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JAMA Oncol ; : e192553, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31486833


Importance: Metformin hydrochloride is emerging as a repurposed anticancer drug. Preclinical and retrospective studies have shown that it improves outcomes across a wide variety of neoplasms, including lung cancer. Particularly, evidence is accumulating regarding the synergistic association between metformin and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs). Objective: To assess the progression-free survival (PFS) in patients with advanced lung adenocarcinoma who received treatment with EGFR-TKIs plus metformin compared with those who received EGFR-TKIs alone. Design, Setting, and Participants: Open-label, randomized, phase 2 trial conducted at the Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. Eligible patients were 18 years or older, had histologically confirmed stage IIIB-IV lung adenocarcinoma with an activating EGFR mutation. Interventions: Patients were randomly allocated to receive EGFR-TKIs (erlotinib hydrochloride, afatinib dimaleate, or gefitinib at standard dosage) plus metformin hydrochloride (500 mg twice a day) or EGFR-TKIs alone. Treatment was continued until occurrence of intolerable toxic effects or withdrawal of consent. Main Outcomes and Measures: The primary outcome was PFS in the intent-to-treat population. Secondary outcomes included objective response rate, disease control rate, overall survival (OS), and safety. Results: Between March 31, 2016, and December 31, 2017, a total of 139 patients (mean [SD] age, 59.4 [12.0] years; 65.5% female) were randomly assigned to receive EGFR-TKIs (n = 70) or EGFR-TKIs plus metformin (n = 69). The median PFS was significantly longer in the EGFR-TKIs plus metformin group (13.1; 95% CI, 9.8-16.3 months) compared with the EGFR-TKIs group (9.9; 95% CI, 7.5-12.2 months) (hazard ratio, 0.60; 95% CI, 0.40-0.94; P = .03). The median OS was also significantly longer for patients receiving the combination therapy (31.7; 95% CI, 20.5-42.8 vs 17.5; 95% CI, 11.4-23.7 months; P = .02). Conclusions and Relevance: To our knowledge, this is the first study to prospectively show that the addition of metformin to standard EGFR-TKIs therapy in patients with advanced lung adenocarcinoma significantly improves PFS. These results justify the design of a phase 3, placebo-controlled study. Trial Registration: identifier: NCT03071705.

Salud Publica Mex ; 61(3): 308-317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276344


OBJECTIVE: Targeted next-generation sequencing (t-NGS) has revolutionized clinical diagnosis allowing multiplexed detection of genomic alterations. This study evaluated the profile of somatic mutations by t-NGS in Mexican patients with nonsmall cell lung cancer (NSCLC). MATERIALS AND METHODS: Genomic DNA was extracted from 90 lung adenocarcinomas and sequences were generated for a panel of 48 cancer genes. Epidermal Growth Factor Receptor (EGFR) mutations were detected in parallel by quantitative PCR. RESULTS: The mutational profile of NSCLC revealed alterations in 27 genes, where TP53 (47.8%) and EGFR (36.7%) exhibited the highest mutation rates. EGFR Q787 mutations were present in 14 cases (15.6%), 10 cases had exon 19 deletions (11.1%), seven cases had L858R (7.8%). The mutational frequency for genes like EGFR, MET, HNF1A, HER2 and GUSB was different compared to caucasian population. CONCLUSIONS: t-NGS improved NSCLC treatments efficacy due to its sensitivity and specificity. A distinct pattern of somatic mutations was found in Mexican population.

Carcinoma Pulmonar de Células não Pequenas/genética , Sequenciamento de Nucleotídeos em Larga Escala , Neoplasias Pulmonares/genética , Mutação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sequência de DNA
Salud pública Méx ; 61(3): 308-317, may.-jun. 2019. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1094469


Abstract: Objective: Targeted next-generation sequencing (t-NGS) has revolutionized clinical diagnosis allowing multiplexed detection of genomic alterations. This study evaluated the profile of somatic mutations by t-NGS in Mexican patients with non-small cell lung cancer (NSCLC). Materials and methods: Genomic DNA was extracted from 90 lung adenocarcinomas and sequences were generated for a panel of 48 cancer genes. Epidermal Growth Factor Receptor (EGFR) mutations were detected in parallel by quantitative PCR. Results: The mutational profile of NSCLC revealed alterations in 27 genes, where TP53 (47.8%) and EGFR (36.7%) exhibited the highest mutation rates. EGFR Q787 mutations were present in 14 cases (15.6%), 10 cases had exon 19 deletions (11.1%), seven cases had L858R (7.8%). The mutational frequency for genes like EGFR, MET, HNF1A, HER2 and GUSB was different compared to caucasian population. Conclusion: t-NGS improved NSCLC treatments efficacy due to its sensitivity and specificity. A distinct pattern of somatic mutations was found in Mexican population.

Resumen: Objetivo: La secuenciación dirigida de nueva generación (SNG) permite la detección múltiple de mutaciones. Este estudio evalúa el perfil de mutaciones somáticas por SNG en pacientes mexicanos con cáncer de pulmón de células no pequeñas (CPCNP). Material y métodos: Se aisló ADN de 90 muestras de pacientes con CPCNP y se analizarón 48 genes relacionados con cáncer. Las mutaciones del receptor del factor de crecimiento epidérmico (EGFR) se detectaron por PCR cuantitativa. Resultados. Se detectaron alteraciones en 27 genes. Las mutaciones más frecuentes fueron TP53 (47.8%) y EGFR (36.7%). En el gen EGFR, 14 casos fueron mutaciones Q787 (15.6%), 10 presentaron microdeleciones en el exón 19 (11.1%), y siete en L858R (7.8%). La frecuencia de mutación en EGFR, MET, HNF1A, HER2 y GUSB fue diferente en comparación con población caucásica. Conclusión: NGS modifica el tratamiento del paciente con CPCNP por su sensibilidad y especificidad para detectar mutaciones. La población mexicana presenta un perfil mutacional particular.

J Thorac Dis ; 11(2): 595-601, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30963004


Malignant pleural effusion (MPE) is an indicator of advanced disease (stage M1a) in patients with non-small cell lung cancer (NSCLC). Typically, these patients are candidates for palliative treatment. There is a lack of evidence about the radical surgical treatment in carcinomatous pleuritis with massive effusion. Here, we present data from a specific subset of patients with MPE treated with systemic therapy and aggressive surgical therapy. M1a NSCLC adenocarcinoma patients with MPE and without extra-thoracic disease were included. After receiving systemic therapy, all patients underwent surgical treatment, which included pneumonectomy or lobectomy, plus mediastinal dissection. Following surgery, patients received radiotherapy to thoracic wall and mediastinum. A total of six patients were analyzed. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status ≤1, two patients harbored EGFR mutation and were treated with tyrosine kinase inhibitors (TKIs), the other four patients were treated with pemetrexed and platin as first-line treatment. Following systemic therapy, two patients had a pneumonectomy, four patients had a lobectomy plus pleurectomy performed. All patients continued with maintenance systemic therapy, and achieved complete responses, according to RECIST 1.1 criteria. The media progression-free survival (PFS) time was 15.9 months (95% CI: 15.6-55.5 months). At the last follow-up, all patients were still alive, with 4 of them without signs of macroscopic tumoral activity. The median overall survival (OS) was not reached. NSCLC patients with MPE without extra-thoracic disease could benefit from an aggressive surgical approach following standard of care systemic therapy. However, considering the low sample size of this study and the relatively low incidence of MPE without extra-thoracic disease, further prospective multi-center studies are necessary to evaluate aggressive surgery as a therapeutic option.

Int J Radiat Oncol Biol Phys ; 101(4): 910-918, 2018 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-29976503


PURPOSE: In lung cancer patients, radiation therapy modifies lung architecture, resulting in functional deterioration, which worsens symptoms and reduces quality of life. METHODS AND MATERIALS: A multicenter, prospective, longitudinal study was conducted in a cohort of patients with locally advanced and oligometastatic non-small cell lung cancer treated with concurrent chemoradiation therapy (CCRT). A wide array of pulmonary function tests (forced spirometry, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity, fraction of exhaled nitric oxide, arterial blood gases, and 6-minute walk test) were used to evaluate lung function at baseline; after radiation therapy; and at 6, 12, 24, and 48 weeks after CCRT. Relative changes in test results (percentages) were estimated at the aforementioned intervals and compared with baseline results. RESULTS: Thirty-seven patients completed the follow-up and were included in the analysis. After CCRT, patients showed a maximum decline in lung volumes as follows: (1) 31% in forced expiratory volume in the first second after 24 weeks (P = .008), (2) 9.6% in forced vital capacity after 48 weeks (P = .04), and (3) 15.1% in total lung capacity after 48 weeks (P = .0015). Similarly, at 12 weeks after CCRT, patients showed a 21.8% decrease in carbon monoxide diffusing capacity (P = .002). Increases were found in total airway resistance (respiratory system resistance at 5 Hz), frequency dependence of resistance (change in respiratory system resistance at 5 Hz-respiratory system resistance at 20 Hz, P = .012), and reactance (P = .0003 for respiratory system reactance at 5 Hz and P = .001 for reactance area), which together indicate small-airway dysfunction. CONCLUSIONS: The longitudinal evaluation of lung function through pulmonary function tests detects CCRT-induced damage before the appearance of clinical symptoms associated with CCRT lung toxicity.

Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Quimiorradioterapia/métodos , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/terapia , Pulmão/efeitos da radiação , Idoso , Resistência das Vias Respiratórias , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Oscilometria , Paclitaxel/administração & dosagem , Pletismografia Total , Estudos Prospectivos , Testes de Função Respiratória , Capacidade Vital , Teste de Caminhada
Rev. colomb. cir ; 32(1): 45-55, 20170000. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-884619


En la última década han surgido los tratamientos guiados por el perfil molecular del tumor, con beneficio clínico para los pacientes con cáncer colorrectal avanzado o metastásico. Esta estratificación molecular permite agrupar o individualizar a los pacientes para un óptimo tratamiento de su enfermedad. Basada en información relevante y actualizada, se presenta una revisión de genes y biomoléculas de las vías de señalización intracelular del receptor del factor de crecimiento epidérmico, involucradas en la carcinogénesis del cáncer colorrectal. Además, se pretende identificar evidencia que soporte el beneficio de utilizar biomarcadores en pacientes con cáncer colorrectal, como factores pronósticos o predictivos para tratamientos biológicos. Se concluye que existe evidencia científica y, además, aceptación por parte de asociaciones internacionales de oncología clínica, para utilizar la evaluación del estado de los genes KRAS y BRAF en la práctica clínica, por su valor predictivo en el tratamiento del cáncer colorrectal avanzado; mientras que, para los genes NRAS, PIK3CA, PETEN y HER2, la aceptación por consenso de expertos de Europa y Estados Unidos aún no es unánime, para recomendar la evaluación rutinaria de estos biomarcadores predictivos en el cáncer colorrectal avanzado

Therapies guided by the molecular profile of the tumor have emerged in the last decade, with clinical benefit for patients with advanced or metastatic colorectal cancer. This molecular stratification allows patients to be grouped or individualized for optimal treatment of their disease. Based on relevant and up-to-date information, a mini-review of genes and biomolecules of epidermal growth factor receptor intracellular signaling pathways involved in the carcinogenesis of colorectal cancer is presented. In addition, we intend to identify evidence supporting the benefit of using biomarkers in clinical scenarios of colorectal cancer as prognostic or predictive factors for biological therapies. It is concluded that there is scientific evidence and also acceptance by international associations of clinical oncology to use the evaluation of the state of the KRAS and BRAF genes in clinical scenarios because of its predictive value in the treatment of advanced colorectal cancer, while for the NRAS, PIK3CA, PETEN and HER2 genes the consensus of experts from Europe and the United States of America to recommend the routine evaluation of these predictive biomarkers in advanced colorectal cancer has not yet been unanimous

Humanos , Neoplasias do Colo , Biomarcadores Tumorais , Detecção Precoce de Câncer , Estadiamento de Neoplasias
Langmuir ; 31(24): 6909-16, 2015 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-26023823


The supramolecular order of a 2,5-bis(dodecanoxy)phenyleneethynylene-butadiyne series of rod-like oligomers with 2, 4, 6, and 8 phenyleneethynylene moieties was studied in the solid state by differential scanning calorimetry (DSC), temperature-dependent small- and wide-angle X-ray scattering (SWAXS), selected area electron diffraction (SAED), polarized optical microscopy (POM), high-resolution transmission microscopy (HRTEM), and scanning tunneling microscopy (STM). It was found that all of the oligomers self-assemble in blocks of molecules that resemble bricks that are randomly oriented. These oligomers are described as sanidic liquid crystals as a term to classify their mesomorphic behavior because of their brick or board-like structure. The strong π-π interaction that governs the package of conjugated backbones was evidenced by the reiterative distances of 0.36 ± 0.017 nm found by SWAXS and 0.32 ± 0.017 nm found by HRTEM. A STM study of a cast film of the tetramer deposited on highly oriented pyrolitic graphite (HOPG) allowed for the visualization and determination of the conjugated backbone length of 2.48 nm and a phenyl-phenyl distance of 0.34 nm, suggesting that the molecules are stacked in lamellae perpendicularly aligned to the substrate.

Front Integr Neurosci ; 7: 110, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24478642


Particular reproductive stages such as lactation impose demands on the female. To cope with these demands, her physiology goes through numerous adaptations, for example, attenuation of immune and stress responses. Hormonal fluctuation during lactation exerts a strong influence, inducing neuroplasticity in the hypothalamus and extrahypothalamic regions, and diminishing the stress and inflammatory responses. Thus, hormones confer decreased vulnerability to the female brain. This mini-review focuses on the adaptations of the immune and stress response during maternity, and on the neuroprotective actions of progesterone and prolactin and their effects on inflammation. The importance of pregnancy and lactation as experimental models to study immune responses and disease is also highlighted.

Rev. colomb. cir ; 27(3): 221-226, jul.-set. 2012. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-657001


Introducción. El abordaje transperitoneal es la técnica más utilizada para la resección de los tumores retroperitoneales. El abordaje extraperitoneal podría ser una alternativa viable para pacientes seleccionados, que no se ha descrito ni evaluado en estudios clínicos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, retrospectivo, de los resultados de dos abordajes para los tumores retroperitoneales: transperitoneal y extraperitoneal. Se revisaron manualmente todas las historias consecutivas de los pacientes con diagnóstico de tumor retroperitoneal, intervenidos quirúrgicamente en el Hospital Pablo Tobón Uribe, desde enero de 2003 hasta marzo de 2011. Resultados. Se evaluaron 37 abordajes, 16 transperitoneales, 19 extraperitoneales y 2 combinados. En 59 % de los pacientes se obtuvo resección R0 (50 % abordaje transperitoneal Vs. 68 % abordaje retroperitoneal). El tiempo quirúrgico promedio fue de 152,96 minutos (159,8 Vs. 134,5). En general, los pacientes no requirieron transfusión de hemoderivados (56,3 Vs. 78,9 %). El 30 % de los paciente presentó complicaciones posoperatorias (25 % Vs. 31,6 %). Hubo una muerte intraoperatoria durante un procedimiento con abordaje extraperitoneal. Discusión. El abordaje extraperitoneal para los tumores retroperitoneales es una técnica nueva. Se requieren más estudios al respecto para aclarar adecuadamente su papel en la resección de los tumores retroperitoneales.

Introduction: The most common technique for resection of retroperitoneal tumors it is by far the transperitoneal approach. The extra peritoneal approach could be a viable alternative for selected patients, but it has not been described nor evaluated in clinical trials. Material and methods: This is a retrospective and descriptive study in which we analyzed the results for the two different approaches for retroperitoneal tumors. The clinical records of all patients with the diagnosis of retroperitoneal tumor that were operated at Hospital Pablo Tobón Uribe during a period of time between January 2003 and March 2011 were reviewed manually. Results: Of a total of 37 surgical procedures, 16 were transperitonal, 19 extraperitoneal and two of them required a combined approach. 59% had a resection graded as R0 (50% with the trans peritoneal approach and 68% with the retroperitoneal approach).The mean operating time was 152.96 minutes (159.8 vs. 134.5, respectively). Most of the patients did not need blood transfusion (56,3 vs 78,9%).The complication rate was 30% (25% vs. 31.6%). One patient that died during an extraperitoneal approach operation. Discussion: The extraperitoneal approach is a new a new technique for the resection of retroperitoneal tumors. More studies are required before a full recommendation favoring this technique can be stated.

Rev. colomb. cancerol ; 15(3): 119-226, sept. 2011.
Artigo em Espanhol | LILACS | ID: lil-661778


Objetivo: Determinar la tasa de recurrencia regional en pacientes diagnosticados con melanoma maligno cutáneo localizado en tronco y extremidades, con una biopsia de ganglio centinela negativa. Métodos: Serie de casos. Se revisaron los registros de pacientes estadio clínico IB, IIA, IIB, IIIC tratados con biopsia de ganglio centinela entre enero de 2000 y diciembre de 2007. Se realizaron análisis descriptivos y se analizó la supervivencia mediante el método de Kaplan-Meier. Resultados: Se incluyó a 170 pacientes. La mediana de seguimiento fue de 21,5 meses, con una tasa de recurrencia regional del 11,76%. La supervivencia global a 24 meses en ganglio centinela negativo fue del 100%. Conclusiones: La tasa de recurrencia regional en la serie analizada de pacientes con melanoma y ganglio linfático centinela negativo se halla dentro de lo reportado en la literatura, aunque el tiempo de seguimiento es relativamente corto.

Objective: To determine the regional recurrence rate in patients diagnosed with cutaneous malignant melanoma in the trunk and extremities, and with negative sentinel node biopsy. Methods: A case series was utilized to review patients with clinical registries IB, IIA, IIB, IIIC treated with sentinel node biopsy between January, 2000 and December, 2007. Descriptive analysis was performed and survival analysis carried out with the Kaplan-Meier method. Results: The study included 170 patients. Median follow-up was 21.5 months, with regional recurrence rate at 11.76%. Overall survival rate at 24 months for negative sentinel node was 100%. Conclusions: The regional recurrence rate in the series analyzed of patients with melanoma and negative sentinel lymph node is situated within that reported in the literature; however, follow up is relatively short.

Humanos , Epidemiologia Descritiva , Melanoma , Biópsia de Linfonodo Sentinela , Sobrevida , Colômbia , Estimativa de Kaplan-Meier
Rev. latinoam. cienc. soc. niñez juv ; 9(1): 227-253, ene.-jun. 2011.
Artigo em Espanhol | LILACS | ID: lil-591106


Este artículo es el resultado de una investigación realizada para optar al título de Magíster en la maestría en Educación y Desarrollo Humano, de la alianza Cinde y Universidad de Manizales, realizada durante el año 2009 con estudiantes y docentes de distintas instituciones educativas de Colombia. Indagamos sobre las incidencias de las prácticas y mecanismos institucionales de formación para la democracia, orientadas por la legislación educativa nacional para la promoción de la participación de los jóvenes y las jóvenes. La información la recogimos a través de una entrevista semiestructurada que aplicamos a todos los sujetos participantes del estudio.Con la información resultante propusimos emprender un camino de comprensión e interpretación de los conceptos y prácticas que tienen docentes y estudiantes para la formación en participación democrática. Para el análisis de los textos utilizamos un enfoque hermenéutico, establecimos relaciones, recurrencias, contrastes y tendencias, e hicimos interpretaciones sobre los textos. Algunas de las tendencias encontradas nos permitieron configurar las categorías de análisis: 1. Visiones de los jóvenes y de las jóvenes frente a la participación en el ámbito escolar; 2. Las concepciones sobre la formación para la participación democrática juvenil de los docentes y de las docentes; 3. La escuela como escenario para la participación juvenil; 4. Las prácticas pedagógicas como oportunidad u obstáculo para la participación democrática; y 5. Mecanismos de participación democrática en el ámbito de la escuela. Cada categoría puede ser leída como una unidad independiente y aunque puede identificarse en ella algún tipo de coincidencia reflexiva, el grupo consideró pertinente dar autonomía al investigador o investigadora para interpretar la información, experiencia que nos permitió una diversa riqueza reflexiva.

Este artigo é o resultado de uma pesquisa realizada para optar ao título de Mestre no mestrado em Educação e Desenvolvimento Humano, na aliança Cinde e Universidade de Manizales, realizada durante o ano 2009 com estudantes e docentes de distintas instituições educativas da Colômbia. Indagamos sobre as incidências das práticas e mecanismos institucionais de formação para a democracia, orientadas pela legislação educativa nacional para a promoção da participação dos jovens e as jovens. A informação a recolhemos através de uma entrevista semi-estruturada que aplicamos a todos os sujeitos do estudo. Com a informação resultante propomos empreender um caminho de compreensão e interpretação dos conceitos e práticas que têm docentes e estudantes para a formação em participação democrática. Para a análise dos textos utilizamos um enfoque hermenêutico, estabelecemos relações, recorrências, contrastes e tendências, e fizemos interpretações sobre os textos. Algumas das tendências encontradas nos permitiram configurar as categorias da análise: 1. Visões dos jovens e das jovens frente à participação no âmbito escolar; 2. As concepções sobre a formação para a participação democrática juvenil dos docentes e das docentes; 3. A escola como cenário para a participação juvenil; 4. As práticas pedagógicas como oportunidade ou obstáculo para a participação democrática; e 5. Mecanismos de participação democrática no âmbito da escola. Cada categoria pode ser lida como uma unidade independente e mesmo que possa identificar-se nela algum tipo de coincidência reflexiva, o grupo considerou pertinente dar autonomia ao pesquisador ou pesquisadora para interpretar a informação, experiência que nos permitiu uma diversa riqueza reflexiva.

This article is the product of a research realized to graduate as a Magister of Education and Human Development, of Cinde and Manizales University alliance, realized along 2009 with students and professors of various education institutions of Colombia. We searched on the impact of practices and institutional mechanisms of formation for democracy, oriented by domestic education legislation for promotion and participation of young individuals. We collected information through a semi-structured interview applied to all subjects participating in the study. Using resulting information we undertook a way of comprehension and interpretation of concepts and practices of professors and students on formation in democratic participation. For analysis of texts we used a hermeneutic approach, we established relationships, recurrences, contrasts and trends; and interpreted texts. Some of the trends found enabled us to configure analysis categories: 1. Vision of young individuals in front of participation in school environment; 2. Conceptions on formation for juvenile democratic participation of professors; 3. The school as an scenary for juvenile participation; 4. Pedagogic practice as an opportunity or a barrier for democratic participation; and 5. Mechanisms of democratic participation in school environment. Each category may be read and an independent unit, although any type of reflexive coincidence may be identified in it; the group considered as pertinent to provide the researcher with autonomy to interpret information; which experience allowed us a diverse reflexive richness.

Utopias , Democracia
Rev. colomb. cancerol ; 13(3): 157-174, sept. 2009.
Artigo em Espanhol | LILACS | ID: lil-661850


El tratamiento neoadyuvante —también denominado “terapia primaria sistémica” o “terapia preoperatoria”— tiene cuatro finalidades en cáncer de mama: disminuir el volumen tumoral para hacer operable lo que antes era inoperable, mejorar las probabilidades para hacer una cirugía conservativa, analizar la quimiosensibilidad in vivo y evaluar el manejo de las micrometástasis. Esta revisión descriptiva toma en cuenta los principales estudios clínicos sobre terapia sistémica neoadyuvante publicados hasta mayo del 2009.

Neoadjuvant treatment —also known as primary systemic therapy or preoperative therapy— has four objectives when applied to breast cancer: to reduce inoperable tumoral volume to operable size; to enhance the possiblility for conservative surgery; to analyze chemosensitivity in vivo; and, to evaluate the management of micrometastasis. This descriptive review takes into account the major clinical studies on systemic neoadjuvant therapy published as of May, 2009.

Humanos , Feminino , Neoplasias da Mama , Mastectomia Segmentar , Micrometástase de Neoplasia/prevenção & controle , Terapia Neoadjuvante , Taxa de Sobrevida , Colômbia