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Técnicas de ablación como tratamiento en pacientes con cá= ncer de mama

 

Ablation techniques as treatment in patients with breast cancer

 

1

Maria Valentina Muñoz Arteaga

3D"https://lh3.googleusercontent.com/PFmtS1a9emcAXn3AJRoHnlrolGjB4Iu9=

https://orcid.org/0000-0002-6321-394= 9

 

Universidad Católica de Cuenca, Unidad Académica de Salud y Bienestar, Cuenca, Ecuado= r.

valentina.munoz@est.ucacue.edu.ec

2

Luz María Bojorque Bojorque

3D"https://lh3.googleusercontent.com/PFmtS1a9emcAXn3AJRoHnlrolGjB4Iu9=

https://orcid.org/0000-0002-8650-627= 7

 

Universidad Católica de Cuenca, Unidad Académica de Salud y Bienestar, Cuenca, Ecuado= r.

lbojo= rqueb@ucacue.edu.ec

3

Debbie Noelia Tebanta Albán

3D"https://lh3.googleusercontent.com/PFmtS1a9emcAXn3AJRoHnlrolGjB4Iu9=

https://orcid.org/0000-0003-4809-158= 1

 

Universidad Católica de Cuenca, Unidad Académica de Salud y Bienestar, Cuenca, Ecuado= r.

debbie.tebanta@est.ucacue.edu.ec

4

Anthony Daniel Armijos Ayala

3D"https://lh3.googleusercontent.com/PFmtS1a9emcAXn3AJRoHnlrolGjB4Iu9=

https://orcid.org/0000-0001-8837-622= 9 

 

Universidad Católica de Cuenca, Unidad Académica de Salud y Bienestar, Cuenca, Ecuado= r.

anthony.armijos@est.ucacue.edu.ec

 

 

 

 =

 

Artí= culo de Investigación Científica y Tecnológica

Envi= ado: 09/10/2022

Revi= sado: 18/11/2022

Acep= tado: 19/12/2022

Publ= icado:05/01/2023

DOI: https://doi.or= g/10.33262/cienciadigital.v7i1.2422   

 

 

 

Cítese:

 

 

Muñoz Arteaga, M. V., Bojorque Bojorque, L. M., Tebanta Albán, D. N., & Armijos Ayala, A. D. (2023). Técnicas de ablación como tratamiento en pacientes con cáncer de mama. Ciencia Digital, 7(1), 20-41. https://doi.org/10.33262/cienciadigital= .v7i1.2422

 

3Deditorial1.png<= !--[if gte vml 1]>

 

 

CIENCIA DIGITAL, es una Revista multidisciplinaria, Trimestral, que se publicará en soporte electrónico tiene como misión contribuir a la   formación de  profesionales competentes con visión humanística y crítica que sean capaces de  exponer  sus resultados  investigativos y científicos en la misma medida que se promueva mediante su intervención cambios positivos en  la sociedad. https://cienciadigital.org<= /a>

La revista es editada por la Editorial Ciencia Digital (Editoria= l de prestigio registrada en la Cámara Ecuatoriana de Libro con No de Afiliaci= ón 663) www.celibro.org.ec

 

 

 

Esta revista está protegida bajo una licencia Creative Commons AttributionNonCommercialNoDerivatives 4.0 International. Copia de la licencia: http://creativecommons.org/licenses/by-nc-nd/4.0= /.

 

Palabras claves: Cáncer de mama, evolución, neoplasias de= la mama, técnicas de ablación, tratamiento.

 

 

Resumen

Intr= oducción: La neoplasia maligna diagnosticada con mayor frecuencia en todo el mundo es el cáncer de mama. Existen nuevas alternativas terapéuticas mínimamente invasivas gracias a las innovaciones tecnológicas, como la crio ablación, la ablación por radiofrecuencia y la ablación por microondas, las cuales han dado buenos resultados. Objeti= vo: Describir las técnicas de ablación como tratamiento en pacientes con cánc= er de mama. Metodología: Se realizó un estudio no experimental narrat= ivo, de revisión bibliográfica. Se utilizaron artículos en inglés y en español= de los últimos cinco años. Resultados: Se describió cuales son las técnicas de ablación, en qué tipo de pacientes se usaron y cuál fue la eficacia de las técnicas de ablación como tratamiento en pacientes con cá= ncer de mama, de forma más clara y con bibliografía más actualizada. Conclu= siones: Las técnicas de ablación tienen una eficacia alta como tratamiento en pacientes con cáncer de mama en etapa temprana, especialmente en mujeres jóvenes y en edad fértil. Estos buenos resultados se observaron mejor en tumores menores o iguales de 2 cm, en los tumores mayores de 2 cm los resultados tardan en aparecer.

 

Keywords:Breast cancer, evolution, breast neoplasms, ablation techniques, treatment.

 

 

Abstr= act

Introduction: The most freque= ntly diagnosed malignancy worldwide is breast cancer. There are new minimally invasive therapeutic alternatives thanks to technological innovations, su= ch as cryoablation, radiofrequency ablation and microwave ablation, which ha= ve given satisfactory results. Objective: Describe ablation technique= s as treatment in patients with breast cancer. Methodology: A non-experimental narrative study was conducted, with a bibliographic revi= ew. Articles in English and Spanish from the last five years were used. Re= sults: The ablation techniques were described; in what type of patients, they we= re used and what was the efficacy of the ablation techniques as a treatment = in patients with breast cancer in a clearer way and with more updated bibliography. Conclusions: Ablation techniques have a high efficac= y as a treatment in patients with early-stage breast cancer, especially in you= ng women and women of childbearing age. These satisfactory results were bett= er observed in tumors less than or equal to 2 cm, in tumors greater than 2 cm the results take time to appear.

 

Introducción

Van de Voort et al. (2021a), menciona que la neoplasia maligna diagnosticada con mayor frecuencia en todo el mundo es la neoplasia de la mama, representando= el 15% de muerte por cáncer más común en las mujeres. En Estados Unidos la tas= a de supervivencia a 5 años es del 99% cuando el tumor se diagnostica en una eta= pa local, del 86% en una etapa regional y un 17% cuanto es metastásico, según = la Organización Mundial de la Salud (OMS), un diagnóstico precoz lleva a un bu= en pronóstico y a una alta tasa de supervivencia (Van de Voort et al., 2021b; Akram et al, 2017).

El tratamiento de cáncer de mama es proporcionado de forma multidisciplinaria,= la elección del tratamiento debe basarse en la localización del tumor, número = de lesiones, grado de afectación, la biología de la persona, así como la edad, estado menopáusico, estado general de salud y sobre todo respetar las preferencias del paciente (Stachs et al., 2019). A pesar de que el tratamie= nto de primera elección es la cirugía, gracias a las innovaciones tecnológicas, existen nuevas terapias terapéuticas mínimamente invasivas (Akram et al., 2= 017). Las técnicas de ablación térmicas percutáneas como la ablación por radiofrecuencia (ARF), la ablación por microondas (MWA), el ultrasonido enfocado de alta intensidad y la crioablación están ganando una alta acepta= ción y son terapias que constituyen las principales alternativas a la resección quirúrgica (Akram et al, 2017; Stachs et al., 2019).

La neoplasia de la mama es una enfermedad potencialmente mortal en las mujeres; sin embargo, durante las dos últimas décadas, los estudios relacionados con= la neoplasia de la mama han guiado a un avance en la comprensión del cáncer, lo que resulta en mejores tratamientos (Akram et al., 2017). Stachs et al. (20= 19) da a conocer que los cambios benignos de las mamas son más comunes en mujer= es en edad fértil, alcanzando su punto máximo entre los 30 y 50 años, mientras= que la incidencia de la neoplasia de la mama alcanza su punto máximo durante la posmenopausia, por lo tanto, para que exista un buen pronóstico y tratamien= to, el diagnóstico precoz es de vital importancia. En la actualidad se prescrib= en diferentes medicamentos modernos para tratar el cáncer de mama como el raloxifeno o el tamoxifeno, la cirugía de ambas mamas es una medida prevent= iva adicional además de ser una estrategia de manejo, así como la quimioterapia= y radioterapia. Sin embargo, los efectos secundarios no suelen ser tolerables, llegando a ser hasta desagradables para el paciente, por eso se buscan tera= pias alternativas que reduzcan los efectos secundarios de la mejor manera posibl= e (Akram et al., 2017).

Ito et al. (2018), menciona que las terapias alternativas como las técnicas de ablación están ganado una alta popularidad. La ablación no quirúrgica desem= peña un papel muy importante como es la ablación por radiofrecuencia en el tratamiento de tumores sólidos. También hay que resaltar, que un gran númer= o de pacientes no pueden someterse a la cirugía como tratamiento principal, ya s= ea debido a cáncer avanzado o afecciones subyacentes, como hipertensión, diabe= tes mellitus, insuficiencia cardíaca o pulmonar (Li et al., 2019). Por lo que, = las técnicas de ablación son una estrategia de tratamiento favorable.

El cáncer de mama en la actualidad es un dilema mundial de salud pública, es el más común de los cánceres en mujeres y comprende un 18% del total de todos = los cánceres de las mujeres (Akram et al., 2017). Snyder et al. (2020) da a con= ocer que, en mujeres, es una de las principales causas de muerte, y según la OMS= se estima que para el año 2040, a nivel mundial el diagnóstico y muerte por cá= ncer de mama aumentaran a tres millones y un millón. Se estima que 9 de cada 10 personas en los países de bajos ingresos carecen de acceso a la cirugía bás= ica, la cual es el tratamiento de primera línea más común para el cáncer de mama, por lo que una buena alternativa de tratamiento son las técnicas de ablació= n (Nief et al., 2022). Las técnicas ablativas tumorales son un tratamiento químico o térmico aplicado a un tejido tumoral para obtener la destrucción parcial o total del tumor. Existen muchas razones por las cuales se consideran a las técnicas de ablación como un buen tratamiento para personas con cáncer de m= ama, entre ellos se destacan que hay menos morbilidad, menos hospitalización, mejores resultados cosméticos, menor costo y resultan una opción más adecua= da para pacientes de edad avanzada con comorbilidades que impiden realizarse la cirugía (Snyder et al., 2020; Nief et al., 2022). Ofrecen la ventaja de realizarse por vía percutánea bajo guía de imagen, obteniendo bajas tasas de complicaciones y malestar de los pacientes (Pusceddu et al., 2019).

Recientemente con el interés y la popularidad que ha estado creciendo en las técnicas mínimamente invasivas, se ha abierto otra forma de tratamiento para tumores= de mama tanto benignos como malignos (Payne et al., 2021). El cáncer de mama es una enfermedad compleja que muestra un gran grado de heterogeneidad inter e= intratumoral (Yeo & Guan, 2017). Tanto la mortalidad como la incidencia del cáncer de mama siguen aumentando, este aumento se ve en países en desarrollo y en paí= ses en vías de desarrollo (Payne et al., 2021). Aunque los avances de detección temprana y la terapia han resultado en una disminución del 38% en la tasa de mortalidad; sin embargo, la tasa de supervivencia varía en todo el mundo, se estima una tasa de supervivencia de 5 años del 80% en los países desarrolla= dos, y una tasa de supervivencia por debajo del 40% en países en desarrollo (Akr= am et al., 2017; Sun et al., 2017). La clave para reducir la mortalidad es el diagnóstico y tratamiento precoz (Zhang et al., 2021).

El tratamiento del cáncer de mama requiere un equipo multidisciplinario de especialistas en oncología médica, quirúrgica y radioterapia. La mayoría de= los cánceres de mama se identifican mediante mamografía o por examen físico, los médicos de atención primaria a menudo son el primer contacto para los pacie= ntes que tienen un diagnóstico de cáncer de mama (Trayes & Cokenakes, 2021).=

Burguin et al. (2021) menciona que la elección del tratamiento se basa en el grado,= la etapa y el subtipo molecular de cáncer de mama para tener la terapia más personalizada, segura y suficiente. Las técnicas de ablación están ganando popularidad por las ventajas que presentan, entre ellas la que más destaca = es que cuenta con mejores resultados cosméticos, tienen menor costa, menos hospitalización y menos mortalidad (Stachs et al., 2019). Existen varios métodos de ablación disponible como la ablación por radiofrecuencia, el ultrasonido enfocado de alta intensidad, crioablación, microondas o láser (= Ito et al., 2018).

Ablación por radiofrecuencia

En los últimos años la ablación por radiofrecuencia (RFA) ha recibido una aten= ción cada vez mayor debido a su naturaleza no invasiva en el tratamiento del cán= cer de mama. RFA utiliza el calor para matar los tumores cancerosos sin afectar= el tejido sano circundante. Se realiza una pequeña incisión para insertar una aguja pequeña en el centro del tumor. Una vez que la aguja está en su lugar= , se envía una corriente eléctrica a la aguja. Eso genera calor extremo, que endurece la sangre a su alrededor y mata células tumorales. El calor solo afecta a las células tumorales, por lo que el tejido sano alrededor del áre= a es seguro, de hecho, debido a que la precisión de la ablación por radiofrecuen= cia es similar a la escisión quirúrgica (Xia et al., 2021). <= /p>

Brem (2018), menciona que antes del procedimiento, los pacientes reciben sedación parcial o total, se puede realizar RFA en varios tumores diferentes en un s= olo entorno, se tarda unos 30 minutos tratar cada tumor. Es un proceso ambulato= rio, y después de la RFA estará en observación durante unas horas, luego podrá i= rse a casa. La mayoría de los pacientes pueden volver a realizar sus actividades normalmente al día siguiente. Sin embargo, Xia et al. (2021) da a conocer q= ue la RFA debe usarse en pacientes cuidadosamente seleccionadas, específicamente = en aquellas con cáncer de mama de menos de 2 cm y tumores no adyacentes a la p= iel o cerca de la pared torácica.

Después del procedimiento, algunos pacientes reportan síntomas similares a la gripe= que duran 10 días, también quemaduras en la piel en el sitio de la aguja, pero = se puede minimizar. Durante varios meses se harán pruebas como biopsias especi= ales y pruebas de imagen para ver si la RFA fue exitosa y si no hay células tumorales restantes. En la mayoría de los casos la RFA elimina completament= e el tumor, pero si hay células cancerosas que permanece o si crecen nuevos tumo= res, los pacientes pueden someterse a otra RFA para destruir las células (Brem, = 2018).

Ablación por microondas

En la actualidad, la ablación por microondas (MWA) ha demostrado ser un tratamiento mínimamente invasivo, seguro y efectivo para el tumor. MWA suministra energía a través de una antena intersticial. El tumor absorbe la energía, e induce los efectos citotóxicos del calor, lo que resulta en la desnaturalización de proteínas y la necrosis de la coagulación. Los resulta= dos de la MWA mamaria muestran una reducción en el volumen y la palpabilidad de= las lesiones y resultados cosméticos satisfactorios (Neira et al., 2020). =

En primer lugar, se diseña un esquema de ablación que incluye la orientación y= la rutina de la penetración de la aguja (la distribución de la antena microond= a en los tumores), el rango de ablación y el tiempo de duración de acuerdo con l= as características del tumor y su entorno en función de los exámenes preoperatorios. El equipo de microondas consiste en un generador de microon= das (2450 MHz) y una antena de aguja refrigerada por agua. La antena tiene un tamaño de calibre 16 (G) de diámetro y 10 cm de longitud con una punta acti= va de 3 o 5 mm de longitud (Xu et al., 2018). Para la ablación se emite una microonda electromagnética, se inicia el procedimiento de ablación con baja energía y luego aumenta gradualmente mientras se monitorea la zona de ablac= ión y posibles complicaciones (Vogl et al., 2017).

Crioablación

La crioablación es el uso de frío extremo para matar las células cancerosas, e= s un procedimiento ambulatorio que se hace bajo anestesia local, es bien tolerado que se ha utilizado para erradicar la enfermedad metastásica y tratar peque= ños cánceres de mama en pacientes que se consideran malos candidatos para la cirugía (Regen-Tuero et al., 2021). Usando una criosonda de mano similar a = una aguja y nitrógeno líquido, los tumores generalmente se ablacionan en dos ci= clos de congelación-descongelación que alcanzan una temperatura central de -180°= C. Las masas mamarias de menor o igual 2 cm se pueden congelar en tan solo 30-= 45 min, una lesión cutánea se previene mediante la inyección repetida de soluc= ión salina debajo de la dermis para mantener la separación entre la piel y la m= asa congelada subyacente (Holmes, 2020).

Las temperaturas frías resultan en el incremento de la osmolaridad intracelular= y la congelación del agua extracelular; esto provoca, a su vez, la extracción= de agua de las células y una deshidratación celular. Durante la fase de deshie= lo pasivo, se genera una hinchazón celular y posterior ruptura. Además, los cristales de hielo en el medio intracelular dañan los orgánulos y las membr= anas plasmáticas. Una segunda congelación es necesario porque los tejidos que se= han lesionado durante la primera congelación conducen las temperaturas frías de manera más eficiente, lo que aumenta los resultados con una expansión del á= rea de necrosis tumoral (Pusceddu et al., 2019).

Ultrasonido enfocado de alta intensidad

El ultrasonido se refiere a las ondas sonoras con una frecuencia de vibración = de 20.000 Hz o superior. La longitud de onda corta del ultrasonido permite que= la energía se enfoque en un área extremadamente pequeña a través del ajuste de fase, permitiendo que la energía se transfiera de manera efectiva al tejido blando. Durante el tratamiento, un has generado por un transductor se propa= ga a través del tejido blando como una onda de presión de alta frecuencia. El ha= z se enfoca en el tejido objetivo y la energía del haz eleva la temperatura del = área objetivo a aproximadamente 60° - 95°C en cuestión de segundos, lo que lleva= a la desnaturalización localizada de proteínas y necrosis coagulativa, evitan= do que los tejidos circundantes sufran datos térmicos. El ultrasonido enfocado= de alta intensidad proporciona un tratamiento completamente no invasivo, evita= ndo las posibles complicaciones asociadas con la anestesia general y la escisión quirúrgica (Yao et al., 2022).

Metodología

Se realizó un estudio no experimental narrativo de tipo revisión bibliográfica, donde se utilizó fuentes de información de buscadores científicos disponibl= es, con la finalidad de describir las técnicas de ablación como tratamiento en cáncer de mama. Se incluyeron artículos en el idioma inglés y español, revisiones sistémicas, metaanálisis, ensayos clínicos, revisiones bibliográficas y artículos publicados en los últimos 5 años realizados en mujeres. La búsqueda dio como resultados 84 artículos en las bases científi= cas de Pubmed y Scopus, donde solo 15 cumplían con los criterios para la investigación.

Resultados

Tabla 1

Descripción de las técnicas de ablación como tratamiento en pacientes con cáncer de mama

Título

Autores

Lugar=

Año

Tipo de documento

Tamaño de muestra

Resultados=

Tratamient= o del cáncer de mama en etapa temprana con ablación térmica percutánea, un ensa= yo de detección de fase 2 aleatorizado abierto: justificación y diseño del ensayo THERMAC.

Van De Voo= rt, Struik, Koppert, Moelker, Debets, Yo, et al.

Países Baj= os, Róterdam.

2021<= /o:p>

Ensayo clí= nico, fase II.

Estudio multicéntrico.

Ensayo controlado aleatorio.

The Franciscus Gasthuis & Vlietland: 355 pacientes.

The Erasmu= s MC – Cancer Institute: 130 pacientes.

La ablación térmica percutánea es un tratamiento mínimamente invasivo que tiene el potencial de reemplazar la cirugía para el cáncer de mama en etapa tempra= na.

 =

Tabla 1

Descripción de las técnicas de ablación como tratamiento en pacientes con cáncer de mama (continuación)

Título<= /span>

Autores<= /span>

Lugar<= /span>

Año= <= /span>

Tipo de documento

Tamaño de muestra

Resultados= <= /span>

Ablación p= or radiofrecuencia del cáncer de mama: un estudio retrospectivo.<= /span>

Ito, Oura, Nagamine, Takahashi, Yamamoto, Yamamichi, et al.=

Japón=

2018<= /o:p>

Estudio retrospectivo.

386 pacien= tes.

La combina= ción de radiofrecuencia ablativa guiada por ultrasonido del cáncer de mama con biopsia simultánea de ganglio linfático podría convertirse en una terapia conservadora de mama de vanguardia para el cáncer de mama temprano.<= /o:p>

Ablación c= on microondas de tumores benignos de mama: un estudio prospectivo con un seguimiento mínimo de 12 meses.

Xu, Wu, Ha= n, Zhang, Li, Dou, et al.

China, Bei= jing.

2018<= /o:p>

Estudio prospectivo.

56 pacient= es.

La ablació= n por microondas podría producir un mayor calentamiento intratumoral, un mayor volumen de necrosis coagulativa, menos duración de la ablación y una mejor estabilidad en el perfil de conducción térmica.<= /p>

 =

 =

 =

 =

Tabla 1

Descripción de las técnicas de ablación como tratamiento en pacientes con cáncer de mama (continuación)

Título<= /span>

Autores

Lugar<= /span>

Año= <= /span>

Tipo de documento

Tamaño de muestra

Resultados= <= /span>

Crioablaci= ón e Inmunoterapia para el cáncer de mama: descripción general y justificación= de la terapia combinada.

Regen-Tuero, Ward, Sikov, Littrup.

Países Baj= os: Ámsterdam y Maastricht.

2021.=

Revisión sistemática.

-

Si la crioablación puede inducir una respuesta sistémica específica del tumor, podría mejorar la susceptibilidad tumoral a los agentes de inmunoterapia.=

Una revisi= ón de la ecografía focalizada de alta intensidad como una técnica de radiología intervencionista novedosa y no invasiva.

Yao, Hu, Zhao, Cheng, Feng.

China.

2022<= /o:p>

Revisión bibliográfica.

-

El ultraso= nido focalizado de alta intensidad es una intervención altamente aceptada, prometedora, para tratamiento no invasivo de tumores benignos y malignos.=

Evaluación= de la curva de aprendizaje de la ecografía de alta intensidad para el fibroaden= oma de mama mediante análisis CUSUM: un estudio multicéntrico.

Xiao, Lian= g, Chen, Li, Xia, Yue, et al.

China.

2022<= /o:p>

Estudio retrospectivo.

110 pacien= tes.

Existen es= tudios que respaldan y han demostrado que el tratamiento del fibroadenoma de mama fue factible y seguro.

 =

 =

 =

Tabla 1

Descripción de las técnicas de ablación como tratamiento en pacientes con cáncer de mama (continuación)

Título<= /span>

Autores<= /span>

Lugar<= /span>

Año= <= /span>

Tipo de documento

Tamaño de muestra

Resultados= <= /span>

Avances recientes en la terapia del cáncer con crioablación y la crioablación med= iada por nanopartículas.

Kwak, Yu, Lewandowski, Kim.

Estados Un= idos: Chicago.

2022.=

Revisión bibliográfica.

-

La crioabl= ación se utiliza cada vez más en el tratamiento de varios tumores sólidos.=

Ablación t= érmica como alternativa para la resección quirúrgica de cáncer de mama pequeños (≤ 2 cm): un metaanálisis.

Van de Voo= rt, Struik, Birnie, Moelker, Verhoef, Klem.

Países Baj= os.

2021<= /o:p>

Metaanális= is.

1266 pacie= ntes.

Las técnic= as de ablación térmicas que tratan el cáncer de mama en estadio temprano son seguras y efectivas.

La ablació= n por microondas induce una respuesta inmunitaria de tipo Th1 con la activación= de la vía ICOS en el cáncer de mama en estadio temprano.

 = ;

Zhou, Yu, = Pan, Qiu, Wang, Qian, et al.

China.

2021<= /o:p>

Estudio cl= ínico.

35 pacient= es.

La ablació= n por microondas es una terapia local prometedora, pero también un desencadenan= te de la inmunidad antitumoral para el cáncer de mama.

 =

 =

 =

 =

 =

 =

 =

Tabla 1

Descripción de las técnicas de ablación como tratamiento en pacientes con cáncer de mama (continuación)

Título<= /span>

Autores<= /span>

Lugar<= /span>

Año= <= /span>

Tipo de documento

Tamaño de muestra

Resultados= <= /span>

Reducción = del volumen para lesiones mamarias benignas ≥2 cm después de ablación c= on microondas guiada por ultrasonido con un seguimiento mínimo de 12 meses.<= o:p>

Cui, Wu, X= u, Han, Zhang, Li, et al.

China.

2021<= /o:p>

Estudio prospectivo.

80 pacient= es.

La ablació= n por microondas es un método satisfactorio para tratar los tumores más grandes= de 2cm en pacientes que tengan inquietudes o ansiedad respecto a la recupera= ción postoperatorio y los efectos cosméticos.

Análisis t= écnico del ultrasonido para la ablación precisa por microondas de tumores benign= os de mama.

Li, Li, Ge, Liang, Ma, Ling, et al.

China.

2018<= /o:p>

Estudio prospectivo.

Ensayo clí= nico.

47 pacient= es.

La ablació= n por microondas ha sido reconocida como una terapia eficaz para tumores sólidos con varias ventajas, incluido un gran volumen de ablación y un corto tiem= po de ablación.

Ablación p= or radiofrecuencia seguida de escisión quirúrgica versus lumpectomía para el cáncer de mama en etapa temprana: un ensayo clínico aleatorizado de fase = II.

García-Tej= edor, Guma, Soler, Valdivieso, Petit, Contreras, et al.

España: Barcelona.

2018<= /o:p>

Ensayo clí= nico.

Estudio comparative.

Ensayo controlado aleatorio.

40 pacient= es.

La eficaci= a de la ablación por radiofrecuencia fue mayor con tumores menores de 20 mm y menor con tumores mayores de 50 mm.

Tabla 1

Descripción de las técnicas de ablación como tratamiento en pacientes con cáncer de mama (continuación)

Título<= /span>

Autores<= /span>

Lugar<= /span>

Año= <= /span>

Tipo de documento

Tamaño de muestra

Resultados= <= /span>

Técnica ac= tual y aplicación de la crioterapia percutánea.

Mahnken, K= önig, Figiel.

Alemania.<= o:p>

2018.=

Revisión sistemática.

-

El tratami= ento da como resultado una reducción significativa del volumen y más del 80% de los fibroadenomas ya no son palpables un año después del tratamiento=

Ultrasonido enfocado de alta intensidad guiado por resonancia magnética (MR-HIFU): Descripción general de las aplicaciones emergentes (Parte 2).<= /span>

Siedek, Yeo, Heijman, Grinstein, Bratke, Henewee= r, Puesken, Persigehl, Maintz, Grüll.

Alemania.<= o:p>

2019.=

Revisión sistémica.

277 pacien= tes.

Las técnic= as ablativas parecen factibles siempre que se observe un margen de seguridad= de por lo menos 10 mm.

Tratamient= o con ultrasonido focalizado de alta intensidad para el fibroadenoma: un estudio clínico en el Centro Nacional de Investigación Científica, Astana, Kazajs= tán.

Imankulov, Tuganbekov, Razbadauskas, Seidagaliyeva.

Kazajistán= .

2018.=

Artículo, = Ensayo controlado aleatorizado.

80 pacient= es.

El ultraso= nido focalizado de alta intensidad puede mejorar la calidad de vida en compara= ción con el tratamiento quirúrgico, reduciendo la intensidad del dolor en un 44,7%.

 

 

Discusión=

Los tumores benignos con bultos palpables o impalpables son las quejas más comu= nes en el seno para las mujeres (Akram et al., 2017; Xu at al., 2018). Debido a= la alta incidencia, la influencia significativa en la condición de vida y el posible progreso maligno de los tumores benignos de mama, se debe prestar m= ás atención a la clínica de la persona, sin embargo, el enfoque terapéutico más frecuente por ahora sigue siendo la resección quirúrgica (Xu et al., 2018), pero a medida que pasa el tiempo va avanzando la tecnología, y gracias a eso existen nuevas técnicas que ayudan en el tratamiento del cáncer de mama, la ablación térmica percutánea es un tratamiento mínimamente invasivo que tien= e el potencial de reemplazar la cirugía para el cáncer de mama en etapa temprana= (Akram et al., 2017). Se reconoce que la ablación por radiofrecuencia percutánea es menos invasiva que la cirugía para muchas enfermedades y cánceres sólidos (= Ito et al., 2018).

En un estudio realizado en Países Bajos con 1266 pacientes se observó una tasa general de ablación completa del 86%, siendo más alta después de la ablación por radiofrecuencia con el 92%, hubieron tasas de recurrencia local con variaciones de 0% a 3% con una mediana de seguimiento de 15 a 61 meses, las tasas de complicaciones fueron bajas, con un buen resultado cosmético, dando más validación a las técnicas de ablación como un tratamiento seguro y efic= az en el cáncer de mama en estadio temprano con masas menores o iguales de 2 c= m (Van de Voort et al., 2021a). Sin embargo, Van de Voort et al. (2021b) en otro estudio, observó que en los tumores menores o iguales de 2 cm se encontraron tasas de ablación completa del 82% hasta el 92% en la ablación por radiofre= cuencia, la ablación por microondas y la crioablación; pero hay que considerar que c= on el avance de los dispositivos se desconoce en la actualidad el porcentaje r= eal de ablación completa.

Mujeres posmenopáusicas mayores de 45 años que cuenten con diagnóstico de cáncer de mama ductal invasivo en estadio temprano sin tipo específico, con el tamaño= del tumor ≤ 2cm, los tumores deben tener una puntuación de 3 o menos por = el Sistema de Registro y Datos de Imágenes Mamarias (BI-RADS), para que las té= cnicas de ablación tengan un buen resultado, en especial es una alternativa de tratamiento para pacientes que se negaron a aceptar otros tratamientos, de = un total de 485, a la mitad se les aplico la técnica de microondas y a la otra mitad la técnica de radiofrecuencia ablativa, así mismo en el estudio de 56 participantes, solo aplicaron la técnica de microondas ablativas en las cua= les se vieron buenos resultados (Van de Voort et al., 2021a; Xu et al., 2018). =

Xiao et al. (2022) realizó un estudio con 110 participantes, los pacientes fueron mayores de 18 años, con un BI-RADS ≤ 3 por ecografía, donde se observó que 57 pacientes tuvieron 98 fibroadenomas de mama en el Centro 1, y 53 pacientes con 155 fibroadenomas de mama en el centro 2, ambos grupos completaron con éxito el tratamiento de ultrasonido focalizado de alta intensidad con buenos resultados. Así mismo, Van de Voort et al. (2021b) en otro estudio favorece a las técnicas de ablación térmica como seguras y eficaces que tratan el cáncer de mama en estadio temprano tumores ≤ 2= cm (47). 80 pacientes con tumores ≥ 2 cm se sometieron a la ablación por microondas con un seguimiento de más de 12 meses donde se observó que el volumen de ablación disminuyó significativamente (Cui et al., 2021). El ultrasonido focalizado de alta intensidad guiado por resonancia magnética no tiene muchos estudios que los respalden, sin embargo, puede considerarse co= mo una opción de tratamiento para tumores localizados y en etapa temprana (Sie= dek et al., 2019).

En un estudio con 80 mujeres participantes, se las dividieron de manera unifor= me y aleatoria en donde a un grupo se lo trato con el ultrasonido focalizado de = alta intensidad y el grupo control se sometió a la técnica quirúrgica tradiciona= l, una resección parcial. La media de edad fue de 30 a 35 años y el tamaño del fibroadenoma en los grupos principales y control fue de 2.02x2.40 cm2 y 1.98x2.41 cm2, dando buenos resultados como técnica no invasiva de tratamie= nto del fibroadenoma mamario para mujeres en edad fértil (Imankulov et al., 201= 8).

Aunque existen estudios de las técnicas de ablación percutánea como la crioablació= n, la ablación por microondas, el ultrasonido focalizado de alta intensidad y = a la ablación por radiofrecuencia, los mejores resultados se han visto en la ablación por radiofrecuencia, con una tasa de éxito alta pero variable que oscila entre el 77% y el 100% de los casos de ablación completa (García-Tej= edor et al., 2018). Los tumores de mama menores o iguales de 2 cm de diámetro son candidatos prometedores de la ablación radiofrecuencia; sin embargo, los cánceres de mama con receptores hormonales negativos, HER2 positivos o trip= les negativos tendían a ser más progresivos, y la quimioterapia primaria debe e= star indicada para estos pacientes en lugar de la ablación por radiofrecuencia (= Ito et al., 2018). Nief et al. (2022) realizó un estudio realizado en España, d= onde resalta la importancia del estado del margen ya que influye en los resultad= os de la ablación, el estado del margen después de la resección puede ayudar a predecir el riesgo de recurrencias locales de cáncer de mama, la ablación p= or radiofrecuencia podría proporcionar márgenes libres de tumor de una manera igual o superior a la lumpectomía, siempre que se realice una ablación gran= de que abarque correctamente el tumor. La complicación más común reportada des= pués de la ablación por radiofrecuencia son las quemaduras en la piel, seguida d= e la retracción del pezón, la cual puede ser causada por una distancia corta de = piel tumoral o por falta de protección de la piel con hielo, estas complicaciones fueron más frecuentes después de la ablación por radiofrecuencia con un 40%, que después de la tumorectomía con un 5%.

En un estudio realizado en China en el 2021 con 35 pacientes diagnosticadas con cáncer de mama invasivo de 3 cm o menos de diámetro, 15 pacientes rechazaro= n o no eran candidatos para la cirugía debido a condiciones médicas, se sometie= ron a la ablación por microondas sin cirugía local, 20 se sometieron a la ablac= ión por microondas seguido de cirugía preprogramada 1 semana después, del total= de 35 pacientes, 32 presentaron ablación completa confirmada por seguimiento o exámenes patológicos, sin embargo, todos los 35 pacientes mostraron hinchaz= ón local en el sitio de tratamiento aproximadamente 2 - 3 días después de la ablación, que luego desapareció en una semana, por lo que se encuentra grac= ias a este estudio que la ablación por microondas es un tratamiento local prometedor para el cáncer de mama con una alta tasa de ablación completa (Z= hou et al., 2021).  La ablación por microondas tiene grandes resultados a largo plazo, en otro estudio se dio un seguimiento a los 12 meses donde se vio que los volúmenes de las masas disminuyeron de 1,64 cm3 antes de la ablación por microondas a 0.38 cm3 des= pués de la ablación por microondas, posterior se realizó un seguimiento en los 24 meses, donde se observó una disminución del volumen de 1.34 cm3 a 0.06 cm3 después de la ablación (Xu et al., 2018).

En otro estudio realizado en China también se usó la ablación por microondas, donde se observó que los pacientes optaron por esta opción ya que la resecc= ión quirúrgica para la mayoría de los pacientes fue difícil de aceptar. Los pacientes en el estudio contaban con un volumen de masa mayor o igual a 2 c= m, dichas lesiones fueron completamente ablacionadas sin lesiones de piel, are= ola o pectoral; sin embargo, existieron limitaciones en pacientes con un volume= n de masa mayor o igual a 3 cm (Cui et al., 2021). Existen varios estudios que confirman que la ablación por microondas es una terapia mínimamente invasiva eficaz para el tratamiento de tumores benignos de mama, con pocos efectos adversos; sin embargo, el monitoreo por ultrasonografía durante el procedimiento de ablación por microondas no es preciso para la ablación completa, pero en el seguimiento de 12 meses se pudo observar una ablación completa del tumor, la mayoría de los tumores presentes en el estudio fueron diagnosticados con fibroadenomas, y otros fueron diagnosticados con otra enfermedad mamaria benigna sólida, aún no existen estudios suficientes que avalen el uso de ablación por microondas como tratamiento para el cáncer de mama (Li et al., 2018).

La crioablación usa el frío extremo para matar las células cancerosas, es un procedimiento ambulatorio bien tolerado que se ha utilizado para tratar pequeños cánceres de mama en pacientes que se consideran malos candidatos p= ara la cirugía (Regen-Tuero et al., 2021). Inicialmente se utilizó para tratar = los fibroadenomas sintomáticos, teniendo un gran éxito, ya que el tratamiento da como resultado una reducción significativa del volumen y más del 80% de los fibroadenomas ya no son palpables un año después del tratamiento, sin embar= go, hay que tener en cuenta ciertas características como el riesgo significativo elevado de ablación localmente incompleta en tumores mayores de 2 cm (Mahnk= en et al., 2018).

Kwak et al. (2022) dan a conocer que en los casos de carcinoma lobulillar multif= ocal no se recomienda la crioablación debido a un mayor riesgo de necrosis grasa= y criolesión en tejidos sanos debido a un tiempo de congelación prolongado. En este estudio también se logró observar que en el cáncer de mama en estadio temprano de menos de 2 cm tuvo una tasa de éxito general del 75,9% y una ta= sa de éxito de 92% en pacientes sin cáncer multifocal, en los pacientes con tumores de mama de menos de 1.5 cm se observó bajas tasas de recurrencia y = un 95% de los pacientes informaron satisfacción con los resultados cosméticos. También hacen énfasis en un cuidado especial para evitar quemaduras en las áreas sensibles alrededor del pezón.

Debido al diagnóstico preciso de cáncer de mama en etapa temprana por resonancia magnética, el ultrasonido focalizado de alta intensidad parece ser aceptado fácilmente entre los pacientes más jóvenes, ya que procede sin cicatrices quirúrgicas, ya que puede suministrar energía con precisión al área sin destruir la integridad de la piel, se mostró una reducción del fibroadenoma= de mama hasta un 43,5% después de 6 meses de tratamiento con ultrasonido focalizado de alta intensidad, y hasta un 72.5% durante el seguimiento de 1 año. Se encontró ablación completa en el 65% de los pacientes, y la tasa de recurrencia local fue del 4.2%, las complicaciones más comunes son quemadur= as en la piel, necrosis, seroma y equimosis (Yao et al., 2022). Sin embargo, o= tro estudio tuvo la queja común de dolor del área de tratamiento durante la ablación de ultrasonido focalizado de alta intensidad, sin quemaduras en la piel, ni lesión cutánea retardada, fiebre o lesión pectoral mayor posterior= a las 72 horas del tratamiento, siendo estos resultados las principales venta= jas por la cual es aceptado cada vez más en pacientes con fibroadenoma de mama, dando buenos resultados para el manejo del dolor, ya que la mayoría de los pacientes con fibroadenoma con dolor previo al tratamiento estaban libres de dolor a los 12 meses de seguimiento (Xiao et al., 2022). Otro estudio nos h= abla que comparable a la resección local, las técnicas ablativas parecen factibl= es siempre que se observe un margen de seguridad de al menos 10 mm, el desafío= de las técnicas ablativas es lograr la ablación total del tumor, incluido un margen de seguridad, a pesar de la que el ultrasonido focalizado de alta intensidad tiene menos efectos secundarios, se deben realizar más estudios = para considerarse como una opción de tratamiento para tumores localizados y en e= tapa temprana, garantizando la ablación completa del tumor (Siedek et al., 2019)= .

Imankulov et al. (2018) asegura que la necrosis de coagulación inducida por el ultrasonido focalizado de alta intensidad y fibrosis posterior del tejido fibroadenoma, permite la eliminación de alta precisión del fibroadenoma y la preservación de tejidos sanos circundantes sin deformación de los contornos mamarios, mejorando así la calidad de vida en comparación con el tratamiento quirúrgico, reduciendo la intensidad del dolor en un 44.7%, llegando a ser = una tendencia prometedora en la medicina para el tratamiento del fibroadenoma mamario en mujeres en edad fértil.

 

Conclusiones

·      =    Las técnicas de ablación son una alternativa prometedora para el tratamiento del cáncer de mama, en especial para mujeres jóvenes en edad fértil y con tumores menores o iguales a 2 cm,= ya que en varios estudios hay resultados positivos en pacientes que tuvieron e= se tamaño de tumores y participaron en el seguimiento posterior a la ablación.= Así como es importante considerar el tamaño del tumor, también es importante la evaluación que se debe hacer al momento de realizar la técnica de ablación.= Las complicaciones que pueden llegar a presentar las mujeres que se someten a e= ste tratamiento como quemaduras en la piel o dolor después del procedimiento ablativo.

·      =    Aunque las técnicas de ablación es la elección de tratamiento en pacientes jóvenes, también tiene una alta tasa de éxito en mujeres mayores de 45, sin embargo, aquí suelen aparecer las complicaciones de dolor, quemaduras de la piel y retracción del pezón de fo= rma más frecuente, pero no graves, por lo que esta población también suele eleg= ir esta opción.

·      =    La ventaja de las técnicas de ablación radica en que no deja cicatriz o es pequeña, el tiempo de procedimiento es corto, se aminora el dolor y la estética de la paciente, además hay una reducción del fibroadenoma hasta un 90% al año de seguimiento. Estas técnic= as dan buen resultado en el tratamiento de cáncer de mama, por lo cual se deben impulsar y elegirlas de acuerdo con el estadio del cáncer.

Conflictos de interés

Los autores del presente artículo científico de revisión bibliográfica manifiestan que no poseen ningún tipo = de conflicto de interés en relación con la presente investigación. =

 

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Yao, R., Hu, J., Zhao, W= ., Cheng, Y., & Feng, C. (2022). A review of high-intensity focused ultrasound as a novel and non-invasive interventional radiology technique= . Journal of interventional medicine, 5(3), 127-132. https://doi.org/10.1016/j.jimed.2022.06.004

Yeo, S. K., & Guan, J.-L. (2017). Breast Cancer: Multiple Subtypes within a Tumor? Trends = in cancer, 3(11), 753-760. https://doi.org/10.1016/j.trecan.2017.09.001<= o:p>

Zhang, Y. N., Xia, K. R., Li, C. Y., Wei, B. L., & Zhang, B. (2021). Review of Breast Cancer Pa= thological Image Processing. BioMed research international, 1994764. https://doi.org/10.1155/2021/1994764

Zhou, W., Yu, M., Pan, H= ., Qiu, W., Wang, H., Qian, M., . . . Wang, S. (2021). Microwave ablation induces Th1-type immune response with activation of ICOS pathway in early-stage breast cancer. Journal for immunotherapy of cancer, 9(= 4), e002343. https://doi.org/10.1136/jitc-2021-002343

3Deditorial1.png<= ![endif]>

 

 

 

 

 

 

 

 

 

 

 

 

 

 

El artículo que se publica es de exclusiva responsabilidad de los autores y no necesariamente reflejan el pensamiento de la Revi= sta Ciencia Digital.

3Deditorial1.png

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 <= /span>

 

El artículo queda en propiedad de la revista y, por tanto, su publicaci= ón parcial y/o total en otro medio tiene que ser autorizado por el director de= la Revista Ciencia Digital.

 

3D"logo_catalogo3b.jpg"
3D"Logo_cicncia_digital
 

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