Article information
Resumen
En países en vías de desarrollo, el cáncer de mama se presenta en estados localmente avanzados en la mitad de los casos. El manejo de estas pacientes se hace a partir de la combinación de quimioterapia, cirugía y radioterapia. La quimioterapia neoadyuvante posibilita la cirugía conservadora con relativa frecuencia, aunque esta aproximación terapéutica no se considera todavía una práctica estándar. No hay recomendaciones claras acerca del uso del refuerzo con radioterapia en este escenario. Se realizó una búsqueda de literatura relevante en Medline. La mayoría de artículos correspondieron a series de casos. La supervivencia libre de recaída loco-regional entre pacientes tratadas con quimioterapia neoadyuvante, cirugía conservadora y radioterapia sobre campos tangenciales asociada a un refuerzo localizado sobre el lecho tumoral es buena. El refuerzo se administró de manera sistemática a todas las pacientes sin considerar factores pronósticos diferentes del estado localmente avanzado. Aunque la evidencia no es de primer nivel, permite recomendar el uso sistemático del refuerzo en pacientes con tumores localmente avanzados de mama tratados con cirugía conservadora
Palabras clave:
Neoplasias de la mama
terapia combinada
terapia neoadyuvante
mastectomía segmental
radioterapia
literatura de revisión como asunto
Abstract
Nearly half of breast cancer patients in developing countries present with a locally advanced cancer. Treatment is centered on a multimodal approach based on chemotherapy, surgery and radiotherapy. The growing use of neoadjuvant chemotherapy has led to a more conservative surgical approach; nonetheless, it is not yet considered as a standard. There are no clear recommendations on the use of a radiotherapy boost in such situation. A Medline search was developed. Most articles are retrospective series. Survival free of locoregional relapse in patients treated with neoadjuvant chemotherapy, breast conserving surgery and radiotherapy is good. All articles described a boost administered to nearly all patients without regard to their prognostic factors, given that a locally advanced tumor is already considered as a poor prognostic factor. Even tough the poor level of evidence, a recommendation can be made: radiotherapy boost should be administered to all patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and breast conserving surgery
Key words:
Breast neoplasms
combined modality therapy
neoadjuvant therapy
mastectomy
segmental
radiotherapy
review literature as topic
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Referencias
[1.]
M.C. Lee, L.A. Newman.
Management of patients with locally advanced breast cancer.
Surg Clin North Am, 87 (2007), pp. 379-398
[3.]
G. Schwartsmann.
Breast cancer in South America: challenges to improve early detection and medical management of a public health problem.
J Clin Oncol, 19 (2001), pp. 118S-124S
[4.]
Murillo RH, Piñeros M, Pardo C, Quintero A. Anuario Estadístico 2006 “Por el control del cáncer”. [Internet]. Bogotá: Instituto Nacional de Cancerología; 2007. Consultado el 25 de enero de 2009. Disponible en: http://www.incancerologia. gov.co/documentos/1_3_2008_10_21_58_AM_anuario% 20estadistico.pdf
[5.]
T. Shenkier, L. Weir, M. Levine, I. Olivotto, T. Whelan, L. Reyno, Steering Committee on Clinical Practice Guidelines for the Care Treatment of Breast Cancer.
Clinical practice guidelines for the care treatment of breast cancer: 15 Treatment for women with stage III or locally advanced breast cancer.
CMAJ, 170 (2004), pp. 983-994
[6.]
B. Fisher, J. Bryant, N. Wolmark, E. Mamounas, A. Brown, E.R. Fisher, et al.
Effect of preoperative chemotherapy on the outcome of women with operable breast cancer.
J Clin Oncol, 16 (1998), pp. 2672-2685
[7.]
P. Broët, S.M. Scholl, A. de la Rochefordière, A. Fourquet, T. Moreau, Y. De Rycke, et al.
Short and long-term effects on survival in breast cancer patients treated by primary chemotherapy: an updated analysis of a randomized trial.
Breast Cancer Res Treat, 58 (1999), pp. 151-156
[8.]
G. Bonadonna, P. Valagussa, C. Brambilla, L. Ferrari, A. Moliterni, M. Terenziani, et al.
Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute.
J Clin Oncol, 16 (1998), pp. 93-100
[9.]
A. Makris, T.J. Powles, S.E. Ashley, J. Chang, T. Hickish, V.A. Tidy, et al.
A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer.
Ann Oncol, 9 (1998), pp. 1179-1184
[10.]
M. Sinacki, J. Jassem, G. van Tienhoven.
Conservative local treatment versus mastectomy after induction chemotherapy in locally advanced breast cancer: a randomised phase III study (EORTC 10974/22002 LAMANOMA)--why did this study fail?.
Eur J Cancer, 41 (2005), pp. 2787-2788
[11.]
Scottish Intercollegiate Guidelines Network (SIGN). SIGN 84: Management of breast cancer in women [Internet]. Edinburgh: SIGN; 2005. [consultado el 18 de enero de 2009]. 52 p. Disponible en: http://www.sign.ac.uk/pdf/ sign84.pdf
[12.]
National Health and Medical Research Center (NHMRC Australia), National Breast Cancer Centre. Clinical practice guidelines for the management and support of younger women with breast cancer [Internet]. Canberra: NHMRC; 2001. [consultado el 18 de enero de 2009]. 215 p. Disponible en: http://www.nhmrc.gov.au/publications/. synopses/_files/cp76.pdf
[13.]
National Comprehensive Cancer Network. Clinical practice guidelines in oncology: breast cancer – version V.1. [Internet]. Fort Washington: NCCN; 2009 [consultado el 18 de enero de 2009]. Disponible en: http://www.nccn. org/professionals/physician_gls/PDF/breast.pdf
[14.]
J.A. Van der Hage, C.J.s van de Velde, J.P. Julien, M. Tubiana-Hulin, C. Vandervelden, L. Duchateau.
Preoperative chemotherapy in primary operable breast cancer: results from. the European Organization for Research and Treatment of Cancer trial 10902.
J Clin Oncol, 19 (2001), pp. 4224-4237
[15.]
M. Tozaki, T. Kobayashi, S. Uno, K. Aiba, H. Takeyama, H. Shioya, et al.
Breast-conserving surgery after chemotherapy: value of MDCT for determining tumor distribution and shrinkage pattern.
AJR Am J Roentgenol, 186 (2006), pp. 431-439
[16.]
N.S. Bese, K. Kiel, El-Gueddari Bel-K, O.B. Campbell, B. Awuah, B. Vikram, International Atomic EnergyAgency.
Radiotherapy for breast cancer in countries with limited resources: program implementation evidence-based recommendations.
J Breast, 12 (2006), pp. S96-S102
[17.]
N.S. Bese, A. Munshi, A. Budrukkar, A. Elzawawy, C.A. Perez, Breast Health Global Initiative Radiation Therapy Focus Group.
Breast radiation therapy guideline implementation in low- and middle-income countries.
Cancer, 113 (2008), pp. 2305-2314
[18.]
R.W. Carlson, B.O. Anderson, R. Chopra, A.E. Eniu, R. Jakesz, R.R. Love, Global Summit Treatment Panel, et al.
Treatment of breast cancer in countries with limited resources.
J Breast, 9 (2003), pp. S67-S74
[19.]
R. Holland, S.H. Veling, M. Mravunac, J.H. Hendriks.
Histologic multifocality of Tis T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery.
Cancer, 56 (1985), pp. 979-990
[20.]
H. Bartelink, J.C. Horiot, P. Poortmans, H. Struikmans, W. Van den Bogaert, I. Barillot, European Organization for Research and Treatment of Cancer Radiotherapy and Breast Cancer Groups, et al.
Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation.
N Engl J Med, 345 (2001), pp. 1378-1387
[21.]
H. Bartelink, J.C. Horiot, P.M. Poortmans, H. Struikmans, W. Van den Bogaert, A. Fourquet, et al.
Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial.
J Clin Oncol, 25 (2007), pp. 3259-3265
[22.]
P. Romestaing, Y. Lehingue, C. Carrie, R. Coquard, X. Montbarbon, J.M. Ardiet, et al.
Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon.
France. J Clin Oncol, 15 (1997), pp. 963-968
[23.]
E. Teissier, M. Hery, A. Ramaioli, J.L. Lagrange, A. Courdi, R.J. Bensadoun, et al.
Boost in conservative treatment: 6 years results of randomized trial.
Breast Cancer Res Treat, 50 (1998), pp. 287
[24.]
R. Jalali, S. Singh, A. Budrukkar.
Techniques of tumour bed boost irradiation in breast conserving therapy: current evidence and suggested guidelines.
Acta Oncol, 46 (2007), pp. 879-892
[25.]
T. Whelan, I. Olivotto, Levine M, Health Canada ‘s Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer..
Clinical practice guidelines for the care and treatment of breast cancer: breast radiotherapy after breast-conserving surgery (summary of the 2003 update).
CMAJ, 168 (2003), pp. 437-439
[26.]
M.L. Sautter-Bihl, W. Budach, J. Dunst, P. Feyer, W. Haase, W. Harms, F. Sedlmayer, R. Souchon, F. Wenz, R. Sauer, German Society of Radiation Oncology; German Cancer Society..
DEGRO practical guidelines for radiotherapy of breast cancer I: breast-conserving therapy.
Strahlenther Onkol, 183 (2007), pp. 661-666
[27.]
A. Rustogi, A. Budrukkar, K. Dinshaw, R. Jalali.
Management of locally advanced breast cancer: evolution and current practice.
J Cancer Res Ther, 1 (2005), pp. 21-30
[28.]
S. Beriwal, G.F. Schwartz, L. Komarnicky, J.A. Garcia-Young.
Breast-conserving therapy after neoadjuvant chemotherapy: long-term results.
J Breast, 12 (2006), pp. 159-164
[29.]
G. Calais, C. Berger, P. Descamps, S. Chapet, A. Reynaud-Bougnoux, G. Body, et al.
Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm.
Cancer, 74 (1994), pp. 1283-1288
[30.]
W.G. Cance, L.A. Carey, B.F. Calvo, C. Sartor, L. Sawyer, D.T. Moore, et al.
Long-term outcome of neoadjuvant therapy for locally advanced breast carcinoma: effective clinical downstaging allows breast preservation and predicts outstanding local control and survival.
Ann Surg, 236 (2002), pp. 295-302
[31.]
A.M. Chen, F. Meric-Bernstam, K.K. Hunt, H.D. Thames, M.J. Oswald, E.D. Outlaw, et al.
Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience.
J Clin Oncol, 22 (2004), pp. 2303-2312
[32.]
J. Clark, J. Rosenman, W. Cance, J. Halle, M. Graham.
Extending the indications for breast-conserving treatment to patients with locally advanced breast cancer.
Int J Radiat. Oncol Biol Phys, 42 (1998), pp. 345-350
[33.]
B. Clouth, S. Chandrasekharan, R. Inwang, S. Smith, N. Davidson, P. Sauven.
The surgical management of patients who achieve a complete pathological response after primary chemotherapy for locally advanced breast cancer.
Eur J Surg Oncol, 33 (2007), pp. 961-966
[34.]
A.A. Ezzat, E.M. Ibrahim, D.S. Ajarim, M.M. Rahal, M.A. Raja, A.M. Tulbah, et al.
Phase II study of neoadjuvant paclitaxel and cisplatin for operable and locally advanced breast cancer: analysis of 126 patients.
Br J Cancer, 90 (2004), pp. 968-974
[35.]
F. Fitzal, O. Riedl, L. Wutzl, W. Draxler, M. Rudas, U. Pluschnig, et al.
Breast-conserving surgery for T3/T4 breast cancer: an analysis of 196 patients.
Breast Cancer Res Treat, 103 (2007), pp. 45-52
[36.]
R. Jalali, R. Malde, R. Bhutani, A. Budrukkar, R. Badwe, R. Sarin.
Prospective evaluation of concomitant tumour bed boost with whole breast irradiation in patients with locally advanced breast cancer undergoing breast-conserving therapy.
Breast, 17 (2008), pp. 64-70
[37.]
K.M. Kling, N. Ostrzega, P. Schmit.
Breast conservation after induction chemotherapy for locally advanced breast cancer.
Am Surg, 63 (1997), pp. 861-864
[38.]
H.M. Kuerer, S.E. Singletary, A.U. Buzdar, F.C. Ames, V. Valero, T.A. Buchholz, et al.
Surgical conservation planning after neoadjuvant chemotherapy for stage II and operable stage III breast carcinoma.
Am J Surg, 182 (2001), pp. 601-608
[39.]
L. Mauriac, G. MacGrogan, A. Avril, M. Durand, A. Floquet, M. Debled, Institut Bergonié Bordeaux Groupe Sein (IBBGS)., et al.
Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up.
Ann Oncol, 10 (1999), pp. 47-52
[40.]
S.A. McIntosh, K.N. Ogston, S. Payne, I.D. Miller, T.K. Sarkar, A.W. Hutcheon, et al.
Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy.
Am J Surg, 185 (2003), pp. 525-531
[41.]
V. Parmar, A. Krishnamurthy, R. Hawaldar, M.S. Nadkarni, R. Sarin, R. Chinoy, et al.
Breast conservation treatment in women with locally advanced breast cancer - experience from a single centre.
Int J Surg, 4 (2006), pp. 106-114
[42.]
F. Peintinger, W.F. Symmans, A.M. Gonzalez-Angulo, J.C. Boughey, A.U. Buzdar, T.K. Yu, et al.
The safety of breastconserving surgery in patients who achieve a complete pathologic response after neoadjuvant chemotherapy.
Cancer, 107 (2006), pp. 1248-1254
[43.]
R. Rouzier, M.C. Mathieu, L. Sideris, E. Youmsi, R. Rajan, J.R. Garbay, et al.
Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors.
Cancer, 101 (2004), pp. 918-925
[44.]
J. Shen, V. Valero, T.A. Buchholz, S.E. Singletary, F.C. Ames, M.I. Ross, et al.
Effective local control and long-term survival in patients with T4 locally advanced breast cancer treated with breast conservation therapy.
Ann Surg Oncol, 11 (2004), pp. 854-860
[45.]
D.G. Tiezzi, J.M. Andrade, H.R. Marana, F.E. Zola, F.M. Peria.
Breast conserving surgery after neoadjuvant therapy for large primary breast cancer.
Eur J Surg Oncol, 34 (2008), pp. 863-867
[46.]
U. Veronesi, G. Bonadonna, S. Zurrida, V. Galimberti, M. Greco, C. Brambilla, et al.
Conservation surgery after primary chemotherapy in large carcinomas of the breast.
Ann Surg, 222 (1995), pp. 612-618
[47.]
G. Vlastos, N.Q. Mirza, J.T. Lenert, K.K. Hunt, F.C. Ames, B.W. Feig, et al.
The feasibility of minimally invasive surgery for stage IIA IIB, and IIIA breast carcinoma patients after tumor downstaging with induction chemotherapy.
Cancer, 88 (2000), pp. 1417-1424
[48.]
B.S. Yadav, S.C. Sharma, R. Singh, G. Singh.
Patterns of relapse in locally advanced breast cancer treated with neoadjuvant chemotherapy followed by surgery and radiotherapy.
J Cancer Res Ther, 3 (2007), pp. 75-80
[49.]
O. Asoglu, M. Muslumanoglu, A. Igci, V. Ozmen, H. Karanlik, K. Ayalp, et al.
Breast conserving surgery after primary chemotherapy in locally advanced breast cancer.
Acta Chir Belg, 105 (2005), pp. 62-68
[50.]
K. Erol, E. Baltali, K. Altundag, N. Guler, Y. Ozisik, D.A. Onat, et al.
Neoadjuvant chemotherapy with cyclophosphamide, mitoxantrone, and 5-fluorouracil in locally advanced breast cancer.
Onkologie, 28 (2005), pp. 81-85
[51.]
A.M. Gonzalez-Angulo, R. Walters, K. Broglio, D.K. Frye, E.A. Strom, R.L. Theriault, et al.
Using Response to Primary Chemotherapy to Select Postoperative Therapy: Long- Term Results from a Prospective Phase II Trial in Locally Advanced Primary Breast Cancer.
Clin Breast Cancer, 8 (2008), pp. 516-521
[52.]
M.M. Khanna, R.J. Mark, M.J. Silverstein, G. Juillard, B. Lewinsky, A.E. Giuliano.
Breast conservation management of breast tumors 4 cm or larger.
Arch Surg, 127 (1992), pp. 1041-1043
[53.]
V. Malhotra, V.J. Dorr, A.P. Lyss, C.M. Anderson, S. Westgate, M. Reynolds, et al.
Neoadjuvant and adjuvant chemotherapy with doxorubicin and docetaxel in locally advanced breast cancer.
Clin Breast Cancer, 5 (2004), pp. 377-384
[54.]
S.E. Singletary, M.D. McNeese, G.N. Hortobagyi.
Feasibility of breast-conservation surgery after induction chemotherapy for locally advanced breast carcinoma.
Cancer, 69 (1992), pp. 2849-2852
[55.]
S.M. Bentzen, R.K. Agrawal, E.G. Aird, J.M. Barrett, P.J. Barrett-Lee, START Trialists’ Group, et al.
The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial.
Lancet Oncol, 9 (2008), pp. 331-341
[56.]
S.M. Bentzen, R.K. Agrawal, E.G. Aird, J.M. Barrett, P.J. Barrett-Lee, START Trialists’ Group, et al.
The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial.
Lancet, 371 (2008), pp. 1098-1107
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