Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/310560
Type: TESE
Title: Ressonancia magnetica no estadiamento e avaliação prognostica de pacientes com carcinoma de colo uterino tratadas com quimioterapia e radioteapia concomitantes
Title Alternative: Magnetic ressonance imaging in staging and prognostic evaluation of patients with cervical carcinoma treated with concurrent chemotheradiotherapy
Author: Camisão, Claudia Cristina
Advisor: Zeferino, Luiz Carlos, 1955-
Abstract: Resumo: Introdução: A despeito do tratamento para o carcinoma de colo uterino, 30% das mulheres não obtêm resposta total e morrem precocemente, devido à recorrência ou persistência da doença. O método de imagem e o momento ideal para avaliar a resposta terapêutica, bem como fatores prognosticos destas pacientes, permanecem indefinidos. Objetivo: Avaliar as contribuições da Ressonância Magnética no estadiamento e na identificação de fatores prognósticos relevantes em pacientes submetidas a tratamento concomitante de quimioterapia e radioterapia, seguido de braquiterapia Sujeito e métodos: estudo de coorte longitudinal, com seguimento antes e após o tratamento das mulheres. Foram selecionadas 56 pacientes, com diagnóstico de carcinoma de colo uterino, tratadas com quimioterapia e radioterapia concomitantes seguido de braquiterapia e acompanhadas no HCII - INCA.Todas foram submetidas a Ressonâncias magnéticas seriadas, sendo a primeira no momento do estadiamento, a segunda após o tratamento concomitante e a terceira após a braquiterapia. Os fatores prognósticos estudados foram: volume tumoral e invasão de corpo uterino, medidos na primeira RM. As respostas ao tratamento foram subdividas de acordo com os criterios de RECIST em resposta completa, resposta parcial, doença estável e progressão de doença, e foram mensuradas no momento da segunda RM após o tratamento combinado e no momneto da terceira RM após a braquiterapia. Análise estatística: a concordância foi avaliada através do coeficiente de Kappa. A sobrevida foi avaliada pelo método de Kapplan-Meier e as curvas foram comparadas pelo teste de log-rank. Foram utilizados modelos de COX (simples e múltiplos) para calcular o Hazard Ratio. O nível de significância foi de 5% e o software utilizado foi o SAS versão 9.1.3. Resultados: O índice de Kappa entre estadiamento FIGO e o estadiamento com RM foi de 0,40. Na segunda RM após o tratamento concomitante, 1 paciente apresentou doença estável, 1 progressão de doença, 20 resposta parcial e 21 obtiveram resposta completa. Na terceira RM, após a braquiterapia, 4 tiveram progressão da doença, 4 resposta parcial e 33 obtiveram resposta completa. Pacientes com volume tumoral maior que 50cm3 tiveram sobrevida global pior. Conclusão: A concordância entre o estadiamento FIGO e o estadiamento com RM foi baixa. O volume tumoral mostrou ser um bom preditor de sobrevida global mesmo quando corrigido em análises multivaridas para o estadiamento FIGO. A invasão do corpo uterino mostrou-se limítrofe como fator de sobrevida global

Abstract: Introduction: Despite the available treatment for cervical cancer, 30% of women fail to achieve full response to therapy and die early due to recurrence or persistence of the disease. The ideal imaging method and the optimal time for evaluating therapeutic response, as well as the prognostic factors in these patients, remain undefined. Objective: To evaluate the contributions of magnetic resonance imaging (MRI) in staging and in the identification of relevant prognostic factors in patients submitted to treatment consisting of concurrent chemoradiotherapy followed by brachytherapy. The agreement between FIGO and MRI staging was also evaluated. Subjects and Methods: A longitudinal, cross sectional study with evaluations prior to and following treatment was carried out in 56 women with a diagnosis of cervical cancer treated with concurrent chemoradiotherapy followed by brachytherapy at the II Cancer Hospital of the National Cancer Institute (INCA). All patients were submitted to serial MRI, the first being carried out at the time of staging, the second following concurrent chemoradiotherapy and the third after brachytherapy. The prognostic factors studied were tumor volume and uterine invasion at first MRI. The responses to treatment were subdivided according to the Response Evaluation Criteria in Solid Tumors (RECIST) into complete response, partial response, stable disease or disease progression, and were assessed at the time of the second MRI following combined treatment and at the time of the third MRI after brachytherapy. Statistical Analysis: Agreement was evaluated using the kappa coefficient. Survival was assessed using the Kaplan-Meier method and the curves were compared using the log-rank test. Univariate and multivariate Cox models were used to calculate the hazard ratios. Statistical significance was defined at 5% and the statistical software package used was SAS, version 9.1.3. Results: The kappa index between FIGO staging and MRI-based staging was 0.40. At the second MRI after concurrent chemoradiotherapy, 1 patient was found to have stable disease, 1 had disease progression, 20 had achieved a partial response and 21 had achieved complete response. At the third MRI, following brachytherapy, 4 patients had disease progression, 4 had a partial response and 33 had obtained complete response. Overall survival was poorer in patients in whom tumor volume was > 50 cm3. Conclusion: Agreement between FIGO staging and MRI staging was low. Tumor volume was found to be a good predictor of overall survival even when corrected for FIGO staging in multivariate analyses. Uterine invasion was found to be a borderline predictive factor of overall survival
Subject: Colo uterino
Ressonância magnética
Prognóstico
Quimioradioterapia
Language: Português
Editor: [s.n.]
Date Issue: 2008
Appears in Collections:FCM - Tese e Dissertação

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