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Tratamiento adyuvante del cáncer gástrico resecable: experiencia en un servicio de Oncología

Adjuvant treatment of resectable gastric cancer: experience in an Oncology Service

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Introducción. El tratamiento curativo del cáncer gástrico es la cirugía. La tasa de recidivas con esta terapia es del 40%–70%. Hasta ahora, la administración de quimioterapia adyuvante ha sido ineficaz en demostrar un descenso en la tasa de recidivas. A la vista de los resultados del estudio INT-0116, pacientes intervenidos de cáncer gástrico estadios desde I-B (T1N1 o T2a/b N0) a IV (T4N1,2,3 M0/T1,2,3 N3M0) recibieron tratamiento combinado quimiorradioterápico según el esquema de McDonalds en nuestro servicio.

Material y métodos. Se incluyeron 39 pacientes a lo largo de los 36 meses que duró el estudio.

Resultados. La principal toxicidad fue la gastrointestinal de grado 1–2 en 17 de 39 pacientes (44%). La neutropenia fue la toxicidad hematológica más frecuente, siendo grado 1–2 en 7 de 39 pacientes (26,5%) Resulta llamativo que 17 de 39 (44%) de los pacientes presentaron astenia durante el tratamiento y tras su finalización. Tras una mediana de seguimiento de 20,2 meses no se alcanzó la mediana de supervivencia global (SG) ni la mediana de supervivencia libre de enfermedad (SLE). Se detectaron recaídas en 14 de los 39 pacientes (35,8%) permaneciendo el resto de los enfermos (25 de 39, 64,2%) libres de enfermedad.

Conclusiones. A la vista de la elevada tasa de recaídas incluso con el tratamiento adyuvante, son necesarios más estudios que mejoren la tasa de supervivencia libre de enfermedad. De la misma forma es prioritaria la administración de esquemas mejor tolerados que favorezcan un mayor cumplimiento terapeútico.

Abstract

Introduction. The curative management of gastric adenocarcinoma depends on complete resection of the primary tumour. The relapse rates from the recurrent cancer are between 40% and 70%. Until recently, attempts at preventing recurrence, usually using adjuvant chemotherapy, have been ineffective. Based on INT-0116 results, gastric cancer patients from stage IB (T1N1 or T2a/b N0) to stage IV (T4 N1,2,3 M0/T1,2,3 N3M0) received combined chemotherapy and radiotherapy treatment following gastric resection.

Material and methods. Patients (n=39) were included over 36 months.

Results. The main toxicity was digestive grade 1 or 2 in 17/39 (44%) cases. More frequent haematological toxicity was grade 1–2 neutropenia, in 7/39 patients (26.5%). Asthenia was a relevant toxicity in 17/39 (44%) of our patients. With a median follow-up of 20.2 months, we have not reached the median overall survival nor the median disease-free survival. There was recurrence in 14/39 (35.8%) cases and the remainder are disease-free (64.2%).

Conclusions. More studies are necessary to evaluate better the disease-free survival following gastric cancer resection. Also, less toxic treatments need to be developed so as to increase treatment compliance.

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Authors and Affiliations

  1. Servicio de Oncología Médica, Hospital La Paz, Madrid, España

    María Sereno Moyano, Javier de Castro Carpeño, Jaime Feliu Batles, Cristóbal Belda Iniesta, Lara Miralles Olmedo & Manuel González Barón

  2. Servicio de Oncología Radioterápica, Hospital La Paz, Madrid, España

    Lara Miralles Olmedo

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  1. María Sereno Moyano
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  2. Javier de Castro Carpeño
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  3. Jaime Feliu Batles
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  4. Cristóbal Belda Iniesta
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  5. Lara Miralles Olmedo
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  6. Manuel González Barón
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Correspondence to María Sereno Moyano.

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Moyano, M.S., Carpeño, J.d.C., Batles, J.F. et al. Tratamiento adyuvante del cáncer gástrico resecable: experiencia en un servicio de Oncología. Rev Oncol 6, 525–531 (2004). https://doi.org/10.1007/BF02712382

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  • DOI: https://doi.org/10.1007/BF02712382

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