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Revista Portuguesa de Pneumologia

versão impressa ISSN 0873-2159

Rev Port Pneumol v.13 n.6 Lisboa dez. 2007

 

Abordagem terapêutica do carcinoma pulmonar de não pequenas células no idoso

 

Treatment of non-small cell lung cancer in elderly patients

 

 

Filipa Costa 1

Fernando J Barata 2

 

 

Resumo

O cancro do pulmão é a primeira causa de morte por cancro. Dado o envelhecimento global da população, actualmente mais de 50% de todos os doentes com carcinoma pulmonar de não pequenas células (CPNPC) têm mais de 65 anos. Até há poucos anos, imperava o cepticismo no tratamento dos doentes neste grupo etário, prevalecendo a noção de que qualquer que fosse o tratamento instituído, o balanço entre o benefício e os efeitos secundários era desfavorável. A falência orgânica dependente da idade, as comorbilidades, a polimedicação e a fragilidade do idoso explicavam esta opinião geral. Nos últimos anos, mudou- -se radicalmente esta atitude. Quando se decide na estratégia terapêutica destes doentes, é a idade biológica (baseada no performance status – PS e nas comorbilidades) e não a idade cronológica que deve ser tida em conta, e a não administração do tratamento standard ou a sua modificação só deverá ser feita perante uma razão válida. Isto aplica-se dimide igual forma à cirurgia, quimioterapia, radioterapia e às novas terapêuticas moleculares, as armas terapêuticas ao nosso dispor para combater esta patologia.

Os estudos publicados recentemente e que se dedicaram especificamente à avaliação dos doentes idosos vieram comprovar que, se tratados de forma adequada, os doentes idosos com bom PS e sem comorbilidades major têm uma sobrevida e uma qualidade de vida semelhante à dos doentes mais jovens.

Dado o número crescente de doentes com cancro do pulmão em idade avançada, os autores fazem uma revisão bibliográfica da literatura existente sobre este tema.

Palavras-chave: CPNPC, idoso, terapêutica.

 

 

Abstract

Lung cancer is the most common cause of cancer death. With the aging of the population, more than 50% of patients with non-small cell lung cancer (NSCLC) are older than 65 years. Until recently, there was some scepticism regarding treatment of patients in this age group, prevailing the notion that whatever treatment was given, the balance between the benefits and the side effects was unfavourable.

The organ failure dependent of age, the comorbidities, the polimedication and the fragility of elderly people, were responsible for this generalized opinion. In the last few years, this nihilistic approach has changed radically. When deciding what treatment strategy should be used in these patients, the biological age (based on performance status: PS and comorbidities) rather than the chronological age should be taken into account, and the modification of standard treatment plans should only be made when there is a valid reason. This applies equally to surgery, chemotherapy, radiotherapy and the new targeted agents, the therapeutic weapons available to treat this disease. Recently published studies, that specifically analysed elderly patients, proved that if treated adequately, elderly patients with a good PS and without major comorbidities have the same survival rates and quality of life as younger patients. The rising number of elderly patients with lung cancer led the authors to do a review of the literature on this topic.

Key-words: NSCLC, elderly, treatment.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

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1 Interna do Internato Complementar de Pneumologia

2 Assistente Hospitalar Graduado de Pneumologia

Serviço de Pneumologia

Centro Hospitalar de Coimbra

Director: Dr. Jorge Pires

Quinta dos Vales

São Martinho do Bispo

3046-853 Coimbra

 

Recebido para publicação/received for publication: 07.04.10

Aceite para publicação/accepted for publication: 07.06.01