FABIO GUILHERME CASERTA MARYSSAEL DE CAMPOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
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Agora exibindo 1 - 5 de 5
- José Hyppolito da Silva (1938-2011)(2012) CAMPOS, Fábio Guilherme Caserta Maryssael de; SILVA, Galdino José Sintonio da
- Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation Long-Term Results of a Prospective Trial (National Clinical Trial 00254683)(2012) PEREZ, Rodrigo Oliva; HABR-GAMA, Angelita; GAMA-RODRIGUES, Joaquim; PROSCURSHIM, Igor; JULIAO, Guilherme Pagin Sao; LYNN, Patricio; ONO, Carla Rachel; CAMPOS, Fabio Guilherme; SOUSA JR., Afonso Henrique Silva e; IMPERIALE, Antonio Rocco; NAHAS, Sergio Carlos; BUCHPIGUEL, Carlos AlbertoBACKGROUND: Neoadjuvant chemoradiation (CRT) therapy may result in significant tumor regression in patients with rectal cancer. Patients who develop complete tumor regression have been managed by treatment strategies that are alternatives to standard total mesorectal excision. Therefore, assessment of tumor response with positron emission tomography/computed tomography (PET/CT) after neoadjuvant treatment may offer relevant information for the selection of patients to receive alternative treatment strategies. METHODS: Patients with clinical T2 (cT2) through cT4NxM0 rectal adenocarcinoma were included prospectively. Neoadjuvant therapy consisted of 54 grays of radiation and 5-fluorouracil-based chemotherapy. Baseline PET/CT studies were obtained before CRT followed by PET/CT studies at 6 weeks and 12 weeks after the completion of CRT. Clinical assessment was performed at 12 weeks after CRT completion. PET/CT results were compared with clinical and pathologic data. RESULTS: In total, 99 patients were included in the study. Twenty-three patients were complete responders (16 had a complete clinical response, and 7 had a complete pathologic response). The PET/CT response evaluation at 12 weeks indicated that 18 patients had a complete response, and 81 patients had an incomplete response. There were 5 false-negative and 10 false-positive PET/CT results. PET/CT for the detection of residual cancer had 93% sensitivity, 53% specificity, a 73% negative predictive value, an 87% positive predictive value, and 85% accuracy. Clinical assessment alone resulted in an accuracy of 91%. PET/CT information may have detected misdiagnoses made by clinical assessment alone, improving overall accuracy to 96%. CONCLUSIONS: Assessment of tumor response at 12 weeks after CRT completion with PET/CT imaging may provide a useful additional tool with good overall accuracy for the selection of patients who may avoid unnecessary radical resection after achieving a complete clinical response. Cancer 2012;35013511. (C) 2011 American Cancer Society.
- Optimal Timing for Assessment of Tumor Response to Neoadjuvant Chemoradiation in Patients With Rectal Cancer: Do All Patients Benefit From Waiting Longer Than 6 Weeks?(2012) PEREZ, Rodrigo O.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; GAMA-RODRIGUES, Joaquim; SOUSA JR., Afonso H. S.; CAMPOS, Fabio Guilherme; IMPERIALE, Antonio R.; LYNN, Patricio B.; PROSCURSHIM, Igor; NAHAS, Sergio Carlos; ONO, Carla Rachel; BUCHPIGUEL, Carlos AlbertoPurpose: To estimate the metabolic activity of rectal cancers at 6 and 12 weeks after completion of chemoradiation therapy (CRT) by 2-[fluorine-18] fluoro-2-deoxy-D-glucose-labeled positron emission tomography/computed tomography ([18 FDG] PET/CT) imaging and correlate with response to CRT. Methods and Materials: Patients with cT2-4N0-2M0 distal rectal adenocarcinoma treated with long-course neoadjuvant CRT (54 Gy, 5-fluouracil-based) were prospectively studied (ClinicalTrials. org identifier NCT00254683). All patients underwent 3 PET/CT studies (at baseline and 6 and 12 weeks fromCRT completion). Clinical assessment was at 12 weeks. Maximal standard uptakevalue (SUVmax) of the primary tumor wasmeasured and recorded at eachPET/CTstudy after 1 h (early) and3 h (late) from 18 FDGinjection. Patientswith an increase in early SUVmax between 6 and 12 weeks were considered "" bad"" responders and the others as ""good"" responders. Results: Ninety-one patients were included; 46 patients (51%) were ""bad"" responders, whereas 45 (49%) patients were "" good"" responders. "" Bad"" responders were less likely to develop complete clinical response (6.5% vs. 37.8%, respectively; PZ. 001), less likely to develop significant histological tumor regression (complete or near-complete pathological response; 16% vs. 45%, respectively; PZ. 008) and exhibited greater final tumor dimension (4.3cmvs. 3.3cm; PZ. 03). Decrease between early (1 h) and late (3 h) SUVmax at 6-week PET/CTwas a significant predictor of "" good"" response (accuracy of 67%). Conclusions: Patients who developed an increase in SUVmax after 6 weeks were less likely to develop significant tumor downstaging. Early-late SUVmax variation at 6-week PET/CT may help identify these patients and allow tailored selection of CRT-surgery intervals for individual patients. (C) 2012 Elsevier Inc.
- Abdominoperineal Excision: Evolution of a Centenary Operation(2012) CAMPOS, Fabio Guilherme; HABR-GAMA, Angelita; NAHAS, Sergio Carlos; PEREZ, Rodrigo OlivaDuring the last century, great improvements have been made in rectal cancer management regarding preoperative staging, pathologic assessment, surgical technique, and multimodal therapies. Surgically, there was a move from a strategy characterized by simple perineal excision to complex procedures performed by means of a laparoscopic approach, and more recently with the aid of robotic systems. Perhaps the most important advance is that rectal cancer is no longer a fatal disease as it was at the beginning of the 20th century. This achievement is definitely due in part to Ernest Mile's contribution regarding lymphatic spread of tumor cells, which helped clarify the natural history of the disease and the proper treatment alternatives. He advocated a combined approach with the rationale to clear ""the zone of upward spread."" The aim of the present paper is to present a brief review concerning the evolution of rectal cancer surgery, focusing attention on Miles' abdominoperineal excision of the rectum (APR) and its controversies and refinements over time. Although APR has currently been restricted to a small proportion of patients with low rectal cancer, recent propositions to excise the rectum performing a wider perineal and a proper pelvic floor resection have renewed interest on this procedure, confirming that Ernest Miles' original ideas still influence rectal cancer management after more than 100 years.
bookPart Videocirurgia colorretal por acesso único(2012) ARAUJO, Sergio Eduardo Alonso; SEID, Victor Edmond; CAMPOS, Fábio Gulherme; BERTONCINI, Alexandre Bruno; ALVES, Aline Marcílio; HORCEL, Lucas de Araujo; NAHAS, Sergio Carlos; CECCONELLO, Ivan