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Vol. 73. Issue 1.
Pages 33-37 (January 2003)
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Vol. 73. Issue 1.
Pages 33-37 (January 2003)
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Resultados de la cirugía con tratamiento neoadyuvante del cáncer de recto
Results of surgery with neoadjuvant treatment in rectal cancer
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Emilio del Valle1
Corresponding author
edelvalle@teleline.es

Correspondencia: Dr. E. del Valle Hernández. Servicio de Cirugía General. I. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo, 46. 28007 Madrid. España.
, María Luisa de Fuenmayor, Marcos Rodríguez, José Perea, Alberto Muñoz-Calero
Fernando Muñoz Jiméneza
a Unidad de Coloproctología. Servicio de Cirugía General I. Hospital General Universitario Gregorio Marañón. Madrid. España.
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Resumen
Objetivo

El tratamiento neoadyuvante en el cáncer de recto está cada vez más establecido como la forma más adecuada de complementar la resección quirúrgica en lesiones localmente avanzadas. Los centros con especial interés en el tratamiento multidisciplinario del cáncer de recto evalúan diversas modalidades de tratamiento adyuvante preoperatorio. El presente trabajo es una revisión crítica de las diversas formas de tratamiento empleadas.

Resultados

La adyuvancia preoperatoria se tolera de forma aceptable, controla la progresión de la enfermedad, facilita la resección de lesiones grandes y, en las localizadas en el tercio inferior, ayuda a la preservación esfinteriana. Mejora las cifras de recidiva local y aumenta la tasa de supervivencia libre de enfermedad. La tendencia actual es asociar quimioterapia durante la radioterapia, aun cuando el beneficio de esta asociación debe ser validado por estudios aleatorizados que están pendientes de resultados. Este tratamiento no está exento de efectos secundarios, tales como alteración de la función anorrectal y sexual, por lo que debe seleccionarse a los pacientes que se beneficiarán de este esquema terapéutico.

Conclusiones

El tratamiento neoadyuvante es de elección en los pacientes con tumores en estadios II y III. En el futuro, nuevos esquemas y agentes quimioterápicos, y sistemas que sean capaces de identificar a los pacientes con tumores que sean respondedores a estas formas de tratamiento complementario, harán posible un mejor uso de estas opciones terapéuticas.

Palabras clave:
Cáncer de recto
Tratamiento neoadyuvante
Quimioterapia
Radioterapia
Quimiorradioterapia
Objective

Neoadjuvant treatment in rectal cancer is becoming the most appropriate form of complement the surgical resection in locally advanced lesions. The institutions with special interest in multidisciplinary treatment of rectal cancer evaluate different modalities in preoperative adjuvant treatment. We make a critical review of the different options employed.

Results

Preoperative adjuvant treatment has an acceptable tolerance, controls the progression of the tumor, helps in the resection of big lesions, and in the located in the lower rectum facilitate sphincter preservation. It reduces the incidence of local recurrence and improves the disease free survival. Actual trend is to associate quimiotherapy during radiotherapy; even the benefit of this complementation is now under validation with randomised trials. This form of treatment is not exempt of secondary effects: alterations in anorectal and sexual function, for which is important the selection of patients that will be favoured with this treatment plans.

Conclusions

Neoadjuvant treatment is the preferred option in patients with stage II and III rectal cancer. In the future, new schemes and quimiotherapy drugs, and systems that allow detect responders to this multidisciplinary treatment will make possible a better selection of patients for this therapeutic alternatives.

Key words:
Rectal cancer
Neoadjuvant treatment
Chemotherapy
Radiotherapy
Chemoradiation
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