Análise de fatores clínicos, radiológicos e patológicos que influenciam o tratamento cirúrgico do câncer de mama localmente avançado, submetido à quimioterapia neoadjuvante
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Data
2010-09-01
Autores
Zucca-Matthes, Angelo Gustavo [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Um dos principais objetivos da quimioterapia neoadjuvante é converter carcinomas mamários localmente avançados(CMLA) em tumores operáveis ou aumentar o número de pacientes que possam ser submetidas ao tratamento conservador da mama (TCM). Um planejamento cirúrgico ideal envolve a tentativa radiológica de predizer a área de tumor residual pós-quimoterapia, possibilitando a ressecção de uma grande quantidade de tecido mamário com segurança oncológica. Poucos dados estão disponíveis no que diz respeito aos exames preditores de tumor residual e à cirurgia oncoplástica em tumores mamários localmente avançados tratados com quimioterapia neoadjuvante. Avaliar o uso de exames pré e pós-quimioterapia, que favoreçam o TCM, em mulheres com CMLA, sobretudo em cirurgias oncoplásticas. Um ensaio clínico prospectivo (www.clinicaltrials.gov) realizado em mulheres com câncer de mama, estádio clínico III, submetidas à quimioterapia neoadjuvante, com base em quatro ciclos de AC (doxorrubicina 60mg/m2 + ciclofosfamida 600 mg/m2) e 4 ciclos de T (paclitaxel 175mg/m2). Em todas as pacientes foi realizada a delimitação das medidas tumorais pré-operatórias por tatuagem. Comparou-se o exame físico (EF), mamografia (MG), ultrassom (US) e ressonância magnética mamária (RNM) no pré-operatório e no pós-operatório. Estes achados foram correlacionados com o anatomopatológico (AP). Para a correlação entre diferentes medidas foi utilizado o índice de correlação intraclasses(ricc). Além disso foi feita correlação entre a média das medidas realizadas por cada método. Às pacientes foram oferecidas cirurgias oncológicas e oncoplásticas em conformidade com a imagem clínica anterior à quimioterapia, a resposta à quimioterapia, a localização, o tamanho do tumor, o volume mamário, a segurança, a comorbidades do paciente e a experiência do cirurgião. 50 pacientes foram...
One of the goals of neoadjuvant chemotherapy was to convert locally advanced breast tumors into operable tumors or increase the number of patients who may be treated with breast-conservative surgery (BCS). An ideal surgical approach involves attempting to predict the radiological area of residual tumor after chemotherapy, allowing the resection of a large amount of breast tissue safely oncology. Few data are available regarding the examinations predictors of residual tumor and oncoplastic surgery in locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy. To evaluate, the use of pre and post-chemotherapy exams in women with CMLA to promote BCS, especially oncoplastic surgery. A prospective clinical trial (www.clinicaltrials.gov) surveyed women with breast cancer, clinical stage III, submitted to neoadjuvant chemotherapy based on four cycles of AC (doxorubicin 60mg/m2 + ciclofosfamide 600 mg/m2) and 4 cycles of T (175mg/m2 paclitaxel). In all patients was carried out the demarcation of the tumor pre-operative measures by tattooing. The measurement of postoperative pathologic finding was correlated with physical examination (PE), mammography (MG), ultasound (US) and magnetic resonance (MRI). To determine the correlation between various measures we used the intraclass correlation (ricc). A correlation between the measures was also made and carried out on the average of each method. Oncoplastic surgery were offered to the patients in accordance with the clinical picture prior to chemotherapy, response to chemotherapy, location, tumor size, breast volume, security, co-morbidities of the patient and surgeon experience. 50 women completed the proposed treatment and were undergone surgery. The size of tumor ranges from... (Complete abstract click electronic access below)
One of the goals of neoadjuvant chemotherapy was to convert locally advanced breast tumors into operable tumors or increase the number of patients who may be treated with breast-conservative surgery (BCS). An ideal surgical approach involves attempting to predict the radiological area of residual tumor after chemotherapy, allowing the resection of a large amount of breast tissue safely oncology. Few data are available regarding the examinations predictors of residual tumor and oncoplastic surgery in locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy. To evaluate, the use of pre and post-chemotherapy exams in women with CMLA to promote BCS, especially oncoplastic surgery. A prospective clinical trial (www.clinicaltrials.gov) surveyed women with breast cancer, clinical stage III, submitted to neoadjuvant chemotherapy based on four cycles of AC (doxorubicin 60mg/m2 + ciclofosfamide 600 mg/m2) and 4 cycles of T (175mg/m2 paclitaxel). In all patients was carried out the demarcation of the tumor pre-operative measures by tattooing. The measurement of postoperative pathologic finding was correlated with physical examination (PE), mammography (MG), ultasound (US) and magnetic resonance (MRI). To determine the correlation between various measures we used the intraclass correlation (ricc). A correlation between the measures was also made and carried out on the average of each method. Oncoplastic surgery were offered to the patients in accordance with the clinical picture prior to chemotherapy, response to chemotherapy, location, tumor size, breast volume, security, co-morbidities of the patient and surgeon experience. 50 women completed the proposed treatment and were undergone surgery. The size of tumor ranges from... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Mamas - Cancer - Cirurgia, Cancer - Tratamento, Quimioterapia, Oncologia, Magnetic resonance imaging
Como citar
ZUCCA-MATTHES, Angelo Gustavo. Análise de fatores clínicos, radiológicos e patológicos que influenciam o tratamento cirúrgico do câncer de mama localmente avançado, submetido à quimioterapia neoadjuvante. 2010. 149 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.