Desenlaces del manejo no quirúrgico posterior a neoadyuvancia del cáncer localmente avanzado de recto
Palabras clave:
Cáncer de recto, Terapia neoadyuvante, Respuesta clínica completa, Manejo no quirúrgico, Marcadores tumoralesResumen
Objetivos: Describir características clínicas, histopatológicas y desenlaces de pacientes con cáncer localmente avanzado de recto y respuesta clínica completa posterior a la neoadyuvancia, sin manejo quirúrgico.
Métodos: Estudio de cohorte retrospectiva de pacientes con cáncer de recto estadios II y III, llevados a quimiorradiación, en seguimiento clínico. Se evaluó supervivencia libre de enfermedad, global y tasa de recaída. Se describen características biológicas (Kras, Ki67,p53) y morfológicas del tumor (grado, invasión linfovascular y perineural).
Resultados: Entre enero de 2003 y junio de 2013, 19 pacientes con cáncer localmente avanzado de recto y respuesta clínica completa postneoadyuvancia, no aceptaron el tratamiento quirúrgico radical. Con mediana de seguimiento de 21 meses (4-92 meses), se presentaron recaídas del: 21% en el primer año, 36% a los 3 años y 42% a los 5 años (total: 8 pacientes). Se presentó recaída local en 50% de casos, regional en 50% y no hubo recaída sistémica. La tasa estimada de recaída local fue 2,3 recaídas por 100 pacientes/mes (IC 95%:1,21-4,5) y de recaída regional 1,3 recaídas por 100 pacientes/mes (IC 95%:0,5-3,1). No se estableció relación, entre la expresión de factores biológicos del tumor primario y los desenlaces.
Conclusiones: Se ratifica la indicación del tratamiento quirúrgico radical, posterior a la neoadyuvancia, en todos los pacientes con cáncer localmente avanzado de recto. Las bajas tasas de recaída local y regional de nuestra serie, sugieren la posibilidad de resección local u observación, en casos seleccionados. La individualización y deseo del paciente, debe orientar la toma de decisiones.
Biografía del autor/a
Pilar Adriana Torres Mesa, Instituto Nacional de Cancerología
Grupo de Cirugía Gastrointestinal Oncológica y Endoscopia Digestiva, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Ricardo Oliveros, Instituto Nacional de Cancerología
Grupo de Cirugía Gastrointestinal Oncológica y Endoscopia Digestiva, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Jorge Mesa, Instituto Nacional de Cancerología
Grupo de Patología Oncológica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Natalia Olaya, Instituto Nacional de Cancerología
Grupo de Patología Oncológica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Ricardo Sánchez, Instituto Nacional de Cancerología
Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá, D.C, Colombia
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