Použití pooperační adjuvantní chemoterapie u pacientů s karcinomem rekta ve stadiu II/III léčených neoadjuvantní terapií:
Použití pooperační adjuvantní chemoterapie u pacientů s karcinomem rekta ve stadiu II/III léčených neoadjuvantní terapií: analýza National Comprehensive Cancer Network
Cíl
Podle doporučených postupů pro praxi se u pacientů, kteří absolvují neoadjuvantní chemoterapii a radioterapii pro lokálně pokročilý karcinom rekta, provádí nezávisle na případném snížení stadia nádoru pooperační adjuvantní systémová chemoterapie.
Pacienti a metody
Databáze kolorektálního karcinomu vedená v rámci NCCN (National Comprehensive Cancer Network) sleduje dlouhodobou léčbu pacientů léčených v osmi odborných onkologických centrech ve Spojených státech amerických. Tato databáze byla použita ke zjištění, jak často podstoupili pacienti s karcinomem rekta po léčbě neoadjuvantní chemoterapií také pooperační systémovou chemoterapii. K posouzení charakteristik pacientů a nádorů byl použit model mnohorozměrné logistické regrese.
Výsledky
Mezi zářím 2005 a prosincem 2010 bylo do uvedené databáze zařazeno 2 073 pacientů s karcinomem rekta ve stadiu II/III. Z těchto nemocných bylo do analýzy uvedené studie zařazeno 1 193 pacientů, kteří podstoupili neoadjuvantní chemoradioterapii, včetně 203 pacientů, kteří adjuvantní chemoterapii neabsolvovali. U pacientů vyšetřených onkologem bylo nejčastějším důvodem pro nedoporučení chemoterapie přidružené onemocnění (25 z 50, 50 %); nejčastějším důvodem neprovedení chemoterapie přes její doporučení nebo přes vedení rozhovoru v tomto postupu bylo odmítnutí pacientem (54 ze 74, 73 %). Po korekci na vliv onkologického centra NCCN a klinického stadia dle klasifi kace TNM v mnohorozměrném logistickém modelu byly faktory, které byly významně spojeny s neprovedením adjuvantní chemoterapie, věk, stav výkonnosti (PS) podle Eastern Cooperative Oncology Group ≥ 1, pojištění Medicaid nebo pojištění pro chudé ve srovnání se soukromým pojištěním, kompletní patologická odpověď, provedení reoperace pro infekci v ráně a neprovedení uzávěru ileostomie/kolostomie.
Závěr
I ve specializovaných onkologických centrech není u překvapivé části pacientů s karcinomem rekta léčených neoadjuvantní chemoradioterapií s kurativním záměrem provedena pooperační chemoterapie. Je třeba zkoumat strategie ke zvýšení schopnosti pacientů dokončit tuto třetí a poslední složku léčby s kurativním záměrem.
J Clin Oncol 31:30-38. © 2012 by American Society of Clinical Oncology
Celý článek naleznete v časopise Journal of Clinical Oncology číslo 1/2013 na straně 1-9
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Zdroj: Journal of Clinical Oncology