Radioterapa con neoadyuvancia concurrente de orquiectomía subcapsular o leuprolide para cáncer de próstata de muy alto riesgo
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El cáncer de próstata de muy alto riesgo (cáncer de próstata de muy alto riesgo ) es una neoplasia que es de particular importancia debido a que aumenta el riesgo de mortalidad. En el hospital Teodoro Maldonado Carbo en Guayaquil, Ecuador, la privación de andrógenos se ha realizado sin que existan estudios de respaldo a una de las opciones terapéuticas. Comparar los resultados terapéuticos de la radioterapia en neoadyuvancia concurrente con orquiectomía subcapsular bilateral (RT+OSB) contra el uso de leuprolide (RT+ADT) para el tratamiento del cáncer de próstata de muy alto riesgo . Se realizó de estudio de cohorte que incluyó sin aleatorización 25 casos consecutivos de pacientes con cáncer de próstata de muy alto riesgo tratados RT+OSB y 25 con RT+ADT entre el 1-03-2016 y el 31-08-2020 con adherencia al esquema terapéuticos, en estado funcional del ECOG ≤ 2, función adecuada de médula ósea, hígado y riñón pretratamiento. Se excluyeron aquellos en los que fue imposible el seguimiento. La comparación de las características basales mostró que la puntuación de Gleason mayor 8 fue mayor en el grupo de RT+OSB) que en los pacientes con RT+ADT (88.9% vs 11.1%; p 0.012). Al comparar los resultados del tratamiento se pudo observar que la necesidad de inicio de quimioterapia citotóxica fue significativamente menor en los pacientes que recibieron RT+OSB que entre los que fueron indicados con RT+ADT (25% vs 75%; p 0.047), no hubo diferencias respecto a eventos adversos, valores de PSA, progresión radiológica o muerte. Una clasificación de Gleason mayor a 8 no influyó en los resultados. RT+OSB tiene ventajas sobre la RT+ADT en pacientes con cáncer de próstata de muy alto riesgo
Very high-risk prostate cancer (very high-risk prostate cancer) is a neoplasm that is of particular importance because it increases the risk of mortality. At the Teodoro Maldonado Carbo hospital in Guayaquil, Ecuador, androgen deprivation has been carried out without any studies supporting one of the therapeutic options. To compare the therapeutic outcomes of concurrent neoadjuvant radiotherapy with bilateral subcapsular orchiectomy (RT+OSB) versus the use of leuprolide (RT+ADT) for the treatment of very high-risk prostate cancer. A cohort study was carried out that included, without randomization, 25 consecutive cases of patients with very high-risk prostate cancer treated with RT+OSB and 25 with RT+ADT between 03-01-2016 and 08-31-2020 with adherence to the therapeutic scheme, in ECOG performance status ≤ 2, adequate bone marrow, liver and kidney function pre-treatment. Those in whom follow-up was impossible were excluded. Comparison of baseline characteristics showed that Gleason score major 8 was higher in the RT+OSB group than in RT+ADT patients (88.9% vs 11.1%; p 0.012). When comparing the treatment results, it was observed that the need to start cytotoxic chemotherapy was significantly lower in patients who received RT+OSB than among those who were indicated with RT+ADT (25% vs 75%; p 0.047), not There were differences regarding adverse events, PSA values, radiological progression or death. A Gleason score greater than 8 did not influence the results. RT+OSB has advantages over RT+ADT in patients with very high-risk prostate cancer
Very high-risk prostate cancer (very high-risk prostate cancer) is a neoplasm that is of particular importance because it increases the risk of mortality. At the Teodoro Maldonado Carbo hospital in Guayaquil, Ecuador, androgen deprivation has been carried out without any studies supporting one of the therapeutic options. To compare the therapeutic outcomes of concurrent neoadjuvant radiotherapy with bilateral subcapsular orchiectomy (RT+OSB) versus the use of leuprolide (RT+ADT) for the treatment of very high-risk prostate cancer. A cohort study was carried out that included, without randomization, 25 consecutive cases of patients with very high-risk prostate cancer treated with RT+OSB and 25 with RT+ADT between 03-01-2016 and 08-31-2020 with adherence to the therapeutic scheme, in ECOG performance status ≤ 2, adequate bone marrow, liver and kidney function pre-treatment. Those in whom follow-up was impossible were excluded. Comparison of baseline characteristics showed that Gleason score major 8 was higher in the RT+OSB group than in RT+ADT patients (88.9% vs 11.1%; p 0.012). When comparing the treatment results, it was observed that the need to start cytotoxic chemotherapy was significantly lower in patients who received RT+OSB than among those who were indicated with RT+ADT (25% vs 75%; p 0.047), not There were differences regarding adverse events, PSA values, radiological progression or death. A Gleason score greater than 8 did not influence the results. RT+OSB has advantages over RT+ADT in patients with very high-risk prostate cancer
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RADIOTERAPIA, TERAPIA NEOADYUVANTE, ORQUIECTOMIA, LEUPROLIDA, NEOPLASIAS DE LA PROSTATA, ESTUDIOS DE COHORTE, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR