Evolução do tratamento local do câncer de mama: Revisão narrativa

Cavalcante, Francisco Pimentel; Millen, Eduardo Camargo; Zerwes, Felipe Pereira; Novita, Guilherme Garcia

doi:10.1055/s-0040-1712125

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 42 (06) • Jun 2020 • https://doi.org/10.1055/s-0040-1712125 copiar

Evolução do tratamento local do câncer de mama: Revisão narrativa

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Este artigo discute o tratamento local do câncer de mama a partir de uma perspectiva histórica. Uma busca de artigos publicados em inglês foi realizada nas bases de dados Medline e EMBASE, sendo selecionados 40 artigos. Nos últimos 10 anos, vários ensaios clínicos controlados e randomizados sobre o tratamento local do câncer de mama indicaram que pacientes com o mesmo subtipo molecular podem receber diferentes tratamentos cirúrgicos individualizados como objetivo de otimizar a terapia adjuvante sistêmica. Pretendendo reter os ganhos obtidos na sobrevida livre de doença e na sobrevida global, as técnicas cirúrgicas avançaram progressivamente da cirurgia radical para mastectomias conservadoras, reduzindo sequelas, enquanto as terapias adjuvantes e neoadjuvantes contribuíram para o controle da doença, tanto em relação às metástases distantes quanto à recorrência local. Estudos atuais avaliam se a terapia futura contra o câncer de mama poderá até mesmo eliminar a cirurgia da mama e da axila por completo.

Palavras-chave:
terapia de câncer de mama; terapia de conservação da mama; biópsia de linfonodo sentinela; mastectomia; terapia neoadjuvante e adjuvante

Study	Study period	Follow-Up	Intervention	Total sample size
Fisher et al³3 Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(08):567-575. Doi: 10.1056/NEJMoa020128 https://doi.org/10.1056/NEJMoa020128...	1971–1974	25 years	Radical mastectomyTotal mastectomyTotal mastectomy + radiotherapy	1,079
Fisher et al⁵5 Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing totalmastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; 347(16):1233-1241. Doi: 10.1056/NEJMoa022152 https://doi.org/10.1056/NEJMoa022152...	1976–1984	20 years	Total mastectomyLumpectomyLumpectomy + radiotherapy	1,851
Veronesi el al⁶6 Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-1232. Doi: 10.1056/NEJMoa020989 https://doi.org/10.1056/NEJMoa020989...	1973–1980	20 years	Radical mastectomyQuadrantectomy + radiotherapy	701
van Dongen et al⁷7 van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breastconserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92(14):1143-1150. Doi: 10.1093/jnci/92.14.1143 https://doi.org/10.1093/jnci/92.14.1143...	1980–1986	10 years	Modified mastectomyLumpectomy + radiotherapy	868
Poggi et al⁸8 Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer. 2003;98(04):697-702. Doi: 10.1002/cncr.11580 https://doi.org/10.1002/cncr.11580...	1979–1987	18.4 years	Modified mastectomyLumpectomy + radiotherapy	237
Blichert-Toft et al⁹9 Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW, et al; Danish Breast Cancer Cooperative Group. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. J Natl Cancer Inst Monogr. 1992;(11):19-25	1983–1989	6 years	MastectomyLumpectomy + radiotherapy	905
Arriagada et al¹⁰10 Arriagada R, Lê MG, Rochard F, Contesso G; Institut Gustave- Roussy Breast Cancer Group. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with15 years of follow-up data. J Clin Oncol. 1996;14(05):1558- -1564. Doi: 10.1200/JCO.1996.14.5.1558 https://doi.org/10.1200/JCO.1996.14.5.15...	1972–1979	15 years	MastectomyConservative surgery + radiotherapy	179
Fisher et al¹¹11 Fisher B, Dignam J, Bryant J, DeCillis A, Wickerham DL, Wolmark N, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors. J Natl Cancer Inst. 1996;88(21):1529- -1542. Doi: 10.1093/jnci/88.21.1529 https://doi.org/10.1093/jnci/88.21.1529...	1982–1988	10 years	TamoxifenPlacebo	2,818
Fisher et al¹²12 Fisher B, Dignam J, Mamounas EP, Costantino JP, Wickerham DL, Redmond C, et al. Sequential methotrexate and fluorouracil for the treatment of node-negative breast cancer patients with estrogen receptor-negative tumors: eight-year results from National Surgical Adjuvant Breast and Bowel Project (NSABP) B-13 and first report of findings from NSABP B-19 comparing methotrexate and fluorouracil with conventional cyclophosphamide, methotrexate, and fluorouracil. J Clin Oncol. 1996;14(07):1982- -1992. Doi: 10.1200/JCO.1996.14.7.1982 https://doi.org/10.1200/JCO.1996.14.7.19... NSABP 13 NSABP 19		8 years	NSABP 13:Methotrexate + fluorouracilPlaceboNSABP 19:Cyclophosphamide + methotrexate + fluorouracilMethotrexate + fluorouracil	7601,095
Haviland et al¹⁹19 Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al; START Trialists' Group. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086- -1094. Doi: 10.1016/S1470-2045(13)70386-3 https://doi.org/10.1016/S1470-2045(13)70... START A START B	1999–2002	10 years	START A:25 radiotherapy fractions (50Gy)13 radiotherapy fractions (41.6 or 39 Gy)START B:25 radiotherapy fractions (50 Gy)15 radiotherapy fractions (40 Gy)	2,2362,215
Hughes et al²⁰20 Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-termfollow-up of CALGB 9343. J Clin Oncol. 2013;31 (19):2382-2387. Doi: 10.1200/JCO.2012.45.2615 https://doi.org/10.1200/JCO.2012.45.2615...	1994–1999	10 years	≥ 70 years:LumpectomyLumpectomy + radiotherapy	636
Kunkler et al²¹21 Kunkler IH,Williams LJ, Jack WJL, Cameron DA,Dixon JM; PRIME II investigators. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16 (03):266-273. Doi: 10.1016/S1470-2045(14)71221-5 https://doi.org/10.1016/S1470-2045(14)71...	2003–2009	5 years	≥ 65 years:LumpectomyLumpectomy + radiotherapy	1,326
Krag et al²⁴24 Krag DN, Anderson SJ, Julian TB, Brown AM, HarlowSP, Costantino JP, 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(10): 927-933. Doi: 10.1016/S1470-2045(10)70207-2 https://doi.org/10.1016/S1470-2045(10)70...	1999–2004	8 years	Negative sentinel lymph node:Sentinel lymph node aloneSentinel lymph node + axillary lymph node dissection	5,611
Giuliano et al²⁵25 Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(03):426-432, discussion 432-433. Doi: 10.1097/ SLA.0b013e3181f08f32 https://doi.org/10.1097/...	1999–2004	6.3 years	Positive sentinel lymph node (1 or 2):Sentinel lymph node aloneSentinel lymph node + axillary lymph node dissection	891
Donker et al²⁶26 Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 noninferiority trial. Lancet Oncol. 2014;15(12):1303-1310. Doi:10.1016/S1470-2045(14)70460-7 https://doi.org/10.1016/S1470-2045(14)70...	2001–2010	5 years	Positive sentinel lymph node:Axillary radiotherapySentinel lymph node + axillary lymph node dissection	1,425
Sávolt et al²⁷27 Sávolt A, Musonda P, Mátrai Z, Polgár C, Rényi-Vámos F, Rubovszky G, et al. [Optimal treatment of the axilla after positive sentinel lymph node biopsy in early invasive breast cancer. Early results of the OTOASOR trial]. Orv Hetil. 2013;154(49):1934-1942. Doi: 10.1556/OH.2013.29765 https://doi.org/10.1556/OH.2013.29765...	2002–2009	5 years	Positive sentinel lymph node:Axillary radiotherapySentinel lymph node + axillary lymph node dissection	526
Galimberti et al²⁸28 Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al; International Breast Cancer Study Group Trial 23-01 investigators. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(04):297-305. Doi: 10.1016/S1470-2045(13)70035-4 https://doi.org/10.1016/S1470-2045(13)70...	2001–2010	5 years	Positive sentinel lymph node (micrometastases):Sentinel lymph node aloneSentinel lymph node + axillary lymph node dissection	934
Solá et al²⁹29 Solá M, Alberro JA, Fraile M, Santesteban P, Ramos M, Fabregas R, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results fromthe multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013;20(01):120-127. Doi: 10.1245/s10434-012-2569-y https://doi.org/10.1245/s10434-012-2569-...	2001–2008	5 years	Positive sentinel lymph node (micrometastases):Sentinel lymph node aloneSentinel lymph node + axillary lymph node dissection	247
Masuda et al³⁴34 Masuda N, Lee SJ, Ohtani S, Im YH, Lee ES, Yokota I, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147-2159. Doi: 10.1056/ NEJMoa1612645 https://doi.org/10.1056/...	2007–2012	5 years	HER2-negative invasive residual disease:CapecitabinePlacebo	910
von Minckwitz et al³⁵35 von Minckwitz G, Huang CS, Mano MS, Loibl S, Mamounas EP, Untch M, et al; KATHERINE Investigators. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380(07):617-628. Doi: 10.1056/NEJMoa1814017 https://doi.org/10.1056/NEJMoa1814017...	2013–2015	3 years	HER2-positive invasive residual disease:TrastuzumabT-DM1	1,486

Study	Residual disease	Sentinel lymph node status	Lymph node recurrence	Alternatives to axillary dissection
NSABP B-32²⁴24 Krag DN, Anderson SJ, Julian TB, Brown AM, HarlowSP, Costantino JP, 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(10): 927-933. Doi: 10.1016/S1470-2045(10)70207-2 https://doi.org/10.1016/S1470-2045(10)70...	10%^* *Residual disease estimated from false-negative rates.	Negative	0.7 (8 years)	Sentinel lymph node biopsy
ACOSOG Z0011²⁵25 Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(03):426-432, discussion 432-433. Doi: 10.1097/ SLA.0b013e3181f08f32 https://doi.org/10.1097/...	27%	Positive	1.5% (10 years)	Sentinel lymph node biopsy^ Some patients in the study were submitted to radiotherapy (high tangents), similarly in both groups.
IBCSG 23–01²⁸28 Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al; International Breast Cancer Study Group Trial 23-01 investigators. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(04):297-305. Doi: 10.1016/S1470-2045(13)70035-4 https://doi.org/10.1016/S1470-2045(13)70...	13%	Positive	2.0% (9.7 years)	Sentinel lymph node biopsy
AATRM 048/13/2000²⁹29 Solá M, Alberro JA, Fraile M, Santesteban P, Ramos M, Fabregas R, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results fromthe multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013;20(01):120-127. Doi: 10.1245/s10434-012-2569-y https://doi.org/10.1245/s10434-012-2569-...	13%	Positive	2.5% (5 years)	Sentinel lymph node biopsy
AMAROS²⁶26 Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 noninferiority trial. Lancet Oncol. 2014;15(12):1303-1310. Doi:10.1016/S1470-2045(14)70460-7 https://doi.org/10.1016/S1470-2045(14)70...	33%	Positive	1.1% (5 years)	Sentinel lymph node biopsy and radiotherapy
OTOASOR²⁷27 Sávolt A, Musonda P, Mátrai Z, Polgár C, Rényi-Vámos F, Rubovszky G, et al. [Optimal treatment of the axilla after positive sentinel lymph node biopsy in early invasive breast cancer. Early results of the OTOASOR trial]. Orv Hetil. 2013;154(49):1934-1942. Doi: 10.1556/OH.2013.29765 https://doi.org/10.1556/OH.2013.29765...	38%	Positive	1.7% (8 years)	Sentinel lymph node biopsy and radiotherapy

Study	False negative rates
Study	Overall rate	≥3 sentinel lymph nodes identified	Use of immunohistochemistry	Clipped node
ACOSOG Z1071³⁰30 Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al; Alliance for Clinical Trials in Oncology. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461. Doi: 10.1001/ jama.2013.278932 https://doi.org/10.1001/...	12.6%	9.1%	8.7%	6.8%
SENTINA³¹31 Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14(07): 609-618. Doi: 10.1016/S1470-2045(13)70166-9 https://doi.org/10.1016/S1470-2045(13)70...	14.2%	7.3%	–	–
SN FNAC³²32 Boileau JF, Poirier B, Basik M, Holloway CM, Gaboury L, Sideris L, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33(03):258-264. Doi: 10.1200/JCO.2014.55.7827 https://doi.org/10.1200/JCO.2014.55.7827...	13.3%	4.9%	8.4%^* *Sentinel lymph node metastases of any size, including isolated tumor cells (≤ 0.2 mm), were considered positive.	–

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[1] Address for correspondence Francisco Pimentel Cavalcante, MD, Rua Avila Goularte, 900, Hospital Geral de Fortaleza, Fortaleza, 60150-160, CE, Brazil (e-mail: fpimentelcavalcante@gmail.com).