–4.
[19] Dayde D, Tanaka I, Jain R, Tai MC, Taguchi A. Predictive and prognostic molecular biomarkers for response to neoadjuvant chemoradiation in rectal cancer. Vol. 18, International Journal of Molecular Sciences. MDPI AG; 2017.
[20] Lawson EH, Melvin JC, Geltzeiler CB, Heise CP, Foley EF, King RS, et al. Advances in the management of rectal cancer. Curr Problem Surg. 2019 Nov 1;56(11).
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