Publication: Tratamiento del cáncer de cabeza y cuello en estadio avanzado inoperable mediante quimioterapia intraarterial y radioterapia concomitante
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2018-03-20
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Universidad Complutense de Madrid
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Abstract
La quimioterapia intraarterial y radioterapia concomitante fue descrita por Robbins en 1994 en el tratamiento de pacientes con tumores irresecables de cabeza y cuello, consistiendo en una infusión supraselectiva intraarterial de cisplatino en la arteria nutricia del tumor y una infusión sistémica de tiosulfato sódico, un agente quelante que protege al resto del organismo de la toxicidad del cisplatino. Se consigue una dosis alta del quimioterápico en la zona tumoral minimizando los efectos tóxicos sistémicos y comorbilidades. Esta infusión intraarterial se combinaba con radioterapia concurrente. Pese a los avances en investigación, la supervivencia en los tumores en estadio avanzado de cabeza y cuello no ha aumentado prácticamente en los últimos 20 años. HIPÓTESIS: El tratamiento del cáncer de cabeza y cuello en estadio avanzado mediante quimioterapia intraarterial y radioterapia es una alternativa eficaz y predecible. OBJETIVOS: Conocer las curvas de supervivencia global y específica de los pacientes, la supervivencia libre de enfermedad, la tasa de control locorregional y la incidencia de metástasis a distancia. Examinar la toxicidad con este tratamiento y conocer los factores pronósticos y las indicaciones...
Intraarterial chemoradiotherapy was developed by Robbins and his group in 1994, consisting of superselective intraarterial infusions of cisplatin combined with intravenous sodium thiosulfate for systemic neutralization. High dose intensity in the tumor site was possible without increasing systemic toxicity and comorbidities. Chemotherapy was combined with concomitant radiotherapy. Although the incidence has decreased over the last decade, outcomes remain stagnant with only a 5% improvement in overall survival in the last 20 years. HYPOTHESIS: Our treatment of patients with head and neck non-surgical carcinoma (IV stage) using intraarterial chemoradiation scheme is effective and predictable. OBJECTIVES: We want to know the overall and cause-especific survival rates, locorregional control and free disease survival rates, complete response rates and incidence of distant recurrence. We want to analyse the toxic events, the factors that influence prognosis and the cases that could benefit from this protocol. MATERIAL AND METHODS: We present 48 patients, stage IV, nonsurgical, head and neck squamous cell carcinoma that were treated with 3 cycles (days 1-8-15) of massive intraarterial cisplatin (150mg/m2), and simultaneous intravenous infusion of the neutralizing agent sodium thiosulfate with concomitant hyperfraccionate radiotherapy. The primary site received 75 Gy and the cervical site was treated with 60 Gy. Our protocol includes an angiographic vascular map of the lesion and an accurate dose distribution of the chemotherapy agent in unilateral or bilateral tumor location before treatment...
Intraarterial chemoradiotherapy was developed by Robbins and his group in 1994, consisting of superselective intraarterial infusions of cisplatin combined with intravenous sodium thiosulfate for systemic neutralization. High dose intensity in the tumor site was possible without increasing systemic toxicity and comorbidities. Chemotherapy was combined with concomitant radiotherapy. Although the incidence has decreased over the last decade, outcomes remain stagnant with only a 5% improvement in overall survival in the last 20 years. HYPOTHESIS: Our treatment of patients with head and neck non-surgical carcinoma (IV stage) using intraarterial chemoradiation scheme is effective and predictable. OBJECTIVES: We want to know the overall and cause-especific survival rates, locorregional control and free disease survival rates, complete response rates and incidence of distant recurrence. We want to analyse the toxic events, the factors that influence prognosis and the cases that could benefit from this protocol. MATERIAL AND METHODS: We present 48 patients, stage IV, nonsurgical, head and neck squamous cell carcinoma that were treated with 3 cycles (days 1-8-15) of massive intraarterial cisplatin (150mg/m2), and simultaneous intravenous infusion of the neutralizing agent sodium thiosulfate with concomitant hyperfraccionate radiotherapy. The primary site received 75 Gy and the cervical site was treated with 60 Gy. Our protocol includes an angiographic vascular map of the lesion and an accurate dose distribution of the chemotherapy agent in unilateral or bilateral tumor location before treatment...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 20-06-2017