Radioterapia e quimioterapia em pacientes com neoplasia maligna de colo uterino

Radioterapia e quimioterapia em pacientes com neoplasia maligna de colo uterino

Título alternativo Radiotherapy and chemotherapy for patients with uterine cervix cancer
Autor Gruenwaldt, Joyce Autor UNIFESP Google Scholar
Orientador Segreto, Roberto Araujo Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Resumo Purpose: To evaluate the response of cervical cancer patients submitted to radiotherapy associated to chemotherapy, followed or not by surgery, regarding individual clinical aspects, tumor-related factors, and treatment-related factors and to correlate these aspects with local control and survival rate. Methods: Forty eight cervical cancer patients were evaluated, beginning at stage Ib2, who were treated with chemotherapy and radiotherapy, followed, or not, by surgery. Patients were classified according to the International Federation of Gynecology and Obstetrics (FIGO), complemented by pelvic Magnetic Resonance (MR). Subsequently, they were treated with external pelvic radiotherapy with a dose of 45 Gy, followed by brachytherapy with 192Ir (4 fractions of 6 to 7 Gy, according to the staging) and parametrium complementation, if necessary. On the first and 25th day of external radiotherapy, patients were treated with cysplatine chemotherapy and a dose of 90 mg/m2 each day. The patients who still showed residual illness after the treatment were referred to surgery. All patients were followed up for five years. Results: The patients were evaluated from 2003 to 2006, with a median follow up time of 36 months. Spinocelular carcinoma was the histological finding in 89.6% of the patients, and 52.1% showed histological level II, 52.1% were classified as stage II of FIGO the, 58.3% exhibited compromised lymphnodes at pelvic MR. Adding pelvic MR to the FIGO staging, there was a disagreement of the staging of 12 patients (p=0.01). Thirty one patients were treated between 9 and 12 weeks, but this variable did not influence the local control or survival rate. Global survival rate was 77% and local control was 53%. There were no statistical differences between operated and nonoperated patients regarding local control (p=0.117). Operated stage I/II FIGO patients showed a better local control than non-operated stage III/IV patients (p=0.005). There were no statistical differences in survival rate between patients with and without lymphnode compromise at MR (p=0.249). Nonetheless, operated patients with compromised lymphnodes had the benefit of local control. There were no worsening or short- or long-term complications. Conclusion: There were no association between individual or neoplasia-related factors and worse prognosis of the patients. According to the purpose of the present study, radiotherapy associated with chemotherapy produced satisfactory results, similar to previous reports in the literature. The surgery improved local control in patients with compromised lymphnodes. There was an improvement of survival in patients in initial staging tumors (I and II), compared to those in non-operated initial or advanced tumors.

Objetivo: avaliar a resposta das pacientes portadoras de neoplasia maligna de colo uterino submetidas a associação de radioterapia e quimioterapia, seguida ou não de cirurgia. Métodos: foram avaliadas 48 pacientes, a partir do estádio Ib2 e tratadas com quimioterapia e radioterapia, seguidas ou não de cirurgia. As pacientes foram tratadas com teleterapia, com dose de 45Gy, seguida de braquiterapia com 192 Ir (4 frações de 6 ou 7Gy, conforme estadiamento) e complementação de paramétrios, se necessário. No D1 e D25 da teleterapia, as pacientes receberam quimioterapia com cisplatina e dose de 90mg/m2. Ao término do tratamento foram encaminhadas para avaliação de cirurgia. Todas as pacientes foram acompanhadas posteriormente por até 5 anos. Resultados: foram analisadas 48 pacientes entre 2003 e 2006, com tempo de seguimento de 36 meses (mediana). A sobrevida global das pacientes foi de 77% e o controle locorregional foi de 63%. Não houve diferença estatisticamente significante entre as pacientes operadas e não operadas, com relação ao controle locorregional (p=0,117). Conclusão: A radioterapia associada a quimioterapia, conforme a proposta deste estudo, apresentou resultados satisfatórios, à semelhança da literatura. A cirurgia melhorou o controle locorregional nas pacientes com linfonodos comprometidos. Houve benefício da sobrevida nas pacientes com tumores iniciais (I e II), comparativamente àquelas com tumores iniciais não operados ou tumores avançados.
Palavra-chave Colo de útero
Radioterapia
Quimioterapia
Resultados de tratamento
Idioma Português
Data de publicação 2010-02-24
Publicado em GRUENWALDT, Joyce. Radioterapia e quimioterapia em pacientes com neoplasia maligna de colo uterino. 2010. Dissertação (Mestrado) - Universidade Federal de São Paulo (UNIFESP), São Paulo, 2010.
Publicador Universidade Federal de São Paulo (UNIFESP)
Extensão 76 p.
Direito de acesso Acesso restrito
Tipo Dissertação de mestrado
Endereço permanente http://repositorio.unifesp.br/handle/11600/10005

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