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LA RADIOTERAPIA EN LA RECURRENCIA IPSILATERAL DEL CÁNCER DE MAMA TRAS LA PRESERVACIÓN DE LA GLÁNDULA
(especial para SIIC © Derechos reservados)
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Autor:
Mark Trombetta
Columnista Experto de SIIC

Institución:
Allegheny General Hospital

Artículos publicados por Mark Trombetta 
Coautor Thomas B Julian* 
MD, Allegheny General Hospital, Pittsburgh, EE.UU.*


Recepción del artículo: 29 de diciembre, 2012
Aprobación: 25 de enero, 2013
Conclusión breve
La repetición de la tumorectomía y de la radioterapia posquirúrgica son factibles y podrían representar una alternativa a la mastectomía de rescate en las pacientes que evolucionan con recurrencia ipsilateral de cáncer de mama después de una cirugía de preservación mamaria.

Resumen

Objetivos: brindar una revisión del retratamiento radiante en el enfoque de las pacientes con recurrencia ipsilateral del cáncer de mama (RICM). Materiales y métodos: se efectuó una revisión de la bibliografía recinete y se la correlacionó con nuestra amplia experiencia de retratamiento en pacientes tratadas en forma original con tumorectomía y radioterapia postoperatoria en el marco de una RICM. Se informan los resultados actualizados de nuestras pacientes tratadas con implantes intersticial transitorios de baja dosis (LDR), braquiterapia con balón a altas dosis (HDR) o radioterapia conformacional tridimensional (3D-CRT) y su comparación con los resultados descritos por otros autores. Resultados: un total de 42 pacientes fueron tratadas según nuestro protocolo. Después de una media de seguimiento de 67.5 meses (intervalo de 5 a 115 meses), 21 de las 22 mujeres tratadas con LDR lograron control local después del último control o al momento del fallecimiento. La única paciente que presentó una segunda recurrencia local se trató de forma exitosa con mastectomía. Una de las 15 mujeres que recibieron HDR evolucionó con una recurrencia inflamatoria que se trató de forma exitosa con mastectomía de rescate. En las 5 pacientes tratadas con 3D-CRT se logró preservación mamaria. Dos de las pacientes que recibieron LDR presentaron disrupción cutánea localizada. Cinco de las 42 participantes murieron; 3 casos se atribuyeron a cáncer mamario metastático. Una de las pacientes falleció como consecuencia de enfermedad pulmonar obstructiva crónica. Otra enferma murió por complicaciones cardíacas de la radioterapia previa. En una de las mujeres se verificó aparición de cáncer de mama contralateal. Los resultados estéticos a largo plazo, definidos por la escala cosmética de Harvard y la modificación de Allegheny General (AGH) se consideraron aceptables. La escala AGH fue más precisa para notificar los cambios estéticos. Conclusiones: estos datos a largo plazo permite sugerir que la repetición de la tumorectomía y de la radioterapia posquirúrgica son factibles y podrían representar una alternativa a la mastectomía de rescate en las pacientes que evolucionan con RICM después de una cirugía de preservación mamaria. Se requiere un mejor sistema de cuantificación estética (escala AGH) para una identificación más adecuada del resultado cosmético posterior al retratamiento.

Palabras clave
cáncer de mama, recurrencia ipsilateral del cáncer de mama, radioterapia, preservación mamaria

Clasificación en siicsalud
Artículos originales> Expertos del Mundo>
página www.siicsalud.com/des/expertos.php/125118

Especialidades
Principal: Obstetricia y GinecologíaOncología
Relacionadas: Anatomía Patológica

Enviar correspondencia a:
Mark Trombetta, Allegheny General Hospital Department of Radiation Oncology, PA 15212, Pittsburgh, EE.UU.


Radiotherapy in the treatment of ipsilateral breast tumor recurrence (IBTR) following breast conservation

Abstract
Purpose: To provide an overview of the state of retreatment irradiation in the management of patients who develop ipsilateral breast tumor recurrence (IBTR). Materials and methods: We reviewed the modern literature and correlated it with our extensive experience in retreatment of the breast in patients originally treated with lumpectomy and post-operative irradiation following IBTR. We report the updated results of our patients treated by low dose rate temporary interstitial implant (LDR), high dose rate (HDR) balloon brachytherapy, and three dimensional conformal radiotherapy (3-D CRT), and compare these to results reported by other authors. Results: A total of 42 patients have been treated on our protocol. With a mean follow up of 67.5 months (range 5-115 months), twenty-one of 22 LDR patients achieved local control at the time of last follow-up, or at the time of their death. The single patient who developed a second local recurrence was treated successfully with mastectomy. One of 15 HDR patients developed an inflammatory recurrence and was successfully treated by salvage mastectomy. All five 3-D CRT patients have retained their breasts. Two LDR patients developed localized skin breakdown. Five of 42 patients have expired with 3/5 succumbing to metastatic breast cancer. One patient died from chronic obstructive pulmonary disease, and one died from cardiac complications secondary to previous mantle radiotherapy. One patient developed a contralateral breast cancer. Long-term cosmetic results as defined by the Harvard cosmesis scale and the Allegheny General (AGH) modification were acceptable, and the AGH modification more accurately reported cosmetic changes. Conclusions: These long-term data suggest that repeat lumpectomy followed by repeat post-operative radiotherapy is feasible and may be an acceptable alternative to salvage mastectomy in patients who develop IBTR following conservation breast therapy. An improved cosmetic reporting system (the AGH modification) is required to more accurately identify post-retreatment cosmesis.


Key words
breast cancer, ipsilateral breast tumor recurrence, radiotherapy, breast conservation


LA RADIOTERAPIA EN LA RECURRENCIA IPSILATERAL DEL CÁNCER DE MAMA TRAS LA PRESERVACIÓN DE LA GLÁNDULA

(especial para SIIC © Derechos reservados)
Artículo completo
Bibliografía del artículo
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