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>Revistas >Revista de Especialidades Médico-Quirúrgicas >Año 2017, No. 3


Erazo-Valle-Solís AA, Juárez-Ramiro A, Mora-Pérez J, Cervantes-Sánchez MG, Fernández-Orozco A, Gil-Ortiz-Mejía C, Plácido-Méndez AM, Plascencia-Álvarez N, Valdez-Orduño R, Núñez-Guardado G, Ceja-García JP, Cruz-López JC, Enríquez-Aceves MI, Figueroa-Martínez P, Flores-Anaya N, González-Vela JL, Guerrero-Maldonado A, Hernández-Hernández CA, Hernández-Luis GN, Landa-Fernández AM, Murillo-Medina K, Padilla-Ponce I, Serna-Camacho ME
Recomendaciones institucionales ISSSTE en el tratamiento multidisciplinario de los gliomas de alto grado
Rev Esp Med Quir 2017; 22 (3)

Idioma: Español
Referencias bibliográficas: 99
Paginas: 110-130
Archivo PDF: 1599.80 Kb.


Texto completo




RESUMEN


Introducción: El glioblastoma multiforme (GBM) es un tumor del sistema nervioso central (SNC) con un pronóstico desfavorable y supervivencia menor a 10 meses. En la última década se han presentado avances importantes tanto en su fisiopatogenia, diagnóstico y tratamiento, lo que ha modificado la expectativa de vida de estos pacientes. En México existe información limitada sobre los nuevos paradigmas de tratamiento de esta enfermedad.
Objetivo: Analizar la evidencia que existe acerca de la epidemiología, diagnóstico y tratamiento del GBM para la creación de recomendaciones internas del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), ya que se cuenta con mayor acceso a medicamentos y a terapias novedosas de tratamiento.
Materiales y Métodos: La Sociedad de Oncología de Instituto de Seguridad Social y Servicios de los Trabajadores del Estado (SOISSTE) convocó a una reunión en la cual médicos con diferentes especialidades y experiencia en el manejo del GBM proporcionaron información actual en el tratamiento y diagnóstico de esta patología, con el fin de ofrecer un documento de apoyo y orientación en su tratamiento. Las recomendaciones vertidas en esta revisión fueron conformadas mediante el sistema GRADE.
Resultados: Se recomienda un tratamiento multidisciplinario, ya que presenta un efecto en supervivencia libre de recurrencia. Se debe de valorar el uso de antiangiogénicos (bevacizumab [BVZ]) ante la recurrencia; persistencia y/o progresión en hospitales que cuenten con estos recursos, se aconseja que este tratamiento sea posterior a un tratamiento estándar pacientes con una puntuación en el Performance Status (PS) ›70 en la escala ECOG (East Cooperative Oncology Group), ECOG 0-1, y subtipo molecular proneural.
Conclusiones El diagnóstico y el tratamiento del GMB deben de individualizarse con base en los recursos de cada sitio. Debe ser multidisciplinario. Se recomienda la realización de la determinación del IDH1 por inmunohistoquímica, así como el perfil molecular, para lograr un impacto en la supervivencia global (SVG) con el uso de BVZ en este grupo de pacientes


Palabras clave: Glioblastoma multiforme, Guía de manejo, Multidisciplinario, Angiogénesis, Bevacizumab.


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