Carcinoma Occulto (Cup Syndrome)

Il carcinoma occulto della mammella è una manifestazione rara, rappresenta meno dell’1% di tutti i tumori mammari, è caratterizzata da metastasi linfonodali ascellari in assenza di lesioni mammarie

rilevabili all’esame clinico e strumentale (35). La prognosi sembrerebbe essere migliore di quella

osservata per lesioni non occulte con il medesimo interessamento linfonodale (stadi II-III); in molte

serie pubblicate l’unico fattore prognostico determinante è il numero di linfonodi positivi, con

risultati peggiori in caso di 4 o più linfonodi interessati. (36). La linfoadenectomia ascellare riveste un ruolo essenziale mentre il trattamento della mammella omolaterale rimane tuttora controverso, basato su dati di serie retrospettive, spesso eterogenee e con scarsa numerosità.

Le opzioni terapeutiche sono rappresentate dalla mastectomia (37), che nel 30% dei casi si associa ad un mancato riscontro del tumore primitivo o , sempre più frequentemente , dalla dissezione ascellare radicale senza alcuna chirurgia sulla mammella, seguita poi da radioterapia whole breast e chemioterapia ( 38).

Non esistono studi prospettici che confrontino mastectomia e radioterapia; entrambi i trattamenti consentono di ottenere il controllo locale nel 75-100% dei casi (35). Studi retrospettivi mostrano un significativo miglioramento della sopravvivenza per il gruppo di pazienti sottoposte a radioterapia adiuvante. Il beneficio della radioterapia si osserva sia dopo mastectomia che dopo chirurgia

conservativa sia con l’irradiazione dei linfonodi regionali (37,38).

Relativamente alla metodologia del trattamento radiante i dati di letteratura riflettono estrema eterogeneità nei volumi di irradiazione utilizzati (mammella +/- drenaggi linfonodali), nel frazionamento convenzionale vs ipofrazionamento e nella dose ottimale da somministrare (50 Gy in 25 frazioni vs 60 Gy in 30 o dosi equivalenti in ipofrazionamento) (37). Dosi più elevate non hanno dimostrato un superiore controllo locale. In ogni caso si consiglia di irradiare la mammella in toto per migliorare il controllo locale (39).

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