Cancro al seno: si bada troppo poco all’estetica?

Pubblicato il 8 Novembre 2012 da AndosVelletri

Con il numero crescente di guarigioni è sempre più importante salvaguardare, quando possibile, l’aspetto estetico.

MILANO – La domanda viene sollevata da due studi presentati nei giorni scorsi a Vienna durante il congresso della Società europea di oncologia medica (Esmo): a fronte dei molti progressi nelle terapie, sempre più donne curate per un carcinoma mammario possono fortunatamente mantenere integro il proprio seno, ma a quante viene davvero proposta l’opzione chirurgica conservativa? Non abbastanza, secondo gli esiti della ricerca di Carmen Criscitiello e colleghi dell’Istituto europeo di oncologia di Milano, che hanno analizzato i dati relativi a quasi 450 donne operate per un tumore dopo essersi sottoposte a diversi tipi di terapia neoadiuvante (ovvero la chemioterapia effettuata prima della chirurgia per ridurre le dimensioni del tumore e facilitarne l’asportazione).

CHIRURGHI TROPPO PRUDENTI? – Nonostante i buoni risultati ottenuti con il trattamento neoadiuvante in molte partecipanti alla sperimentazione, la percentuale di operazioni conservative si aggira intorno al 40 per cento, indipendentemente dal tipo di farmaci ricevuti. «Per quanto soddisfacenti siano i risultati ottenuti con la chemio preoperatoria – chiarisce Criscitiello -, anche di fronte a una risposta completa, questi non si traducono in un numero crescente di interventi che preservano il seno. In pratica sono le caratteristiche del tumore prima della chemio che giocano il ruolo cruciale nel decidere quale tipo di intervento chirurgico eseguire, a prescindere da quanto si riesce ad ottenere con il trattamento neoadiuvante». L’atteggiamento di molti medici, secondo gli autori, sarebbe quindi ancora troppo prudente. «In parte è vero – commenta Franco Di Filippo, direttore della Chirurgia generale e della mammella all’Istituto Tumori Regina Elena di Roma – c’è una certa reticenza dei chirurghi. Va però anche detto che un atteggiamento di prudenza è spesso ragionevole perché dettato dal dubbio: e se esistono delle cellule cancerose non visibili? A quel punto molti colleghi preferiscono ampliare l’asportazione. Per verificare l’efficacia di un intervento conservativo e ampliare la resezione solo se necessario si possono però eseguire controlli istologici intraoperatori. Per questo è bene farsi curare in centri dove sono presenti adeguate strumentazioni e specialisti con esperienza».

L’ESTETICA DOPO CHEMIO E RADIO – Sempre pensando all’importanza del benessere psicofisico delle pazienti dopo la malattia, una ricerca inglese ha analizzato le conseguenze estetiche lasciate da chemio e radioterapia effettuate congiuntamente nelle donne a rischio di recidiva. Valutando i dati clinici, l’aspetto fisico e lo stato psicologico di oltre 300 pazienti operate per un carcinoma mammario e poi sottoposte a chemio e radio in sequenza o in contemporanea fra loro, gli studiosi inglesi della University Hospitals Birmingham NHS Foundation Trust hanno appurato che eseguire entrambi i trattamenti insieme non crea problemi o danni maggiori alla pelle e all’estetica generale del seno. «Se ulteriori studi confermeranno questo dato – ha commentato Michael Gnant, chirurgo oncologo della Vienna Medical University – potremo considerarlo un nuovo standard: le donne con un carcinoma in stadio iniziale si potranno sottoporre alle cure congiunte, con tempi più rapidi e senza conseguenze estetiche negative».

Vera Martinella (Fondazione Veronesi)

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