12
GUNAIKEIA
VOL 18 Nr 4
2013
chirurgisch waren behandeld (p = 0,007). Radiotherapie tot
slot is een risicofactor, maar verhoogt het risico niet verder bij
patiënten die met chemotherapie werden behandeld.
In een prospectieve, niet-gerandomiseerde studie werd een
functionele MRI uitgevoerd bij patiënten onder chemothera-
pie (vooral ECT) of radiotherapie en controlepatiënten. Daarin
werd aangetoond dat de waargenomen verschillen wat de
neurocognitieve functies betreft (geheugen, vermoeidheid)
al bestonden voor de adjuvante chemotherapie en een voor-
spellende waarde hadden wat de ernst van vermoeidheid na
behandeling betreft (38).
Uitgaande van het principe dat botmarkers een hogere agres-
siviteit voor het bot zouden kunnen voorspellen, hebben de
vorsers van de AZURE-studie, een translationele studie, aan-
getoond dat alleen de vitamine D-spiegel een voorspellende
waarde had (39). Bij postmenopauzale vrouwen had toedie-
ning van zoledroninezuur in geval van een vitamine D-spiegel
< 30ng/ml een voorspellende waarde.
In de LOTUS-studie, een Belgische observationele studie van
de doeltreffendheid en de veiligheid van zoledroninezuur over
2 jaar, werd aangetoond dat slechts 37% van de patiënten de
behandeling krijgt volgens het geregistreerde schema. Des-
ondanks was het percentage skeletcomplicaties bevredigend
(0,13/patiënte/jaar) tijdens de 18 maanden van de studie. Het
resultaat was beter bij de patiënten die de behandeling `cor-
rect' kregen (HR = 0,26; p = 0,0009). Er hebben zich geen
onverwachte bijwerkingen voorgedaan. Slechts 16% van de
patiënten kreeg vitamine- en calciumsupplementen (40).
In een studie werd aangetoond dat toevoeging van zoledro-
ninezuur aan een neoadjuvante chemotherapie het pCR ver-
hoogde van 7,9% tot 14,9% (p = 0,16) en van 5,4% tot 18,4%
na de menopauze (p = 0,15) (41).
De incidentie van skeletcomplicaties bij vrouwen met borst-
kanker en botmetastasen tot slot was significant lager met
zoledroninezuur i.v. dan met ibandronaat
per os (0,44 tegen
0,54; p = 0,02) (42).
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