MARCO AURELIO VAMONDES KULCSAR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
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- Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer(2018) GUSMON-OLIVEIRA, Carla Cristina; KUBOKI, Yeda Mayumi; PAULO, Gustavo Andrade de; LIMA, Marcelo Simas de; UEMURA, Ricardo Sato; MARTINS, Bruno Costa; TOLENTINO, Luciano Lenz; SAFATLE-RIBEIRO, Adriana Vaz; KULCSAR, Marco Aurelio; RIBEIRO JR., Ulysses; MALUF-FILHO, FauzeBackground. Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge. It is not uncommon that PES is refractory to dilation sessions. This study aimed at evaluating the efficacy of Mitomycin C (MMC) endoscopic injection for the treatment of refractory pharyngoesophageal stenosis. Patients and methods. This is a prospective study in patients with dysphagia following head and neck cancer treatment, without evidence suggestive of tumor recurrence, and refractory to endoscopic treatment. These patients were submitted to endoscopic dilation of the stenotic segment with thermoplastic bougies, followed by injection of MMC. We repeated the endoscopic sessions every three weeks. Results. From January 2015 to May 2015, we treated 13 patients with PES. Three patients were initially enrolled in the study for refractory stricture. We observed adverse events in all of them, with intense neck pain and ulcer development, justifying the interruption of the trial. Conclusion. The repeated injection in the short interval of MMC in refractory PES is not recommended, because it resulted in serious adverse events.
- Neutrophil-to-lymphocyte ratio as a prognostic factor for pharyngocutaneous fistula after total laryngectomy(2018) AIRES, F. T.; DEDIVITIS, R. A.; V, M. A. Kulcsar; RAMOS, D. M.; CERNEA, C. R.The role of systemic inflammatory response as a prognostic factor has been proposed in a variety of cancers. The purpose of this study was to investigate the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the incidence of pharyngocutaneous fistula (PCF) in patients who underwent total laryngectomy. We conducted a retrospective cohort analysis of 141 patients with squamous cell carcinoma of larynx who underwent total laryngectomy from 2009 to 2015. The incidence of PCF was 49.6%. A higher risk of 23% was observed among patients with NLR > 2.5 for the occurrence of PCF (p = 0.007). Patients with laryngeal squamous cell carcinoma who present elevated values in the ration > LR> (> 2.5) presented a higher risk of developing pharyngocutaneous fistula in the postoperative setting of total laryngectomy.
- Supracricoid Laryngectomy: The Function of the Remaining Arytenoid in Voice and Swallowing(2018) BUZANELI, Elaine Cristina Pires; ZENARI, Marcia Simoes; KULCSAR, Marco Aurelio Vamondes; DEDIVITIS, Rogerio A.; CERNEA, Claudio Roberto; NEMR, KatiaIntroduction Supracricoid laryngectomy still has selected indications; there are few studies in the literature, and the case series are limited, a fact that stimulates the development of new studies to further elucidate the structural and functional aspects of the procedure. Objective To assess voice and deglutition parameters according to the number of preserved arytenoids. Methods Eleven patients who underwent subtotal laryngectomy with cricohyoidoepiglottopexy were evaluated by laryngeal nasofibroscopy, videofluoroscopy, and auditory-perceptual, acoustic, and voice pleasantness analyses, after resuming oral feeding. Results Functional abnormalities were detected in two out of the three patients who underwent arytenoidectomy, and in six patients from the remainder of the sample. Almost half of the sample presented silent laryngeal penetration and/or vallecular/hypopharyngeal stasis on the videofluoroscopy. The mean voice analysis scores indicated moderate vocal deviation, roughness and breathiness; severe strain and loudness deviation; shorter maximum phonation time; the presence of noise; and high third and fourth formant values. The voices were rated as unpleasant. There was no difference in the number and functionality of the remaining arytenoids as prognostic factors for deglutition; however, in the qualitative analysis, favorable voice and deglutition outcomes were more common among patients who did not undergo arytenoidectomy and had normal functional conditions. Conclusion The number and functionality of the preserved arytenoids were not found to be prognostic factors for favorable deglutition efficiency outcomes. However, the qualitative analysis showed that the preservation of both arytenoids and the absence of functional abnormalities were associated with more satisfactory voice and deglutition patterns.
- New method of sentinel lymph node biopsy in transoral robotic surgery for oropharyngeal squamous cell carcinoma(2018) KULCSAR, Marco Aurélio V.; CANOVAS, Natasha Sobreira; ARAUJO-NETO, Vergilius Jose Furtado de; KIM, Jorge Du Ub; CERNEA, Claudio Roberto
- Oral Cancer Treatment: Still an Indication for Elective Neck Dissection?(2018) KOYAMA, Leonardo Kenji Sakaue; MATOS, Leandro Luongo; KULCSAR, Marco Aurelio Vamondes; ARAUJO FILHO, Vergilius Jose Furtado de; CERNEA, Claudio RobertoIntroduction: Oral squamous cell carcinoma has a high incidence and, although elective neck dissection is recommended, the removed nodes frequently present without metastasis. This surgical approach causes disabilities and increases possible surgical complications. Objective: To evaluate the possibility of a watchful waiting approach in oral cancer. Methods: We compared 78 patients with clinical and pathological node metastases and their counterparts with pathological node metastases but without evident clinical neck disease. Therefore, we provided a theoretical comparison between the patients who had an elective neck dissection and those who waited until a clinically positive node was evident. Results: The prognostic factor rates were similar between the groups. Their regional recurrence and mortality rates had no statistical differences. Conclusion: A watchful waiting policy could be applied to selected oral cancer patients who can undergo a very close follow-up. This option would be more cost effective and less harmful than elective neck dissection. (C) 2018 S. Karger AG, Basel
- Malignancy Rates in Thyroid Nodules Classified as Bethesda Categories III and IV: Retrospective Data from a Tertiary Center(2018) CAVALHEIRO, Beatriz Godoi; LEITE, Ana Kober Nogueira; MATOS, Leandro Luongo de; MIAZAKI, Aline Palermo; IENTILE, Jan Marcel; KULCSAR, Marco Aurelio V.; CERNEA, Claudio RobertoBackground: Thyroid fine needle aspiration (FNA) has a well-established role in the diagnosis of thyroid nodules, and the ""Bethesda system for reporting thyroid cytopathology"" is used to interpret FNA results. Bethesda categories III and IV encompass varying risks of malignancy. In addition, there is some debate in the literature about how to select among many acceptable treatment approaches. Objectives: To establish an association between these 2 cytological categories and malignancy rates in patients treated in a referral tertiary cancer center, where surgical treatment is recommended for all these patients. Methods: A total of 615 thyroid nodules (582 patients) were included in this retrospective study. There were 478 nodules that were classified as Bethesda category III and 137 nodules as Bethesda category IV. Electronic records were reviewed to establish a correlation between the FNA cytological results and the final histopathological analyses. Incidentally detected carcinomas were considered separately. Results: Among the bethesda category III group, 75 malignant nodules (15.7%) were coincident with the target nodule (74 patients, 16.2%). Incidental carcinomas were found in 13.8% of these patients. The remaining 403 (84.3%) target nodules were benign. Among the bethesda category IV nodules, 23 malignant nodules (16.8%) were coincident with the target nodule. Incidental carcinomas were found in 25 patients (19.7%). The other 114 target nodules were benign. A total of 46 patients (52.3%) had carcinomas in the thyroid lobe contralateral to the one containing the target nodule, and 40 patients (45.5%) had carcinomas exclusively in the contralateral lobe. Conclusions: We observed a 16% rate of malignancy in nodules classified as bethesda category III and 17% among bethesda category IV. When incidental carcinomas were included, the rates of malignancy doubled.
- Risk factors for salvage surgery failure in oral cavity squamous cell carcinoma(2018) MATSUURA, Danielli; VALIM, Tiago Dias; KULCSAR, Marco Aurelio Vamondes; PINTO, Fabio Roberto; BRANDAO, Lenine Garcia; CERNEA, Claudio Roberto; MATOS, Leandro LuongoObjectives/HypothesisLocoregional recurrences of oral cavity squamous cell carcinoma (SCC) may be diagnosed during follow-up of surgically treated patients. Nevertheless, few studies have investigated factors that impact salvage surgery failure and the mortality rates of these patients. The objectives were to identify predictive factors of salvage surgery failure and mortality in patients who undergo surgical treatment for recurrent oral cavity SCC and to compare the overall survival rates of these patients with those of patients who undergo only one surgical treatment. Study DesignRetrospective cohort study. MethodsForty-six patients submitted to salvage surgery for local or locoregional recurrence. ResultsThe presence of lymph node metastasis and positive surgical margins at the salvage surgery time were the only independent factors associated with both recurrence rates (hazard ratio [HR]: 5.04 and 2.82, respectively) and mortality (HR: 3.51 and 3.24, respectively). When the overall survival rates of the 199 patients who only underwent one surgical treatment were compared to those of the 46 patients subjected to salvage surgery, a similarity was evident when patients who underwent salvage surgery did not have a new disease recurrence (70.7% vs. 54.7%, respectively; P = .158). Likewise, patients with new recurrences after salvage surgery and patients who received palliative treatment for relapsed disease had similar overall survival rates (0.6% vs. 0.0%, respectively; P = .475). ConclusionsThe presence of lymph node metastasis at the time of recurrence and positive surgical margins after the salvage surgery were associated with a worse overall survival rate in patients with oral cavity SCC relapse.
- Potential role of sorafenib as neoadjuvant therapy in unresectable papillary thyroid cancer(2018) DANILOVIC, Debora L. S.; CASTRO JR., Gilberto; ROITBERG, Felipe S. R.; VANDERLEI, Felipe A. B.; BONANI, Fernanda A.; FREITAS, Ricardo M. C.; COURA-FILHO, George B.; CAMARGO, Rosalinda Y.; KULCSAR, Marco A.; MARUI, Suemi; HOFF, Ana O.Total thyroidectomy, radioiodine (RAI) therapy, and TSH suppression are the mainstay treatment for differentiated thyroid carcinomas (DTCs). Treatments for metastatic disease include surgery, external-beam radiotherapy, RAI, and kinase inhibitors for progressive iodine-refractory disease. Unresectable locoregional disease remains a challenge, as standard therapy with RAI becomes unfeasible. We report a case of a young patient who presented with unresectable papillary thyroid carcinoma (PTC), and treatment with sorafenib allowed total thyroidectomy and RAI therapy. A 20-year-old male presented with severe respiratory distress due to an enlarging cervical mass. Imaging studies revealed an enlarged multinodular thyroid gland, extensive cervical adenopathy, severe tracheal stenosis, and pulmonary micronodules. He required an urgent surgical intervention and underwent tracheostomy and partial left neck dissection, as the disease was deemed unresectable; pathology revealed PTC. Treatment with sorafenib was initiated, resulting in significant tumor reduction allowing near total thyroidectomy and bilateral neck dissection. Postoperatively, the patient underwent radiotherapy for residual tracheal lesion, followed by RAI therapy for avid cervical and pulmonary disease. The patient's disease remains stable 4 years after diagnosis. Sorafenib has been approved for progressive RAI-refractory metastatic DTCs. In this case report, we describe a patient with locally advanced PTC in whom treatment with sorafenib provided sufficient tumor reduction to allow thyroidectomy and RAI therapy, suggesting a potential role of sorafenib as an induction therapy of unresectable DTC.
conferenceObject ENDOSCOPIC SUBMUCOSAL DISSECTION OF SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA - COMPARISON BETWEEN PATIENTS WITH AND WITHOUT HEAD AND NECK SQUAMOUS CELL CANCER(2018) MOURA, Renata N.; ARANTES, Vitor N.; RIBEIRO, Tarso M.; GUIMARAES, Roberto G.; OLIVEIRA, Joel F.; KULCSAR, Marco A.; SALLUM, Rubens A.; RIBEIRO, Ulysses; MALUF-FILHO, Fauze- Combined Vocal Exercises for Rehabilitation After Supracricoid Laryngectomy: Evaluation of Different Execution Times(2018) SILVEIRA, Hevely Saray Lima; SIMOES-ZENARI, Marcia; KULCSAR, Marco Aurelio; CERNEA, Claudio Roberto; NEMR, KatiaIntroduction. The supracricoid partial laryngectomy allows the preservation of laryngeal functions with good local cancer control. Objective. To assess laryngeal configuration and voice analysis data following the performance of a combination of two vocal exercises: the prolonged /b/vocal exercise combined with the vowel /e/ using chest and arm pushing with different durations among individuals who have undergone supracricoid laryngectomy. Methods. Eleven patients undergoing partial laryngectomy supracricoid with cricohyoidoepiglottopexy (CHEP) were evaluated using voice recording. Four judges performed separately a perceptive-vocal analysis of hearing voices, with random samples. For the analysis of intrajudge reliability, repetitions of 70% of the voices were done. Intraclass correlation coefficient was used to analyze the reliability of the judges. For an analysis of each judge to the comparison between zero time (time point 0), after the first series of exercises (time point 1), after the second series (time point 2), after the third series (time point 3), after the fourth series (time point 4), and after the fifth and final series (time point 5), the Friedman test was used with a significance level of 5%. The data relative to the configuration of the larynx were subjected to a descriptive analysis. Results. In the evaluation, were considered the judge results 1 which have greater reliability. There was an improvement in the general level of vocal, roughness, and breathiness deviations from time point 4 [T4]. Conclusion. The prolonged /b/vocal exercise, combined with the vowel /e/ using chest- and arm-pushing exercises, was associated with an improvement in the overall grade of vocal deviation, roughness, and breathiness starting at minute 4 among patients who had undergone supracricoid laryngectomy with CHEP reconstruction.