Información del artículo
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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