Actualización de las indicaciones del uso de la radioterapia de intensidad modulada en el Instituto Nacional de Cancerología. Protocolo clínico informado en la evidencia

  • Rosalba Ospino Instituto Nacional de Cancerología - ESE
  • María Teresa Vallejo Instituto Nacional de Cancerología - ESE
  • John Edwin Feliciano-Alfonso Instituto Nacional de Cancerología - ESE
  • Giovanna Andrea Gómez Instituto Nacional de Cancerología - ESE
  • Garvin González Instituto Nacional de Cancerología - ESE
  • Holman Duvan Ballesteros Instituto Nacional de Cancerología - ESE
  • Paola Andrea Triviño Instituto Nacional de Cancerología - ESE
Palabras clave: Protocolos clínicos, Neoplasias, Radioterapia de intensidad modulada

Resumen

Antecedentes: La radioterapia de intensidad modulada (IMRT) es una técnica avanzada que se usa ampliamente a nivel mundial; sin embargo, su uso adecuado en nuestro país requiere ser revisado.
Objetivo: Actualizar un protocolo clínico (PC) basado en evidencia que contiene las indicaciones clínicas para la utilización de la técnica IMRT en el tratamiento de las patologías oncológicas tratadas más frecuentemente en el servicio de oncología radioterápica del Instituto Nacional de Cancerología (INC) – Colombia.

Métodos: La elaboración de este documento fue realizada por un equipo multidisciplinario empleando un manual nacional para el desarrollo de PC. Se realizó una búsqueda sistemática de la literatura, seguido por la selección de los artículos relevantes y su evaluación utilizando las herramientas apropiadas. La evidencia fue resumida, contextualizada y empleada para generar las recomendaciones mediante un consenso formal tipo RAND/UCLA.

Resultados: Se generaron indicaciones para el uso de la IMRT en pacientes con alguno de los siguientes tipos de cáncer: próstata y pene, cabeza y cuello, piel, sistema nervioso central, mama, sarcomas de tejidos blandos, pulmón, gastrointestinal, ginecológico y urgencias oncológicas.

Conclusiones: En el periodo 2014 a 2017 ha surgido escasa evidencia sobre el impacto de la IMRT en desenlaces relacionados con la supervivencia y la calidad de vida y por tanto el uso de la IMRT sigue siendo en pacientes seleccionados.

Biografía del autor/a

Rosalba Ospino, Instituto Nacional de Cancerología - ESE

Grupo Área Oncología Radioterápica, Instituto Nacional de Cancerología - ESE, Bogotá, D. C., Colombia

María Teresa Vallejo, Instituto Nacional de Cancerología - ESE

Grupo de Investigación Clínica, Instituto Nacional de Cancerología - ESE, Bogotá, D. C., Colombia

John Edwin Feliciano-Alfonso, Instituto Nacional de Cancerología - ESE

Grupo de Investigación Clínica, Instituto Nacional de Cancerología - ESE, Bogotá, D. C., Colombia

Giovanna Andrea Gómez, Instituto Nacional de Cancerología - ESE

Grupo de Investigación Clínica, Instituto Nacional de Cancerología - ESE, Bogotá, D. C., Colombia

Garvin González, Instituto Nacional de Cancerología - ESE

Grupo Área Oncología Radioterápica, Instituto Nacional de Cancerología - ESE, Bogotá, D. C., Colombia

Holman Duvan Ballesteros, Instituto Nacional de Cancerología - ESE

Grupo Área Oncología Radioterápica, Instituto Nacional de Cancerología - ESE, Bogotá, D. C., Colombia

Paola Andrea Triviño, Instituto Nacional de Cancerología - ESE

Grupo de Investigación Clínica, Instituto Nacional de Cancerología - ESE, Bogotá, D. C., Colombia

Citas

1. Instituto Nacional de Cancerología ESE. Protocolo Indicaciones de IMRT. Bogotá, Colombia: Manuscrito no publicado; 2015. p. 1-27.

2. Vallejo-Ortega MT, Sánchez-Pedraza R, Feliciano-Alfonso JE, García-Pérez MJ, GutiérrezSepúlveda MP, Merchán- Chaverra RA. Manual Metodológico para la elaboración de protocolos clínicos en el Instituto Nacional de Cancerología. Bogotá: Instituto Nacional de Cancerología; 2016.

3. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluz eau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839-42.
https://doi.org/10.1503/cmaj.090449

4. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
https://doi.org/10.1136/bmj.d5928

5. Scottish Intercollegiate Guidelines Network. Critical appraisal notes and checklist [internet]. Available from: https://www.sign.ac.uk/checklists-and-notes.html

6. National Institute for Health and Care Excellence. NICE Guideline on Prostate Cancer: Diagnosis and Management [internet]. 2014. Available from: https://www.nice.org. uk/guidance/cg175/resources/prostate-cancer-diagnosis- and-management-pdf-35109753913285

7. Cancer Care Ontario. CCO Guideline on Adjuvant radiotherapy following radical prostatectomy for pathologic T3 or margin-positive prostate cancer [internet]. 2016. Available from: https://www.cancercare.on.ca/common/ pages/UserFile.aspx?fileId=14042

8. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71(4):618-29.
https://doi.org/10.1016/j.eururo.2016.08.003

9. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Prostate Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/prostate_blocks.pdf

10. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Penile Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/physician_gls/pdf/penile_blocks.pdf

11. Chien GW, Slezak JM, Harrison TN, Jung H, Gelfond JS, Zheng C, et al. Health-related quality of life outcomes from a contemporary prostate cancer registry in a large diverse population. BJU Int. 2017.
https://doi.org/10.1111/bju.13843

12. Ministerio de Salud y Protección Social de Colombia. Guía de práctica clínica (GPC) para la detección temprana, diagnóstico, tratamiento, seguimiento y rehabilitación del cáncer de próstata [internet]. 2013. Disponible en: https:// www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/ RIDE/INEC/IETS/GPC_Comple_Prostata.pdf

13. Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W. Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol. 2008;9(4):367-75.
https://doi.org/10.1016/S1470-2045(08)70098-6

14. Marta GN, Silva V, de Andrade Carvalho H, de Arruda FF, Hanna SA, Gadia R, et al. Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Radiother Oncol. 2014;110(1):9-15.
https://doi.org/10.1016/j.radonc.2013.11.010

15. Cancer Care Ontario. CCO Guideline on Systemic Therapy in the Curative Treatment of Head and Neck Squamous Cell Cancer [internet]. 2016. Available from: https:// www.cancercare.on.ca/common/pages/UserFile. aspx?fileId=364309

16. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Head and Neck Cancers: Very Advanced Head and Neck Cancer 2017. [internet]. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/head-and-neck_blocks.pdf

17. Ratko TA, Douglas GW, de Souza JA, Belinson SE, Aronson N. Radiotherapy treatments for head and neck cancer update [internet]. Rockville (USA): Agency for Healthcare Research and Quality; 2014. Available from: https://www.ncbi.nlm. nih.gov/books/NBK269018/

18. Ministerio de Salud y Protección Social de Colombia. Guía de Práctica Clínica con evaluación económica para la prevención, diagnóstico, tratamiento y seguimiento del cáncer de piel no melanoma: carcinoma basocelular. [internet]. 2014. Disponible en: https://www.minsalud. gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IETS/ completa-carcinoma-basocelular.pdf

19. Ministerio de Salud y Protección Social de Colombia. Guía de Práctica Clínica con evaluación económica para la prevención, diagnóstico, tratamiento y seguimiento del cáncer de piel no melanoma: carcinoma escamocelular de piel 2014. Disponible en: http://gpc.minsalud.gov.co/gpc_ sites/Repositorio/Conv_563/GPC_piel_escamocelular/ GPC_escamocelular_completa.aspx.

20. Scottish Intercollegiate Guidelines Network (SIGN). SIGN Cutaneous melanoma [internet]. 2017. Available from: http://www.sign.ac.uk/pdf/SIGN146.pdf

21. Cancer Care Ontario. CCO Guideline on The use of adjuvant radiation therapy for curatively resected cutaneous melanoma [internet]. 2016. Available from: https://www.cancercare.on.ca/common/pages/UserFile. aspx?fileId=351575

22. National Institute for Health and Care Excellence. NICE Guideline on Melanoma: Assessment and Management [internet]. 2015. Available from: https://www.nice.org. uk/guidance/ng14/resources/melanoma-assessment-and- management-pdf-1837271430853

23. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Basal Cell Skin Cancer [internet]. 2017. Available from: https://www.nccn.org/ professionals/physician_gls/pdf/nmsc_blocks.pdf

24. Scottish Intercollegiate Guidelines Network (SIGN). SIGN Management of primary cutaneous squamous cell carcinoma. [internet]. 2014. Available from: http://www. sign.ac.uk/pdf/SIGN140.pdf

25. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Cell Skin Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/squamous_blocks.pdf

26. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Melanoma [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/melanoma_blocks.pdf

27. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Dermatofibrosarcoma Protuberans [internet]. 2017. Available from: https://www. nccn.org/professionals/physician_gls/pdf/dfsp_blocks.pdf

28. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Merkel Cell Carcinoma [internet]. 2017. Available from: https://www.nccn.org/ professionals/physician_gls/pdf/mcc_blocks.pdf

29. Cabrera AR, Kirkpatrick JP, Fiveash JB, Shih HA, Koay EJ, Lutz S, et al. Radiation therapy for glioblastoma: Executive summary of an American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline. Pract Radiat Oncol. 2016;6(4):217-25.
https://doi.org/10.1016/j.prro.2016.03.007

30. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Central Nervous System Cancer [internet]. 2016. Available from: https://www. nccn.org/professionals/physician_gls/pdf/cns_blocks.pdf

31. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Breast Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/breast_blocks.pdf

32. Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, et al. The treatment outcome and radiation- induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters. Biomed Res Int. 2013;2013:401261.
https://doi.org/10.1155/2013/401261

33. De Neve W, De Gersem W, Madani I. Rational use of intensity-modulated radiation therapy: the importance of clinical outcome. Semin Radiat Oncol. 2012;22(1):40-9.
https://doi.org/10.1016/j.semradonc.2011.09.003

34. Ministerio de Salud y Protección Social. Guía de Práctica Clínica (GPC) para la detección temprana, tratamiento integral, seguimiento y rehabilitación de pacientes con cáncer de mama [internet]. 2013. Disponible en: https:// www.minsalud.gov.co/sites/rid/1/Gu%C3%ADa%20de%20 Pr%C3%A1ctica%20Cl%C3%ADnica%20%20de%20Cancer%20 de%20Mama%20versi%C3%B3n%20completa.pdf

35. Centro Nacional de Excelencia Tecnológica en Salud. Guía para el diagnóstico y tratamiento del sarcoma de tejidos blandos en extremidades yretroperitoneo en adultos [internet]. 2015. Disponible en: http://www.cenetec. salud.gob.mx/descargas/gpc/CatalogoMaestro/286_ IMSS_0_Sarcoma_tejido_blando/GRR_IMSS_286_10.pdf

36. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Soft Tissue Sarcoma [internet]. 2017. Available from: https://www.nccn.org/ professionals/physician_gls/pdf/sarcoma.pdf

37. The Royal College of Radiologist. Radiotherapy Dose Fractionation [internet]. 2016. Available from: https:// www.rcr.ac.uk/system/files/publication/field_ publication_files/bfco163_dose_fractionation_2nd_ed_ march2017.pdf

38. Roeder F, Ulrich A, Habl G, Uhl M, Saleh-Ebrahimi L, Huber PE, et al. Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis. BMC Cancer. 2014;14:617.
https://doi.org/10.1186/1471-2407-14-617

39. Folkert MR, Singer S, Brennan MF, Kuk D, Qin LX, Kobayashi WK, et al. Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity. J Clin Oncol. 2014;32(29):3236-41.
https://doi.org/10.1200/JCO.2013.53.9452

40. Ministerio de Salud y Protección Social de Colombia - Instituto Nacional de Cancerología. Guía de Práctica Clínica para la detección temprana, diagnóstico, estadificación, y tratamiento del cáncer de pulmón. Bogotá; 2014.

41. Scottish Intercollegiate Guidelines Network (SIGN). SIGN Management of lung cancer [internet]. 2014. Available from: http://www.sign.ac.uk/pdf/SIGN137.pdf

42. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Non-Small Cell Lung Cancer [internet]. 2017. Available from: https://www.nccn.org/ professionals/physician_gls/pdf/nscl_blocks.pdf

43. American Society for Radiation Oncology. Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small- Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline [internet]. 2015. Available from: http:// ascopubs.org/doi/pdf/10.1200/JCO.2014.59.2360

44. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Small Cell Lung Cancer [internet]. 2017. Available from: https://www.nccn.org/ professionals/physician_gls/pdf/sclc_blocks.pdf

45. HuX, HeW, WenS, FengX, FuX, LiuY, et al. IsIMRT superior or inferior to 3DCRT in radiotherapy for NSCLC? A meta-analysis. PLoS One. 2016;11(4):e0151988.
https://doi.org/10.1371/journal.pone.0151988

46. Chun SG, Hu C, Choy H, Komaki RU, Timmerman RD, Schild SE, et al. Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer: A secondary analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial. J Clin Oncol. 2017;35(1):56-62.
https://doi.org/10.1200/JCO.2016.69.1378

47. National Institute for Health and Care Excellence. NICE Guideline on Colorectal cancer: Diagnosis and Management [internet]. 2014. Available from: https://www.nice. org.uk/guidance/cg131/resources/colorectal-cancer- diagnosis-and-management-pdf-35109505330117

48. Scottish Intercollegiate Guidelines Network (SIGN). SIGN Diagnosis and management of colorectal cancer [internet]. 2016. Available from: http://www.sign.ac.uk/assets/ sign126.pdf

49. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Esophageal and Esophagogastric Junction Cancers [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/esophageal.pdf

50. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Gastric Cancer [internet]. 2016. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/gastric_blocks.pdf

51. European Society for Medical Oncology. ESMO Guideline on Gastric cancer: ESMO Clinical Practice Guidelines for Diagnosis, treatment and Follow-up [internet], 2016. Available from: https://www.esmo.org/Guidelines/ Gastrointestinal-Cancers/Gastric-Cancer

52. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Hepatobiliary Cancers [internet]. 2016. Available from: https://www.nccn.org/ professionals/physician_gls/pdf/hepatobiliary_blocks.pdf

53. Goodman KA, Patton CE, Fisher GA, Hoffe SE, Haddock MG, Parikh PJ, et al. Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method. Pract Radiat Oncol. 2016;6(3):166-75.
https://doi.org/10.1016/j.prro.2015.11.014

54. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Colon Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/colon_blocks.pdf

55. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Rectal Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/rectal_blocks.pdf

56. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Anal Carcinoma [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/anal_blocks.pdf

57. Cancer Care Ontario. CCO Guideline on The Role of IMRT in Gastrointestinal Cancers [internet]. 2010. Available from: http://ocp.cancercare.on.ca/common/pages/UserFile. aspx?fileId=87015

58. Ministerio de Salud y Protección Social de Colombia. Guía de práctica clínica para el manejo del cáncer de cuello uterino invasivo [internet]. 2014. Disponible en: http://gpc. minsalud.gov.co/gpc_sites/Repositorio/Otros_conv/GPC_ cuello_uterino_inv/CCU_Guia_profesionales_julio_2016.pdf

59.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Cervical Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/cervical_blocks.pdf

60.American Society for Radiation Oncology. ASTRO Guideline on the Role of Postoperative Radiation Therapy for Endometrial Cancer [internet]. 2014. Available from: https://www.astro.org/Patient-Care-and-Research/ Clinical-Practice-Statements/ASTRO-39;s-guideline-on- postop-RT-in-endometrial-c

61.Jones E, Beriwal S, Beyer D, Chino J, Jhingran A, Lee L, et al. An Analysis of Appropriate Delivery of Postoperative Radiation Therapy for Endometrial Cancer Using the RAND/ UCLA Appropriateness Method: Executive summary. Adv Radiat Oncol. 2015;1(1):26-34.
https://doi.org/10.1016/j.adro.2015.10.001

62.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Vulvar Cancer [internet]. 2017. Available from: https://www.nccn.org/professionals/ physician_gls/pdf/vulvar_blocks.pdf

63.Alberta Health Services. Oncologic Emergencies: A Guide for Family Physicians [internet]. 2014. Available from: https:// www.albertahealthservices.ca/assets/info/hp/cancer/if- hp-cancer-guide-oncologic-emergencies.pdf
Publicado
2019-06-26
Sección
Artículos especiales