Neoadyuvancia en cáncer de mama

Autores/as

  • Ricardo Brugés Instituto Nacional de Cancerología
  • Luis Hernán Guzmán Instituto Nacional de Cancerología
  • Oswaldo Sánchez Instituto Nacional de Cancerología
  • Sandra Díaz Instituto Nacional de Cancerología
  • Édgar Vergara Instituto Nacional de Cancerología

Palabras clave:

neoplasias de la mama, terapia neoadyuvante, protocolos antineoplásicos, trastuzumab, lapatinib, bevacizumab, tamoxifeno, tasas de supervivencia, supervivencia libre de enfermedad

Resumen

El tratamiento neoadyuvante —también denominado “terapia primaria sistémica” o “terapia preoperatoria”— tiene cuatro finalidades en cáncer de mama: disminuir el volumen tumoral para hacer operable lo que antes era inoperable, mejorar las probabilidades para hacer una cirugía conservativa, analizar la quimiosensibilidad in vivo y evaluar el manejo de las micrometástasis. Esta revisión descriptiva toma en cuenta los principales estudios clínicos sobre terapia sistémica neoadyuvante publicados hasta mayo del 2009.

Biografía del autor/a

Ricardo Brugés, Instituto Nacional de Cancerología

Instituto Nacional de Cancerología. Bogotá, Colombia.

Luis Hernán Guzmán, Instituto Nacional de Cancerología

Instituto Nacional de Cancerología. Bogotá, Colombia.

Oswaldo Sánchez, Instituto Nacional de Cancerología

Instituto Nacional de Cancerología. Bogotá, Colombia.
Hospital San Ignacio. Bogotá, Colombia.

Sandra Díaz, Instituto Nacional de Cancerología

Instituto Nacional de Cancerología. Bogotá, Colombia.

Édgar Vergara, Instituto Nacional de Cancerología

Instituto Nacional de Cancerología. Bogotá, Colombia.

Referencias bibliográficas

Kaufmann M, Hortobagyi G, Goldhirsch A, Scholl S, Makris A, Valagussa P, et al. Recommendations from an International Expert Panel on the use of neoadjuvant (Primary) systemic treatment of operable breast cancer: an update. J Clin Oncol. 2006;24(12):1940-9.

https://doi.org/10.1200/JCO.2005.02.6187

República de Colombia; Ministerio de la Protección Social; Instituto Nacional de Cancerología. Anuario estadístico 2007. Bogotá: Legis; 2008.

Charfare H, Limongelli S, Purushotham AD. Neoadjuvant chemotherapy in breast cancer. Br J Surg. 2005;92(1):14-23.

https://doi.org/10.1002/bjs.4840

Bafaloukos D. Neo-adjuvant therapy in breast cancer. Ann Oncol. 2005;16 Suppl 2: ii174-81.

https://doi.org/10.1093/annonc/mdi704

van der Hage JA, van de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol. 2001;19(22):4224-37.

https://doi.org/10.1200/JCO.2001.19.22.4224

Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16(8):2672-85.

https://doi.org/10.1200/JCO.1998.16.8.2672

Chevallier B, Roche H, Olivier JP, Chollet P, Hurteloup P. Inflammatory breast cancer: Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histology response rate. Am J Clin Oncol. 1993;16(3):223-8.

https://doi.org/10.1097/00000421-199306000-00006

Sinn HP, Schmid H, Junkermann H, Huober J, Leppien G, Kaufmann M, et al: Histologische regression des mammakarzinoms nach primarer (neoadjuvanter) Chemotherapie. Geburtsh Frauenheilk. 1994;54:552-8.

https://doi.org/10.1055/s-2007-1022338

Sataloff DM, Mason BA, Prestipino AJ, Seinige UL, Lieber CP, Baloch Z. Pathologic response to induction chemotherapy in locally advanced carcinoma of the breast: A determinant of outcome. J Am Coll Surg. 1995;180(3):297-306.

Honkoop AH, van Diest PJ, de Jong JS, Linn SC, Giaccone G, Hoekman K, et al. Prognostic role of clinical, pathological and biological characteristics in patients with locally advanced breast cancer. Br J Cancer. 1998;77(4):621-6.

https://doi.org/10.1038/bjc.1998.99

Kuerer HM, Newman LA, Smith TM, Ames FC, Hunt KK, Dhingra K, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17(2):460-9.

https://doi.org/10.1200/JCO.1999.17.2.460

Pierga JY, Mouret E, Dieras V, Laurence V, Beuzeboc P, Dorval T, et al. Prognostic value of persistent node involvement after neo adjuvant chemotherapy in patients with operable breast cancer. Br J Cancer. 2000;83(11):1480-7.

https://doi.org/10.1054/bjoc.2000.1461

Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003;12(5):320-7.

https://doi.org/10.1016/S0960-9776(03)00106-1

Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer. 1981;47(1):207-14.

https://doi.org/10.1002/1097-0142(19810101)47:1<207::AID-CNCR2820470134>3.0.CO;2-6

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228-47.

https://doi.org/10.1016/j.ejca.2008.10.026

Bonadonna G, Veronesi U, Brambilla C Ferrari L, Luini A, Greco M, et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst. 1990;82(19):1539-45.

https://doi.org/10.1093/jnci/82.19.1539

Gardin G, Rosso R, Campora E, Repetto L, Naso C, Canavese G, et al. Locally advanced non-metastatic breast cancer: Analysis of prognostic factors in 125 patients homogenously treated with a combined modality approach. Eur J Cancer. 1995;31A(9):1428-33.

https://doi.org/10.1016/0959-8049(95)00199-S

Smith IE, Walsh G, Jones A, Prendiville J, Johnston S, Gusterson B, et al. High complete remission rates with primary neoadjuvant infusional chemotherapy for large early breast cancer. J Clin Oncol. 1995;13(2):424-9.

https://doi.org/10.1200/JCO.1995.13.2.424

Chollet P, Charier S, Brain E, Curé H, van Praagh I, Feillel V, et al. Clinical and pathological response to primary chemotherapy in operable breast cancer. Eur J Cancer. 1997;33(6):862-6.

https://doi.org/10.1016/S0959-8049(97)00038-5

Jacquillat C, Weil M, Baillet F, Borel C, Auclerc G, de Maublanc M, et al. Results of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer. 1990;66(1):119-29.

https://doi.org/10.1002/1097-0142(19900701)66:1<119::AID-CNCR2820660122>3.0.CO;2-3

Amat S, Bougnoux P, Penault-Llorca F, Fetissof F, Curé H, Kwiatkowski F, et al. Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breastconservation rate. Br J Cancer. 2003;88(9):1339-45.

https://doi.org/10.1038/sj.bjc.6600916

Belembaogo E, Feillel V, Chollet P, Curé H, Verrelle P, Kwiatskowski F, et al. Neoadjuvant chemotherapy in 126 operable breast cancers. Eur J Cancer. 1992;28A(4-5): 896-900.

https://doi.org/10.1016/0959-8049(92)90145-R

Schwartz GF, Cantor RI, BiermannWA. Neoadjuvant chemotherapy before definitive treatment for stage III carcinoma of the breast. Arch Surg. 1987;122(12):1430-4.

https://doi.org/10.1001/archsurg.1987.01400240078014

Mieog JSD, van der Hage JA, van de Velde CJH. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. 2007;18(2):CD005002.

https://doi.org/10.1002/14651858.CD005002.pub2

Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188-94.

https://doi.org/10.1093/jnci/dji021

Semiglazov VF, Topuzov EE, Bavli JL, Moiseyenko VM, Ivanova OA, Seleznev IK, et al. Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb-IIIa breast cancer. Ann Oncol. 1994;5(7):591-5.

https://doi.org/10.1093/oxfordjournals.annonc.a058929

Mauriac L, Durand M, Avril A, Dilhuydy JM. Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm. Results of a randomized trial in a single centre. Ann Oncol. 1991;2(5):347-54.

https://doi.org/10.1093/oxfordjournals.annonc.a057953

Mauriac L, MacGrogan G, Avril A, Durand M, Floquet A, Debled M, et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS). Ann Oncol. 1999;10(1):47-52.

https://doi.org/10.1023/A:1008337009350

Scholl SM, Fourquet A, Asselain B, Pierga JY, Vilcoq JR, Durand JC, et al. Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6. Eur J Cancer. 1994;30A(5):645-52.

https://doi.org/10.1016/0959-8049(94)90537-1

Scholl SM, Pierga JY, Asselain B, Beuzeboc P, Dorval T, Garcia-Giralt E, et al. Breast tumour response to primary chemotherapy predicts local and distant control as well as survival. Eur J Cancer. 1995;31A(12):1969-75.

https://doi.org/10.1016/0959-8049(95)00454-8

Scholl SM, Asselain B, Palangie T, Dorval T, JouveM, GarciaGiral E, et al. Neoadjuvant chemotherapy in operable breast cancer. Eur J Cancer. 1991;27(12):1668-71.

https://doi.org/10.1016/0277-5379(91)90442-G

Powles TJ, Hickish TF, Makris A, Ashley SE, O'Brien ME, Tidy VA, et al. Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol. 1995;13(3):547-52.

https://doi.org/10.1200/JCO.1995.13.3.547

Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;(30):96-102.

https://doi.org/10.1093/oxfordjournals.jncimonographs.a003469

Avril A, Faucher A, Bussières E, Stöckle E, Durand M, Mauriac L, et al. Results of 10 years of a randomized trial of neoadjuvant chemotherapy in breast cancers larger than 3 cm. Chirurgie. 1998;123(3):247-56.

https://doi.org/10.1016/S0001-4001(98)80116-5

Cleator SJ, Makris A, Ashley SE, Lal R, Powles TJ. Good clinical response of breast cancers to neoadjuvant chemoendocrine therapy is associated with improved overall survival. Ann Oncol. 2005;16(2):267-72.

https://doi.org/10.1093/annonc/mdi049

Makris A, Powles TJ, Ashley SE, Chang J, Hickish T, Tidy VA, et al. A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer. Ann Oncol. 1998;9(11):1179-84.

https://doi.org/10.1023/A:1008400706949

Gazet JC, Ford HT, Gray R, McConkey C, Sutcliffe R, Quilliam J, et al. Estrogen-receptor-directed neoadjuvant therapy for breast cancer: results of a randomised trial using formestane and methotrexate, mitozantrone and mitomycin C (MMM) chemotherapy. Ann Oncol. 2001;12(5):685-91.

https://doi.org/10.1023/A:1011115107615

Danforth DN Jr, Cowan K, Altemus R, Merino M, Chow C, Berman A, et al. Preoperative FLAC/granulocytecolony-stimulating factor chemotherapy for stage II breast cancer: a prospective randomized trial. Ann Surg Oncol. 2003;10(6):635-44.

https://doi.org/10.1245/ASO.2003.12.008

Deo SV, Bhutani M, Shukla NK, Raina V, Rath GK, Purkayasth J. Randomized trial comparing neo-adjuvant versus adjuvant chemotherapy in operable locally advanced breast cancer (T4b N0-2 M0). J Surg Oncol. 2003;84(4):192-7.

https://doi.org/10.1002/jso.10323

Forouhi P, Dixon JM, Leonard RC, Chetty U. Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer. Br J Surg. 1995;82(1):79-82.

https://doi.org/10.1002/bjs.1800820127

Enomoto K, Ikeda T, Matsui A, Kitajima M, Koh J, Masamura S, et al. Neoadjuvant therapy in stage IIwith Toe=4CMand stage III breast cancer. 6th International Conference Adjuvant therapy for Primary Breast Cancer St Gallen. 1998:P73.

https://doi.org/10.1016/S0959-8049(97)89290-8

Bulotiene G, Veseliunas J, Ostapenko V. Quality of life of Lithuanian women with early stage breast cancer. BMC Public Health. 2007;26;7:124.

https://doi.org/10.1186/1471-2458-7-124

Buzdar AU, Singletary SE, Theriault RL, Booser DJ, Valero V, Ibrahim N, et al. Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer. J Clin Oncol. 1999;17(11):3412-7.

https://doi.org/10.1200/JCO.1999.17.11.3412

Bear HD, Anderson S, Smith RE et al. A randomized trial comparing preoperative doxorubicin/cyclophosphamide (AC) to preoperative AC followed by preoperat ive docetaxel (T) and to preoperative AC fol lowed by postoperative T in patients with operable carcinoma of the breast: results of NSABP B-27. San Antonio Breast Cancer Symposium 2004, San Antonio, Texas, December 8-11, 2004.

Bear HD, Anderson S, Smith RE, Geyer CE, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project protocol B-27. J Clin Oncol. 2006;24(13):2019-27.

https://doi.org/10.1200/JCO.2005.04.1665

Evans TR, Yellowlees A, Foster E, Earl H, Cameron DA, Hutcheon AW, et al. Phase III randomized trial of doxorubicin and docetaxel versus doxorubicin and cyclophosphamide as primary medical therapy in women with breast cancer: an Anglo-Celtic Cooperative Oncology Group Study. J Clin Oncol. 2005;23(13):2988-95.

https://doi.org/10.1200/JCO.2005.06.156

von Minckwitz G, Raab G, Caputo A, Schütte M, Hilfrich J, Blohmer JU, et al. Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: the GEPARDUO study of the German Breast Group. J Clin Oncol. 2005;23(12):2676-85.

https://doi.org/10.1200/JCO.2005.05.078

Untch M, Konecny G, Ditsch N et al. Dose-dense sequential epirubicin paclitaxel as preoperative treatment of breast cancer: results of a randomized AGO study. Proc Am Soc Clin Oncol. 2002;21:133a.

Sachelarie I, Grossbard ML, Chadha M, Feldman S, Ghesani M, Blum R. Primary systemic therapy of breast cancer. Oncologist. 2006;11(6):574-89.

https://doi.org/10.1634/theoncologist.11-6-574

Green MC, Buzdar AU, Smith T, Ibrahim NK, Valero V, Rosales MF, et al. Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol. 2005;23(25):5983-92.

https://doi.org/10.1200/JCO.2005.06.232

Henderson IC, Berry DA, Demetri GD, Cirrincione CT, Goldstein LJ, Martino S, et al. Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol. 2003;21(6):976-83.

https://doi.org/10.1200/JCO.2003.02.063

Trudeau M, Sinclair S, Clemons M, Shelley W; Breast Cancer Disease Site Group. The role of taxanes in neoadjuvant chemotherapy for women with non-metastatic breast cancer Practice Guideline Report #1-20. Ontario: Cancer Care Ontario; 2004.

Loibl S, von Minckwitz G, Harbeck N, Janni W, Elling D, Kaufmann M, et al. Clinical feasibility of (neo)adjuvant taxane-based chemotherapy in older patients: analysis of >4,500 patients from four German randomized breast cancer trials. Breast Cancer Res. 2008;10(5):R77.

https://doi.org/10.1186/bcr2144

Gazet JC, Ford HT, Coombes RC, Bland JM, Sutcliffe R, Quilliam J, et al. Prospective randomized trial of tamoxifen vs surgery in elderly patients with breast cancer. Eur J Surg Oncol. 1994;20(3):207-14.

Fentiman IS, Christiaens MR, Paridaens R, van Geel A, Rutgers E, Berner J, et al. Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10851. Comparing tamoxifen alone with modified radical mastectomy. Eur J Cancer. 2003;39(3):309-16.

https://doi.org/10.1016/S0959-8049(02)00673-1

Fennessy M, Bates T, MacRae K, Riley D, Houghton J, Baum M, et al. Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancer. Br J Surg. 2004;91(6):699-704.

https://doi.org/10.1002/bjs.4603

Ellis MJ, Ma C. Letrozole in the neoadjuvant setting: the P024 trial. Breast Cancer Res Treat. 2007;105 Suppl 1:33-43. Epub 2007 Oct 3. Erratum in: Breast Cancer Res Treat. 2008 Nov;112(2):371.

https://doi.org/10.1007/s10549-007-9701-x

Eiermann W, Paepke S, Appfelstaedt J, Llombart-Cussac A, Eremin J, Vinholes J, et al. Preoperative treatment of postmenopausal breast cancer patients with letrozole: randomized double-blind multicenter study. Ann Oncol. 2001;12(11):1527-32.

https://doi.org/10.1023/A:1013128213451

De la Garza JG, Bargallo E, Solorio C, Ramírez T, Salazar F, Sánchez J. Multicentric study with neoadjuvant endocrine therapy for breast conserving surgery. Experience in Mexico; 2008 Dic 13; San Antonio: San Antonio Breast Cancer.

https://doi.org/10.1158/0008-5472.SABCS-5119

Smith, IE, Dowsett, M, Ebbs, SR, Dixon JM, Skene A, Blohmer JU, et al. Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial. J Clin Oncol. 2005; 23(22):5108-16.

https://doi.org/10.1200/JCO.2005.04.005

Cataliotti L, Buzdar AU, Noguchi S, Bines J, Takatsuka Y, Petrakova K, et al. Comparison of anastrozole versus tamoxifen as preoperative therapy in postmenopausal women with hormone receptor-positive breast cancer: the Pre-Operative "Arimidex" Compared to Tamoxifen (PROACT) Trial. Cancer. 2006;106(10):2095-103.

https://doi.org/10.1002/cncr.21872

Krainick U, Astner A, Jonat W, Wallwiener D. Phase II study to define safety and efficacy of exemestane as preoperative therapy for post menopausal patient with primary breast cancer-final results of the German Neoadjuvant Aromasin Initiative (GENARI). Breast Cancer Rest Treat. 2003;82 suppl 1:S55.

Semiglazov VV, Semiglazov VF, Dashyan GA, Ziltsova EK, Ivanov VG, Bozhok AA, et al. Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor positive breast cancer. Cancer. 2007;110(2):244-54.

https://doi.org/10.1002/cncr.22789

Burstein HJ, Harris LN, Gelman R, Lester SC, Nunes RA, Kaelin CM, et al. Preoperative therapy with trastuzumab and paclitaxel followed by sequential adjuvant doxorubicin/ciclophosphamide for HER2 over expressing stage II or III breast cancer: pilod study. Clin Oncol. 2003;21(1):46-53.

https://doi.org/10.1200/JCO.2003.03.124

Hurley J, Dolini P, Reis I, Silva O, Gómez-Fernández C, Vélez P, et al. Docetaxel, cisplatin, and trastuzumab as primary systemic therapy for human epidermal grow factor receptor 2-positive locally advanced breast cancer. J Clin Oncol. 2006;24(12):1831-8.

https://doi.org/10.1200/JCO.2005.02.8886

Buzdar AU, Ibrahim NK, Francis D, Booser DJ, Thomas ES, Theriault RL, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel and epirubicin chemotherapy: results of a randomized trial in human epidermal grow factor receptor 2- positive operable breast cancer. J Clin Oncol. 2005;23(16):3676-85.

https://doi.org/10.1200/JCO.2005.07.032

Coudert BP, Largillier R, Arnould L, Chollet P, Campone M, Coeffic D, et al. Multicenter phase II trial of neoadjuvant therapy with trastuzumab, docetaxel and carboplatin for human epidermal grow factor receptor 2- over expressing stage II or III breast cancer: results of the GENT (A)-1 trial. J Clin Oncol. 2007;25(19):2678-84.

https://doi.org/10.1200/JCO.2006.09.9994

Greil R, Moik M, Reitsamen R, Ressler S, Stoll M, Namberger K, et al. Neoadjuvant, docetaxel and capecitabine combination therapy for HER2/neu negative invasive breast- cancer: Efficacy and safety in phase II pilot study. EJSO. 2009;35(10):1048-54.

https://doi.org/10.1016/j.ejso.2009.01.014

Makhoul I, Vicki KS, Korourian S, Henry-Tillman RS. Bevacizumab combined with chemotherapy significantly improves pathologic complete response in patients with operable or locally advanced breast cancer. SABCS. 2008.

https://doi.org/10.1158/0008-5472.SABCS-5114

Madarnas Y, Trudeau M, Franek JA, McCready D, Pritchard KI, Messersmith H. Adjuvant/neoadjuvant trastuzumab therapy in women with HER2/neu overexpressing breast cancer: a systematic review. Cancer Treat Rev. 2008;34(6):539-57.

https://doi.org/10.1016/j.ctrv.2008.03.013

Miller WR, Bartlett J, Brodie A, Brueggemeier RW, di Salle E, Lønning PE, et al. Aromatase Inhibitors: Are there differences between steroidal and nonsteroidal aromatase inhibitors and do they matter? The Oncologist. 2008;13:829-37.

https://doi.org/10.1634/theoncologist.2008-0055

Cómo citar

[1]
Brugés, R. et al. 2009. Neoadyuvancia en cáncer de mama . Revista Colombiana de Cancerología. 13, 3 (sep. 2009), 157–174.

Descargas

Los datos de descargas todavía no están disponibles.

Descargas

Publicado

01-09-2009

Número

Sección

Artículos de revisión