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Oncological outcomes in extended time intervals between preoperative chemoradiotherapy with capecitabine and surgery in operable rectal adenocarcinoma / Resultados oncológicos en intervalos extendidos de tiempo entre quimioradioterapia preoperatoria con capecitabina y cirugía en adenocarcinoma rectal operable
Muñoz, Miguel A.; Palacios, Manuel G.; Malca, Jenny; Mantilla, Raúl; Montenegro, Paola C.; Chavez, Ivan.
  • Muñoz, Miguel A.; Instituto Nacional de Enfermedades Neoplasicas. Department of Oncologic Surgery. Lima. PE
  • Palacios, Manuel G.; Instituto Nacional de Enfermedades Neoplasicas. Department of Oncologic Surgery. Lima. PE
  • Malca, Jenny; Instituto Nacional de Enfermedades Neoplasicas. Department of Radiation Therapy. Lima. PE
  • Mantilla, Raúl; Instituto Nacional de Enfermedades Neoplasicas. Lima. PE
  • Montenegro, Paola C.; Instituto Nacional de Enfermedades Neoplasicas. Department of Oncology Medicine. Lima. PE
  • Chavez, Ivan; Instituto Nacional de Enfermedades Neoplasicas. Department of Abdominal Surgery. Lima. PE
Rev. gastroenterol. Perú ; 38(1): 9-21, jan.-mar. 2018. ilus, tab
Article in English | LILACS | ID: biblio-1014052
ABSTRACT

Objective:

To assess whether extended time intervals (8-12, 13-20 and >20 weeks) between the end of neoadjuvant chemoradiotherapy and surgery affect overall survival, disease-free survival. Materials and

methods:

Retrospective study in 120 patients with rectal adenocarcinoma without evidence of metastasis (T1-4/N0-2/M0) at the time of diagnosis that underwent surgery with curative intent after neoadjuvant chemoradiotherapy with capecitabine and obtained R0 or R1 resection between January 2010 to December 2014 at the National Cancer Institute of Peru. Dates were evaluated by Kaplan-Meier method, log- rank test and Cox regression analysis.

Results:

Of the 120 patients, 70 were women (58%). The median age was 63(26-85) years. All received neoadjuvant chemoradiotherapy. No significant difference was found between the association of the median radial (0.6, 0.7 and 0.8 cm; p=0.826) and distal edge (3.0, 3.5 and 4.0 cm; p=0.606) with time interval groups and similarly the mean resected (18.8, 19.1 and 16.0; p=0.239) and infiltrated nodules (1.05, 1.29 and 0.41); p=0.585). The median follow-up time of overall survival and desease free survival was 40 and 37 months, respectively. No significant differences were observed in overall survival (79.0%, 74.6% and 71.1%; p=0.66) and disease-free survival (73.7%, 68.1% and 73.6%; p=0.922) according to the three groups studied at the 3-year of follow-up.

Conclusions:

We found that widening the time intervals between the end of neoadjuvant chemoradiotherapy and surgery at 24 weeks does not affect the overall survival, disease-free survival and pathological outcomes. It allows to extend the intervals of time for future studies that finally will define the best time interval for the surgery
RESUMEN

Objetivo:

Evaluar si los intervalos de tiempo extendidos (8-12, 13-20 y >20 semanas) entre el fin de la quimioradioterapia neoadyuvante y la cirugía afectan la sobrevida global, y la sobrevida libre de enfermedad. Material y

métodos:

Estudio retrospectivo de 120 pacientes con adenocarcinoma rectal sin evidencia de metástasis (T1-4/N0-2/M0) al momento del diagnóstico que se sometieron a cirugía con intención curativa luego de quimioradioterapia neoadyuvante con capecitabina y tuvieron resección R0 o R1 entre enero 2010 y diciembre 2014 en el Instituto Nacioanal de Enfermedades Neoplásicas de Perú. El análisis se hizo con el método de Kaplan-Meier, la prueba log-rank y la regresión de Cox.

Resultados:

De 120 pacientes, 70 fueron mujeres (58%). La mediana de la edad fue 63 años (26-85 años). Todos recibieron quimioradioterapia neoadyuvante. No hubo diferencia significativa entre la asociación de las medianas de los bordes radial (0,6, 0.7 y 0,8 cm; p=0,826) y distal (3,0, 3,5 y 4,0 cm; p=0,606) con los intervalos de tiempo de los grupos y similarmente con la media de los ganglios resecados (18,8, 19,1 y 16,0; p=0,239) e infiltrados (1,05, 1,29 y 0,41; p=0,585). No se observaron diferencias significativas en sobrevida global (79,0%, 74,6% y 71,1%; p=0,66) y sobrevida libre de enfermedad (73,7%, 68,1% y 73,6%; p=0,922), en los tres grupos estudiados a 3 años de seguimiento.

Conclusiones:

Encontramos que aumentar los intervalos de tiempo entre el fin de la quimioradioterapia neoadyuvante y la cirugía hasta 24 semanas no afecta la sobrevida global, sobrevida libre de enfermedad ni los desenlaces patológicos. Esto permitiría extender los intervalos de tiempo en estudios futuros para definir el mejor intervalo de tiempo para la cirugía
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Rectal Neoplasms / Rectum / Adenocarcinoma / Neoadjuvant Therapy / Chemoradiotherapy, Adjuvant / Capecitabine / Antimetabolites, Antineoplastic Type of study: Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Aged80 / Female / Humans / Male Language: English Journal: Rev. gastroenterol. Perú Journal subject: Gastroenterology Year: 2018 Type: Article Affiliation country: Peru Institution/Affiliation country: Instituto Nacional de Enfermedades Neoplasicas/PE

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Full text: Available Index: LILACS (Americas) Main subject: Rectal Neoplasms / Rectum / Adenocarcinoma / Neoadjuvant Therapy / Chemoradiotherapy, Adjuvant / Capecitabine / Antimetabolites, Antineoplastic Type of study: Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Aged80 / Female / Humans / Male Language: English Journal: Rev. gastroenterol. Perú Journal subject: Gastroenterology Year: 2018 Type: Article Affiliation country: Peru Institution/Affiliation country: Instituto Nacional de Enfermedades Neoplasicas/PE