Tratamento adjuvante em câncer de pulmão de células não pequenas

Abstract

Objective: Adjuvant chemotherapy is recommended for most patients submitted to resection due to non-small cell lung cancer (NSCLC) staged as II or IIIA. However, although various chemotherapy regimens that include cisplatin have been used in phase III trials, the best choice remains unclear. The objective of this study was to describe the experience of the Instituto Nacional do Câncer (INCA, Brazilian National Cancer Institute), located in the city of Rio de Janeiro, Brazil, with the use of the cisplatin-etoposide combination in such patients, with a special focus on survival data. Methods: We retrospectively evaluated the medical charts of the patients receiving adjuvant therapy for NSCLC at the INCA between 2004 and 2008. Results: We included 51 patients, all of whom were treated with the cisplatin-etoposide combination. The median follow-up period was 31 months, and the median overall survival was 57 months. In the univariate analysis, median survival was lower in the patients submitted to chemotherapy plus radiotherapy than in those submitted to chemotherapy alone (19 vs. 57 months; p < 0.001), and there was a trend toward lower median survival in stage III patients than in stage I-II patients (34 vs. 57 months; p = 0.22). Overall survival was not significantly associated with gender (p = 0.70), histological pattern (p = 0.33), or cisplatin dose (p = 0.13). Conclusions: Our results support the use of adjuvant chemotherapy, and our survival data are similar to those reported in major randomized clinical trials. However, long-term follow-up is warranted in this population.Keywords: Lung neoplasms; Chemotherapy, adjuvant; Survival analysis. ResumoObjetivo: A quimioterapia adjuvante é recomendada na maioria dos casos de câncer de pulmão de células não pequenas (CPCNP) ressecados em pacientes nos estádios II ou IIIA. No entanto, diferentes esquemas quimioterápicos contendo cisplatina foram utilizados em estudos de fase III, e a melhor escolha permanece obscura. O objetivo deste estudo foi descrever a experiência do Instituto Nacional de Câncer (INCA), localizado na cidade do Rio de Janeiro (RJ), com o uso da combinação de cisplatina e etoposídeo nessa situação, com especial foco para os dados de sobrevida. Métodos: Foram avaliados retrospectivamente os prontuários dos pacientes com diagnóstico de CPCNP que receberam terapia adjuvante no INCA entre 2004 e 2008. Resultados: Foram incluídos 51 pacientes, e todos foram tratados com a combinação de cisplatina e etoposídeo. A mediana de tempo de seguimento foi de 31 meses de seguimento, e a mediana de sobrevida global foi de 57 meses. Na análise univariada, a sobrevida foi inferior nos pacientes submetidos a radioterapia + quimioterapia do que aqueles somente submetidos a quimioterapia (mediana de 19 vs. 57 meses; p < 0,001), e houve uma tendência a menor sobrevida nos pacientes em estádio III em relação àqueles em estádios I-II (mediana de 34 vs. 57 meses, respectivamente; p = 0,22). Não houve associações significativas entre a sobrevida global e gênero (p = 0...

Lung cancer in Brazil: epidemiology and treatment challenges

“…There are 3 historical cohort reports 19 – 21 on adjuvant treatment in Brazil in the literature. A retrospective cohort study performed in the National Cancer Institute – INCA included 51 stage I–III NSCLC patients treated with surgery and adjuvant chemotherapy from 2004 to 2008.…”