CINTHIA DENISE ORTEGA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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Agora exibindo 1 - 9 de 9
article 1 Citação(ões) na Scopus T <= 2N0 TRG1-2 in Post-Chemoradiation Therapy MRI: What can it Predict?(2019) NAHAS, Caio Sergio Rizkallah; NAHAS, Sergio Carlos; BUSTAMANTE-LOPEZ, Leonardo; SPARAPAN, Carlos Marques Frederico; ORTEGA, Cinthia; AZAMBUJA, Rodrigo; JR, Ulysses Ribeiro; COTTI, Guilherme Cutait; IMPERIALE, Antonio Rocco; CECCONELLO, IvanBackground: Total mesorectal excision is the standard radical operation after neoadjuvant chemoradiotherapy for patients with middle/low locally advanced rectal cancer. However, it carries significant rates of morbidity, sexual/urinary dysfunction, fecal impairment and permanent stoma. The ability to identify patients with a complete or nearly-complete response could help steer patients to less-invasive surgery or a watch-and-wait strategy. Objective: To assess the ability to predict good responders and a favorable prognosis among rectal cancer patients by post-chemoradiation therapy MRI. Patients: Consecutive patients stage T3-4N0M0 or T(any)N+M0 located within 10cm from the anal verge were enrolled. Patients were staged and re-staged 8.8 weeks after the completion of chemoradiation by digital exam, colonoscopy, pelvic-MRI, and thorax and abdominal CT scans. All patients underwent total mesorectal excision with curative intent. Results: Of the total 309 patients, 275 were eligible, and 199 (72.4%) of these were stage III. Restaging-MRI identified 59 (21.4%) T <= 2N0/TRG1-2. Specimen pathologic evaluation revealed 43 (15.6%) patients with a complete pathologic response. Estimates of the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRIyT=2N0/TRG1-2 for the identification of ypT0N0 were 79.7%, 84.5%, 53.5%, 39%, and 90.7%, respectively. Estimates for the identification of ypN0 were 48.4%, 27.8%, 92%, 88.1%, and 48.4%, respectively. In a multivariate analysis, the only pre-CRT/MRI variables that were associated with an increased risk of lymph node involvement at the specimen were N+ (OR=2.22) and extramural vascular invasion (OR=2.28). MRI yT <= 2N0/TRG1-2 patients showed improved estimated 5-year disease-free survival, but no difference in estimated 5-year survival. Conclusion: Although MRIyT <= 2N0/TRG1-2 cannot predict all cases of a complete pathologic response, it can effectively predict a low rate of lymph node involvement and a better prognosis in patients who undergo total mesorectal excision.conferenceObject OBSERVATION VERSUS SURGICAL RESECTION IN PATIENTS WITH RECTAL CANCER WHO ACHIEVED COMPLETE CLINICAL RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY: PRELIMINARY RESULTS OF A RANDOMIZED TRIAL (NCT02052921).(2015) NAHAS, S.; NAHAS, C.; RIBEIRO JUNIOR, U.; MARQUES, C. Sparapan; COTTI, G. C.; IMPERIALE, A.; ORTEGA, C.; AZAMBUJA, R.; CHEN, A.; HOFF, P.; CECCONELLO, I.- Value of Primary Rectal Tumor PET/MRI in the Prediction of Synchronic Metastatic Disease(2022) QUEIROZ, Marcelo A.; ORTEGA, Cinthia D.; FERREIRA, Felipe R.; CAPARELI, Fernanda C.; NAHAS, Sergio C.; CERRI, Giovanni G.; BUCHPIGUEL, Carlos A.Purpose: To analyze the associations between positron emission tomography (PET)/magnetic resonance imaging (MRI) features for primary rectal tumors and metastases. Procedures: Between November 2016 and April 2018, 101 patients with rectal adenocarcinoma were included in this prospective study (NCT02537340) for whole-body PET/MRI for baseline staging. Two readers analyzed the PET/MRI; they assessed the semiquantitative PET features of the primary tumor and the N- and M-stages. Another reader analyzed the MRI features for locoregional staging. The reference standard for confirming metastatic disease was biopsy or imaging follow-up. Nonparametric tests were used to compare the PET/MRI features of the participants with or without metastatic disease. Binary logistic regression was used to evaluate the associations between the primary tumor PET/MRI features and metastatic disease. Results: A total of 101 consecutive participants (median age 62 years; range: 33-87 years) were included. Metastases were detected in 35.6% (36 of 101) of the participants. Among the PET/MRI features, higher tumor lesion glycolysis (352.95 vs 242.70; P =.46) and metabolic tumor volume (36.15 vs 26.20; P =.03) were more frequent in patients with than in those without metastases. Additionally, patients with metastases had a higher incidence of PET-positive (64% vs 32%; P =.009) and MRIpositive (56% vs 32%; P =.03) mesorectal lymph nodes, extramural vascular invasion (86% vs 49%; P >.001), and involvement of mesorectal fascia (64% vs 42%; P =.04); there were also differences between the mrT stages of these two groups (P =.008). No differences in the maximum standardized uptake values for the primary tumors in patients with and without metastases were observed (18.9 vs 19.1; P =.56). Multivariable logistic regression showed that extramural vascular invasion on MRI was the only significant predictor (adjusted odds ratio, 3.8 [95% CI: 1.1, 13.9]; P =.001). Conclusion: PET/MRI facilitated the identification of participants with a high risk of metastatic disease, though these findings were based mainly on MRI features.
- Diagnostic accuracy of FDG-PET/MRI versus pelvic MRI and thoracic and abdominal CT for detecting synchronous distant metastases in rectal cancer patients(2021) QUEIROZ, Marcelo A.; ORTEGA, Cinthia D.; FERREIRA, Felipe R.; NAHAS, Sergio C.; CERRI, Giovanni G.; BUCHPIGUEL, Carlos A.Purpose We compared the diagnostic accuracy of detecting distant metastases for baseline rectal cancer staging between PET/MRI and conventional staging (CS). Materials and methods This prospective study from November 2016 to April 2018 included 101 rectal adenocarcinoma patients for primary staging. These patients underwent whole-body PET/MRI in addition to CS (pelvic MRI and thoracic and abdominal contrast-enhanced CT). Different readers analyzed CS and PET/MRI findings for primary tumor, nodal, and metastatic staging. The presence, number, and location of metastases were recorded according to the organ involved (non-regional lymph nodes (LNs), liver, lungs, or others). Lesions were defined as positive, negative, or indeterminate. The number of lesions per organ was limited to 10. The McNemar test was used to compare the accuracies. Results PET/MRI exhibited a higher accuracy in detecting metastatic disease than CS in all patients (88.4% vs. 82.6%,p = 0.003) and in patients with extramural vascular invasion (EMVI) (88.9% vs. 85.5%,p = 0.013). The detection rate of PET/MRI was superior to that of CS for all lesions [84.1% vs. 68.9%,p = 0.001], as well as those in the liver (89.2% vs. 84.2%), non-regional LNs (90.0% vs. 36.7%), and lungs (76.4% vs. 66.9%). PET/MRI correctly classified 19/33 (57.5%) patients with indeterminate lesions on CS. Conclusion PET/MRI yields higher accuracy than CS for detecting distant synchronous metastases in the baseline staging of patients with rectal cancer and EMVI. PET/MRI exhibited a higher detection rate than CS for identifying non-regional LNs, hepatic lesions, and pulmonary lesions as well as correctly classifying patients with indeterminate lesions.
conferenceObject T <= 2N0, TRG1-2 IN POST CHEMORADIATION THERAPY MRI: WHAT IT CAN PREDICT?(2017) NAHAS, C.; NAHAS, S.; BUSTAMANTE, L.; MARQUES, C.; IMPERIALE, A.; COTTI, G.; AZAMBUJA, R.; ORTEGA, C.- A randomized, open-label, parallel-design phase III study to compare adjuvant 5-FU plus oxaliplatin (mFLOX) versus observation in locally advanced rectal cancer after neoadjuvant chemoradiation(2020) BRAGHIROLI, M. I.; MONIZ, C. M. V.; RIECHELMANN, R. S. P.; DORNELLAS, A. F. L.; CAPARELLI, F.; ALBAN, L.; ALEX, A.; BARIANI, G. M.; LEITE, L. A. Senna; RIVELLI, T. Giollo; NEBULONI, D.; ORTEGA, C.; BRAGHIROLI, O. F. M.; MOUTINHO, K.; NAHAS, S.; NAHAS, C.; COTTI, G.; SABBAGA, J.; CECONELLO, I.; HOFF, P. M.
- Value of Primary Rectal Tumor PET/MRI in the Prediction of Synchronic Metastatic Disease (vol 24, pg 453, 2021)(2022) QUEIROZ, Marcelo A.; ORTEGA, Cinthia D.; FERREIRA, Felipe R.; CAPARELI, Fernanda C.; NAHAS, Sergio C.; CERRI, Giovanni G.; BUCHPIGUEL, Carlos A.
conferenceObject PET/MR for staging rectal cancer: a comparison to conventional staging with pelvic MR and thoracoabdominal CT(2018) QUEIROZ, M.; BARBOSA, F. G.; ORTEGA, C.; FERREIRA, F.; MORAES, M.; BLASBALG, R.; NAHAS, S.; CERRI, G. G.; BUCHPIGUEL, C.conferenceObject CAN MRI PREDICT PATHOLOGIC RESPONSE OF RECTAL CANCER AFTER NEOADJUVANT TREATMENT?(2014) NAHAS, C.; NAHAS, S.; ORTEGA, C.; AZAMBUJA, R.; JOAQUIM, H.; MARQUES, C.; RIBEIRO, U.; BUSTAMANTE, L. L.; HOFF, L. P.; CECCONELLO, I.