RODRIGO OLIVA PEREZ
Índice h a partir de 2011
25
Projetos de Pesquisa
Unidades Organizacionais
6 resultados
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- Conditional Survival in Patients With Rectal Cancer and Complete Clinical Response Managed by Watch and Wait After Chemoradiation Recurrence Risk Over Time(2020) JULIAO, Guilherme P. Sao; KARAGKOUNIS, Georgios; FERNANDEZ, Laura M.; HABR-GAMA, Angelita; VAILATI, Bruna B.; DATTANI, Mit; KALADY, Matthew F.; PEREZ, Rodrigo O.Objective: Analyze conditional recurrence-free survival (cRFS) for rectal cancer patients with complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT) managed nonoperatively after each year without recurrence. Summary Background Data: Select patients with cCR after nCRT have been managed nonoperatively. Risk factors for local recurrence, the need for prolonged follow-up, and the risk of recurrence over time are not well defined. Methods: Retrospective review of patients with rectal cancer cT2-4N0-2M0 treated with nCRT. Mean follow-up was 64 months. Patients who achieved cCR were managed nonoperatively. cRFS was used to investigate the evolution of recurrence-odds, as patients remain recurrence-free after completion of nCRT. Three-year cRFS was estimated at ""x"" years after completion of nCRT based on the formula cRFS(3) = RFS(x+3)/RFS(x). Results: One hundred ninety-seven patients with cCR after nCRT were included. Overall survival and recurrence-free survival (RFS) at 5 years were 81.9% (95% CI 74.0%-87.6%) and 60.4% (95% CI 52.5%-67.4%) respectively. Using cRFS estimates, the probability of remaining disease-free for an additional 3 years if the patient survived without disease at 1, 3, and 5 years, was 77.4% (95% CI 68.8%-83.8%), 91.0% (95% CI 81.9%-95.7%), and 94.3% (95% CI 82.9%-98.2%), respectively. In contrast, actuarial RFS rates for similar intervals were 79.1% (95% CI 72.5%-84.2%), 64.2% (95% CI 56.5%-70.8%), and 60.4% (95% CI 52.5%-67.4%). After 2 years disease-free, 3 year cRFS became similar for T2 and T3 cancers. In contrast, patients undergoing extended nCRT became less likely to develop recurrences only after initial 2 years of successful organ-preservation. Conclusions: Conditional survival suggests that patients have significantly lower risks (<= 10%) of developing recurrences after 2 years of achieving cCR following nCRT.
- Salvage Surgery Following Organ Preservation With Local Regrowth After Watch and Wait: Picture Still Unclear Reply(2021) FERNANDEZ, Laura M.; FIGUEIREDO, Nuno L.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VIEIRA, Pedro; VAILATI, Bruna B.; NASIR, Irfan; PARES, Oriol; SANTIAGO, Ines; CASTILLO-MARTIN, Mireia; CARVALHO, Carlos; PARVAIZ, Amjad; PEREZ, Rodrigo O.
- Salvage Surgery With Organ Preservation for Patients With Local Regrowth After Watch and Wait: Is It Still Possible?(2020) FERNANDEZ, Laura M.; FIGUEIREDO, Nuno L.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VIEIRA, Pedro; VAILATI, Bruna B.; NASIR, Irfan; PARES, Oriol; SANTIAGO, Ines; CASTILLO-MARTIN, Mireia; CARVALHO, Carlos; PARVAIZ, Amjad; PEREZ, Rodrigo OlivaBACKGROUND: Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively. Thirty percent of these patients may develop a local regrowth, and salvage resection with radical surgery is usually recommended. However, selected patients could be offered additional organ preservation by local excision. We hypothesized that patients with baseline T2 who underwent neoadjuvant therapy (for the specific purpose of achieving a complete clinical response) were more likely to harbor recurrent disease at an earlier stage and amenable to organ preservation strategies (local excision) when compared with T3/T4 (undergoing neoadjuvant chemoradiation for oncologic reasons). OBJECTIVE: The purpose of this study was to compare patients with local regrowth requiring salvage resection according to their baseline stage. DESIGN: This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation. SETTINGS: The study included 2 independent tertiary centers with institutional watch-and-wait organ preservation programs. PATIENTS: Consecutive patients with distal rectal cancer (cT2-4N1-2M0) managed by watch and wait and local regrowth from 2 institutions were included. MAIN OUTCOMES MEASURES: Final pathologic features and surgical and oncologic outcomes were compared according to baseline staging. RESULTS: A total of 73 of 257 patients experienced local regrowth. cT2 presented similar to ypT, ypN, R0, and abdominal perineal resection rates (p> 0.05) at the time of salvage when compared with cT3 to cT4. Patients with cT2 at baseline were more likely to undergo an organ preservation procedure for salvage (56.2% vs 26.5%;p= 0.03). Overall and disease-free survival after salvage were similar between groups irrespective of the type of surgery for the regrowth. LIMITATIONS: Retrospective study, small sample size, and possible inaccurate baseline staging. CONCLUSIONS: Although patients with baseline cT2 rectal cancer had similar pathologic stage at the time of recurrence, these patients were more likely to continue an organ preservation pathway after local regrowth through transanal local excision when compared with cT3 to cT4. Despite differences in the use of radical salvage resection, there were no differences in oncologic outcomes.
- cT2N0 Distal Rectal Cancer: Do Not Believe in Fairy Tales(2022) FERNANDEZ, Laura M.; FIGUEIREDO, Nuno; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VIEIRA, Pedro; VAILATI, Bruna B.; NASIR, Irfan; PARES, Oriol; SANTIAGO, Ines; CASTILLO-MARTIN, Mireia; CARVALHO, Carlos; PARVAIZ, Amjad; PEREZ, Rodrigo O.
- Organ Preservation Among Patients With Clinically Node-Positive Rectal Cancer: Is It Really More Dangerous?(2019) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; FERNANDEZ, Laura M.; ORTEGA, Cinthia D.; FIGUEIREDO, Nuno; GAMA-RODRIGUES, Joaquim; PEREZ, Rodrigo OlivaBACKGROUND: Select patients with complete clinical response to chemoradiation have been managed without radical surgery. The presence of radiologic evidence of nodal metastases at baseline could be a risk factor for local tumor regrowth, more advanced stage at the time of recurrence, and worse distant metastases-free survival. OBJECTIVE: The purpose of this study was to compare the outcomes of patients with baseline node-positive and node-negative cancer after neoadjuvant chemoradiation and complete clinical response managed nonoperatively. DESIGN: This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation. PATIENTS: Consecutive patients with clinical and radiologic evidence of complete clinical response at 8 to 10 weeks were managed nonoperatively and enrolled in a strict follow-up program (watch and wait). Patients with incomplete clinical response or tumor regrowth after initial complete clinical response were referred to surgery. MAIN OUTCOMES MEASURES: Surgery-free and distant metastases-free survival were compared between patients according to nodal status at baseline. RESULTS: A total of 117 patients with node-positive and 218 with node-negative cancer at baseline were reviewed. Overall, 62 (53.0%; node positive) and 135 (61.9%; node negative) achieved a complete clinical response and were managed nonoperatively (p = 0.13). Patients with baseline node-positive cancer had similar rates of pathologic nodal metastases at the time of recurrence. Five-year surgery-free (39.7% vs 46.8%; p = 0.2) and distant metastases-free survival (77.5% vs 80.5%; p = 0.49) were similar between baseline node-positive and node-negative patients. LIMITATIONS: This was a retrospective study with a small sample size and possible inaccurate nodal staging. CONCLUSIONS: Patients with rectal cancer with node-positive cancer at baseline who develop a complete clinical response after neoadjuvant chemoradiation are not at increased risk for local tumor regrowth or development of more advanced disease at the time of recurrence. These patients seem to be safe candidates for organ-preserving strategies after achieving complete clinical response. See Video Abstract at http://links.lww.com/DCR/A902.
- Longer Intervals from Neoadjuvant Therapy to Rectal Cancer Surgery: The Clock is Ticking ...(2019) FERNANDEZ, Laura Melina; PEREZ, Rodrigo Oliva