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Tratamiento adyuvante del carcinoma de recto

Adjuvant treatment in rectal carcinoma

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Resumen

Objectivo

Neustro objetivo es analizar los resultados del tratamiento adyuvante en pacientes operados por un carcinoma rectal localmente avanzado, tratados con radioquimioterapia concomitante o secuencial.

Material y métodos

Entre enero de 1994 y septiembre de 1997, 122 pacientes fueron tratados postquirúrgicamente por un adenocarcinoma rectal en estadio B2-C. Setenta y siete pacientes fueron tratados siguiendo un esquema alternante de quimiorradioterapia y 45 siguiendo un esquema concomitante. Los fármacos empleados fueron 5-fluorouracilo (5-FU) y leucovorín en todos los casos y el volumen irradiado incluyó la pelvis hasta una dosis de 50 Gy con fraccionamiento estándar.

Resultados

Tras un seguimiento mediano de 68,9 meses, la supervivencia global, cáncer-específica y libre de recidiva a 5 años fue del 58,62%, 60,5% y 51,33%, respectivamente. La probabilidad de recidiva global a 5 años fue del 48,7% de recidiva local del 34,6% y de metástasis del 32,6%. El estadio ganglionar y el estadio según la clasificación de Astler-Coller fueron los principales factores pronósticos (p<0,0001). El esquema del tratamiento combinado no mostró influencia estadística. Un 20,5% de los pacientes presentó toxicidad aguda relevante, sin ningún caso de toxicidad grado 4, ni muertes atribuibles al tratamiento combinado. El uso de una técnica radioterápica de dos campos y la secuencia significativamente en la incidencia e intensidad de toxicidad aguda. Apareció toxicidad tardía grado 3 en 13 pacientes (10,6%); de éstos, 10 (8,2%) requirieron tratamiento quirúrgico para solucionar una obstrucción intestinal.

Conclusiones

Podemos concluir que, en nuestro medio, el tratamiento radioquimioterápico adyuvante en el carcinoma rectal es un tratamiento efectivo, con cifras de supervivencia, recurrencía y toxicidad similares a los príncipales trabajos publicados en la literatura, y sin influencia de la secuencia de combinación en dichas cifras.

Abstract

Objective

Our objective was to assess the value of adjuvant treatment of patients undergoing surgery for locally-advanced rectal carcinoma, treated with concomitant, or alternating, radiochemotherapy.

Material and methods

Between January 1994 and September 1997, 122 patients with B2-C rectal adenocarcinoma were treated with a post-operative scheme of radiochemotherapy which was alternating (n=77) or concomitant (n=45). The chemotherapy agents were 5-FU and leucovorin in all cases. Radiotherapy volume included pelvis and was administered in 25 fractions up to a total dose of 50 Gy.

Results

With a median follow-up of 68.9 months, the overall survival, cancer-specific survival and disease-free survival at 5 years were 58.6%, 60.5% and 51.3%, respectively. The 5-year overall recurrence rate was 48.7%, local recurrence rate was 34.6%, and metastases rate was 32.6%. The nodal stage and the Astler-Coller classification stage were the main prognostic factors (p<0.0001). The combined treatment scheme showed no statistical influence on outcome. Severe acute toxicity occurred in 20.5% of patients, with no case of toxicity grade 4 nor any toxic deaths. Two-field radiotherapy technique and the sequence of combination of radiochemotherapy were predictive factors of acute toxicity, both in incidence and severity. Delayed grade 3 toxicity occurred in 15 patients (10.6%) and, of these, 10 patients (8.2%) required surgical treatment to resolve an intestinal obstruction.

Conclusions

Our results indicate that adjuvant radiochemotherapy for rectal carcinoma is an effective treatment. The rates of survival, recurrence and toxicity are similar to other major published studies, and with the sequence of administration having no significant effect on outcomes.

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Bibliografía

  1. Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following curative surgery for adenocarcinoma of the rectum: Clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974;34:1278–92.

    Article  CAS  Google Scholar 

  2. Schild SE, Marterson JA Jr, Gunderson LL. et al. Postoperative adjuvant therapy of rectal cancer: An analysis of disease control, survival and prognostic factors. Int J Radiat Oncol Biol Phys 1989;17:55–62.

    Article  CAS  Google Scholar 

  3. Hoskins RB, Gunderson LL, Dorosetz DE, et al. Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid. Cancer 1985;55:61–70.

    Article  CAS  Google Scholar 

  4. Gastrointestinal Tumor Study Group: Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985;312:1465–72.

    Article  Google Scholar 

  5. Douglass HO Jr, Moertel CG, Mayer RJ, et al. Survival after postoperative combination treatment of rectal cancer [cartal]. N Engl J Med 1986;315:1294.

    Article  Google Scholar 

  6. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991;324:709–15.

    Article  CAS  Google Scholar 

  7. National Institute of Health Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–9.

    Article  Google Scholar 

  8. Glimelius B. Chemoradiotherapy for rectal cancer. Is there an optimal combination? Ann Oncol 2001;12(8):1039–45.

    Article  CAS  Google Scholar 

  9. Bosset JF, Mantion G, Lorchel F, et al. Adjuvant and neoadjuvant radiation therapy for rectal cancer. Semin Oncol 2000;27(5 Suppl):60–5.

    CAS  PubMed  Google Scholar 

  10. Minsky BD. Adjuvant radiation therapy for rectal cancer: is there finally an answer? Lancet 2001;358:1285–6.

    Article  CAS  Google Scholar 

  11. Swedish rectal cancer trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997;336:980–7.

    Article  Google Scholar 

  12. Astler VB, Coller FA. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954;139:846–50.

    Article  CAS  Google Scholar 

  13. Rubin P. Special issue: Late effects of normal tissues consensus conference, including RTOG/EORTC SOMA scales. Int J Radiat Oncol Biol Phys 1995;31:1035–360.

    Article  Google Scholar 

  14. Rich T, Gunderson LL, Lew R, et al. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983;52:1317–29.

    Article  CAS  Google Scholar 

  15. Schild SE, Marterson JA Jr, Gunderson LL, et al. Longterm survival and patterns of failure after postoperative radiation therapy for subtotally resected rectal carcinoma. Int J Radiat Oncol Biol Phys 1989;16:459–64.

    Article  CAS  Google Scholar 

  16. Quirke P, Dixon MF, Durdey P, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Lancet 1986;ii:996–9.

    Article  Google Scholar 

  17. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circunferential margin involvement in the local recurrence of rectal cancer. Lancet 1994;344:707–11.

    Article  CAS  Google Scholar 

  18. Soreide O, Norstein J. Local recurrence after operative treatment of rectal carcinoma: a strategy for change. J Am Coll Surg 1997;184:84–92.

    CAS  PubMed  Google Scholar 

  19. Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995;181:335–46.

    CAS  PubMed  Google Scholar 

  20. Arbman G, Nilsson E, Hallbook O, Sjodahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 1996;83:375–9.

    Article  Google Scholar 

  21. Kapiteijn E, Marijnen AM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorrectal excision for resectable rectal cancer. N Engl J Med 2001; 345:638–46.

    Article  CAS  Google Scholar 

  22. Heald RJ. Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensus. Br J Surg 1995;82:1297–9.

    Article  CAS  Google Scholar 

  23. Bentzen SM, Balslev I, Pedersen M, et al. Time to locoregional recurrence after resection of Dukes B and C colorectal cancer with or without adjuvant postoperative radiotherapy: A Multivariate regression analysis. Br J Cancer 1992;65:102–7.

    Article  CAS  Google Scholar 

  24. Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy por rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 1988;80:21–9.

    Article  CAS  Google Scholar 

  25. Wolmark N, Wieand HS, Hyams DM, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst 2000;92(5):388–96.

    Article  CAS  Google Scholar 

  26. Marijnen CAM, Nagtegaal ID, Kranenbarg EK, et al. No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 2001;19(7):1976–84.

    Article  CAS  Google Scholar 

  27. Minsky BD. Adjuvant therapy for rectal cancer. A good first step. N Engl J Med 1997;336(14):1016–7.

    Article  CAS  Google Scholar 

  28. Cammà C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M. Preoparative radiotherapy for resectable rectal cancer. A meta-analysis. JAMA 2000;284(8):1008–15.

    Article  Google Scholar 

  29. Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet 2001; 358:1291–304.

    Article  Google Scholar 

  30. Janjan NA, Khoo VS, Abbruzzese J, et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the MD Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 1999;44:1027–38.

    Article  CAS  Google Scholar 

  31. Bosset JF, Horiot JC, Pavy JJ. Postoperative treatment of rectal cancer. En: Bleiberg H, Rougier P, Wilke HJ, editors. Management of colorectal cancer. London, UK: Martin Dunitz, 1998;p. 345–9.

    Google Scholar 

  32. León AI, López MP, Dorta FJ. Cáncer de Colon y Recto (II). Tratamiento de la enfermedad localizada. En: Gonzalez Barón M, editor. Oncología Clínica. Patología especial. 2a ed. Madrid: McGraw-Hill/Interamericana, 1998;p. 203–12.

    Google Scholar 

  33. Martenson JA, Urias R, Smalley SR, et al. Radiation therapy quality control in a clinical trial of adjuvant postoperative treatment for rectal cancer. Int J Radiat Oncol Biol Phys 1995;32(1):51–5.

    Article  Google Scholar 

  34. Kollmorgen CF, Meagher AP, Wolff BG, et al. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;220:676.

    Article  CAS  Google Scholar 

  35. O'Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protacted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994; 331:502–7.

    Article  CAS  Google Scholar 

  36. Ma R, Phang PT. Results of curative surgery and postoperative chemoradiation for rectal adenocarcinoma in British Columbia, 1985 to 1994. Can J Surg 2001;44(5):377–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Lupattelli M, Maranzano E, Bellavita R, et al. Adjuvant radiochemotherapy in high-risk rectal cancer results of prospective non-randomized study. Tumori 2001;87(4):239–47.

    CAS  PubMed  Google Scholar 

  38. Cabrera J, Montero MV, Muñoz JL, Mendicote F. Radioquimioterapia complementaria a cirugía radical en el adenocarcinoma de recto. Rev Oncol 2001;3:79–84.

    Google Scholar 

  39. Minsky BD, Mies C, Rich TA, et al. Potentially curative surgery of colon cancer: Patterns of failure and survival. J Clin Oncol 1988;6:106–18.

    Article  CAS  Google Scholar 

  40. Ooi BS, Tjandra JJ, Green MD. Morbidities of adjuvant chemotherapy and radiotherapy for resectable rectal cancer: an overview. Dis Colon Rectum 1999;42(3):403–18.

    Article  CAS  Google Scholar 

  41. Bertuccelli M, Cartei F, Falcone A, et al. Postoperative adjuvant chemoradiotherapy for rectal cancer: analysis of acute and chronic toxicity. Tumori 1997;83(2):599–603.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Servicio de Oncología Radioterápica, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco, 15, 50009, Zaragoza, Spain

    Javier Valencia Julve & Ricardo Escó Barón

  2. Servicio de Oncología, Hospital General San Jorge, Huesca, Spain

    Javier Sanz Lacalle & Miguel Burillo Cordero

  3. Centro Privado de Oncología, Zaragoza, Spain

    Pedro Mateo de las Heras

  4. Servicio de Oncología Radioterápica, Centre de Radioterapia i Oncologia, Barcelona, Spain

    Carmen Lainez Baquero

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  1. Javier Valencia Julve
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  2. Ricardo Escó Barón
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  3. Javier Sanz Lacalle
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Correspondence to Javier Valencia Julve.

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Julve, J.V., Barón, R.E., Lacalle, J.S. et al. Tratamiento adyuvante del carcinoma de recto. Rev Oncol 5, 524–536 (2003). https://doi.org/10.1007/BF02710400

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  • DOI: https://doi.org/10.1007/BF02710400

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