Estudo prospectivo da resposta a quimioterapia neoadjuvante na determinação do tratamento cirúrgico conservador em pacientes com câncer de mama

Abstract

This present prospective study mtended to evaluate the contribution of neoadjuvant chemotherapy upon the reduction of breast malignant tumors with views to perform conservative operation as oposed to a more aggressive radical surgical procedure. Thirty two patients with mfiiltrating carcinoma of the breast stages I, IIa, lib, DIa and DIb eligible to underço radical inastectomy were included in this work. All patients studied were submited to fisical examination with measure of tumor size using tumorimeter, mammography, mammary ltrasonography, citology and core biopsy of the tuinor using tru-cut needle. With confirmed carcinoma of the breast upon results either from citology or core biopsy, aU patients received combmed neoadjuvant chemotherapy with 5- fluorouracü SOOmg/m , epirrubicine 50mg/m and cyclophophamide 500mg/m (FEC), every 21 days for three consecutive cycles as their initial therapy. After tree cycles of chemotherapy, patients were subjected again to the previous applied set of investigations including fisical examination with new measure of the tumor, mammography, mammary ultrasonography, citology and core biopsy of remaining tumor. Surçical local treatment m the form of either radical mastectomy (Madden operation) or quadrantectomy plus axilary clearence was performed. The mean tumor volumes before and after adjuvant chemotherapy were according to dsical exammatíon 24.23cm and 7.53cm , measured by mammography 10.81cm and 5.93cm3 and evaluated through mammary ultrasonography 5.70cm3 and 2.67 Objective response (OR) based on results from the above performed investigations was considered when patients presented either complete tumor size reduction (100%) or tumor size reduction equal or superior to 50%. Objective response (OR) based on fisical examination was observed m 84.5% of patients. When mammography was applied as the anaUzing method 81.2% of patients also presented objective response (OR). Accordmg mammary ultrasonography 80.0% of patients presented objective response (OR). These results were therefore very simuar irrespective of the method of evaluation applied. The rate of breast sakage was 81.2% which means that twenty six out of thirty two patients previously etígible to radical mastectomy underwent conservative surçery. The esthetic results obtained from conseryative surçery were considered good and excellent. The neoadjuvant Qt was efective to promove significance response, without stimulate important agressive m the pacients. The toxicity induced by neoadjuvant chemotherapy caused a high percentage of alopecia and a moderate incidence of nausea and vomits. These resuhs indicate that neoadjuvant chemotherapy can modify the use of radical mastectomy to a nnore conservative surçical treatment in the majority of patients studied. Futhermore, neoadjuvant chemotherapy response may be used to select patients with aggresive non-responsive breast tumors to receive other combmations of chemotherapy drugs which may be more efifective during post operative chemotherapy.