ABSTRACT
OBJECTIVE: To assess the pathological complete response (pCR) rate after neoadjuvant chemotherapy (NC) with anthracyclines with or without taxanes in management of locally advanced breast cancer (LABC). METHOD: Patients with LABC were included. A cohort received four cycles of 5-fluorouracil [FEC] (FEC 500 mg/m2, epirubicin 75 mg/m2, cyclophosphamide 500 mg/m2) every 3 weeks followed by four cycles of docetaxel (D) 75 mg/m2 as 1 h infusion intravenous every 3 weeks. Another cohort received six cycles of FE100C (500, 100 and 600 mg/m2). The chemotherapy was followed by surgery and radiotherapy. RESULTS: There was no statistically significant difference in overall response rate (ORR) (ORR: 78.5 vs. 85%; p = 0.299) and clinical complete response (cCR) (c CR: 20.6 vs. 33.3%; p = 0.103) for 4FECâ4D compared to 6FE100C, respectively. Instead, there was a statistically significant improved rate of pCR (30.2 vs. 16.7%; p = 0.049) and negative axillary lymph nodes (51.6 vs. 35%; p = 0.03) for 4FECâ4D compared to 6FE100C, respectively. Serious toxicity was low and non-significant in both cohorts. The logistic regression multivariate models showed that main significant predictors to obtain a pCR were 4FECâ4D NC (odds ratio [OR]: 2.7; p = 0.019) and stage IIIA (OR: 3.8; p = 0.002). CONCLUSION: This study showed that 4FECâ4D regimen with conventional dose is highly active and well tolerated in patients with LABC in our hospital.
OBJETIVO: Evaluar la tasa de respuesta patológica completa (RPc) posterior a la quimioterapia neoadyuvante (QN) con antraciclinas con o sin taxanos en el manejo del cáncer de mama localmente avanzado (CMLA). MÉTODO: Se incluyeron pacientes con CMLA. Una cohorte recibió cuatro ciclos de FEC (5-fluorouracilo 500 mg/m2, epirubicina 75 mg/m2, ciclofosfamida 500 mg/m2) cada 3 semanas seguido por cuatro ciclos de docetaxel (D) 75 mg/m2 en infusión intravenosa de 1 hora cada 3 semanas. Otra cohorte recibió seis ciclos de FE100C (500, 100 y 600 mg/m2). Se realizó cirugía posterior a la quimioterapia. RESULTADOS: No hubo diferencia estadísticamente significativa en las tasas de respuesta objetiva (78.5 vs. 85.0%; p = 0.299) ni en la respuesta clínica completa (20.6 vs. 33.3%; p = 0.103) para 4FECâ4D comparado con 6FE100C, respectivamente. En cambio, hubo una mejora significativa en la tasa de RPc (30.2 vs. 16.7%; p = 0.049) y en los ganglios linfáticos axilares negativos (51.6 vs. 35%; p = 0.03) para 4FECâ4D en comparación con 6FE100C, respectivamente. La toxicidad grave fue baja y no significativa en ambas cohortes. Los modelos multivariados de regresión logística mostraron que los principales predictores significativos para obtener una RPc fueron la QN con 4FECâ4D (odds ratio [OR]: 2.7; p = 0.019) y el estadio IIIA (OR: 3.8; p = 0.002). CONCLUSIÓN: Este estudio mostró que el régimen 4FECâ4D con dosis convencional es muy activo y bien tolerado en pacientes con CMLA en nuestro hospital.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Breast Neoplasms/drug therapy , Docetaxel/administration & dosage , Epirubicin/administration & dosage , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Breast Neoplasms/pathology , Cohort Studies , Docetaxel/adverse effects , Drug Therapy, Combination , Epirubicin/adverse effects , Female , Humans , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Remission Induction , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To explore the relation between tumor kinetic assessed by (18)F-FDG PET and final neoadjuvant chemotherapy (NC) response within a molecular phenotype perspective. MATERIAL AND METHODS: Prospective study included 144 women with breast cancer. All patients underwent a dual-time point (18)F-FDG PET/CT previous to NC. The retention index (RI), between SUV-1 and SUV-2 was calculated. Molecular subtypes were re-grouped in low, intermediate and high-risk biological phenotypes. After NC, all residual primary tumor specimens were histopathologically classified in tumor regression grades (TRG) and response groups. The relation between SUV-1, SUV-2 and RI with the TRG and response groups was evaluated in all molecular subtypes and in accordance with the risk categories. RESULTS: Responder's lesions showed significant greater SUVmax compared to non-responders. The RI value did not show any significant relation with response. Attending to molecular phenotypes, statistical differences were observed with greater SUV for responders having high-risk molecular subtypes. CONCLUSION: Glycolytic tumor characteristics showed a significant correlation with NC response and dependence of risk phenotype.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/drug therapy , Neoadjuvant Therapy , Positron Emission Tomography Computed Tomography , Biomarkers , Breast Neoplasms/genetics , Female , Humans , Phenotype , Prospective StudiesABSTRACT
AIM: To compare axillary involvement (N+) at initial staging in locally advanced breast cancer (LABC) with axillary lymphadenectomy histologic results after neoadjuvant chemotherapy treatment (NeoChemo). MATERIAL AND METHODS: Retrospective study between November 2011 and September 2013 of LABC cases treated with neoadjuvant chemotherapy based on docetaxel (associated with trastuzumab in HER2 positive cases and carboplatin/adriamycin in HER2 negative cases). Those clinically or radiologically suspected cases of axillary involvement were histologically confirmed. When there was no suspicion of axillary involvement, sentinel lymph node radioguided biopsy (SLNRB) was performed using intradermal injection of (99m)Tc-nanocolloid albumin prior to neoadjuvant treatment. Axillary lymphadenectomy after NeoChemo was undertaken in all cases with positive axilla. Final pathologic response was classified as complete (pCR) when there was no evidence of tumoral disease and as non-pathologic complete response (no pCR) in the opposite case. RESULTS: A total of 346 patients treated with docetaxel were reviewed, identifying 105 LABC. Axillary involvement at initial staging was detected in 70 (67%) before starting NeoChemo. From these 70, 73% (n=51) were N+ (fine needle biopsy and/or biopsy) and the remaining 19 (27%) were occult N+ detected by SLNRB. Axillary lymphadenectomy detected pCR in 56% (39/70), increasing up to 84% pCR when initial N+ status was reached using SNLB. On the other hand, when N+ was detected using fine needle biopsy/lymph biopsy, pCR was only 45%. CONCLUSION: More than 50% of women affected by locally advanced breast cancer with tumoral axillary involvement at initial diagnosis present free metastatic axilla after therapeutic neoadjuvant chemotherapy effect. This increases up to almost 90% in case of occult metastatic axilla detected with sentinel node biopsy prior starting neoadjuvant chemotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Lymphatic Metastasis , Neoadjuvant Therapy , Adult , Aged , Algorithms , Axilla , Breast Neoplasms/pathology , Carboplatin/administration & dosage , Docetaxel , Doxorubicin/administration & dosage , Female , Humans , Lymph Node Excision , Lymphatic Metastasis/diagnostic imaging , Male , Middle Aged , Radiopharmaceuticals , Retrospective Studies , Sentinel Lymph Node Biopsy , Taxoids/administration & dosage , Technetium Tc 99m Aggregated Albumin , Trastuzumab/administration & dosage , Treatment OutcomeABSTRACT
AIM: To assess dual time point 2-deoxy-2-[(18)F]fluoro-D-glucose (18)(F)FDG PET-CT accuracy in nodal staging and in detection of extra-axillary involvement. MATERIAL AND METHODS: Dual time point [(18)F] FDG PET/CT scan was performed in 75 patients. Visual and semiquantitative assessment of lymph nodes was performed. Semiquantitative measurement of SUV and ROC-analysis were carried out to calculate SUV(max) cut-off value with the best diagnostic performance. Axillary and extra-axillary lymph node chains were evaluated. RESULTS: Sensitivity and specificity of visual assessment was 87.3% and 75%, respectively. SUV(max) values with the best sensitivity were 0.90 and 0.95 for early and delayed PET, respectively. SUV(max) values with the best specificity were 1.95 and 2.75, respectively. Extra-axillary lymph node involvement was detected in 26.7%. CONCLUSION: FDG PET/CT detected extra-axillary lymph node involvement in one-fourth of the patients. Semiquantitative lymph node analysis did not show any advantage over the visual evaluation.
Subject(s)
Breast Neoplasms/diagnostic imaging , Carcinoma, Ductal, Breast/secondary , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Lymphatic Metastasis/diagnostic imaging , Multimodal Imaging/methods , Neoplasm Staging/methods , Positron-Emission Tomography/methods , Radiopharmaceuticals , Tomography, X-Ray Computed/methods , Adult , Aged , Axilla , Biopsy, Fine-Needle , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/diagnostic imaging , Carcinoma, Ductal, Breast/pathology , Female , Humans , Middle Aged , Predictive Value of Tests , Prospective Studies , ROC Curve , Sensitivity and Specificity , Sentinel Lymph Node Biopsy , ThoraxABSTRACT
Introducción: el cáncer de mama es actualmente el tumor maligno más frecuente en la mujer y la quimioterapia constituye una de las principales armas terapéuticas en este padecimiento. Objetivo: caracterizar el comportamiento de los enfermos con cáncer de mama localmente avanzado, que recibieron tratamiento con quimioterapia neoadyuvante.Métodos: se realizó un estudio de serie de casos. El universo estuvo constituido por 144 pacientes con cáncer de mama localmente avanzado que recibieron quimioterapia neoadyuvante en el Centro Oncológico Territorial de Holguín en el período de enero de 2010 a diciembre de 2011. La muestra estuvo representada por los 87 que cumplieron todos los ciclos del tratamiento indicado, previo diagnóstico citológico o histológico de cáncer de mama.Resultados: entre los pacientes con cáncer de mama localmente avanzado que recibieron quimioterapia predominaron las mujeres ,96,56 por ciento, y el grupo de edad entre ,4049, años ,35,63 por ciento, La adriamicina con ciclofosfamida fue el esquema de tratamiento más empleado en el ,44,83 por ciento, y el ,37,93 por ciento , de estos pacientes y realizaron hasta cuatro ,434, ciclos. La toxicidad medicamentosa no interfirió en la administración de la terapéutica y las náuseas y vómitos fueron las más frecuentes ,90,80 por ciento, La respuesta al tratamien to fue parcial en el ,55,17 por ciento, y la cirugía radical se efectuó en el ,74,71 por ciento,Conclusiones: el cáncer de mama localmente avanzado se presentó, comúnmente, en mujeres entre ,40, a ,49, años, el esquema más usado fue adriamicina y ciclofosfamida, el cual logró respuesta parcial en la mayoría de los pacientes con toxicidad que no retrasó la terapéutica(AU)...
Introduction: breast cancer is the most common malignant tumor in women at this moment. Chemotherapy is one of the main therapeutic tools against this pathology.Objective: characterize the behavior of patients with local advanced breast cancer who recieved neoadyuvant chemotherapy at Holguín Oncological Center from January ,2010, to December ,2011,Methods: a prospective and descriptive study was carried out. All patients with breast cancer were the universe and the sample comprised ,87, patients who completed all the treatment.Results: women were the predominant gender ,96.56 percent, as well as the age group between ,40-49, years ,35.63 percent, Doxorubicin with Cyclophosphamide treatment prevailed ,44.83 percent, and ,37.93 percent, of these patients received four cycles of it. The toxicity by chemotherapy did not interfere in this therapy and nauseas with or without vomiting was the most frequent adverse reaction ,90.80 percent, Most patients assimilated the treatment partially ,55.17 percent, of them. Thus, with this treatment there was a partial recovery in the majority of patients and the toxicity did not delay the therapy.Conclusions: locally advanced breast cancer could be found commonly in ,40 -49, years old women. Chemotherapy schedule more frequently used was the junctions of doxorubicin and cyclophosphamide, reaching a partial response in the majority number of patients and the toxicity never delay the therap(AU)...
Subject(s)
History, 18th Century , Carcinoma/drug therapy , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Doxorubicin/therapeutic use , Cyclophosphamide/therapeutic use , Case ReportsABSTRACT
Introducción: el cáncer de mama es actualmente el tumor maligno más frecuente en la mujer y la quimioterapia constituye una de las principales armas terapéuticas en este padecimiento. Objetivo: caracterizar el comportamiento de los enfermos con cáncer de mama localmente avanzado, que recibieron tratamiento con quimioterapia neoadyuvante. Métodos: se realizó un estudio de serie de casos. El universo estuvo constituido por 144 pacientes con cáncer de mama localmente avanzado que recibieron quimioterapia neoadyuvante en el Centro Oncológico Territorial de Holguín en el período de enero de 2010 a diciembre de 2011. La muestra estuvo representada por los 87 que cumplieron todos los ciclos del tratamiento indicado, previo diagnóstico citológico o histológico de cáncer de mama. Resultados: entre los pacientes con cáncer de mama localmente avanzado que recibieron quimioterapia predominaron las mujeres (96,56%) y el grupo de edad entre 40-49 años (35,63%). La adriamicina con ciclofosfamida fue el esquema de tratamiento más empleado en el 44,83% y el 37,93% de estos pacientes y realizaron hasta cuatro ciclos. La toxicidad medicamentosa no interfirió en la administración de la terapéutica y las náuseas y vómitos fueron las más frecuentes (90,80%). La respuesta al tratamiento fue parcial en el 55,17% y la cirugía radical se efectuó en el 74,71%. Conclusiones: el cáncer de mama localmente avanzado se presentó, comúnmente, en mujeres entre 40 a 49 años, el esquema más usado fue adriamicina y ciclofosfamida, el cual logró respuesta parcial en la mayoría de los pacientes con toxicidad que no retrasó la terapéutica.
Introduction: breast cancer is the most common malignant tumor in women at this moment. Chemotherapy is one of the main therapeutic tools against this pathology. Objective: characterize the behavior of patients with local advanced breast cancer who recieved neoadyuvant chemotherapy at Holguín Oncological Center from January 2010 to December 2011 Methods: a prospective and descriptive study was carried out. All patients with breast cancer were the universe and the sample comprised 87 patients who completed all the treatment. Results: women were the predominant gender (96.56%) as well as the age group between 40-49 years (35.63%). Doxorubicin with Cyclophosphamide treatment prevailed (44.83%) and 37.93% of these patients received four cycles of it. The toxicity by chemotherapy did not interfere in this therapy and nauseas with or without vomiting was the most frequent adverse reaction (90.80%). Most patients assimilated the treatment partially 55.17% of them. Thus, with this treatment there was a partial recovery in the majority of patients and the toxicity did not delay the therapy. Conclusions: locally advanced breast cancer could be found commonly in 40-49 years old women. Chemotherapy schedule more frequently used was the junctions of doxorubicin and cyclophosphamide, reaching a partial response in the majority number of patients and the toxicity never delay the therapy.