Estado Atual do Tratamento do Câncer Colorretal
Palavras-chave:
Câncer Colorretal, Tratamento do Câncer Colorretal, TNT, Cirurgia Minimamente Invasiva no Câncer ColorretalResumo
O câncer colorretal (CCR) é o terceiro câncer mais frequente no Brasil e o segundo mais letal, desta forma sua prevenção e tratamento são extremamente importantes para a saúde dos brasileiros. Diversas estratégias de tratamento, surgidas nos últimos anos, vêm tornando os resultados oncológicos cada vez melhores. Como o tratamento do CCR deve ser individualizado, diversos protocolos têm sido divulgados mostrando evidências de melhor prognóstico, porém devem ser empregados em situações particulares. Este artigo foi escrito para facilitar o entendimento das situações onde cada abordagem terapêutica se apresentará como melhor opção de tratamento e resultará em melhores resultados. A avaliação genética dos tumores também já é uma realidade, e influencia de maneira assertiva a opção terapêutica e seus desfechos oncológicos, sendo abordada em caráter bem prático no texto que se segue.
Referências
Instituto Nacional de Câncer (Brasil). Estimativa 2023: incidência de câncer no Brasil. Rio de Janeiro: INCa, 2022.
Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004; 240:711-7; discussion 717-8.
Lindholm E, Brevinge H, Haglind E. Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer. Br J Surg 2008. 95(8):1029-36.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Colorectal. V.2.2023. Disponível em: https://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdf. Acesso em 24 de junho de 2024.
Lang CA, Ransohoff DF. Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy? JAMA 1994. 271(13):1011-3.
American Cancer Society revisado em 24 de janeiro de 2024. Disponível em: https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/staged.html. Acesso em 08 de junho de 2024.
Shinji S, Yamada T, Matsuda A et al. Recent Advances in the Treatment of Colorectal Cancer: A Review. J Nippon Med Sch 2022; 89 (3): 247.
Vogel JD, Felder SI, Bhama AR, Weiser MD, Chang GJ et all. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum 2022; 65: 148-177.
Chalabi M, Verschoor YL, Tan PB, Balduzzi S, Van Lent AU, Grootscholten C, Dokter S, Büller NV, Grotenhuis BA, Kuhlmann K, Burger JW, Huibregtse IL, Aukema TS, Hendriks ER, Oosterling SJ, Snaebjornsson P, Voest EE, Wessels LF, Beets-Tan RG, Van Leerdam ME, Schumacher TN, van den Berg JG, Beets GL, Haanen JB. Neoadjuvant Immunotherapy in Locally Advanced Mismatch Repair-Deficient Colon Cancer. Niche-2 trial. N Engl J Med. 2024 Jun 6;390(21):1949-1958.
Del Paggio JC, Peng Y, Wei X, et al. Population-based study to re-evaluate optimal lymph node yield in colonic cancer. Br J Surg. 2017;104:1087-1096.
Basilio P, Fonseca LMB. Detecção de linfonodo-sentinela no câncer colorretal. Arq Gastroenterol, São Paulo, v.43, n.3: p.163-167, 2006.
Deijen CL, Vasmel JE, de Lange-de Klerk ESM, et al.; COLOR (COlon cancer Laparoscopic or Open Resection) Study Group. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surg Endosc. 2017;31:2607-2615.
Green BL, Marshall HC, Collinson F, et al. Long-term follow- up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100:75-82.
Cuk P, Kjær MD, Mogensen CB et al. Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc, 2022; (36):32-46.
Seymour MT, Morton D. International FOxTROT Trial Investigators. FOxTROT: an international randomised controlled trial in 1052 patients (pts) evaluating neoadjuvant chemotherapy (NAC) for colon cancer. J Clin Oncol. 2019;15(suppl):3504-3504.
Karoui M, Rullier A, Piessen G, et al; for PRODIGE 22 investi- gators/collaborators. Perioperative FOLFOX 4 versus FOLFOX 4 plus cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a phase II multicenter randomized controlled trial (PRODIGE 22). Ann Surg. 2020;271:637-645.
Jensen LH, Kjaer ML, Larsen FO et al; Phase III randomized clinical trial comparing the efficacy of neoadjuvant chemotherapy and standard treatment in patients with locally advanced colon cancer: The NeoCol trial. JCO 2023;41,17 suppl. LBA3503.
Starling N, Newmann K, Colwell B, Strickler JH; AZUR-2, a phase III, open-label, randomized study of perioperative dostarlimab monotherapy vs standard of care in previously untreated patients with T4N0 or stage III dMMR/MSI-H resectable colon cancer. JCO, 2024;42, 3_suppl, TPS240
Krishnamurty DM, Hawkins AT, Wells KO, et al. Neoadjuvant radiation therapy in locally advanced colon cancer: a cohort analysis. J Gastrointest Surg. 2018;22:906-912.
Hogan J, Samaha G, Burke J, et al. Emergency presenting colon cancer is an independent predictor of adverse disease-free survival. Int Surg. 2015;100:77-86.
Lahaye MJ, Engelen SM, Nelemans PJ, et al. Imaging for pre- dicting the risk factors–the circumferential resection margin and nodal disease–of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR. 2005;26:259-268.
Atallah S, Albert M & Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010 24:2200-2205.
Smits LJ, Van Lieshout AS, Grüter AAJ, et all. Multidisciplinary management of early rectal cancer – The role of surgical local excision in current and future clinical practice, Surgical Oncology 2020 (40) #101687.
Clancy C, Flanagan M, Marinello F, O’Neill BD, McNamara D, Burke JP. Comparative oncologic outcomes of upper third rectal cancers: a meta-analysis. Clin Colorectal Cancer. 2019;18:e361-e367.
Peeters KC, Marijnen CA, Nagtegaal ID, et al; Dutch Colorectal Cancer Group. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246:693-701.
Schrag D, Shi Q, Weiser MR, et al. Preoperative treatment of locally advanced rectal cancer. N Engl J Med. 2023;389:322-334. PROSPECT TRIAL.
Bahadoer RR, Dijkstra EA, van Etten B, et al; RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22:29-42.
Thompson HM, Omer DM, Lin S, et al. Organ Preservation and Survival by Clinical Response Grade in Patients With Rectal Cancer Treated With Total Neoadjuvant Therapy: A Secondary Analysis of the OPRA Randomized Clinical Trial. JAMA Netw Open. 2024;7(1) :e2350903. doi:10.1001/jamanetworkopen.2023.50903
Habr-Gama A, de Souza PM, Ribeiro U Jr, et al. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum. 1998;41:1087-1096.
Conroy T, Etienne P-L, Rio E, et al. Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: 7-year results of the PRODIGE 23 phase III trial, a UNICANCER GI trial. J Clin Oncol. 2023;41:LBA3504–LBA3504.
Cardelli S, Stocchi L, Merchea A, Colibaseanu D, DeLeon M, Mishra N, Hancock K, Larson DW Comparative Outcomes of Robotic Versus Open Proctectomy for Rectal Cancer at High Risk of Positive Circumferential Resection Margin. Diseases of the Colon & Rectum ():10.1097/DCR.0000000000003466, August 06, 2024.