Evaluación Y Manejo De La Enfermedad Temprana Y Localmente Avanzada: 1er Consenso Nacional Del Cáncer De Mama de la Sociedad Panameña de Oncología (SPO)

Alejandro Crismatt Zapata, Moises Cukier Barahona, Erick Arauz, Irma Barrera, Maylin Ruiz, Karla Franco

Texto completo:



[Evaluation and Management of Early and Locally Advanced Disease: 1st National Consensus of Breast Cancer of the Panamanian Society of Oncology (SPO)]

El manejo de los pacientes con cáncer de mama temprano o localmente avanzado requiere de la evaluación inicial de un grupo de médicos familiarizados con el diagnóstico, estadificación y tratamientos de estas enfermedades, de tal manera que se pueda optimizar los resultados no solamente oncológicos (Curación), sino también cosméticos. La decisión sobre el tratamiento local (cirugía y Radioterapia) y sistémico (Quimioterapia y Hormonoterapia) está basada en las características clínicas y moleculares de tumor, así como por las preferencias del paciente.

The management of patients with early or locally advanced breast cancer requires the initial evaluation of a group of physicians familiar with the diagnosis, staging and treatment of these diseases, in order to optimize the results not only oncological (Healing), but also cosmetics. The decision on local treatment (surgery and Radiotherapy) and systemic treatment (Chemotherapy and Hormonotherapy) is based on the clinical and molecular characteristics of the tumor, as well as on the patient's preferences.


Wilson A, Marotti L, Bianchi S, et al. The requirements of a specialist Breast Center. Eur J Cancer. 2013; 49: p. 3579–3587.

Senkus E, Kyriakides S, Ohno S, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; Suppl 5: p. 8-30.

Sardanelli F, Boetes C, Borisch B, et al. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer. 2010; 46: p. 1296-316.

Postma E, Verkooijen H, Van Esser S, et al. Efficacy of 'radioguided occult lesion localisation' (ROLL) versus 'wire-guided localisation' (WGL) in breast conserving surgery for non-palpable breast cancer: a randomised controlled multicentre trial. Breast Cancer Res Treat. 2012;: p. 469-78.

Chan B, Wiseberg-Firtell J, Jois R, et al. Localization techniques for guided surgical excision of non-palpable breast lesions. Cochrane Database Syst Rev. 2015; 12(Art. No.: CD009206): p. CD009206.

Heywang-Köbrunner S, Heinig A, Pickuth D, et al. Interventional MRI of the breast: lesion localisation and biopsy. Eur Radiol. 2000; 10: p. 36 - 45.

Association of Breast Surgery at Baso 2009. Surgical guidelines for the management of breast cancer. EJSO. 2009; 35: p. S1 - S22.

Schnitt S, Moran M, Houssami N, et al. The Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer. Arch Pathol Lab Med. 2015; 139: p. 575-577.

Houssami N, Macaskill P, Marinovich M, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010; 46: p. 3219–3232.

Moran M, Schnitt S, Giuliano A, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast- conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;(32): p. 1507-1515.

Senkus-Konefka E, Welnicka-Jaskiewicz M, Jaskiewic J, et al. Radiotherapy for breast cancer in patients undergoing breast reconstruction or augmentation. CANCER TREATMENT REVIEWS. 2004; 30: p. 671–682.

Krag D, Anderson S, Julian T, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010; 11: p. 927-33.

Giuliano A, Hawes D, Ballman K, et al.. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early- stage invasive breast cancer. JAMA. 2011; 306: p. 385–393..

Morris A, Morris R, Wilson J, et al. Breast-conserving therapy vs mastectomy in early-stage breast cancer: a meta-analysis of 10-year survival. Cancer J Sci Am. 1997; 1: p. 6-12.

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. 2011; 378: 1707–16.

Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015; 16: p. 47–56..

Early Breast Cancer Trialists’ Collaborative Group. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383: p. 2127–35.

Poortmants P. Postmastectomy radiation in breast cancer with one to three involved lymph nodes: ending the debate. Lancet 2014; 383: 2104–2106. 2014; 383: p. 2104–2106.

Whelan T, Olivotto I, Parulekar W, et al. Regional nodal irradiation in early- stage breast cancer. N Engl J Med. 2015; 373: p. 307–316.

Viale G. Pathological work up of the primary tumor: Getting the proper information out of it. Breast. 2011; suppl 2: p. s82-86.

Engel K, Moore H, et al. Effects of preanalytical variables on the detection of proteins by immunohistochemistry in formalin-fixed, paraffin-embedded tissue. Arch Pathol Lab Med. 2011; 135: p. 537-543.

Babic A, Loftin I, Stanislaw S, et al. The impact of pre-analytical processing on staining quality for H&E, dual hapten, dual color in situ hybridization and fluorescent in situ hybridization assays. Methods. 2010;52:287--. 2010; 52: p. 287 - 300.

Lester S, Bose C, Chen Y, et al. College of American Pathologists (CAP): Protocol for the Examination of Specimens From Patients With Invasive Carcinoma of the Breast. Based on AJCC/UICC TNM, 7th edition. Protocol web posting date: December 2013;: p. 1-37.

Maguire A, Brogi E. Sentinel lymph nodes for breast carcinoma: an update on current practice. Histopathology. 2016; 68: p. 152-167.

Wolff A, Davidson N. Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease. Oncol. 2002; 7: p. 239-245..

Harbeck N, Gnant M. Breast cancer. Lancet. 2016; 389: p. 1134-1150.

Von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012; 30: p. 1796 - 8.

Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014; 164 - 172.: p. 384.

Curigliano G, Burstein H, Winer E, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Annals of Oncology. 2017; 28: p. 1700–1712.

Polley M, Leung S, Gao D, et al. An international study to increase concordance in Ki67 scoring. Mod Pathol. 2015; 28: p. 778-786.

Harris LN INMLea, Harris L, Ismaila N, McShane L, et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline..J Clin Oncol. 2016; 34: p. 1134–1150.

Sparano J, Gray R, Makower D, et al. Prospective validation of a 21- gene expression assay in breast cancer. N Engl J Med. 2015; 373: p. 2005–2014.

Gluz 0, Nitz U, Christgen M, et al.. West German Study Group Phase III PlanB Trial: first prospective outcome data for the 21-gene recurrence score assay and concordance of prognostic markers by central and local pathology assessment. J Clin Oncol. 2016; 34: p. 2341–2349.

Cardoso F, Van’t Veer L, Bogaerts J, et al. MINDACT Investigators. 70-Gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med. 2016; 375: p. 717–729.

Gnant M, Filipits M, Greil R, et al. Predicting distant recurrence in receptor-positive breast cancer patients with limited clinicopathological risk: using the PAM50 risk of recurrence score in 1478 postmenopausal patients of the ABCSG-8 trial treated with adjuvant endocrine therapy alone. Ann Oncol. 2014; 25: p. 339–345.

Peto R, Davies C, et al. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 2012; 379: p. 432–444.

Gianni L, Baselga J, Eiermann W, et al. Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial. J Clin Oncol. 2009; 27: p. 2474–2481.

Shao N, Wang S, Yao C, et al. Sequential versus concurrent anthracyclines and taxanes as adjuvant chemotherapy of early breast cancer: a meta-analysis of phase III randomized control trials. Breast. 2012; 21: p. 389–393.

Möbus V, Jackisch C, Lück H, et al. Ten-year results of intense dose-dense chemotherapy show superior survival compared with a conventional schedule in high-risk primary breast cancer: final results of AGO phase III iddEPC trial. Ann Oncol. 2018; 29: p. 178-185.

Gray R, Bradley R, Braybrooke J, et al. Increasing the dose density of adjuvant chemotherapy by shortening intervals between courses or by sequential drug administration significantly reduces both disease recurrence and breast cancer mortality: an EBCTCG meta-analysis. San Antonio Breast Cancer Symposium. 2017.

Gianni L, Dafni U, Gelber R, et al. Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4 year follow-up of a randomised controlled trial. Lancet Oncol. 2011; 12: p. 236–244.

Perez E, Romond E, Suman V, et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831. J Clin Oncol. 2014; 32: p. 3744–37.

Gonzalez-Angulo A, Litton J, Broglio K, et al. High risk of recurrence for patients with breast cancer who have human epidermal growth factor receptor 2-positive, node-negative tumors 1 cm or smaller. J Clin Oncol. 2009; 27: p. 5700–5706.

Early Breast Cancer Trialists' Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 365: p. 1687-717.

Hammond M, Hayes D, Dowsett M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for cancer. Journal of clinical oncology. 2010; 28: p. 2784-95.

(EBCTCG), Early Breast Cancer Trialists’ Collaborative Group. Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet. 2015; 386: p. 1341–1352.

Francis P, Regan M, Fleming G, et al. Adjuvant ovarian suppression Adjuvant ovarian suppression. N Engl J Med. 2015; 372: p. 436–446.

Pagani O, Regan M, Walley B, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med. 2014; 371: p. 107–118.

Gnant M, Mlineritsch B, Stoeger H, et al. Zoledronic acid combined with adjuvant endocrine therapy of tamoxifen versus anastrozol plus ovarian function suppression in premenopausal early breast cancer: final analysis of the Austrian Breast and Colorectal Cancer Study Group Trial 12. Ann Oncol. 2012; 6: p. 313–320.

Goss P, Ingle J, Pritchard K, et al. Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med. 2016; 375: p. 209–219.

Tjan-Heijnen V, Van Hellemond I, Peer P, et al. Extended adjuvant aromatase inhibition after sequential endocrine therapy (DATA): a randomised, phase 3 trial. Lancet Oncol. 2017; 18: p. 1502-1511.

Blok E, Van de Velde C, Meershoek-Klein Kranenb E, et al. Optimal Duration of Extended Adjuvant Endocrine Therapy for Early Breast Cancer; Results of the IDEAL Trial (BOOG 2006-05). J Natl Cancer Inst. 2018 Jan 1;110(1). 2018; 110: p. 40-48.

Mamounas E, Bandos H, Lembersky B, et al. A Randomized, double-blinded, placebo-controlled clinical trial of extended adjuvant endocrine therapy (tx) with letrozole (L) in postmenopausal women with hormone-receptor (+) breast cancer (BC) who have completed previous adjuvant tx with AI. San Antonio Breast Cancer Symposium. 2016;: p. Dec 6–10, San Antonio, TX (abstr S1-05).

Enlaces refback

  • No hay ningún enlace refback.

Revista Oficial de las siguientes instituciones:
Académia Panameña de Medicina y Cirugía. Derechos reservados 2004-2019. Editorial Médico Infomedic International S,A.