QUIMIOTERAPIA DE ALTAS DOSES E TRANSPLANTE AUTÓLOGO DE MEDULA ÓSSEA NO TRATAMENTO DE CÂNCER DE MAMA: REVISÃO DA LITERATURA E EXPERIÊNCIA PRELIMINAR DO GRUPO DE QUIMIOTERAPIA DE ALTAS DOSES DO HOSPITAL SAMARITANO
Palavras-chave:
Câncer de mama, Transplante autólogo de medulaResumo
O câncer de mama quando metastático é considerado incurável com quimioterapia
em doses convencionais. Com o intuito de aumentar a sua curabilidade, concebeu-se
o uso de Altas Doses de Quimioterapia (ADQT) para algumas pacientes portadoras de
câncer de mama avançado. Estudos preliminares com esta modalidade terapêutica
demonstraram a possibilidade de se produzir cerca de 20% de sobrevida livre de doença
em pacientes com metástases. Tais resultados encorajadores motivaram o estudo da
ADQT em mulheres com doença completamente ressecada, porém de alto risco para
recaída. Paralelamente a estes estudos, os riscos e custos deste procedimento diminuíram
após a recente incorporação dos fatores de crescimento hematopoéticos (FHC) e das
células progenitoras hematopoéticas (CPH) coletadas do sangue periférico. Tais
avanços abreviaram significativamente o período de aplasia subseqüente à ADQT.
Entretanto, este procedimento, hoje factível em grande número de centros médicos,
encontra uma aplicabilidade potencial crescente nestas pacientes sem que, até o
momento, seu exato papel na terapêutica destas mulheres tenha sido bem definido.
Nosso intuito neste artigo é, através de um exame da literatura pertinente, colocar o
leitor diante das controvérsias que envolvem a utilização deste procedimento nas
pacientes com câncer de mama. Para isso, discutiremos inicialmente as bases teóricas
desta modalidade terapêutica e, em seguida, a experiência da literatura com a sua
aplicação nestas pacientes. Neste contexto, apresentaremos nossos resultados preliminares
com ADQT em pacientes com câncer de mama metastático e, finalmente, abordaremos as
futuras direções que a pesquisa nesta área irá provavelmente seguir nos próximos anos.
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