Eficacia y seguridad de la neoadyuvancia en el carcinoma ductal de mama según repuesta patológica
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2020
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Introducción. Actualmente el cáncer de mama es el tumor de mayor incidencia entre las mujeres ecuatorianas. En estadios localmente avanzados, la quimioterapia neoadyuvante seguida de cirugía y radioterapia es el estándar terapéutico. Sin embargo, la literatura menciona diversos esquemas a ofrecer, con distintos resultados según la población de estudio. Objetivo. Establecer la eficacia y seguridad de la neoadyuvancia en pacientes con cáncer ductal localmente avanzado, en el Instituto Oncológico Nacional “Dr. Juan Tanca Marengo” en el período 2015 – 2016. Materiales y métodos. Diseño no experimental, descriptivo, transversal de tipo correlacional. Pacientes con diagnóstico de cáncer de mama ductal localmente avanzado sometidas a tratamiento neoadyuvante, datos obtenidos del sistema de intranet institucional. La respuesta clínica se clasificó según los Criterios de RECIST; sometidas a cirugía, y la respuesta patológica se clasificó de acuerdo con la carga residual del cáncer mediante el método RCB (Residual Cancer Burden) que se registra en el informe patológico de la pieza quirúrgica. Resultados. Se analizó 121 casos evidenciándose respuesta patológica completa (pCR) en 30/121 (24.8%) casos, observándose mayor pCR en los casos tratados con quimioterapia asociada a trastuzumab 10/14 (71.4%-p<0.001), en quienes también hubo mayor regresión en cuanto al tamaño tumoral (p=0.004) y ganglionar (p=0.021), con una supervivencia libre de enfermedad (SLE) y sobrevida global (SG) más prolongados (85.7% y 35.8 meses, 92.9% y 36.9 meses) en contraste con FAC (73.3%-31.6 meses, 86.7%-32.9 meses) o taxano-antraciclina (65.9%-30.8 meses, 89.4%-32.5 meses), si bien no fueron estadísticamente significativos (p=0.25 y p=0.81; respectivamente). Conclusiones. De los esquemas neoadyuvantes analizados, quimioterapia más trastuzumab en sobreexpresión del HER2 presentó mayor respuesta terapéutica, sin impactar ésta de forma positiva en la SLP/SG.
Currently, breast cancer is the tumor with the highest incidence among Ecuadorian women. In locally advanced stages, neoadjuvant chemotherapy followed by surgery and radiotherapy is the therapeutic standard. However, the literature mentions various schemes to offer, with different results according to the study population. Objective. Establish the efficacy and safety of neoadjuvant in patients with locally advanced ductal cancer, at the National Oncological Institute "Dr. Juan Tanca Marengo” in the period 2015 - 2016. Materials and methods. Non-experimental, descriptive, cross-sectional type design. Patients diagnosed with locally advanced ductal breast cancer undergoing neoadjuvant treatment, data obtained from the institutional intranet system. The clinical response was classified according to the RECIST Criteria; underwent surgery, and the pathological response was classified according to the residual burden of the cancer using the RCB (Residual Cancer Burden) method that is recorded in the pathological report of the surgical specimen. Results. 121 cases were analyzed, showing a complete pathological response (pCR) in 30/121 (24.8%) cases, observing a greater pCR in the cases treated with chemotherapy associated with trastuzumab 10/14 (71.4% -p <0.001), in whom there was also greater regression in terms of tumor size (p = 0.004) and lymph node (p = 0.021), with longer disease-free survival (SLE) and longer overall survival (OS) (85.7% and 35.8 months, 92.9% and 36.9 months) in contrast with FAC (73.3% -31.6 months, 86.7% -32.9 months) or taxane-anthracycline (65.9% -30.8 months, 89.4% -32.5 months), although they were not statistically significant (p = 0.25 and p = 0.81; respectively). Conclusions. Of the neoadjuvant schemes analyzed, chemotherapy plus trastuzumab in overexpression of HER2 presented a greater therapeutic response, without positively impacting this on the SLP / SG.
Currently, breast cancer is the tumor with the highest incidence among Ecuadorian women. In locally advanced stages, neoadjuvant chemotherapy followed by surgery and radiotherapy is the therapeutic standard. However, the literature mentions various schemes to offer, with different results according to the study population. Objective. Establish the efficacy and safety of neoadjuvant in patients with locally advanced ductal cancer, at the National Oncological Institute "Dr. Juan Tanca Marengo” in the period 2015 - 2016. Materials and methods. Non-experimental, descriptive, cross-sectional type design. Patients diagnosed with locally advanced ductal breast cancer undergoing neoadjuvant treatment, data obtained from the institutional intranet system. The clinical response was classified according to the RECIST Criteria; underwent surgery, and the pathological response was classified according to the residual burden of the cancer using the RCB (Residual Cancer Burden) method that is recorded in the pathological report of the surgical specimen. Results. 121 cases were analyzed, showing a complete pathological response (pCR) in 30/121 (24.8%) cases, observing a greater pCR in the cases treated with chemotherapy associated with trastuzumab 10/14 (71.4% -p <0.001), in whom there was also greater regression in terms of tumor size (p = 0.004) and lymph node (p = 0.021), with longer disease-free survival (SLE) and longer overall survival (OS) (85.7% and 35.8 months, 92.9% and 36.9 months) in contrast with FAC (73.3% -31.6 months, 86.7% -32.9 months) or taxane-anthracycline (65.9% -30.8 months, 89.4% -32.5 months), although they were not statistically significant (p = 0.25 and p = 0.81; respectively). Conclusions. Of the neoadjuvant schemes analyzed, chemotherapy plus trastuzumab in overexpression of HER2 presented a greater therapeutic response, without positively impacting this on the SLP / SG.
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Neoplasias de la mama, Quimioterapia adyuvante, Carcinoma ductal de mama, Patología, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador, Resultado del tratamiento, Epidemiología descriptiva