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Revisiones en Cáncer H0164

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Revisión

Cirugía de cáncer localmente avanzado de mama

Publicado: 2023-03-29

VOLUMEN 36, NÚM. 6, noviembre-diciembre (2022), PAG. 271-338

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Los cánceres de mama localmente avanzados (CMLA) se definen como tumores de mama voluminosos o que afectan estructuras vecinas o adenopatías extensas en pacientes en las que se ha descartado metástasis de cáncer de mama. La incidencia de CMLA ha disminuido con el tiempo, probablemente debido a los programas de detección de cáncer de mama y al conocimiento de la población general sobre la importancia de la consulta precoz ante cambios en la mama. La quimioterapia es el enfoque convencional para pacientes con CMLA. La terapia endocrina neoadyuvante es una opción en los tumores con receptores hormonales positivos, especialmente en mujeres de edad avanzada. La radioterapia neoadyuvante puede ser una opción terapéutica de rescate para pacientes que no son candidatas a recibir tratamiento sistémico. Antes del tratamiento primario se necesita una estadificación exhaustiva. La estadificación local debe incluir exploración física, mamografía, ecografía axilar y, en casos seleccionados, resonancia magnética nuclear (RMN). Las metástasis a distancia pueden detectarse mediante FDG-PET/TC o TC convencional más gammagrafía ósea si no se dispone de FDG-PET/TC. El marcaje de los tumores de mama y ganglios positivos permite un correcto abordaje quirúrgico postratamiento neoadyuvante (TNA). La RMN es la herramienta más útil para valorar la respuesta del cáncer a la terapia neoadyuvante. En casos de buena respuesta a esta, permite reducir la agresividad quirúrgica. Los pacientes seleccionados que no pueden ser tratados con TNA pueden beneficiarse de resecciones extensas con tejido autólogo o reconstrucciones complejas de la pared torácica. Los ensayos clínicos multicéntricos prospectivos son la mejor opción para los pacientes con LABC. Todos los pacientes con LABC deben ser tratados por equipos multidisciplinarios.

Palabras Clave: Cáncer de mama localmente avanzado. Tratamiento neoadyuvante. Quimioterapia. Cirugía.

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