Tratamento do Câncer do Colo do útero Estádio III com Adriamicina, Bleomicina e Cispiatinum (ABC) Neo-adjuvante, Histerectomia Radical Modificada e ABC Adjuvante
DOI:
https://doi.org/10.32635/2176-9745.RBC.1987v33n2.3193Palabras clave:
Neoplasias del Cuello Uterino/terapia, Antineoplásicos, Doxorrubicina, HisterectomíaResumen
Quarenta e oito pacientes com carcinoma do colo do útero estádio III A e B foram tratadas com a associação de adriamicina (ADE), bleomicina (BLEO) e cisplatinum (CDDP), três a cinco ciclos neo-adjuvante, seguidos de histerectomia radical modificada e seis ciclos de ABC adjuvante. Quarenta doentes foram consideradas avaliáveis. Os primeiros 17 casos receberam ADR 50mg/m2, BLEO 10mg/d x 5 e CDDP 100mg/m2administrados no dia 1 e repetidos de 21/21 dias (ABC DA). A toxicidade neste grupo foi considerada inaceitável, com dois óbitos, sendo reduzidas as doses de CDDP e BLEO, respectivamente, 50mg/m2 e 6mg/d x 5 (ABD DB) nas 23 seguintes. Das 17 tratadas com o ABC DA, 12(70%) foram elegíveis para a cirurgia e o exame da peça revelou resposta completa (RC) em dois (11%) e resposta parcial (RP) em 10(59%). Das 23 tratadas com ABC DB, 16 (69%) foram operadas com RC confirmada em três (13%) e RP em 13 (56%). Após 38 meses, no grupo ABC DA, duas (12%) estão sem evidência de doença, quatro (23%) estão vivas com recorrência, sete (41%) morreram pela neoplasia, duas (12%) morreram por toxicidade (cardíaca e pulmonar), uma (5%) morreu de causa desconhecida e uma (5%) foi perdida do seguimento. No grupo ABC DB, em 36 meses, nove (39%) estão sem evidência de doença, sete (30%) estão vivas com recorrência, cinco (22%) morreram pela neoplasia e duas (9%) foram perdidas do seguimento. A sobrevida média estimada pelo método de Kaplan-Meier do grupo ABC DA é de 29% e do controle histórico de 102 pacientes tratadas pela radioterapia no mesmo período é de 52% (p < 0,01) e no ABC DB 63% (p <0,70 N.S.). Os resultados do grupo ABC DB, em 36 meses, analisados nas tabelas de vida e comparados com os controles demonstram resultados similares, porém, com melhor qualidade de sobrevida para as tratadas pelo ABC DB. O ABC DA por sua toxicidade não é recomendado. Das 28 que se submeteram à histerectomia radical modificada, 24 completaram pelo menos três ciclos adjuvantes do ABC e decorridos 38 meses, 20 das operadas estão vivas (71 %) comparado com 52% do grupo da RT (p = 0,004). O presente programa parece ser uma melhor alternativa de tratamento do câncer do colo do útero E III, necessitando, contudo, maior observação.
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