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Radiocirurgia no tratamento multimodal da doença metastática encefálica : casuística do Centro Oncológico Doutora Natália Chaves
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Introdução: A incidência da doença metastática encefálica está a aumentar, sendo a radiocirurgia uma das principais abordagens terapêuticas, garantindo a eficácia no controlo da mesma. Contudo, as sobrevidas obtidas ainda são, maioritariamente, inferiores a 1 ano, pelo que se deve melhorar a compreensão das respostas radiobiológicas, a fim de melhor selecionar os doentes que possam beneficiar desta técnica. Métodos: Com o objetivo de avaliar o contributo da radiocirurgia no tratamento multimodal da doença metastática encefálica, procedeu-se à análise da casuística do Centro Oncológico Doutora Natália Chaves, incluindo um total de 307 doentes, desde janeiro de 2004 a dezembro de 2017. Os objetivos principais foram avaliar a sobrevida média global, as respostas a esta técnica, o controlo local da doença e a recorrência de novas metástases. O objetivo secundário foi avaliar os fatores preditivos da sobrevida.
Resultados: Do subgrupo de 144 doentes selecionados dos 307 doentes tratados, para os quais havia informação, a sobrevida média foi de 32.3meses, com uma mediana de 10 meses e com taxas de sobrevida global de 65.2% aos 6 meses, de 43.4% aos 12 meses e 25.5% aos 24 meses. Do subgrupo de 121 doentes, a taxa de controlo local da doença foi de 98.3% aos 7 meses e 88.5% aos 25 meses. Deste subgrupo, 80.6% dos doentes aos 6 meses e 48.6% aos 12 meses, não apresentaram recorrência de novas metástases. A resposta à intervenção foi completa em 11.5% dos doentes, parcial em 36.1%, tendo ocorrido estabilização em 27.9% e progressão em 24.6%. O grupo de doentes com idade igual ou inferior a 65 anos e o grupo de doentes do sexo feminino obtiveram sobrevidas médias estatisticamente significativas. Na análise multivariada, apenas o tumor primário do pulmão constituiu um fator preditivo da sobrevida.
Conclusão: Considerando os resultados, a radiocirurgia provou ser eficaz, em termos de sobrevida e controlo local da doença. De acordo com os resultados da sobrevida média, os critérios de seleção, nomeadamente o Karnosfsky performance status e o Recursive partioning analysis, parecem ser adequados para realização de radiocirurgia.
Introduction: The incidence of metastatic brain disease is increasing, with radiosurgery being one of the main therapeutic approaches that guarantees efficacy and safety in the control of the disease. However, survival outcomes are still mostly less than 1 year, so the understanding of the radiobiological responses should be improved in order to a better selection of the patients who can benefit from this technique. Methods: In order to evaluate the contribution of radiosurgery in the multimodal treatment of metastatic brain disease, it was developed a case series study including 307 patients from Centro Oncológico Doutora Natália Chaves, between January 2004 and December 2017. The primary endpoints were the evaluation of the overall mean survival, the responses to this technique, the local control of the disease and the recurrence of new metastases. The secondary endpoints were the evaluation of the survival predictive factors. Results: In a subgroup including 144 patients, the mean survival was 32,3 months, with a median survival of 10 months. Overall survival rates were 65,2% at 6 months, 43,4% at 12 months and 25,5% at 24 months, In the 121 patients subgroup, the local control rate was 98,3% at 7 months and 88,5% at 25 months. In this subgroup, 80,6% of the patients at 6 months and 48,6% at 12 months did not present recurrence of new metástases. Responses to radiosurgery were complete in 11,5% of patients, partial in 36,1%. There was stabilization in 27,9% and progression in 24,6%. Patients with 65 years or less and females had a statistically significant median survival. In the multivariate analysis, only the primary lung tumor was found as a survival predictive factor. Conclusion: Considering the results, radiosurgery proved to be effective in terms of overall survival and local control of the disease. Based on the median survival results, the selection criteria, such as Karnosfsky performance status and Recursive partioning analysis seems to be adequate for radiosurgery.
Introduction: The incidence of metastatic brain disease is increasing, with radiosurgery being one of the main therapeutic approaches that guarantees efficacy and safety in the control of the disease. However, survival outcomes are still mostly less than 1 year, so the understanding of the radiobiological responses should be improved in order to a better selection of the patients who can benefit from this technique. Methods: In order to evaluate the contribution of radiosurgery in the multimodal treatment of metastatic brain disease, it was developed a case series study including 307 patients from Centro Oncológico Doutora Natália Chaves, between January 2004 and December 2017. The primary endpoints were the evaluation of the overall mean survival, the responses to this technique, the local control of the disease and the recurrence of new metastases. The secondary endpoints were the evaluation of the survival predictive factors. Results: In a subgroup including 144 patients, the mean survival was 32,3 months, with a median survival of 10 months. Overall survival rates were 65,2% at 6 months, 43,4% at 12 months and 25,5% at 24 months, In the 121 patients subgroup, the local control rate was 98,3% at 7 months and 88,5% at 25 months. In this subgroup, 80,6% of the patients at 6 months and 48,6% at 12 months did not present recurrence of new metástases. Responses to radiosurgery were complete in 11,5% of patients, partial in 36,1%. There was stabilization in 27,9% and progression in 24,6%. Patients with 65 years or less and females had a statistically significant median survival. In the multivariate analysis, only the primary lung tumor was found as a survival predictive factor. Conclusion: Considering the results, radiosurgery proved to be effective in terms of overall survival and local control of the disease. Based on the median survival results, the selection criteria, such as Karnosfsky performance status and Recursive partioning analysis seems to be adequate for radiosurgery.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Radiocirurgia Doença metastática encefálica Tumor do pulmão Sobrevida Neurocirurgia