Cumprir com o plano de tratamento de radioterapia em doentes com tumores de cabeça e pescoço e impacto na eficácia do tratamento

Um estudo realizado pela Universidade de Aveiro e a Escola Superior de Tecnologia de Saúde do Porto (IPP), em colaboração com o Instituto Português de Oncologia de Coimbra (IPOCFG), no âmbito do projeto RESPONSE avaliou o cumprimento do plano de tratamento de radioterapia e os benefícios clínicos obtidos em doentes com tumores de cabeça e pescoço com o protocolo clínico adotado pelo IPOFG a partir de 2006.

Este estudo concluiu que os doentes que receberam a radioterapia tal como planeada tiveram uma probabilidade de controlo tumoral 10-19% superior à dos doentes que interromperam o tratamento. Estas diferenças foram estatisticamente significativas para o subgrupo de doentes com tumores avançados (estadio N2-3), para os doentes que realizaram radioterapia concomitantemente com quimioterapia e doentes que efetuaram radioterapia adjuvante (pós-operatória) (figura). A causa mais frequente para a interrupção da radioterapia foi a severidade dos efeitos secundários agudos e outras co-morbilidades. É por isso fundamental adotar medidas preventivas que minimizem as interrupções do tratamento.

Autores e Afiliações:

BC Ferreira^1,2, P Sa-Couto³, MC Lopes⁴, L Khouri⁵

¹I3N Departamento de Física, Universidade, Aveiro

² Escola Superior de Tecnologia de Saúde do Porto – Instituto Politécnico do Porto, Porto

³ Departamento de Matemática, Universidade de Aveiro, Aveiro

⁴ Serviço de Física Médica, Instituto Português Oncologia do Porto Francisco Gentil, Coimbra

⁵ Serviço de Radioterapia, Instituto Português Oncologia do Porto Francisco Gentil, Coimbra

Abstract:

Aims: Evaluate head and neck (HNC) cancer patient’s compliance to the planned radiation therapy (RT) using the department policy established in 2005 at IPOCFG. Estimate the impact in treatment outcome due to failure in receiving RT as prescribed.

Material and Methods: 359 HN cancer patients irradiated from 2007-2013 were included in this study. Patient cohort was divided into Group 1: patients receiving RT as prescribed and Group 2: patients that interrupted or suspended RT. Group Tox is the subgroup of patients that interrupted RT due toxicity or intercurrent disease. Number and causes for treatment interruptions were assessed. The cumulative incidence of locoregional control (LRC), disease free survival (DFS) and overall survival for Group 1 and 2 was determined. Cox regression was performed to investigate potential hazard factors and logistic regression was made to determine risk factors related to treatment interruptions.

Results: Major causes for treatment interruptions were toxicity plus intercurrent disease (41.7%) and public holidays (30.1%). 10.3% of the patients interrupted 3-9 days. Significant differences in survival distributions of LRC between Group 1 and 2, of up to 19%, were found for the subgroup of patients with N2-3 tumours, for post-operative RT and for concomitant RT. Treatment breaks larger than two days had an almost four-fold increased risk of poorer LRC and DFS.

Conclusions: Twin accelerators and treating on public holidays are effective measures minimizing RT breaks. For HNC, patient compliance is mostly limited by RT side-effects. Efforts to maintain RT biological effective dose in HNC must be always undertaken.

Revista: Clinical and Translational Oncology

Link: http://link.springer.com/article/10.1007/s12094-015-1417-5