Radioterapia neoadjuvante no carcinoma do recto: resposta à terapêutica e sua toxicidade

  • João Casalta-Lopes Serviço de Radioterapia Centro Hospitalar e Universitário de Coimbra Unidade de Biofísica, Faculdade de Medicina, Universidade de Coimbra.
  • Inês Nobre-Góis Serviço de Radioterapia Centro Hospitalar e Universitário de Coimbra
  • Tânia Teixeira Serviço de Radioterapia Centro Hospitalar e Universitário de Coimbra
  • Mário Rui Silva Serviço de Anatomia Patológica Centro Hospitalar e Universitário de Coimbra
  • Anabela Sá Serviço de Oncologia Médica Centro Hospitalar e Universitário de Coimbra
  • Margarida Borrego Serviço de Radioterapia Centro Hospitalar e Universitário de Coimbra
  • Paula Soares Serviço de Radioterapia Centro Hospitalar e Universitário de Coimbra

Resumo

Introdução: O carcinoma do recto localmente avançado (CRLA) é habitualmente tratado com Radioterapia (RT) seguida por Cirurgia. Existem dois esquemas possíveis para irradiação neoadjuvante: o longo (EL), associado a quimioterapia (QT), e o curto (EC). Objectivos: Comparar resposta e toxicidade à terapêutica com EL e EC em doentes com CRLA. Material e Métodos: Foram incluídos doentes com CRLA tratados de 2002 a 2012, que realizaram RT pré-operatória segundo EL ou EC. A resposta foi avaliada pela classificação pTNM e regressão de Dworak (GRD); a toxicidade foi avaliada pela escala CTCAE3. Resultados: Foram incluídos 215 doentes de EL e 55 de EC. Os de EC tinham idade superior e Karnofsky inferior aos de EL (p<0,001). 20% dos EC eram estádio IV e 92,6% dos EL estádio III (p<0,001). Efectuaram cirurgia curativa 208 doentes após EL e 47 após EC; foram realizadas mais cirurgias conservadoras. Obteve-se GRD 4 em 16,8% vs. 6,4%, downstaging N em 66,3% vs. 23,4% e resposta loco-regional em 79,8% vs. 57,4% (EL vs. EC; p<0,001). Não foi descrita toxicidade aguda no EC; no EL ocorreu em 77,7% (p<0,001) mas apenas 7,9% com grau 3/4 (p=0,028). Não houve diferenças nas complicações pós-operatórias (p=0,299). Mais doentes EL realizaram QT adjuvante (p<0,001). Pior resposta patológica pTN e GRD 0-1 no EL estão associados a mais ressecções R+ (p<0,01). Conclusões: O EL aparenta estar associado a melhor resposta do que o EC, o que facilita uma ressecção curativa, à custa de uma toxicidade tolerável.

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Publicado
2015-12-01
Como Citar
CASALTA-LOPES, João et al. Radioterapia neoadjuvante no carcinoma do recto: resposta à terapêutica e sua toxicidade. Revista Portuguesa de Cirurgia, [S.l.], n. 35, p. 23-32, dec. 2015. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/550>. Acesso em: 29 oct. 2020.
Secção
Artigos de Revisão