Tratamiento multimodal en el carcinoma broncogénico no microcítico (N2) clínico: ¿cuál es la respuesta?
Multimodal Treatment of Clinical Non-Small Cell N2 Bronchogenic Carcinoma. What Is the Answer?
a Servicio de Neumología. Hospital Universitario 12 de Octubre. Madrid. España.
b Servicio de Cirugía de Tórax. Hospital Universitario 12 de Octubre. Madrid. España.
c Servicio de Oncología Médica. Hospital Universitario 12 de Octubre. Madrid. España.
d Servicio de Oncología Radioterapéutica. Hospital Universitario 12 de Octubre. Madrid. España.
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Hospital Universitario 12 de Octubre. Madrid. España." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía de Tórax. Hospital Universitario 12 de Octubre. Madrid. España." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Servicio de Oncología Médica. Hospital Universitario 12 de Octubre. Madrid. España." "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Servicio de Oncología Radioterapéutica. Hospital Universitario 12 de Octubre. Madrid. España." "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Multimodal Treatment of Clinical Non-Small Cell N2 Bronchogenic Carcinoma. What Is the Answer?" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Sr. Director:</span> Hace 10 años nos planteábamos la pregunta<span class="elsevierStyleSup">1</span>; ahora parece que hay respuesta. En la última reunión de la American Society of Clinical Oncology (mayo de 2005) se han presentado los informes finales de 2 ensayos clínicos aleatorizados<span class="elsevierStyleSup">2,3</span> donde la pregunta de investigación era: ¿mejora la supervivencia a los 5 años el hecho de añadir cirugía a la quimioterapia o a la quimiorradioterapia de inducción? La respuesta de ambos ensayos clínicos, uno realizado en Norteamérica<span class="elsevierStyleSup">2</span> y el otro en Europa<span class="elsevierStyleSup">3</span>, es que la cirugía no mejora la supervivencia. Por tanto, la mejor evidencia disponible (ensayos aleatorizados repetidos) no considera, en general, que la cirugía sea parte del tratamiento multimodal en el carcinoma broncogénico no microcítico con N2c evidenciado con certeza citohistológica.</p><p class="elsevierStylePara">Sin embargo, de los análisis posteriores de ambos ensayos se deducen ciertos factores que, considerados de forma individual en cada paciente, pueden favorecer la aceptación de indicación quirúrgica en esa situación clínica. Un factor importante es la constatación de una clasificación N0y (estadificación N0 tras tratamiento de inducción). Ahora, por tanto, hemos cambiado la pregunta: ¿cuál es la estrategia que permite seleccionar el mejor de los métodos posibles para poder asegurar la categoría N0y? Este debate no ha hecho más que iniciarse.</p>" "pdfFichero" => "6v42n03a13085558pdf001.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Tratamiento multimodal en carcinoma broncogénico no microcelular N2 ''clínico''." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "López Encuentra A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "¿Cuál es la pregunta? Arch Bronconeumol" "fecha" => "1995" "volumen" => "31" "paginaInicial" => "43" "paginaFinal" => "4" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "North American Lung Cancer Intergroup. Phase III study of concurrent chemotherapy and radiotherapy (CT/RT) vs CT/RT followed by surgical resection for stage IIIA (pN2) non-small cell lung cancer (NSCLC): outcomes update of North American Intergroup 0139 (RTOG 9309) [resumen 7014]. Actas de ASCO Meeting 2005; mayo 13-17; Orlando (Florida); 2005." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "North American Lung Cancer Intergroup. Phase III study of concurrent chemotherapy and radiotherapy (CT/RT) vs CT/RT followed by surgical resection for stage IIIA (pN2) non-small cell lung cancer (NSCLC): outcomes update of North American Intergroup 0139 (RTOG 9309) [resumen 7014]. Actas de ASCO Meeting 2005; mayo 13-17; Orlando (Florida); 2005." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Albain KS" 1 => "Swann RS" 2 => "Rusch VR" 3 => "Turrisi AT" 4 => "Shepherd FA" 5 => "Smith CJ" 6 => "et al." ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "EORTC-Lung Cancer Group. A randomized trial of radical surgery (S) versus thoracic radiotherapy (TRT) in patients (pts) with stage IIIA-N2 non-small cell lung cancer (NSCLC) after response to induction chemotherapy (ICT) (EORTC 08941) [resumen 7015]. Actas de ASCO Meeting 2005; mayo 13-17; Orlando (Florida); 2005." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "EORTC-Lung Cancer Group. A randomized trial of radical surgery (S) versus thoracic radiotherapy (TRT) in patients (pts) with stage IIIA-N2 non-small cell lung cancer (NSCLC) after response to induction chemotherapy (ICT) (EORTC 08941) [resumen 7015]. Actas de ASCO Meeting 2005; mayo 13-17; Orlando (Florida); 2005." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Van Meerbeeck JP" 1 => "Kramer G" 2 => "Van Schil PE" 3 => "Legrand C" 4 => "Smit EF" 5 => "Schramel FM" 6 => "et al." ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000004200000003/v0_201307090925/13085558/v0_201307090926/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000004200000003/v0_201307090925/13085558/v0_201307090926/es/6v42n03a13085558pdf001.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13085558?idApp=UINPBA00003Z" ]
Article information
ISSN: 03002896Original language: Spanish
DOI:10.1157/13085558
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