Qual o valor do índice preditor de resposta terapêutica na quimioterapia neoadjuvante em portadores de carcinoma mamário localmente avançado por cintilografia? / What is the value of the predictive index of therapeutic response in neoadjuvant chemotherapy in patients with locally advanced breast cancer by scintigraphy?

Larissa Cristina Tozin, Adriana Camargo Ferrasi, Eduardo Tinóis, Ana Lúcia Coradazzi, Kátia Hiromoto Koga, Heloisa Maria de Luca Vespoli, Diego Petrocelli, Sonia Marta Moriguchi

Abstract


O câncer de mama é o câncer mais comum entre as mulheres, tanto no Brasil quanto no mundo, com 28% dos casos a cada ano sendo novos. O diagnóstico retardado pode identificar o carcinoma de mama localmente avançado (LABC), que requer quimioterapia sistêmica pré-operatória que visa reduzir o tamanho e a carga do tumor. A quimio-resistência pode estar relacionada à expressão da glicoproteína P (GpP) que promove o efluxo celular do medicamento, diminuindo não apenas seu tempo dentro da célula, mas conseqüentemente a apoptose celular. [99mTc]Tc-sestamibi (MIBI), utilizado na realização de cintimografia (SMM), é um substrato destas proteínas, semelhante às drogas quimioterápicas, sendo o único método de imagem a representar o tempo de permanência desta droga. O índice preditivo de resposta quimioterápica da SMM tem sido utilizado para prever o tempo de permanência das drogas quimioterápicas nestas células. Este estudo teve como objetivo verificar se o índice preditivo da resposta quimioterápica neoadjuvante, obtido pela SMM com MIBI proposta por Alonso e colegas, está relacionado à resposta quimioterápica, conforme demonstrado pelo estudo anatomopatológico pós-operatório das mamas (AP), considerado o padrão ouro, analisando os índices isolados, índice precoce (EI) e índice tardio (LI), e índice associado (EI+LI). Este foi um estudo transversal, observacional e descritivo, com dados retrospectivos coletados de quadros de pacientes portadores de LABC atendidos nesta Instituição no período de 2012 a 2017, que foram submetidos à SMM, definindo os valores dos índices de boa resposta isolados ou combinados como EI>1,5 e LI>1,4, quimioterapia neoadjuvante com esquema AC-T e mastectomia posterior ou quadrantectomia, com redução do tamanho do tumor >30% (G>30%) considerada uma boa resposta à PA. O nível de significância foi p<0,05. A amostra foi composta de 151 mulheres com idade média de 54,00 ±10,71 anos (26 a 77 anos, dos quais 72 foram acometidas no lado direito e 79 no lado esquerdo). O tipo histológico predominante foi ductal (n=141; 93,38%), seguido por lobular (n=6; 3,97%), metaplástico (n=2; 1,32%) e papilífero (n=2; 1,32%). A classificação imunohistoquímica evidenciou predominância do tipo luminal B (n=47, 32,41%), seguido pelos tipos triplo-negativo (n=31; 21,38%), HER 2 positivo (n=24; 16,55%), híbrido (n=24; 16,55%), luminal A (n=18; 12,41%) e luminal não-A não-B (n=1; 0,69%). O tamanho inicial dos tumores variou de 0,20 a 16,00 cm, com uma média de 3,40±2,26 cm. O tamanho final do tumor variou de 0,00 a 11,00 cm, com uma média de 1,63±2,01 cm. Em média, a redução percentual do tamanho do tumor foi de 51,72±58,46%, variando de -185,71 a 100%, uma vez que alguns tumores apresentaram uma progressão de tamanho. Não houve associação significativa entre EI versus G>30% (p=0,8054); LI versus G>30% (p=0,2097), e (EI+LI) versus G>30% (p=0,1289). Em conclusão, não existe associação entre os índices preditivos de boa resposta descritos no SMM e a resposta de redução de tamanho observada na AP em transportadoras LABC tratadas com o esquema quimioterápico AC-T.


Keywords


Neoplasias mamárias, Radionuclídeos, Agentes Antineoplásicos, Medicina Nuclear.

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DOI: https://doi.org/10.34119/bjhrv4n3-144

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