Carcinoma Avançado do Colo do Útero: Tratamento Inicial pela Quimioterapia
DOI:
https://doi.org/10.32635/2176-9745.RBC.1994v40n4.3000Palabras clave:
Quimioterapia e Carcinoma do Colo do Útero, Carcinoma do Colo do Útero, Carcinoma Avançado do Colo do Útero, Tratamento NeoadjuvanteResumen
Utilizamos a quimioterapia como tratamento inicial do carcinoma avançado do colo do útero em 40 pacientes, nos estádios lLa, llb e lllb a fim de aumentar a eficácia da radioterapia e torna-los operáveis. As drogas utilizadas foram cisplatina (80-100 mg/rrf/ciclo) e bleomicina (15 mg/ciclo), seguidas de radioterapia e cirurgia quando localmente possível. Foram operadas 21 pacientes (12 Wertheim-Meigs e nove pan-histerectomias). Em oito peças cirúrgicas (21,7%) não foi encontrada neoplasia residual. Quanto aos gânglios pélvicos, 83,3% dos casos submetidos a linfadenectomia não apresentavam metástases. Dos tumores operáveis, 85,7% eram exofíticos e três endofíticos (19,3%) e entre estes últimos houve dois óbitos e uma recidiva em cúpula vaginal. Nós concluímos que a associação da quimioterapia à radioterapia é efetiva em tornar operável mais da metade dos casos de tumores avançados do colo do útero. Os tumores exofíticos relacionam-se com melhor prognóstico em termos de resposta clínica e sobrevida livre de doença, e que possivelmente a quimioterapia diminui a porcentagem de pacientes com gânglios pélvicos metastáticos.
Descargas
Citas
ORGANIZAÇÃO PAN-AMERICANA DE SAÚDE. Manual de Normas e Procedimentos para Controle do Cancer Cérvico-uterino 1985; O.P.A. n»6pp. 9-14.
SOUHAMI L, GIL RA, ALL7N SE et al. A randomized trial of chemotherapy followed by pelvic radiation therapy ih stage lll-b carcinoma of the cervix. J Clin Oncol 1991; 9: 970-977. DOI: https://doi.org/10.1200/JCO.1991.9.6.970
BRUMINI R. Cancer Brasil, Dados Histopatológicos, Rio de Janeiro: Campanha Nacional de Combate ao Cancer, Ministério da Saúde, 1982.
SOUHAMI L, MELO JAC, PAREJA G. The treatment of stage III carcinoma of the uterine cervix with telecobait irradiation. Gynecol Oncol 1987; 28: 262-267. DOI: https://doi.org/10.1016/0090-8258(87)90171-5
FRIEDLANDER ML, KEYE SB, SULLIVAN A et al. Cervical carcinoma: A drug responsive tumor - experience with combined cisplatin, vinblastine and bleomicin. Therapy Gynecol Oncol 1983; DOI: https://doi.org/10.1016/0090-8258(83)90102-6
:275-281.
KIM DS, MOON H, HWANG YY, CHO SH. Preoperative adjuvante chemotherapy in the treatment of cervical cancer stage Ib, lla, and llb with Bulkey tumor. Gynecol Oncol 1988; 29(3): 321-332. DOI: https://doi.org/10.1016/0090-8258(88)90231-4
KUCHNLE H, MEERPOHL HG, EIERMANN W, ACHTERRATH W. Neoadjuvant therapy for cervical cancer. Sem Oncol 1992; 19 (suppl.) 1: 94-98.
PANICI PB, SCAMBIAG, GREGGI S, Dl ROBERTO P, BAIOCCHI G, MANCUSO S. Neoadjuvant chemotherapy and radical surgery in locally advanced cervical carcinoma. A pilot study. Obstet Gynecol 1988; 71 (3): 344-348.
RUSTIN GJS, NEWLAiNDS ES, SOUTHCATT BM, SINGER A. Cisplatin, vincristine, methotrexate and bleomycin (POMB) asinitial or palliative chemotherapy for carcinoma of the cervix. Br J Obstet
Gynecol 1987; 94: 1204-1211.
JONES WB. New approaches to high-risk cervical cancer. Advanced. Cervical Cancer. Cancer 1993; 71 (Suppl.): 1451 -1459. DOI: https://doi.org/10.1002/cncr.2820710408
INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS. Report on the results of treatment in gynecological cancer. FIGO 1988; 20: 29-71.
VERA R. Refections on the management of cancer cérvix in developing countries. Int J Radiat Oncol Biol Phys 1982; 8: 953-955, DOI: https://doi.org/10.1016/0360-3016(82)90109-2
OKEN MM, CREECH RH, TORMEY DC, HORTON J, DAVIS TE, McFADDEN ET, CARBONE PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-655, DOI: https://doi.org/10.1097/00000421-198212000-00014
ROSEN G, CAPARROS, HUVOS AG, KOSLOFFC, NIREMBERG A, CACUIO A et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer 1987; 49; 1122-1230, DOI: https://doi.org/10.1002/1097-0142(19820315)49:6<1221::AID-CNCR2820490625>3.0.CO;2-E
VICKW.WALSH JW. WHEELOCKJB, BRUMER WH. CT of the normal and abnormal parametria in cervical Cancer. Am J Roentgen 1984; 143: 597-603. DOI: https://doi.org/10.2214/ajr.143.3.597
BONADONNA G, VALAGUSSA P, ROSSI A, TANCINI G, BRAMBELLAC, ZAMBETTIM etal. (1985). Tenyears experience with CMF based adjuvant chemotherapy in resectable breast Cancer. Breast Cancer Res Treat 1985; 5: 95-115. DOI: https://doi.org/10.1007/BF01805984
KELSEN DP, MINSKEYB, SMITH M, BEITHER J, NIEDJWLECKI D, CHAPMAN Det al. Preoperative therapy for esophageal Cancer: a randomized comparison of chemotherapy versus radiation
therapy. Clln Oncol 1990; 8: 1352-1361. DOI: https://doi.org/10.1200/JCO.1990.8.8.1352
BONOMIP, BLESSING JA, STEHMAN FB, DISAIAPJ, WALTON L, MAJOR FJ. Randomized trial of three cisplatin dose schedules in squamous-celi carcinoma of the cervix: a Gynecological Oncology Group Study. J Clln Oncol 1985; 3:1079-1085. DOI: https://doi.org/10.1200/JCO.1985.3.8.1079
BLOCH B, NELCP, KRIELA, ATAD J, GOLBERG G. Combination chemotherapy wlth cisplatin and bleomycin in advanced cervical Cancer. Cancer Treat Rep 1984; 68: 891-893.
DAGHESTANI AN, HAKES TB, LYNCH G, LEWIS JL Jr. Cervix carcinoma treatment with combination cisplatin and bleomycin, Gynecol Oncol 1983; 16: 334-339. DOI: https://doi.org/10.1016/0090-8258(83)90159-2
SOUEN JS. Cancer do colo uterino. Tratamento e prognóstico. In: Haibe H. 13 ed. Tratado de Ginecologia. Haibe H 1989:1526-1531.
RUSSEL AH, BURT AR, EK M et al. Adjunctive hysterectomy followlng radiation therapy for bulky carcinoma of the uterine cervix: prognostic implications of tumor persistence. Gynecol Oncol 1987; 28: 200-225. DOI: https://doi.org/10.1016/0090-8258(87)90217-4
WHEELER JA, ZAGARS GK, AYALA AG. Dedifferentiation of locally recurrent prostate Cancer after radiation therapy. Cancer 1993; 71:378 3-3787, DOI: https://doi.org/10.1002/1097-0142(19930601)71:11<3783::AID-CNCR2820711149>3.0.CO;2-X
VOKES EE, SCHILSKYRL, WEICHSELBAUM RR, KOZLOFF MF, PANJE WR. Induction chemotherapy with cisplatin fluorouracil, and high-dose leucovorin for locally advanced head and neck Cancer. J Clin Oncol 1990; 8: 241 -247, DOI: https://doi.org/10.1200/JCO.1990.8.2.241
