Ruiz-García E, Ramírez-Torres N, López-Camarillo C, Marchat LA, Silva JA, Guadarrama-Orozco JA, Astudillo-de la Vega H

Idioma: Español
Referencias bibliográficas: 23
Paginas: 81-86
Archivo PDF: 276.25 Kb.

RESUMEN

Objetivo: Estudio de una cohorte retrospectiva de pacientes con cáncer de mama localmente avanzado (CMLA). El propósito fue evaluar la respuesta patológica completa con quimioterapia neoadyuvante con dosis convencional del esquema con 5-fluorouracilo, epirrubicina y ciclofosfamida (FEC respectivamente). Pacientes y métodos: Pacientes diagnosticadas con cáncer de mama en etapa III fueron seleccionadas de enero de 1999 a diciembre de 2000. 63 pacientes recibieron FEC (500 mg/m², 75 mg/m² y 500 mg/m², respectivamente) cada tres semanas por cuatro ciclos seguido de cirugía y radioterapia. Las pacientes también recibieron quimioterapia adyuvante. Se evaluaron variables como la edad, tipo histológico, grado histológico, tamaño tumoral inicial, tamaño clínico del ganglio axilar previo y posterior a la quimioterapia y quimioterapia adyuvante. Resultados: Se obtuvo una tasa de respuesta clínica objetiva (RO) de 77.7% (RC 19%; RP 58.7%), una tasa de respuesta patológica completa (RPc) de 14.2% (n = 9) y una tasa de ganglios axilares negativos de 33.3% (n = 21). Los datos predominantes fueron mayor edad (60.3%), tamaño de tumor categoría T3 (44.4%), conglomerado axila N2 (61.9%), etapa IIIA (57.1%), tumor moderadamente diferenciado (66.6%), adenocarcinoma ductal (75%) y ausencia de permeación vascular (81%). Conclusión: Este estudio mostró que el esquema FEC neoadyuvante de cuatro ciclos con dosis convencional para tratar pacientes con CMLA presentó una baja tasa de RPc.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status and survival in 24,740 breast cancer cases. Cancer. 1989; 63: 181-187.

2. Tercera revisión del Consenso Nacional sobre Diagnóstico y Tratamiento del Cáncer Mamario. GAMO. 2008; 7 Supl. 6: 2.

3. Shenkier T, Weir L, Levine M et al. Clinical practice guidelines for the care and treatment of breast cancer: 15. Treatment for women with stage III or locally advanced breast cancer. CMAJ. 2004; 170: 983-994.

4. Esteva FJ, Hortobagyi GN. Integration of systemic chemotherapy in the management of primary breast cancer. Oncologist. 1988; 3: 300-313.

5. Jacquillat C, Weil M, Baillet F et al. Results of the neoadjuvant chemotherapy, and external and radiation therapy in breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer. 1990; 66: 119-129.

6. Cocconi G, di Blasio B, Bisagni G et al. Neoadjuvant chemotherapy and endocrine therapy in locally advanced breast carcinoma. A prospective randomized study. Am J Oncol. 1990; 13: 226-232.

7. Hortobagyi GN, Ames FC, Buzdar AU. Management of stage III primary breast cancer with primary chemotherapy, surgery and radiation therapy. Cancer. 1988; 62: 2507-2516.

8. Fisher B, Brown AM, Mamounas E et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast Project B-18. J Clin Oncol. 1997; 15: 2483-2493.

9. Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Moliterni A, Terenziani M et al. Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol. 1998; 16: 93-100.

10. Buzdar AU, Singletary SE, Theriault RL, Booser DJ, Valero V, Ibrahim N et al. Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer. J Clin Oncol. 1999; 17: 3412-3417.

11. Feldman DL, Hortobagyi GN, Buzdar AU et al. Pathologic assessment of response to induction chemotherapy in breast cancer. Cancer Res. 1986; 46: 2578-2581.

12. Calais G, Berger C, Descamps P et al. Conservative treatment feasibility with induction chemotherapy, surgery and radiotherapy for patients with breast carcinoma larger than 3 cm. Cancer. 1994; 74: 1283-1288.

13. Fisher B, Bryant J, Wolmark N et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998; 16: 2672-2685.

14. Valero VV, Buzdar AU, Hortobagy GN. Locally advanced breast cancer. The Oncologist. 1996; 1: 8-17.

15. Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999; 17: 460-469.

16. Singletary SE, Allred C, Ashley P et al. Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol. 2002; 20 (17): 3628-3636.

17. Miller AB, Hoogstraten B, Staquet et al. Reporting results of cancer treatment. Cancer. 1981; 47: 207-214.

18. Chevallier B, Roche H, Oliver JP et al. inflammatory breast cancer. Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histologic response rate. Am J Clin Oncol. 1993; 16: 223-228.

19. Dieras V, Fumoleau P, Romieu G et al. Randomized parallel study of doxorrubicin plus paclitaxel and doxorubicin plus cyclophosphamide as neoadjuvant therapy of patients with breast cancer. J Clin Oncol. 2004; 22: 4958-4965.

20. Chollet P, Amat S, Cure H et al. Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer. Br J Cancer. 2002; 86: 1041-1046.

21. Lee MC, Jagsi R. Postmastectomy radiotherapy: indications and controversies. Surg Clin N Am. 2007; 87: 511-526.

22. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival. On overview of the randomized trials. Lancet. 2005; 366: 2087-2106.

23. Recht A et al. Postmastectomy radiation therapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2003; 83: 995-1013.