Recomendaciones para el diagnóstico, seguimiento y tratamiento cáncer del pulmón de células no pequeñas temprano en Colombia
DOI:
https://doi.org/10.56050/01205498.2316Resumen
Introducción: El cáncer de pulmón de células no pequeñas (CPCNP) de- rivado o no de la exposición crónica al humo por combustión del tabaco representa un problema sanitario global y local dada su alta letalidad, por la rápida progresión de la medicina de precisión y el impacto presupues- tal de las nuevas intervenciones. Dada la notable evolución de los métodos diagnósticos y terapéuticos para el CPCNP, se decidió realizar un consenso orientado a priorizar las necesidades del entorno colombiano, adaptando las recomendaciones de múltiples esfuerzos integrativos previos. Objetivo: Generar recomendaciones para optimizar el manejo integral de los pacientes con CPCNP en Colombia a partir de la discusión estructurada en un grupo focal de expertos incluyendo cirujanos de tórax, oncólogos clínicos, radiólogos, patólogos, neumólogos y genetistas. Dada la transición epidemiológica de la enfermedad se hizo énfasis en las etapas tempranas de la enfermedad. Métodos: Usando una herramienta digital (AGREE II Tool) para la caracterización de información relevante se elaboraron y discutieron las preguntas orientadoras para cada sesión sincrónica. En paralelo se hizo una revisión sistemática de la literatura usando la plataforma SCOPUS con énfasis en la extracción de guías de práctica clínica (GPC), metaanálisis, estudios clínicos y documentos de consenso. Además, se evaluaron y sintetizaron las principales recomendaciones de la International Agency for the Study of Lung Cancer (IASLC), de la American Asociation of Clinical Oncology (ASCO), de la European Society of Medical Oncology (ESMO), la National Comprehensive Cancer Network (NCCN), y del National Institute for Health and Care Excellence (NICE). A partir de las discusiones se seleccionaron 15 ejes primarios para la discusión considerando el tamizaje para poblaciones en riesgo, la estadificación, el tratamiento y el seguimiento. Después de cada discusión virtual se realizaron votaciones y se estimó el nivel de acuerdo para cada una. Resultados: En 5 sesiones grupales se discutieron 15 preguntas orientadoras que derivaron en 82 recomendaciones (8 tamizaje, 11 estadificación, 4 diagnóstico y 59 tratamiento). Setenta y siete obtuvieron un alto nivel de acuerdo (>80 %), 5 un nivel intermedio (30-79 %), y ninguna obtuvo nivel bajo. Finalmente, 67 cumplieron con los dos criterios de aceptación (tamizaje 8, estadificación 11, diagnóstico 3, tratamiento 48). Conclusión: A partir de la revisión sistemática de la literatura y la discusión multidisciplinaria se realizaron recomendaciones orientadas a mejorar el manejo del paciente con CPCNP en el contexto colombiano.
Biografía del autor/a
Diego Hernando Pardo, Asociación Colombiana de Cirugía de Tórax
Asociación Colombiana de Cirugía de Tórax (ASOCOLTORAX), Bogotá, Colombia.
Lucia Viola, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica de Oncología Torácica, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Unidad Oncología Torácica, Fundación Neumológica Colombiana - FNC, Bogotá Colombia.
Jairo Zuluaga, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica de Oncología Torácica, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Leonardo Rojas, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica de Oncología Torácica, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Iván Andrés Bobadilla, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Asistencial Radioterapia, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Stella Martínez, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica de Oncología Torácica, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Iván José Bustillo, Clínica Portoazul, Barranquilla
Departamento Oncología Clínica, Clínica Portoazul, Barranquilla, Colombia.
Luis Gerardo Garcia-Herreros, Fundación Santa Fe de Bogotá
Departamento de Cirugía, Unidad Cirugía de Tórax, Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Ricardo Adolfo Zapata, Clínica CardioVID
Clínica CardioVID. Obra de la Congregación Mariana, Medellín Colombia.
Adriana Serna, Hospital Santa Clara, Bogotá
Unidad Cirugía de Tórax, Hospital Santa Clara, Bogotá, Colombia.
Ana Margarita Baldión, Fundación Santa Fe de Bogotá
Departamento de Patología, Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Darwin José Padilla, Clínica General del Norte, Barranquilla
Organización Clínica General del Norte, Barranquilla, Colombia.
Willfredy Castaño, Hospital Pablo Tobón Uribe
Hospital Pablo Tobón Uribe, Medellín Colombia.
Liliana Arias, Hospital Universitario San Ignacio
Hospital Universitario San Ignacio, Bogotá, Colombia.
Alejandro Ruíz, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica de Oncología Torácica, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer – FICMAC, Bogotá, Colombia.
Oscar Arrieta, Instituto Nacional de Cancerología – INCaN, México
Unidad Oncología Torácica, Instituto Nacional de Cancerología – INCaN, Ciudad de México, México.
Andrés Felipe Cardona, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica de Oncología Torácica, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
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