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Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12710/2442
Title: Metode de optimizare a tratamentului pacientelor cu cancer mamar avansat loco-regional
Other Titles: Methods of optimization of the treatment of patients with regional breast cancer
Authors: Sedakov, Igor Yevgenievich
Dubinina, Vladlena Gennadiyevna
Bondar, Oleksandr Vadimovich
Lukianchuk, Oleg Valerievich
Zavoloka, Oleksandr Vasilievich
Keywords: breast cancer;internal mammary artery;intraarterial introduction;regional polychemotherapy;regional advancement
Issue Date: 2015
Publisher: Instituţia Publică Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu” din Republica Moldova
Citation: SEDAKOV, Igor Yevgenievich, DUBININA, Vladlena Gennadiyevna, BONDAR, Oleksandr Vadimovich, LUKIANCHUK, Oleg Valerievich, ZAVOLOKA, Oleksandr Vasilievich. Metode de optimizare a tratamentului pacientelor cu cancer mamar avansat loco-regional = Methods of optimization of the treatment of patients with regional breast cancer. In: Revista de Ştiinţe ale Sănătăţii din Moldova. 2015, vol. 5(3), pp. 54-61. ISSN 2345-1467.
Abstract: Introducere. În ultimii 20 de ani, incidenţa cancerului mamar este în continuă creștere. Elaborarea unor noi programe de tratament complex, mai eficiente, reprezintă o problemă de actualitate stringentă. Material și metode. Studiate 279 de paciente cu cancer avansat loco-regional, cu factori nefavorabili de prognostic, aflat în stadiile T4 N0-2M0, care au fost tratate în Centrul Oncologic Regional din Doneţk în perioada anilor 2000-2013. Lotul a fost împărţit în două grupuri: primul, grupul de bază, a inclus 221 de paciente, dintre care – 168 de paciente cu subtip HER/2-neu pozitiv și 53 de paciente – cu subtipuri biologice basal-like, diagnosticate prin metode imunocitochimice. Programul de tratament complex pentru grupul de bază a inclus: cateterizarea arterei mamare interne (prin artera epigastrică superioară), prin care s-au realizat 2-3 cure de polichimioterapie (PCT) intra-arterială și intravenoasă, cu intervale de 21 de zile, urmată de evaluarea efectului; în continuare – radioterapia (XRT) glandei mamare și zonelor de drenaj limfatic regional, cu doze unice de 2-2,5 Gy, doze totale de 40 Gy, urmată de evaluarea efectului. Mastectomia a fost efectuată pacientelor din grupul de bază doar dacă tumoarea a răspuns complet sau parţial la tratament (în total, 136 de operaţii radicale). Cursul de tratament intra-arterial a fost administrat în perfuzii de durată (4-6 ore), conform schemelor CMF, CAF sau CAMF. Grupul de control a inclus 58 de paciente, dintre care 45 – diagnosticate cu subtip HER/2-neu și 13 paciente – cu subtip basal-like. La prima etapă a tratamentului, pacientele din acest grup au urmat 4-6 cure de PCT (conform schemelor CMF, CAF sau CAMF), cure preoperatorii de XRT cu fracţii mici asupra glandei mamare și zonelor de drenaj limfatic (doza unică – de 2-2,5 Gy, doza totală – de 40 Gy), urmate de mastectomie. Rezultate. Supravieţuirea la 3 ani în grupul de bază a constituit 59,9%, la 5 ani – 43,1%. Supravieţuirea la 3 și la 5 ani în grupul de control a fost semnificativ mai joasă, constituind 58,0% și, respectiv, 17,9%. Concluzii. Polichimioterapia regională, administrată combinat, intra-arterial și intravenos, în cadrul tratamentului complex (XRT, PCT, hormonoterapie, la indicaţii – mastectomie) al cancerului mamar avansat loco-regional, cu factori de pronostic negativ referitor la creșterea tumorală, a avut o rată de supravieţuire semnificativ mai înaltă la 3 și la 5 ani, comparativ cu programele tradiţionale de tratament (polichimioterapie sistemică și mastectomie).
Introduction. In the past 20 years, the incidence of breast cancer is in continuous growth. Elaboration of new programs of more efficient complex treatment represents a stringent problem. Material and methods. The basis for this research was the data collected from 279 patients with regional forms of BC and unfavorable predictive factors, with stages T4 N0-2M0 , who were treated at Donetsk Regional Antitumoral Center in 2000- 2013. Two groups of patients were formed during this research for adequate analysis of results of treatment, according to considered methodologies. The first test group consisted of 221 patients, among which 168 patients with HER/2-neu positive subtype and 53 patients with basal like biological subtypes, diagnosed through immunocytochemical tests. The program for complex treatment of patients in this group included: catheterization of internal mammary artery through upper epigastric artery, performed in two-three cycles for selective intra-arterial and intravenous polychemotherapy (PCT) with interval of 21 days; evaluation of effect; X-ray therapy (XRT) of mammary gland and zones of regional lymphatic outflow in static mode with single boost dose – 2-2.5 Gy, total boost dose – 40 Gy; monitoring of intervals. Mastectomy was performed to patients from test group only if complete or partial response from tumor was received (136 radical surgeries). The courses of intra-arterial PCT were administered in continuous long infusion (4-6 hours) according to CMF, CAF or CAMF scheme. The control group consisted of 58 patients, among them 45 patients with HER/2-neu positive subtype and 13 patients with basal like subtype. At the first stage of treatment the patients in this group underwent to 4-6 cycles of systemic PCT due to CMF, CAF or CAMF schemes, preoperative course of XRT in small fractions on mammary gland and zones of regional lymphatic outflow in static mode, were performed with single boost doses – 2-2.5 Gy, total boost doses – 40 Gy, followed by mastectomy. Results. The indices for total 3 years survival rate of patients in test group were 59.9% and 5 years survival rate – 43.1%. The indices for total 3 years and 5 years survival rate of patients in control group were significantly lower – 58.0% and 17.9%, accordingly. Conclusions. The results after complex treatment of regional breast cancer, with unfavorable factors of prognosis of tumor growth, using the method of combined introduction of selective intra-arterial and intravenous poly-chemotherapy in internal mammary artery, in addition with radiological and hormonal therapy, exceed the results from standard programs of treatment of patients with regional forms of breast cancer with mastectomy and systemic chemotherapy.
metadata.dc.relation.ispartof: Revista de Științe ale Sănătății din Moldova = Moldovan Journal of Health Sciences
URI: https://stiinta.usmf.md/sites/default/files/2018-09/MJHS%20nr.%203%20_2015.pdf
http://repository.usmf.md/handle/20.500.12710/2442
ISSN: 2345-1467
Appears in Collections:Revista de Științe ale Sănătății din Moldova : Moldovan Journal of Health Sciences 2015 Vol. 5(3) ediție specială

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