C16. Terapêutica multidisciplinar no estádio loco-regional do carcinoma do pulmão não-pequenas células

• Main Authors: Jorge Dionísio, Teresa Almodovar, Paula Pereira, Julieta Silva, Dina Matias, Silva Raposo, Nuno Abecasis, Duro da Costa
• Format: Article
• Language: English
• Published: Elsevier 2003-11-01
• Series: Revista Portuguesa de Pneumologia
• Online Access: http://www.sciencedirect.com/science/article/pii/S0873215915307200

Efectuou-se estudo retrospectivo, baseado na nossa experiência com terapêutica multidisciplinar em doentes com neoplasia do pulmão em estadio loco-regional, tendo sido avaliadas as terapêuticas efectuadas, resposta ao tratamento, intervalo livre de doença e sobrevivência.A análise de sobrevivência foi efectuada pela curva de Kaplan-Meier. Estudaram-se 95 doentes (84 homens), idade média-61 anos. Carcinoma Epidermóide â 46; Adenocarcinoma â 36. Performance Status 0/1 â 84. Emagrecimento <5% - 82.Esquema de tratamento habitual - Quimioterapia (QT) 2 ciclos de Cisplatina e Vinorelbina seguidos de Radioterapia (RT) numa dose total de 60 Gy ou Cirurgia (C) se downstaging. Em doentes com obstrução endobrônquica foi efectuada terapêutica endoscópica (TE).Sessenta e seis doentes efectuaram QTRT sequencial. Em 32 doentes (48,5%) verificou-se uma resposta parcial ao tratamento, com intervalo livre de doença até à recidiva de 32,9 semanas. A sobrevida global foi de 73.5 semanas (58.3-88.8), sendo a sobrevida a 1 ano de 53,8% e a 2 anos de 12,9%. Da toxicidade da QT salienta-se neutropénia G3/4 em 36,5% e da toxicidade da RT, Esofagite G3/4 em 1,5% e Pneumonite G3/4 em 6%.Treze doentes foram submetidos previamente a TE num total de 17 tratamentos com Laser em 5, Ãrgon-Plasma e Electrocoagulação em 1 cada e colocação de 13 próteses, permitindo desobstrução brônquica.Foram operados 10 doentes após QT neoadjuvante e 1 após QRT.O esquema de QTRT sequencial teve uma sobrevivência média sobreponível à da literatura, apresentando uma toxicidade aceitável. A TE como terapêutica inicial na prevenção de pneumonia obstrutiva facilitou o uso de QT. Foi possível downstaging para C em 24% dos doentes em estádio IIIa. : This retrospective study, based in our clinical database, represents the experience of our department with multidisciplinary treatment. Therapeutic schedule, clinical response, progression free interval and survival were evaluated.Kaplan-Meier curve was done to evaluate survival.Ninety-five patients (84 male), mean age 61 years were studied. Squamous Cell Carcinoma was present in 46; Adenocarcinoma in 36 and other in 13 patients. Performance Status was 0/1 in 84 patients, in 82 wasting < 5% was present.Usual treatment schedule included Chemotherapy (CT): two cycles of Cisplatin and Vinorelbine followed by Radiotherapy (RT) with 60 Gy or Surgery (S) if downstaging. In patients with endobronchial obstruction Endoscopic Therapy (ET) was added whenever indicated.Sixty-six patients underwent sequential QTRT Schedule. In 32 patients (48,5%) a partial response was obtained; the progression free interval was 32,9 weeks. Global survival was 73.5 weeks (58.3-88.8) with 95% confidence interval. The one-year survival was 53,8% and the two-years survival was 12,9%. Toxic neutropenic G3/4 was noticed in 36,5% and RT induced Esophagitis G3/4 in 1,5% and Pneumonitis G3/4 in 6%.Thirteen patients underwent previous 17 ET; five were treated with Yag laser, one with Argon-plasma and another with electrocoagulation. Thirteen stents were placed, which allowed bronchial permeability.Ten patients were submitted to S after neoadjuvant CT and one after CTRT.The CTRT schedule had identical mean survival to the reported in the literature with acceptable toxicity. First line ET prevented obstructive pneumonia and allowed CT. Downstaging and surgical resection was possible in 24% of Stage IIIa patients. Palavras-chave: Neoplasia do pulmão, Terapêutica multidisciplinar, Key-words: Lung cancer, Multidisciplinary treatment