Enfermedad ganglionar residual tras quimio-radioterapia con intención radical en pacientes con tumores de faringolaringe

Blanca Pilar GALINDO-TORRES, Mahfoud EL UALI-ABEIDA, María LLANO-ESPINOSA, Emilio VIVES-RICOMÀ, Laura REBOLLEDO-BERNAD, Félix DE MIGUEL-GARCÍA, Rafael FERNÁNDEZ-LIESA

Resumen


[ES]

Introducción y objetivo: La afectación ganglionar cervical es el principal factor pronóstico en el carcinoma epidermoide de cabeza y cuello. La cirugía de rescate se considera la intervención más curativa para la enfermedad residual o recurrente tras el tratamiento con quimio-radioterapia. Los objetivos del estudio fueron describir los datos epidemiológicos de los pacientes, valorar la utilidad de las pruebas de imagen, analizar la supervivencia y realizar una revisión de la bibliografía actual.

Método: Se realizó un estudio retrospectivo en el que se incluyeron pacientes intervenidos de cirugía ganglionar cervical entre Enero de 2010 y Diciembre de 2015, con sospecha radiológica de enfermedad ganglionar persistente, tras haber recibido tratamiento quimio-radioterápico con intención radical por presentar un carcinoma de faringe o laringe.

Resultados: Se incluyeron 30 pacientes. La localización tumoral más común fue la supraglotis (13). El resultado histológico más frecuente fue de carcinoma epidermoide pobremente y moderadamente diferenciado (10 casos en cada uno). El 60% de los pacientes presentaban un estadio IVa. El valor predictivo positivo (VPP) de la TAC fue de 55,26%. El 87,5% de las histologías que confirmaron la sospecha diagnóstica radiológica en una primera cirugía ocurrieron en los pacientes a los que se les había realizado una TAC de forma precoz. La supervivencia global fue del 53,33%, terminando el 40% de los pacientes libres de enfermedad al final del periodo.

Conclusiones: El bajo VPP de la TAC hace replantear su utilidad como método para valorar respuesta ganglionar a la quimio-radioterapia. Parece razonable plantear la realización de vaciamientos ganglionares selectivos en pacientes seleccionados.

[EN]

Introduction and objective: Cervical nodal involvement is the main prognostic factor in squamous cell carcinoma of the head and neck. Salvage surgery is considered the most curative intervention for residual or recurrent disease after treatment with chemo-radiotherapy. The objectives of the study were to describe the epidemiological data of the patients, to evaluate the usefulness of the imaging tests, to analyze the survival, and to make a review of the current bibliography.

Method: A retrospective study was carried out, including patients undergoing cervical lymph node surgery between January 2010 and December 2015, after radiological suspicion of persistent regional disease was found. All the patients had previously received chemo-radiotherapy treatment with radical intention due to a carcinoma of pharynx or larynx.

Results: Thirty patients were included. The most common tumoral site was supraglottis (13). The most frequent histological result was poorly and moderately differentiated epidermoid carcinoma (10 cases in each). Sixty percent of the patients had stage IVa. The positive predictive value (PPV) of the CT scan was 55.26%. Eighty-seven point five percent of the histologies confirming radiological diagnostic suspicion in a first surgery occurred in patients who had an early CT scan. Overall survival was 53.33%; forty percent of the patients were free of disease at the end of the period.

Conclusions: The low PPV of the CT scan makes its usefulness questionable as a method to assess nodal response to chemo-radiotherapy. It seems reasonable to propose selective lymph node surgery in selected patients.


Palabras clave


Carcinoma epidermoide; Cabeza y cuello; Quimio-radioterapia; Adenopatías; Cirugía de rescate.

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