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INTRODUCTION: Currently, the indication for neoadjuvant chemotherapy is increasing in the treatment of breast cancer. Variability in the expression of biomarkers following neoadjuvant treatment has been observed, which could be accompanied by changes in the adjuvant treatment. OBJECTIVES: The primary objective was to evaluate the variability of biomarkers prior to and following neoadjuvant therapy. Secondary objectives were to determine which tumour subtype (as determined by immunohistochemical markers) most frequently achieved pathological complete response (pCR); whether the biomarker variation resulted in a change in immunophenotype and subsequently modification to the adjuvant treatment. MATERIALS AND METHODS: A retrospective observational analysis was carried out on patients with a diagnosis of breast cancer who had neoadjuvant therapy prior to surgery in the Breast Care Service of the Buenos Aires British Hospital between January 2009 and June 2020. RESULTS: One hundred and seventy-two patients were included. The pCR rate was 28.5%. The tumour immunophenotype that achieved pCR most frequently was the hormone receptor negative /HER2+ group with a value of 85.2%. The analysis was carried out on the 123 patients with residual disease. The observed variability for oestrogen receptors (ER) was 8.9%, for progesterone receptors (PR), 29.9% and for HER2, 13.8%. These changes were statistically significant. There were changes to the tumour immunophenotype in 26 cases (21.1%) with modifications to the adjuvant treatment in nine of these (34.6%; 7.3% of all tumours with residual disease). CONCLUSIONS: In this study, we observed statistically significant variability in the expression of ER, PR and HER2 prior to and following neoadjuvant treatment, which identified modifications in the tumour immunophenotype in 21.1%, and changes to the adjuvant treatment in 7.3% of all tumours with residual disease, justifying the re-assay of biomarkers in the surgical specimen.
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Introducción: La mastectomía de reducción de riesgo contalateral (MRRC) es una procedimiento que ha ido incrementándose en los últimos años sin demostrar un claro beneficio en cuanto a supervivencia global. Este incremento paradójicamente se ve reflejado en pacientes con bajo riesgo de desarrollar un carcinoma de mama contralateral. Objetivo: El objetivo de este trabajo es analizar las características de las pacientes con diagnóstico de cáncer de mama unilateral, que optan por realizar MRRC y su calidad de vida, evaluado el procedimiento, la satisfacción global y el impacto que genera en las pacientes, tanto a nivel psicológico, cosmético, social y sexual. Material y método: Se realizó un estudio retrospectivo transversal de pacientes con diagnostico de cáncer de mama unilateral tratadas con mastectomía que optaron por realizar MRRC entre el año 2005 y octubre del año 2019. Se incluyeron 74 pacientes que realizaron MRRC. Resultados: La edad de las pacientes fue de 43.6 años. Dentro de nuestra casuística el 92.8% de las pacientes se encuentran satisfechas reflejando una buena calidad de vida. La totalidad de las pacientes volvería a optar por este procedimiento y están satisfechas con la decisión tomada. Por el contrario el 7.2% no se encuentran satisfechas, reflejándose negativamente en su bienestar sexual, imagen corporal y comodidad frente a una reunión social. Conclusiones: Si bien el grado de satisfacción en cuanto a la realización de la MRRC es elevado, hay que tener en cuenta que este procedimiento no está libre de complicaciones y efectos adversos los cuales impactan en diferentes aspectos psicosociales de las pacientes afectando así su calidad de vida, Es por esto que la decisión para realizar este procedimiento debe ser contemplada con cuidado asesorando a las pacientes e informando tanto los riesgos como los beneficios del mismo.
Introduction: Contralateral Prophylactic Mastectomy (CPM) it's a procedure that has been increasing in the last years, without demonstrating a clear benefit in overall survival. Paradoxically this increase is reflected in low risk patients who decide to undergo CPM. Objetive: The purpose of this study is to describe the characteristics of the patients with unilateral breast cancer who decide to undergo CPM, analyzing this procedure, evaluating quality of life, global satisfaction and the psychological, cosmetic social and sexual outcomes. Material and method: A restrospective trial was conducted on patients diagnosed with unilateral breast cancer, who underwent mastectomy and CPM between the year 2005 and october 2019. 74 patients were included in this tria. Results: The mean age of patients in this study was 43.6 years. In our study 92.8% of the patients were satisfied, reflecting this in their quality of life. All patients would choose this procedure again, and are satisfied with the decision they have mad. On the other end 7.2% were dissatisfied, reflecting this result negatively in their sexual well being, body image and comfort in social meeting. Conclusions: Although the rate of satisfaction with performance of CPM is elevated, we must consider that this procedure is not free of complications and adverse errects. In fact they do exist and they impact in different psychosocial aspect, and quality of lige. This is why the decision to carry out this procedure must be carefully considered, advising patients and informing both the risks and benefits of it.