1 / 81

RADIOTERAPIA EN CÁNCER CÉRVICO UTERINO

RADIOTERAPIA EN CÁNCER CÉRVICO UTERINO. DR. RAYMUNDO HERNÁNDEZ MONTES DE OCA R3. Instituto Nacional de Cancerología. FACTORES QUE AFECTAN LA RESPUESTA A RADIOTERAPIA. Niveles de hemoglobina. Pacientes con Hb <12g/dl tienen menor respuesta a tratamiento. Tiempo de protracción.

skaggs
Download Presentation

RADIOTERAPIA EN CÁNCER CÉRVICO UTERINO

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. RADIOTERAPIA EN CÁNCER CÉRVICO UTERINO DR. RAYMUNDO HERNÁNDEZ MONTES DE OCA R3 Instituto Nacional de Cancerología

  2. FACTORES QUE AFECTAN LA RESPUESTA A RADIOTERAPIA Niveles de hemoglobina. Pacientes con Hb <12g/dl tienen menor respuesta a tratamiento. • Tiempo de protracción. • Debe ser inferior a 8 semanas (56 días). • Reducción de 0.5% a 1% en SCE y control pélvico por cada día extra en el tratamiento. NCCN Guidelines Version 1.2016 Cervical Cancer

  3. China. Retrospectivo. 1992-1997. 257 pacientes. The Adverse Affect of Treatment Prolongation in Cervical Cancer by High Dose Rate Intracavitary Brachytherapy Shang Wen Chen Radiation and Oncology 67 (2003) 69-76

  4. The Adverse Affect of Treatment Prolongation in Cervical Cancer by High Dose Rate Intracavitary Brachytherapy Shang Wen Chen Radiation and Oncology 67 (2003) 69-76

  5. The Adverse Affect of Treatment Prolongation in Cervical Cancer by High Dose Rate Intracavitary Brachytherapy Shang Wen Chen Radiation and Oncology 67 (2003) 69-76

  6. The Adverse Affect of Treatment Prolongation in Cervical Cancer by High Dose Rate Intracavitary Brachytherapy Shang Wen Chen Radiation and Oncology 67 (2003) 69-76

  7. The Adverse Affect of Treatment Prolongation in Cervical Cancer by High Dose Rate Intracavitary Brachytherapy Shang Wen Chen Radiation and Oncology 67 (2003) 69-76

  8. The Adverse Affect of Treatment Prolongation in Cervical Cancer by High Dose Rate Intracavitary Brachytherapy Shang Wen Chen Radiation and Oncology 67 (2003) 69-76

  9. Multicéntrico. Canadá. 630 pacientes. 1989-1992. The Effect of Hemoglobin Level on Radiotherapy Outcomes: The Canadian Experience Gillian Thomas Seminars in Oncology Vol 28 No 1 Suppl 8 2001; 60-65

  10. The Effect of Hemoglobin Level on Radiotherapy Outcomes: The Canadian Experience Gillian Thomas Seminars in Oncology Vol 28 No 1 Suppl 8 2001; 60-65

  11. The Effect of Hemoglobin Level on Radiotherapy Outcomes: The Canadian Experience Gillian Thomas Seminars in Oncology Vol 28 No 1 Suppl 8 2001; 60-65

  12. 2454 pacientes. MDACC. 1980-2011. RT definitiva 43.2 – 45Gy. BQT 80-90Gy pto A. 702 pacientes (29%) QT concomitante. Relationship Between Low Hemoglobin Levels and Outcomes After Treatment With Radiation or Chemoradiation in Patients with Cervical Cancer: Has the Impact of Anemia Been Overstated? Andrew J. Bishop Int J Radiation Oncol Biol Phys Vol 91 No 1; 196-205, 2015

  13. SLR Central SLMD SEE

  14. El tiempo de protracción disminuye la supervivencia global y el control pélvico por cada día extra en duración de tratamiento (<8 semanas). Los niveles de hemoglobina influyen en el control local y supervivencia enfermedad específica. Conclusiones

  15. ESTADIOS CLÍNICOS TEMPRANOS

  16. ESTADIOS CLÍNICOS TEMPRANOS TRATAMIENTO DEFINITIVO Pacientes médicamente inoperables o que rechazan cirugía. Radioterapia sola. Dosis 70-80Gy a punto A. NCCN Guidelines Version 1.2016 Cervical Cancer

  17. Aleatorizado, prospectivo. 1986 – 1991. 343 pacientes. EC Ib y IIa. Histerectomía radical tipo III Dosis Punto A 70-90Gy (mediana 76Gy). Randomised Study of Radical Surgery Versus Radiotherapy for Stage Ib – IIa Cervical Cancer Fabio Landoni Lancet 1997; 350: 535-540

  18. Randomised Study of Radical Surgery Versus Radiotherapy for Stage Ib – IIa Cervical Cancer Fabio Landoni Lancet 1997; 350: 535-540

  19. Randomised Study of Radical Surgery Versus Radiotherapy for Stage Ib – IIa Cervical Cancer Fabio Landoni Lancet 1997; 350: 535-540

  20. Randomised Study of Radical Surgery Versus Radiotherapy for Stage Ib – IIa Cervical Cancer Fabio Landoni Lancet 1997; 350: 535-540

  21. Randomised Study of Radical Surgery Versus Radiotherapy for Stage Ib – IIa Cervical Cancer Fabio Landoni Lancet 1997; 350: 535-540

  22. ESTADIOS CLÍNICOS TEMPRANOS Beneficios de la cirugía sobre la radioterapia. Menor tiempo de tratamiento. Preservación de la función ovárica. «Mejor función sexual». No hay riesgo de 2dos primarios. No hay toxicidad crónica. NCCN Guidelines Version 1.2016 Cervical Cancer

  23. TRATAMIENTO ADYUVANTE Radioterapia (>1 riesgo intermedio). Tumor >4cm. Invasión > 1/3 al estroma cervical. Permeación linfovascular. • Quimioradioterapia concomitante (riesgo alto). • Ganglios positivos. • Márgenes positivos. • Invasión a parametrios. Rotman MZ. Gynecol Oncol 1999; 177-183 Peters WA. J Clin Oncol 2000; 18: 1606-1613

  24. Preservación de la función hormonal: Transposición ovárica. <45 años. Pre menopausia. Histología células escamosas. • Falla ovárica 5 - 10Gy. • Esterilidad 2 - 3Gy. J Pahisa. Int J Gynecol Cancer 2008, 18, 584-589

  25. ENFERMEDAD AVANZADAIB2, IIA2, IIB-IVA

  26. ENFERMEDAD AVANZADAIB2, IIA2, IIB-IVA TRATAMIENTO DEFINITIVO Quimioradioterapia concomitante. Dosis 70-80Gy a punto A NCCN Guidelines Version 1.2016 Cervical Cancer

  27. ENFERMEDAD AVANZADAIB2, IIA2, IIB-IVA National Cancer Institute: strong consideration should be given to the incorporation of concurrent cisplatin based chemotherapy with radiation therapy in women who require radiation therapy for treatment of cervical cancer. Gillian M Thomas. The New England Journal of Medicine 1999.

  28. ENFERMEDAD AVANZADAIB2, IIA2, IIB-IVA Keys HM. N Engl J Med 1999; 340: 1154-1161 Rose PG. N Engl J Med 1999; 340: 1144-1153 Morris M. N Engl J Med 1999; 340: 1137-1143 Whitney CW. J Clin Oncol 1999; 1339-1348 Peters WA. J Clin Oncol 2000: 1606-1613

  29. ENFERMEDAD AVANZADAIB2, IIA2, IIB-IVA Keys HM. N Engl J Med 1999; 340: 1154-1161 Rose PG. N Engl J Med 1999; 340: 1144-1153 Morris M. N Engl J Med 1999; 340: 1137-1143 Whitney CW. J Clin Oncol 1999; 1339-1348 Peters WA. J Clin Oncol 2000: 1606-1613

  30. 15 estudios aleatorizados. 3452 pacientes. RT vs QTRT Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A systematic Review and Meta Analysis Claire Vale J Clin Oncol 26: 5802-5812, 2008

  31. Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A systematic Review and Meta Analysis Claire Vale J Clin Oncol 26: 5802-5812, 2008

  32. Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A systematic Review and Meta Analysis Claire Vale J Clin Oncol 26: 5802-5812, 2008

  33. Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A systematic Review and Meta Analysis Claire Vale J Clin Oncol 26: 5802-5812, 2008

  34. Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A systematic Review and Meta Analysis Claire Vale J Clin Oncol 26: 5802-5812, 2008

  35. RADIOTERAPIA A GANGLIOS PARA AÓRTICOS

  36. Cobalto 60. Dosis pelvis 40-50Gy. Dosis para aórticos 45Gy. 367 pacientes. Prophylactic Irradiation of the Para Aortic Lymph Node Chain in Stage IIB and Bulky Stage IB Carcinoma of the Cervix, RTOG 7920 M. Rotman Int J Radiation Oncology Biol Phys Vol 19 513-521, 1990

  37. Prophylactic Irradiation of the Para Aortic Lymph Node Chain in Stage IIB and Bulky Stage IB Carcinoma of the Cervix, RTOG 7920 M. Rotman Int J Radiation Oncology Biol Phys Vol 19 513-521, 1990

  38. Prophylactic Irradiation of the Para Aortic Lymph Node Chain in Stage IIB and Bulky Stage IB Carcinoma of the Cervix, RTOG 7920 M. Rotman Int J Radiation Oncology Biol Phys Vol 19 513-521, 1990

  39. 390 pacientes. Multicéntrico. Campos AP , PA, laterales opuestos. Dosis 45Gy (1.8Gy/fx). Pelvic Irradiation with Concurrent Chemotherapy Versus Pelvic and Para Aortic Irradiation for High Risk Cervical Cancer: An Update of RTOG 90-01 Patricia Eifel J Clin Oncol 22: 872-880, 2004

  40. Pelvic Irradiation with Concurrent Chemotherapy Versus Pelvic and Para Aortic Irradiation for High Risk Cervical Cancer: An Update of RTOG 90-01 Patricia Eifel J Clin Oncol 22: 872-880, 2004

  41. Pelvic Irradiation with Concurrent Chemotherapy Versus Pelvic and Para Aortic Irradiation for High Risk Cervical Cancer: An Update of RTOG 90-01 Patricia Eifel J Clin Oncol 22: 872-880, 2004

  42. TÉCNICAS DE RADIOTERAPIA

  43. VOLÚMENES DE TRATAMIENTO TRATAMIENTO DEFINITIVO Enfermedad macroscópica. Parametrios. Ligamentos útero sacros. Margen vaginal (3cm). Ganglios pre sacros. Ganglios iliacos comunes, internos y externos. Ganglios obturadores. Ganglios para aórticos (nivel de los vasos renales): si hay ganglios positivos en iliaca común, para aórticos. Ganglios inguinales (invasión de tercio inferior de vagina). • RADIOTERAPIA POST OPERATORIA. • 3-4 cm de cúpula vaginal. • Parametrios. • Ganglios pre sacros. • Ganglios iliacos comunes, internos y externos. • Ganglios obturadores. • Ganglios para aórticos (nivel de los vasos renales): si hay ganglios positivos en iliaca común, para aórticos. NCCN Guidelines Version 1.2016 Cervical Cancer

More Related