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Performance do PET/CT pré-operatório na predição de resposta patológica após tratamento com quimioterapia neoadjuvante para pacientes com câncer de mama / Diagnostic performance of preoperative 18F-FDG PET/CT in predicting pathologic tumor response after neoadjuvant chemotherapy for patients with breast cancer
São Paulo; s.n; 2014. 78 p. ilus, tab, quadros.
Thesis in Portuguese | LILACS, Inca | ID: lil-756703
Responsible library: BR30.1
Localization: BR30.1
RESUMO
O tratamento do câncer de mama não metastático é primordialmente cirúrgico tanto para o câncer de mama inicial quanto para o câncer de mama localmente avançado (CMLA). Atualmente, a melhor estratégia para o tratamento do CMLA e para os tumores com relação/mama desfavorável é o uso de quimioterapia neoadjuvante (QTN) com o objetivo de preservação da mama, mensurar a taxa de resposta à quimioterapia in vivo e tratar de princípio doença micrometastática. Com o advento de novas drogas as taxas de resposta patológica completa (RpC) chegam até 65%. Estas altas taxas de RpC despertam o interesse por estudar e tentar selecionar um grupo de pacientes que poderia se beneficiar do tratamento não cirúrgico do câncer de mama e leva ao desafio de tentar identificar estas pacientes com resposta máxima no pré-operatório através de algum método de imagem. Neste cenário se destaca o uso do PET/CT realizado após o término de todo o esquema de QTN na tentativa de avaliar se tumores que apresentam PET/CT normal ao final da neoadjuvância, teriam também RpC o que poderia contribuir na seleção de pacientes para tratamento não cirúrgico do câncer de mama.

Objetivo:

Analisar o papel do PET/CT realizado após o término da quimioterapia neoadjuvante como instrumento de avaliação/predição de resposta patológica completa em pacientes com câncer de mama submetidas a tratamento com quimioterapia neoadjuvante. Pacientes e

métodos:

Este trabalho consiste em um estudo prospectivo longitudinal que incluiu 73 pacientes com CMLA ou com tumores com relação/mama desfavorável e que foram submetidas à QTN. Todas as pacientes foram avaliadas através da realização de PET/CT ao final da QTN e subsequentemente submetidas a tratamento cirúrgico oncológico. As peças provenientes da ressecção cirúrgica foram avaliadas em relação aos critérios do TNM e também em relação aos critérios de RCB (Residual Cancer Burden).

Resultados:

No período de fevereiro de 2010 a junho de 2013, analisamos...
ABSTRACT
Breast cancer is the most common malignant neoplasm in women, and its treatment is based on surgery even for advanced disease. The best strategy for patients with locally advanced breast cancer (LABC) and for those with unfavorable tumor/breast size index is to begin the treatment with neoadjuvant chemotherapy (NAC) with the objective of further breast conservative surgery, measure in vivo response to chemotherapy, and potentially treat micrometastatic disease. A 65% complete pathologic response rate (pCR) can be obtained after recent improvement in NAC efficacy based on new regimens. The progress in pCR rates may theoretically help to select a group of patients that do not require surgery, since their tumors have been completely eradicated by NAC. The present challenge is to develop of a diagnostic tool capable to precisely predict pCR after NAC and further omit surgical treatment. In this scenario, PET/CT is a nearly recent imaging tool that should be tested after NAC. Theoretically, a negative PET/CT after NAC should correspond also to pCR.

Objective:

The aim of our study was to analyze the role of PET/CT after NAC as a method to predict pathologic response for patients with breast cancer and correlate its result with the other pathologic variables in the surgical specimen. Patients and

Methods:

We performed a prospective study that included 73 patients with either LABC or unfavorable tumor/breast size index that were submitted to NAC followed by surgery. The surgical specimens were evaluated with TNM and RCB (Residual Cancer Burden) protocols.

Results:

Between February 2010 and June 2013, 73 patients entered the protocol. Median age was 41 years (range, 26-76) and median primary tumor size was 55mm (range, 21-200). According to TNM criteria, complete clinical complete response (cCR) was 45.2% (33/73), metabolic complete response (mCR) 61.6% (45/73), and pCR (ypT0 ypN0) vi was 27.4% (20/73). We correlated the PET/CT results with pCR...
Subject(s)

Full text: Available Collection: International databases Database: LILACS / Inca Main subject: Breast Neoplasms / Chemotherapy, Adjuvant / Positron-Emission Tomography / Dose-Response Relationship, Drug / Drug Therapy Type of study: Diagnostic study / Practice guideline / Observational study / Prognostic study / Risk factors Limits: Humans Language: Portuguese Year: 2014 Document type: Thesis
Full text: Available Collection: International databases Database: LILACS / Inca Main subject: Breast Neoplasms / Chemotherapy, Adjuvant / Positron-Emission Tomography / Dose-Response Relationship, Drug / Drug Therapy Type of study: Diagnostic study / Practice guideline / Observational study / Prognostic study / Risk factors Limits: Humans Language: Portuguese Year: 2014 Document type: Thesis
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