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Terapia neoadyuvante en el cáncer de vesícula biliar mejora la resecabilidad y la supervivencia: un estudio
Anupam Lahiri1, Suchita Chowdhury2, Shaifali Goel1
1Department of GI and HPB Services, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, 110085, India.
Resumen
La quimioterapia neoadyuvante (NACT) mejora significativamente las tasas de resección del cáncer de vesícula biliar, ofreciendo una oportunidad de cirugía curativa en más del 60% de los pacientes que completan el tratamiento. Este enfoque muestra beneficios prometedores en la supervivencia para la enfermedad localmente avanzada.
Área de la Ciencia:
- Oncología
- Oncología Quirúrgica
- Quimioterapia
Sus antecedentes:
- El carcinoma de vesícula biliar presenta un mal pronóstico con resecabilidad limitada en el momento del diagnóstico.
- La eficacia de la quimioterapia neoadyuvante (NACT) para el cáncer de vesícula biliar no está bien establecida.
Objetivo del estudio:
- Evaluar el impacto de la NACT en la resecabilidad y los resultados de supervivencia en pacientes con carcinoma de vesícula biliar.
- Evaluar la seguridad y viabilidad de la NACT en un entorno clínico prospectivo.
Principales métodos:
- Un estudio prospectivo, unicéntrico en el que participaron 226 pacientes con carcinoma de vesícula biliar.
- Los pacientes recibieron NACT basada en gemcitabina-platino seguida de evaluación de la respuesta.
- Los criterios de valoración principales incluyeron la consecución de la resecabilidad y la supervivencia global.
Principales resultados:
- La tasa de resección por intención de tratar fue del 36,2%, aumentando al 60,7% entre los que completaron la NACT.
- Se logró una resección R0 en el 95,1% de los pacientes resecados.
- La supervivencia global mediana fue de 27 meses para los casos resecables frente a 13 meses para los irresecables (p < 0,001).
- Se produjo toxicidad de grado ≥3 en el 9,7% de los pacientes, con una mortalidad relacionada con el tratamiento del 1,7%.
Conclusiones:
- La NACT mejora significativamente las tasas de resección curativa en pacientes con cáncer de vesícula biliar que completan el tratamiento.
- Los hallazgos respaldan la integración de la NACT en las estrategias de tratamiento para el cáncer de vesícula biliar localmente avanzado.
- La NACT demuestra perfiles de toxicidad aceptables y resultados de supervivencia mejorados.
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