Experiencia en el tratamiento de Hepatocarcinoma en Guatemala. Cuando el dinero es el problema
Este trabajo fue presentado en el congreso de cáncer gastrointestinal de ESMO, sociedad Europea de Oncologia Medica, realizado en Barcelona, España en el 2017. Se expone la experiencia de 132 casos tratados en Guatemala, con tatamiento multimodal, discutidos en la Clínica de Tumores, donde participan cirujanos de abdomen, gastroenterologos, patologos, cuidados paliativos, trabajo social y oncologos médicos.
EVOLUTION OF THE TREATMENT OF HEPATOCELLULAR CARCINOMA IN AN DEVELOPING COUNTRY. WHEN MONEY MATTERS
Hugo Castro Salguero1, Cesar Hernandez2, Lourdes Salazar Guzman2, Noe Castro Sanchez2, Luis Garcia Aceituno2, Hesler Morales2, Raul Jimenez2, David Porras3 1 Grupo Medico Angeles, Guatemala, Guatemala, 2 Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala, 3 Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala
Background: We present our data in the treatment of hepatocellular carcinoma (HCC) before and after the sorafenib and the incorporation of transarterial chemoembolization (TACE), in the Guatemalan Social Security (IGSS), because of the high cost of treatment each case is discussed for the Tumor Board together with hepatologists, pathologists, surgeons of abdomen and medical oncologists. Surprisingly, our data are bets to those published, probably by the small number of patients.
Methods: The retrospective analysis of the data was approved by the institutional review board. 28 patients with HCC according to the American Joint Committee on Cancer (AJCC) staging classification (TNM) were treated between October 2008 and April 2012. Tumor size and density were assessed on CT scans by using RECIST and Choi criteria.
Results: Their main characteristics were: sex (male/female) 23/5, median age: 57 yrs, median PS 80, localized resectable 1 (3.6%), localized and locally advanced unresectable 24 (85.7%) and advanced metastatic liver cáncer 3 (10.7%), Child-Pugh (CP) class A (21) and B (7) and biopsy was performed in 96% of patients. We identified three groups Group 1: 13 (46%), patients were treated with chemotherapy (idarubicin range 2 a 12 cycles), Group 2: 8 (29%) patients treated with sorafenib, (the median duration of treatment was 7.1 months) and Group 3: 7 (25%) patients underwent conventional TACE with doxorubicin (The median number of sessions per patient was 1 – 2) and sorafenib. The time to progression (TTP) was 4.7, 6.9 and 8.3 months, and overall survival (OS) were 10.8, 15.7 and 19.1 months, for groups 1, 2 and 3 respectively.
Conclusion: The cases must be carefully selected, for better use of resources. TACE and sorafenib achieved a promising outcome in select patients with advanced HCC.