Radioterapia e cirurgia na abordagem do câncer do reto: revisão de literatura, fatores prognósticos e resultados de tratamento

Radiation therapy and surgery in the approach of the rectal cancer: literature revision, prognostic factors and results of treatment

ARTIGOS ORIGINAIS

Radioterapia e cirurgia na abordagem do câncer do reto: revisão de literatura, fatores prognósticos e resultados de tratamento

Radiation therapy and surgery in the approach of the rectal cancer: literature revision, prognostic factors and results of treatment

Benedito Mauro Rossi, TCBC-SP^I; Wilson Toshihiko Nakagawa^I; Arno Yukio Borges^I; Wilson Bechara Júnior^I; René Aloísio da Costa Vieira, ACBC-SP^II; Ademar Lopes, TCBC-SP^III; Luiz Paulo Kowalski, TCBC-SP^IV

^IMédico Titular

^IIDiretor do Departamento de Prevenção e Detecção Precoce do Câncer

^IIIDiretor do Departamento de Cirurgia Pélvica

^IVDiretor do Departamento de Cirurgia de Cabeça e Pescoço

^{Endereço para correspondência}

RESUMO

O objetivo principal deste estudo foi avaliar os resultados da cirurgia isolada ou associada a radioterapia pré-operatória em pacientes portadores de adenocarcinoma do reto. Foram analisados retrospectivamente 96 pacientes submetidos a cirurgias curativas entre 1972 e 1993. A análise visou, principalmente, comparar as taxas de sobrevida global em cinco anos e de recidiva local. Quarenta e seis pacientes tratados por cirurgias isoladas tiveram taxas de sobrevida em cinco anos e de recidiva local de 51,7% e 26,9%, respectivamente, nos estádios II e III. Cinqüenta pacientes submeteram-se a radioterapia pré-operatória na dosagem de 4.500 cGy, em 25 sessões de 180 cGy, com taxas de sobrevi da em cinco anos e de recidiva local de 60,8% e 18,2%, respectivamente, nos estádios II e III. As diferenças entre os dois grupos terapêuticos não foram estatisticamente significativas. A análise multivariada demonstrou que o estadiamento da neoplasia, principalmente com relação à presença ou não de linfonodos regionais metastáticos, foi o fator prognóstico mais importante, independentemente do grupo terapêutico analisado. Baseados nos resultados apresentados, discutimos que a indicação da radioterapia em câncer do reto deve ser mais seletiva, com realização de cirurgia imediata em pacientes portadores de tumores retais móveis, mesmo infiltrativos na parede, irradiando no pós-operatório apenas os casos com maior risco de recidiva, de acordo com o resultado do exame anatomopatológico da peça cirúrgica. Pacientes portadores de tumores com mobilidade reduzida em relação às paredes pélvicas devem ser irradiados no pré-operatório com a finalidade de facilitação do ato cirúrgico e diminuição do risco de disseminação de células tumorais no intra-operatório e conseqüente diminuição das taxas de recidiva local.

Unitermos: Câncer retal; Adenocarcinoma; Radioterapia; Cirurgia.

ABSTRACT

The main objective of this study was to evaluate the results of surgical treatment alone or associated to preoperative radiation therapy in patients with rectal adenocarcinoma. Ninety-six patients submitted to curative surgeries between 1972 and 1993 were analyzed. The main objective of the statistical analysis was to compare the five-year overall survival and local recurrence rates in patients submitted or not to preoperative radiation therapy. The five-year overall survival and the local recurrence rates for the 46 patients submitted to curative surgery alone, stage II and III, were 51.7% and 26.9%, respectively. The five-year overall survival and the local recurrence rates for the 50 patients submitted to preoperative radiation therapy (25 sessions of 180 cGy - total dose = 4,500 cGy), stage II and III, were 60.8% and 18.2%, respectively. No statistical differences in the five-year overall survival or in the local recurrence rates were observed between the two therapeutic groups. The rectal tumor stage, mainly related to pelvic metastatic lymph nodes, was the most important prognostic factor in the multivariate analysis for all therapeutic groups. Radiation in rectal cancer could be more selective: patients with mobile tumors, even infiltratives, might be submitted to immediate surgery and radiation therapy only in the high risk cases according to the pathological examination. Patients with tethered tumors could be submitted to preoperative radiation therapy due to the high risk for local recurrence.

Key words: Rectal cancer; Adenocarcinoma; Radiation therapy; Surgery.

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Recebido em 25/2/97

Aceito para publicação em 24/11/97

Trabalho realizado no Departamento de Cirurgia Pélvica do Hospital A. C. Camargo - Fundação Antonio Prudente - São Paulo

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Endereço para correspondência:

Dr. Benedito Mauro Rossi

Hospital A. C. Camargo

Depto. Cirurgia Pélvica

Rua Prof. Antonio Prudente, 211

01509-010 - São Paulo - SP

Datas de Publicação

• Publicação nesta coleção
  05 Ago 2010
• Data do Fascículo
  Abr 1998

Histórico

• Aceito
  24 Nov 1997
• Recebido
  25 Fev 1997