Tratamento pré-operatório do carcinoma do recto localmente avançado: Capecitabina versus Capox

  • Pedro C. Barata Internato Complementar de Oncologia Médica, Centro Hospitalar de Lisboa Central, Portugal
  • Sónia D. Oliveira Internato Complementar de Oncologia Médica, Centro Hospitalar de Lisboa Central, Portugal
  • Luis L. Mascarenhas Internato Complementar de Anatomia Patológica, Centro Hospitalar de Lisboa Central, Portugal
  • Carlos Almeida Médico-Cirurgião Geral, Responsável da Unidade Patologia Colo-Rectal, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
  • Lurdes V. Batarda Director de Serviço de Oncologia Médica, Centro Hospitalar de Lisboa Central, Portugal

Resumo

Introdução: A terapêutica pré-operatória com quimioterapia e radioterapia concomitante (QRT-PO) é o tratamento de primeira-linha no carcinoma do recto localmente avançado, estadios II e III (classificação TNM). O objectivo deste estudo é o de comparar a eficácia e perfil de segurança e toxicidade de dois esquemas alternativos de quimioterapia em combinação com radioterapia: capecitabina versus capecitabina em associação com oxaliplatina.

Métodos: Entre Janeiro 2007 e Janeiro 2011, foram estudados retrospectivamente setenta e seis doentes com 68,3 anos de idade mediana (limites, 45-88 anos), 68% do sexo masculino, com o diagnóstico de carcinoma do recto nos estadios II e III, com uma distância mediana à margem anal de 7 cm (3-12cm), submetidos a QRT-PO. Foram administrados dois esquemas de QRT-PO: radioterapia 50,4 Gy dose total concomitante com a capecitabina 825 mg/m2 bi-diário, dia 1-38 (esquema CAP), versus radioterapia 50,4 Gy dose total concomitante com capecitabina 825 mg/m2 bi-diário, dia 1-38 e oxaliplatina 50 mg/m2 semanal (esquema CAPOX). O grau de regressão histológica (GRH) foi determinado pela quantidade de tumor viável versus fibrose. A toxicidade foi monitorizada de acordo com os critérios de toxicidade do National Cancer Institute.

Resultados: O esquema CAP foi aplicado em 67% e o esquema CAPOX em 33% dos doentes. O total de respostas completas (pRC) foi de 13,2% (GRH 4). Na avaliação histopatológica, a caracterização ypTNM documentou um downstaging de T e N em 52.6% e 65.8% dos casos, respectivamente. A toxicidade grau 3 foi reportada em menos de 10% dos casos e não foi observada toxicidade grau 4.

Conclusão: Este estudo sugere não haver benefício da adição da oxaliplatina ao esquema pré-operatório com RT e capecitabina.

Palavras-chave: carcinoma recto, neo-adjuvante, downstaging, capecitabina, oxaliplatina. 

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Como Citar
BARATA, Pedro C. et al. Tratamento pré-operatório do carcinoma do recto localmente avançado: Capecitabina versus Capox. Revista Portuguesa de Cirurgia, [S.l.], n. 27, p. 11-18, jan. 2014. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/328>. Acesso em: 23 jul. 2019.
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