Escalación de dosis de radioterapia con intensidad modulada y boost simultáneo integrado, asociada a capecitabine concurrente para cáncer de recto localmente avanzado
DOI:
https://doi.org/10.56969/oc.v27i2.80Palabras clave:
cáncer rectal, radioterapia de intensidad modulada, respuesta patológica, toxicidad, respuesta parcial, respuesta patológica completa, rectal cancer, intensity modulated radiotherapy, pathological response, toxicity, partial response, complete pathologic responseResumen
La radioquimioterapia neoadyuvante radiosensibilizante seguida de escisión total del mesorecto, es tratamiento estándar en cáncer de recto localmente avanzado (LARC). La radioterapia de intensidad modulada (IMRT) permite respetar dosis de tolerancia en órganos a riesgo. El objetivo de este estudio fue registrar toxicidad aguda y tardía, cuantificar respuesta patológica completa (pCR) y su efecto en supervivencia global (SG) en la serie y pacientes operados y no operados.
Estudio retrospectivo en108 pacientes tratados entre 2016-2019 con IMRT- SIB (boost simultáneo integrado) 54 Gy (Equivalente 57Gy) en 20 fracciones.
El seguimiento medio fue de 31 meses, en 108 pacientes toxicidad aguda: dolor abdominal 55 (51%); meteorismo 42 (38.8%); enteritis G1 54 (50%), G2 31 (28.7%) y G3 4 (3.7%); rectitis G1 56 (51.4%), G2 33 (30.3%) y G3 1 (0.9%); epidermitis G1 55 (51%) y G2 18 (16.5%); proctorragia 57 (52.7%); disuria 33 (30.5%) e incontinencia anal 13 (12%). Toxicidad tardía en 103/108: enteritis G1 23 (22.3%), G2=6 (5.8%); rectitis G1 28 (27.2%), G2 6 (5.8%); proctorragia 14 (13.6%), incontinencia anal 10 (9.7%), disuria 3 (2.9%). En 51/103 ausencia de toxicidad tardía. En 80/108 operados 45 (56.25%) pCR. No hubo diferencia significativa en SG pCR versus respuesta parcial. La SG fue mejor en pacientes operados
IMRT levemente hipofraccionada permite reducir el tiempo total de tratamiento y aplicar dosis > 50Gy en el tumor, obteniendo tasa de respuesta parcial y completa alentadoras con aceptable toxicidad.
Citas
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