Cirurgia Conservadora e Radioterapia no Tratamento do Câncer da Mama
DOI:
https://doi.org/10.32635/2176-9745.RBC.1985v31n4.3358Palabras clave:
Câncer da Mama, Tratamento Conservador, RadioterapiaResumen
No período de janeiro de 1973 a dezembro de 1983, 59 pacientes com carcinoma da mama, tratadas conservadoramente, foram encaminhadas ao serviço de radioterapia do Instituto Nacional de Câncer. A idade média do grupo foi de 53 anos (variação: 24 a 83 anos), com 50% das pacientes em pré-menopausa. O estadiamento clínico revelou 13 pacientes com tumores TI, 34 com tumores T2 e três com tumores T3. Em nove pacientes essa informação não pôde ser obtida. A axila estava clinicamente positiva em 10 casos e foi cirurgicamente estadiada em 29 pacientes com um número médio de linfonodos retirados de 14,2 (variação: 2-36). A correlação clínica/cirúrgica foi de 63%. Após tumorectomia (56% das pacientes), quadrantectomia (39%). ou biópsia (3%). As pacientes eram submetidas à irradiação de todo o parênquima mamário com dose de 5000 cGy seguida de reforço sobre o leito tumoral (1000-2000 cGy). Todas as pacientes foram tratadas com cobaltoterapia e elétrons. As cadeias linfáticas foram irradiadas em 48% dos casos. A sobrevida aos 5 anos foi de 78% com 64% das pacientes sobrevivendo livre de doença (local e a distância) ao término desse período. Quatro pacientes (7%) falharam na mama, três (5%) na axila e nove (15%) a distância. O resultado cosmético foi considerado excelente e bom em 60% dos casos e isso foi observado mais frequentemente nas pacientes tratadas com tumorectomia. O tratamento conservador do câncer da mama parece ser uma opção aceitável de tratamento para essa patologia. A não mutilação do órgão não altera os resultados e oferece à paciente um resultado cosmético extremamente satisfatório.
Descargas
Citas
Halsted WS: The resuits of radical operations for the cure of carcinoma of the breast. Ann Surg 1907; 46: 1-19. DOI: https://doi.org/10.1097/00000658-190707000-00001
Morris T: Psychological aspects of breast cancer: A review. Europ. J. Clin. Oncl. 1983; 19: 1725-1731. DOI: https://doi.org/10.1016/0277-5379(83)90160-8
Morris T: Psychological adjustment to mastectomy. Cancer Treat. Rev. 1979; 6: 41-61. DOI: https://doi.org/10.1016/S0305-7372(79)80058-4
Meyerowitz BF: Psychological correlates of breast cancer and its treatment. Psychol. Bull. 1980; 87: 108-131. DOI: https://doi.org/10.1037/0033-2909.87.1.108
Keynes G: Conservative treatment of cancer of the breast. Br. Med. J. 1937; 2: 643-647. DOI: https://doi.org/10.1136/bmj.2.4004.643
Peters MV: Wedge resection with or without radiation in early breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 1977; 2: 1151-1156. DOI: https://doi.org/10.1016/0360-3016(77)90124-9
Mustakallio S: Conservative treatment of breast cancer-Review of 25 years followup. Clin. Radiol. 1972; 23; 110-116. DOI: https://doi.org/10.1016/S0009-9260(72)80151-X
Amalric R, Santamaria F, Rober F, et al; Radiation therapy with or without primary limited surgery for operable breast cancer. A 20 year experience at the Maseilles Cancer Institute. Cancer 1982; 40: 30-34. DOI: https://doi.org/10.1002/1097-0142(19820101)49:1<30::AID-CNCR2820490107>3.0.CO;2-L
Bedwinek HM, Perez CA, Kramer S, et al. Irradiation as the primary management of stage I and II adenocarcinoma of the breast. Analysis of the RTOG breast registry. Cancer Clin. Trials. 1980; 3:. 11-18.
Hellman S, Harris JR, Levene MB: Radiation therapy of early carcinoma of the breast without mastectomy. Cancer 1980; 46; 988-994. DOI: https://doi.org/10.1002/1097-0142(19800815)46:4+<988::AID-CNCR2820461323>3.0.CO;2-O
Danoff BF, Pajak TF. Solin LJ, et al: Excisional biopsy, axiliary node dissection and definitive radiotherapy for stages I and II breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 1985; 11: 479-483. DOI: https://doi.org/10.1016/0360-3016(85)90178-6
Harris JR, Botnick L, Bloomer WD.et al: Primary radiation therapy for early breast cancer: the experience at the Joint Center for Radiation Therapy. Int. J. Radiat. Oncol. Biol. Phys. 1981; 7: 1549-1552. DOI: https://doi.org/10.1016/0360-3016(81)90087-0
Ghossein NA, Vilcoq JR, Stacey P. et al; Conservation surgery and radiotherapy in the treatment of localized breast Cancer. A restropective analysis. Front. Radiat. Ther. One. 1983; 17: 102-109. DOI: https://doi.org/10.1159/000407283
Clark RM: Conservative surgery and radiation therapy in the treatment of operable breast cancer. Front Radiat. Ther. One. 1983; 17: 91-101. DOI: https://doi.org/10.1159/000407282
Montague ED, Schell SR, Romsdahl MD, et al: Conservation surgery and irradiation in the treatment of breast cancer. Front. Radiat. Ther. One. 1 983; 1 7: 76-83. DOI: https://doi.org/10.1159/000407280
Veronesi U, Saccozzi R, Del Veicchio M, et al; Comparing radical mastectomy with quadrantectomy, axiliary dissection and radiotherapy in patients with small cancers of the breast. N. Engl. J. Med. 1981; 305: 6-11. DOI: https://doi.org/10.1056/NEJM198107023050102
Sarrazin D, Le M, Fontaine F, et al; Conservative treatment versus mastectomy in T1 or small T2 breast cancer. A randomized clinicai trial. In Conservative Management of Breast Cancer. Harris JR. Hellman S, Silen W (Eds). J. B. Lippincott Co. 1983; 101 -111.
Fisher B, Bauer M, Margolese R, et al: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N. Engl. J. Med. 1985; 312: 665-673. DOI: https://doi.org/10.1056/NEJM198503143121101
Fisher B, Redmond C, Fisher ER, et al: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N. Engl. J. Med. 1985; 312: 674-681. DOI: https://doi.org/10.1056/NEJM198503143121102
Union Internationale Contre le Cancer. TNM. Classification of Malignant Tumors. Edited by M.H. Harmer. Third Edition. 1978.
Fletcher GH: Textbook of radiotherapy 3rd ed. Lea & Febiger, Philadelphia, 1980.
Kaplan EL, Meier P: Non parametric estimation for incomplete observations. J. Am. Stat. Assoe. 1958; 53: 457-481. DOI: https://doi.org/10.1080/01621459.1958.10501452
Souhami L: O tratamento conservador do câncer da mama. Uma nova era. Rev. Bras. Cancerol. 1982; 29: 36-41. DOI: https://doi.org/10.32635/2176-9745.RBC.1982v29n1.3513
Faria SL. Chiminazao HRr: Radioterapia no tratamento conservador do câncer da mama — técnica, complicações e resultados cosméticos. Radiol. Bras. 1985; 18:216-220.
Bedwinek J: Treatment of stage I and II adenocarcinoma of the breast by tumor excision and irradiation. Int. J. Radiat. Oncol. Biol. Phys. 1981; 7: 1553-1559. DOI: https://doi.org/10.1016/0360-3016(81)90088-2
Harris JR, Levene MB, Svensson G,et al: Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int. J. Radiat. Oncol. Biol. Phys. 1979; 5: 257-261. DOI: https://doi.org/10.1016/0360-3016(79)90729-6
Ray GR, Fish VJ: Biopsy and definitive radiation therapy in stage I and II adenocarcinoma of the female breast: Analysis of cosmesis and the role of electron beam suppiementation. Int. J. Radiat. Oncol. Phys. 1983; 9: 813-818. DOI: https://doi.org/10.1016/0360-3016(83)90006-8
Clarke D, Martinez A, Cox RS: Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int. J. Radiat. Oncol. Biol. Phys. 1983; 9: 1807-1813. DOI: https://doi.org/10.1016/0360-3016(83)90348-6
Haagensen CC, Miller E, Handiey RS, et al: Treatment of early breast cancer; A cooperativa International study. Ann surg 1969; 170: 875-899. DOI: https://doi.org/10.1097/00000658-196912000-00001
Nobler MP, Vinet L: Prognostic factors in patients undergoing curative irradiation for breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 1985; 11: 1323-1331. DOI: https://doi.org/10.1016/0360-3016(85)90248-2
Recht A, Silver S, Schnitt S, et al: Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int. J. Radiat. Oncol. Biol, Phys. 1985; 11: 127M276. DOI: https://doi.org/10.1016/0360-3016(85)90241-X
Arriagada R, Mourlesse H, Sarrazin D, et al: Radiotherapy alone in breast cancer. I Analysis of tumor parameters, tumor dose and local control: The experience of the Gustave-Roussy Institute and the Princess Margaret Hospital. Int. J. Radiat. Oncol. Biol. Phys. 1985; 11: 1751-1757. DOI: https://doi.org/10.1016/0360-3016(85)90027-6
Fisher B, Wolmark N, Redmond C, et al; Findings from NSABP Protocol n° B-04: comparison of radical mastectomy with alternative treatments. II. The clinical and biologic signifícance of medial-central breast cancers. Cancer 1981; 48: 1863-1872. DOI: https://doi.org/10.1002/1097-0142(19811015)48:8<1863::AID-CNCR2820480825>3.0.CO;2-U
Fisher ER, Gregorio R, Redmond C, et al: Pathologic findings from the NSABP (Protocol n° 4). I: Observations concerning the multicentricity of mammary cancer. Cancer 1975; 35: 247-254. DOI: https://doi.org/10.1002/1097-0142(197501)35:1<247::AID-CNCR2820350130>3.0.CO;2-S
Gallagher HS: Multicentricity in breast cancer. In Conservative Management of Breast Cancer. Harris JR, Hellman S.Silen W, Editors. Philadelphia, J .B., Lippincott 1983; pp 117-122.
Rosen PP, Fracchia AA, Urban JA, et al: "Residual” mammary carcinoma following simulated partial mastectomy. Cancer 1975; 35: 739-747. DOI: https://doi.org/10.1002/1097-0142(197503)35:3<739::AID-CNCR2820350329>3.0.CO;2-5
Urban JA: Surgical management of palpable breast cancer. Cancer 1980; 46: 983-987. DOI: https://doi.org/10.1002/1097-0142(19800815)46:4+<983::AID-CNCR2820461322>3.0.CO;2-5
Fletcher GH: Clinical dose-response curves of human malignant epithelial tumors. Br. J. Radiol. 1973; 46; 1-12. DOI: https://doi.org/10.1259/0007-1285-46-541-1
