GEORGE BARBERIO COURA FILHO

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/43 - Laboratório de Medicina Nuclear, Hospital das Clínicas, Faculdade de Medicina

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  • article 5 Citação(ões) na Scopus
    Evaluation of Parotid Salivary Gland Echo Texture by Ultrasound Examinations and Correlation With Whole-Body Scintigraphy After Radioiodine Therapy in Patients With Differentiated Thyroid Carcinoma
    (2020) LIMA, Graziele Aparecida Simoes; LOPEZ, Rossana Veronica Mendoza; FREITAS, Ricardo Miguel Costa de; WILLEGAIGNON, Jose; SAPIENZA, Marcelo Tatit; CHAMMAS, Maria Christina; COURA-FILHO, George Barberio
    Objectives This study aimed to evaluate the echo texture of the parotid salivary glands before and after radioiodine therapy (RIT) using ultrasound (US) images in patients with differentiated thyroid cancer and to evaluate the correlations between post-RIT whole-body scintigraphy (WBS) images and US image patterns in salivary and cervical areas. Methods A retrospective study was performed with data on demographic and clinical information, US examinations, and WBS images collected through medical recordings. Results Comparing the US features before and after RIT, significant echo texture heterogeneity was found in 31.3% of all patients evaluated. When evaluated according to the level of iodine 131 (I-131) radioactivity (<5.6, 5.6-<9.3, and >= 9.3 GBq), echo texture heterogeneity was significantly associated with the 5.6-GBq I-131 radioactivity group (P < .001). No association was found for any level of I-131 post-RIT WBS uptake intensity and changes in US feature patterns. Conclusions Ultrasound may be a useful tool for evaluating chronic sialadenitis after RIT, and the I-131 uptake intensity using a routine post-RIT WBS is not associated with US echo texture changes.
  • article 12 Citação(ões) na Scopus
    Clinical and Dosimetric Variables Related to Outcome After Treatment of Graves' Disease With 550 and 1110 MBq of I-131
    (2015) SAPIENZA, Marcelo Tatit; COURA-FILHO, George Barberio; WILLEGAIGNON, Jose; WATANABE, Tomoco; DUARTE, Paulo Schiavom; BUCHPIGUEL, Carlos Alberto
    Therapy of Graves' hyperthyroidism (HTG) with I-131 is still mostly performed on an empirical basis. The present study was carried out to evaluate clinical and dosimetric variables associated with outcome in HTG therapy, which could contribute to planning and defining the most appropriate activity to be administered. Methods Patients with HTG were randomly assigned to therapy with 555 MBq (15mci) or 1110 MBq (30 mCi) of I-131. Estimation of thyroid radiation absorbed dose was made according to MIRD methodology. Success was defined as clinical/laboratory euthyroidism or hypothyroidism one year after therapy. The association between clinical, laboratory, and dosimetric variables with 1-year outcome was measured using bivariate analysis, followed by logistic regression. Results Ninety-one patients included completed the follow-up. Therapeutic success was observed in 77 (84.6%) of them, in a greater proportion when 1110 MBq of I-131 was administered as compared with 550 MBq (94.8% vs 77.4%, P = 0.02). Besides administered activity, multivariate analysis indicated that outcome was related to patient age and gland mass. A higher therapeutic success rate was achieved with doses greater than 300 Gy as compared with doses less than 300 Gy (89% vs 60%, P = 0.01). Conclusion Administered activity, age, and gland mass were related to the outcome. Radiation absorbed dose, although not significant according to multivariate analysis, may be used as a quantitative parameter in therapy planning, with a target dose of 300 Gy. In cases where a rapid and efficient response to radioiodine treatment is required, adoption of a simplified protocol employing high activities is justified.
  • article 14 Citação(ões) na Scopus
    Ga-68-Prostate-specific membrane antigen (PSMA) positron emission tomography (pet) in prostate cancer: a systematic review and meta-analysis
    (2021) MATUSHITA, Cristina S.; SILVA, Ana M. Marques da; SCHUCK, Phelipi N.; BARDISSEROTTO, Matteo; PIANT, Diego B.; PEREIRA, Jonatas L.; CERCI, Juliano J.; COURA-FILHO, George B.; ESTEVES, Fabio P.; AMORIM, Barbara J.; V, Gustavo Gomes; BRITO, Ana Emilia T.; BERNARDO, Wanderley M.; MUNDSTOCK, Eduardo; FANTI, Stefano; MACEDO, Bruna; ROMAN, Diego H.; TEM-PASS, Cinthia Scatolin; HOCHHEGGER, Bruno
    Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. Ga-68-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive Ga-68-PSMA PET and the accuracy of this technique. Materials and methods: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was alpha=0.05. Results: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. Conclusion: Ga-68-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.
  • article 5 Citação(ões) na Scopus
    SDHB large deletions are associated with absence of MIBG uptake in metastatic lesions of malignant paragangliomas
    (2021) PETENUCI, Janaina; FAGUNDES, Gustavo F. C.; BENEDETTI, Anna Flavia F.; GUIMARAES, Augusto G.; AFONSO, Ana Caroline F.; MOTA, Flavia T.; MAGALHAES, Aurea Luiza F.; COURA-FILHO, George B.; ZERBINI, Maria Claudia N.; SIQUEIRA, Sheila; MONTENEGRO, Fabio L. M.; SROUGI, Victor; TANNO, Fabio Y.; CHAMBO, Jose Luis; FERRARI, Marcela S. S.; BEZERRA NETO, Joao Evangelista; PEREIRA, Maria Adelaide A.; LATRONICO, Ana Claudia; FRAGOSO, Maria Candida B. V.; MENDONCA, Berenice B.; HOFF, Ana O.; ALMEIDA, Madson Q.
  • article 35 Citação(ões) na Scopus
    Comparison of Ga-68 PET/CT to Other Imaging Studies in Medullary Thyroid Cancer: Superiority in Detecting Bone Metastases
    (2018) CASTRONEVES, Luciana Audi; COURA FILHO, George; FREITAS, Ricardo Miguel Costa de; SALLES, Raphael; MOYSES, Raquel Ajub; LOPEZ, Rossana Veronica Mendoza; PEREIRA, Maria Adelaide Albergaria; TAVARES, Marcos Roberto; JORGE, Alexander Augusto de Lima; BUCHPIGUEL, Carlos Alberto; HOFF, Ana Oliveira
    Context: Persistent disease after surgery is common in medullary thyroid cancer (MTC), requiring lifelong radiological surveillance. Staging workup includes imaging of neck, chest, abdomen, and bones. A study integrating all sites would be ideal. Despite the established use of gallium-68 (Ga-68) positron emission tomography (PET)/CT with somatostatin analogues in most neuroendocrine tumors, its efficacy is controversial in MTC. Objective: Evaluate the efficacy of Ga-68 PET/CT in detecting MTC lesions and evaluate tumor expression of somatostatin receptors (SSTRs) associated with Ga-68 PET/CT findings. Methods: Prospective study evaluating 30 patients with MTC [group 1 (n = 16), biochemical disease; group 2 (n = 14), metastatic disease]. Patients underwent Ga-68 PET/CT, bone scan, CT and ultrasound of the neck, CT of the chest, CT/MRI of the abdomen, and MRI of the spine. Ga-68 PET/CT findings were analyzed by disease site as positive or negative and as concordant or discordant with conventional studies. Sensitivity and specificity were calculated using pathological or cytological analysis or unequivocal identification by standard imaging studies. Immunohistochemical analysis of SSTRs was compared with Ga-68 PET/CT findings. Results: In both groups, Ga-68 PET/CT was inferior to currently used imaging studies except for bone scan. In group 2, Ga-68 PET/CT sensitivities were 56%, 57%, and 9% for detecting neck lymph nodes, lung metastases, and liver metastases, respectively, and 100% for bone metastases, superior to the bone scan (44%). Expression of SSTRs, observed in 44% of tumors, was not associated with Ga-68-DOTATATE uptake. Conclusions: Ga-68 PET/CT does not provide optimal whole-body imaging as a single procedure in patients with MTC. However, it is highly sensitive in detecting bone lesions and could be a substitute for a bone scan and MRI.
  • article 7 Citação(ões) na Scopus
    Ga-68-DOTATATE PET: temporal variation of maximum standardized uptake value in normal tissues and neuroendocrine tumours
    (2019) COURA-FILHO, George Barberio; HOFF, Ana A. F. O.; DUARTE, Paulo S.; BUCHPIGUEL, Carlos A.; JOSEFSSON, Anders; HOBBS, Robert F.; SGOUROS, George; SAPIENZA, Marcelo T.
    Objectives Higher affinity of Ga-68 compounds to somatostatin receptors (SSTRs) and PET better image resolution increased interest in Ga-68-labelled somatostatin analogs in the management of neuroendocrine tumours (NETs). This study aimed to evaluate the maximum standardized uptake value (SUVmax) variation in sequential somatostatin analogs-PET in NET patients and identify optimal tumour detection and characterization imaging time. Methods Patients with histological or biochemical NET diagnosis performed two to three PET/computed tomography (CT) scans after intravenous injection of Ga-68-DOTATATE: Early PET [EarlyPET: <15 minutes postinjection (p.i.)], diagnostic PET (DiagPET: 45-90 minutes p.i.) and delayed PET (DelayPE: 90-240 minutes p.i.). Up to five tumour sites and normal tissues had SUVmax determined. Time-SUVmax curves were created for the target lesions and normal organs. Ratios between tumour and liver SUVmax (SUVTU/Liver) and tumour/blood pool (SUVTU/BP) were also calculated. Results Twenty-nine patients were included, 16 female, mean age of 46.5 +/- 14.3 years. Average administered activity was 129.5 +/- 29.6 MBq. Kidneys SUVmax was higher in EarlyPET compared with DiagPET (P = 0.04) and DelayPET showed higher SUVmax compared with DiagPET for normal liver, pancreas and kidneys (P = 0.02). No differences were noted between EarlyPET, DiagPET and DelayPET in tumour SUVmax (P > 0.05). SUVTU/Liver and SUVTU/BP did not change between EarlyPET and DiagPET, with a slight decrease in DelayPET. Conclusion Stability in tumour SUVmax values measured at different intervals independently of tumour location, as also in normal tissues as kidneys and liver suggest that a more flexible imaging protocol may be adopted.
  • conferenceObject
    Performance of the 2021 CKD-EPI equations without a race coefficient in a multi-racial population of adults with solid tumors: A prospective cross-sectional study.
    (2022) SILVA, Veronica Torres Costa E; GIL- JR., Luiz A.; INKER, Lesley; CAIRES, Renato; COSTALONGA, Elerson; COURA-FILHO, George; ESTEVEZ-DIZ, Maria Del Pilar; CASTRO, Gilberto; MATHEW, Paul; LEVEY, Andrew; BURDMANN, Emmanuel de Almeida
  • article 20 Citação(ões) na Scopus
    A prospective cross-sectional study estimated glomerular filtration rate from creatinine and cystatin C in adults with solid tumors
    (2022) SILVA, Veronica T. Costa e; JR, Luiz A. Gil; INKER, Lesley A.; CAIRES, Renato A.; COSTALONGA, Elerson; COURA-FILHO, George; SAPIENZA, Marcelo T.; JR, Gilberto Castro; ESTEVEZ-DIZ, Maria Dp; ZANETTA, Dirce Maria T.; ANTONANGELO, Leila; MARCAL, Lia; TIGHIOUART, Hocine; MIAO, Shiyuan; MATHEW, Paul; LEVEY, Andrew S.; BURDMANN, Emmanuel A.
    Current guidelines recommend estimating glomerular filtration rate (eGFR) using creatinine (eGFRcr) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation as the first test for GFR evaluation, but the Cockcroft-Gault (CG) equation is still commonly used in oncology practice and clinical trials despite increasing evidence of its inaccuracy compared to measured GFR (mGFR). Guidelines recommend eGFR using cystatin C (eGFRcys) or both markers (eGFRcr-cys) as a confirmatory test, but neither was carefully evaluated in cancer patients. Therefore, we compared performance of the CKD-EPI equations and others to the CG equation in adults with a variety of solid tumors. The mGFR was determined by plasma clearance of Cr-51-EDTA. Bias was defined as the median of the differences between mGFR and eGFR while accuracy was defined as the percentage of estimates that differed by more than 30% from the measured GFR (1-P30). We prospectively recruited 1,200 patients between April 2015 and September 2017 with a mean age and mGFR of 58.8 years and 78.4 ml/min/1.73m 2 , respectively. Bias among eGFRcr equations varied from -8.1 to +6.1 ml/min/1.73 m(2). CG was the least accurate, 1-P30 (95% confidence interval) was 24.9 (22.4- 27.3)%; CKD-EPI had 1-P30 of 19.1 (16.8-21.2)% while eGFRcr-cys had the best performance: bias -2.0 (-2.6 to -1.1) ml/min/1.73m(2) and 1-P30 7.8 (6.3-9.4)%. Thus, the CG equation should not be preferred over CKD-EPI equation, and eGFRcr-cys can be used as a confirmatory test in adults with solid tumors. Hence, a major policy implication would be to adopt general practice guideline-recommended methods for GFR evaluation in oncology practice and clinical trials.
  • article 12 Citação(ões) na Scopus
    Graves' disease radioiodine-therapy: Choosing target absorbed doses for therapy planning
    (2014) WILLEGAIGNON, J.; SAPIENZA, M. T.; COURA-FILHO, G. B.; WATANABE, T.; TRAINO, A. C.; BUCHPIGUEL, C. A.
    Purpose: The precise determination of organ mass (m(th)) and total number of disintegrations within the thyroid gland ((A) over tilde) are essential for thyroid absorbed-dose calculations for radioiodine therapy. Nevertheless, these parameters may vary according to the method employed for their estimation, thus introducing uncertainty in the estimated thyroid absorbed dose and in any dose-response relationship derived using such estimates. In consideration of these points, thyroid absorbed doses for Graves' disease (GD) treatment planning were calculated using different approaches to estimating the m(th) and the (A) over tilde. Methods: Fifty patients were included in the study. Thyroid I-131 uptake measurements were performed at 2, 6, 24, 48, 96, and 220 h postadministration of a tracer activity in order to estimate the effective half-time (T-eff) of I-131 in the thyroid; the thyroid cumulated activity was then estimated using the Teff thus determined or, alternatively, calculated by numeric integration of the measured time-activity data. Thyroid mass was estimated by ultrasonography (USG) and scintigraphy (SCTG). Absorbed doses were calculated with the OLINDA/EXM software. The relationships between thyroid absorbed dose and therapy response were evaluated at 3 months and 1 year after therapy. Results: The average ratio (+/- 1 standard deviation) between m(th) estimated by SCTG and USG was 1.74 (+/- 0.64) and that between (A) over tilde obtained by Teff and the integration of measured activity in the gland was 1.71 (+/- 0.14). These differences affect the calculated absorbed dose. Overall, therapeutic success, corresponding to induction of durable hypothyroidism or euthyroidism, was achieved in 72% of all patients at 3 months and in 90% at 1 year. A therapeutic success rate of at least 95% was found in the group of patients receiving doses of 200 Gy (p = 0.0483) and 330 Gy (p = 0.0131) when m(th) was measured by either USG or SCTG and (A) over tilde was determined by the integration of measured I-131 activity in the thyroid gland and based on T-eff, respectively. No statistically significant relationship was found between therapeutic response and patients' age, administered I-131 activity (MBq), 24-h thyroid I-131 uptake (%) or T-eff (p >= 0.064); nonetheless, a good relationship was found between the therapeutic response and mth (p >= 0.035). Conclusions: According to the results of this study, the most effective thyroid absorbed dose to be targeted in GD therapy should not be based on a fixed dose but rather should be individualized based on the patient's m(th) and (A) over tilde. To achieve a therapeutic success (i.e., durable euthyroidism or hypothyroidism) rate of at least 95%, a thyroid absorbed dose of 200 or 330 Gy is required depending on the methodology used for estimating m(th) and (A) over tilde. (C) 2014 American Association of Physicists in Medicine.
  • article 4 Citação(ões) na Scopus
    Is there a role for diagnostic scans in the management of intermediate-risk thyroid cancer?
    (2022) DANILOVIC, Debora L. S.; COURA-FILHO, George B.; RECCHIA, Giulianna M.; CASTRONEVES, Luciana A.; MARUI, Suemi; BUCHPIGUEL, Carlos A.; HOFF, Ana O.; KOPP, Peter
    Radioiodine (RAI) is selectively recommended for intermediate-risk differentiated thyroid carcinomas (DTC). The information gleaned from pretherapy stimulated thyroglobulin levels (sTg) and diagnostic I-131 whole-body scans (DxWBS) to guide therapy remains controversial. The present study aimed at evaluating the impact of preablation sTg and DxWBS in the management of intermediate-risk DTC. A retrospective analysis of 301 intermediate-risk DTC patients submitted to total thyroidectomy and RAI therapy was performed. Pretherapy sTg and DxWBS and post-therapy WBS (RxWBS) findings were analyzed and compared to outcomes. Fifty-two patients (17.3%) had metastases diagnosed by DxWBS and/or RxWBS. The DxWBS identified 10.6% of patients with functioning metastases, including unexpected distant metastases. If combined with SPECT-CT, DxWBS detected RAI-avid metastases more frequently, particularly lymph node metastases (13.1% vs 4.2% planar WBS, P = 0.015). The DxWBS findings modified patient management in 8.3%. A pretherapy sTg <1 ng/mL was associated with a low false-negative rate for the presence of metastases (5.2%), and its performance in excluding metastasis was improved by a negative DxWBS (2.7% of patients with both negative exams had metastases in RxWBS). A sTg <1 ng/mL predicted statistically significant lower rates of recurrent/persistent disease and biochemical/structural incomplete responses. In conclusion, preablation sTg and DxWBS contribute to the detection of unknown or persistent metastatic disease in intermediate-risk DTC patients. A sTg <1 ng/mL in combination with a negative DxWBS is highly suggestive of the absence of remaining malignant disease, and one may consider deferring RAI ablation if both exams are negative. A stunning effect is rarely observed and it does not impair proper treatment of metastases.