MARIA DEL PILAR ESTEVEZ DIZ
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
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- Carboplatin-based chemoradiotherapy in advanced cervical cancer: an alternative to cisplatin-based regimen?(2016) SEBASTIAO, Ana Morais; ROCHA, Lucila Soares da Silva; GIMENEZ, Rodrigo Darouche; BARROS, Laryssa Almeida Borges de; FUKUSHIMA, Julia Tizuko; SILVA, Samantha Cabral Severino da; MIRANDA, Vanessa da Costa; CAIRES, Inacelli Queiros de Souza; FREITAS, Daniela de; ABDO FILHO, Elias; DIZ, Maria Del Pilar EstevezObjective: To evaluate the results of treatment with cisplatin or carboplatin concomitant with radiotherapy (RT) in cases of locally advanced cervical cancer (CC). Methods: This study is a retrospective analysis of medical records of 184 patients with cervical cancer stage IIB-IVA who were treated at Instituto do Cancer do Estado de Sao Paulo from May 2008 to December 2012. All patients received complete pelvic region external-beam RT with weekly cisplatin (cis-RT, 40 mg/m(2); n = 159) or carboplatin (carbo-RT, AUC 2; n = 25), followed by high-dose-rate intracavitary brachytherapy (HDR-ICBT). Primary endpoint was progression free survival; secondary endpoints were overall survival and overall response rate, which includes complete and partial responses. Results: Five or more chemotherapy cycles were administered to 87.3% and 84% of the cis-RT- and carbo-RT- treated patients, respectively (p = 0.749). Estimated 3-years progression free survival was 59% in the cis-RT group vs 40% in the carbo-RT group (p = 0.249). Estimated 3-years overall survival was 70% in the cis-RT group vs 68% in the carbo-RT group (p = 0.298). Overall response rate (95.3% cis-RT vs 95.4% carbo-RT; p = 0.911) and grade >= 3 toxic effects (8.5% cis-RT vs 11.8% carbo-RT; p = 0.757) were similar. In multivariate analysis, only the overall response rate was a significant predictor of survival. Conclusions: Patients with advanced cervical cancer who are treated with carbo-RT have similar 3-years overall survival, progression free survival, overall response rate, and toxic effects when compared to cis-RT-treated patients. Carbo-RT may be an alternative treatment in patients that cannot receive cisplatin.
article BRAZILIAN DIRECTOR OF CARDIO-ONCOLOGY OF THE BRAZILIAN CARDIOLOGY SOCIETY ACHIEVEMENT(2011) KALIL FILHO, Roberto; HAJJAR, Ludhmila Abrahao; BACAL, Fernando; HOFF, Paulo Marcelo Gehm; DIZ, Maria Del Pilar Estevez; GALAS, Filomena Regina Barbosa Gomes; FUKUSHIMA, Julia Tizue; ALMEIDA, Juliano Pinheiro de; NAKAMURA, Rosana Ely; TRIELLI, Thalia Rodrigues; BITTAR, Cristina Salvadori; SANTOS, Marilia Harumi dos; GALDEANO, Flavia Gomes; AULER JUNIOR, Jose Otavio da Costa; SILVESTRINI, Anderson Arantes; ALENCAR, Aristoteles; MOTA, Augusto Cesar de Andrade; GUSMAO, Cid Abreu Buarque de; ALMEIDA, Dirceu Rodrigues; SIMOES, Claudia Marques; BOCCHI, Edimar Alcides; LIMA, Enaldo Melo de; FERNANDES, Fabio; SILVEIRA, Fabio Serra; VILAS-BOAS, Fabio; SILVA NETO, Luis Beck da; ROHDE, Luis Eduardo Paim; MONTERA, Marcelo Westerlund; BARBOSA, Marcia; MANO, Max Senna; RIECHELMANN, Rachel Simoes; ARAI, Roberto Jun; MARTINS, Silvia M.; FERREIRA, Silvia Moreira Ayub; SANTOS, Veronica- First report of a clinical isolate of Candida haemulonii in Brazil(2012) ALMEIDA JR., Joao Nobrega de; MOTTA, Adriana Lopes; ROSSI, Flavia; ABDALA, Edson; PIERROTTI, Ligia Camera; KONO, Adriana Satie Goncalves; DIZ, Maria Del Pilar Estevez; BENARD, Gil; NEGRO, Gilda Maria Barbaro Del
- Brazilian Cardio-oncology Guideline-2020(2020) HAJJAR, Ludhmila Abrahao; COSTA, Isabela Bispo Santos da Silva da; LOPES, Marcelo Antonio Cartaxo Queiroga; HOFF, Paulo Marcelo Gehm; DIZ, Maria Del Pilar Estevez; FONSECA, Silvia Moulin Ribeiro; BITTAR, Cristina Salvadori; REHDER, Marilia Harumi Higuchi dos Santos; RIZK, Stephanie Itala; ALMEIDA, Dirceu Rodrigues; FERNANDES, Gustavo S. Santos; BECK-DA-SILVA, Luis; CAMPOS, Carlos Augusto Homem de Magalhaes; MONTERA, Marcelo Westerlund; ALVES, Silvia Marinho Martins; FUKUSHIMA, Julia Tizue; SANTOS, Maria Veronica Camara dos; NEGRAO, Carlos Eduardo; SILVA, Thiago Liguori Feliciano da; FERREIRA, Silvia Moreira Ayub; MALACHIAS, Marcus Vinicius Bolivar; MOREIRA, Maria da Consolacao Vieira; VALENTE NETO, Manuel Maria Ramos; FONSECA, Veronica Cristina Quiroga; SOEIRO, Maria da Carolina Feres de Almeida; ALVES, Juliana Barbosa Sobral; SILVA, Carolina Maria Pinto Domingues Carvalho; SBANO, Joao; PAVANELLO, Ricardo; PINTO, Ibraim Masciarelli F.; SIMAO, Antonio Felipe; DRACOULAKIS, Marianna Deway Andrade; HOFF, Ana Oliveira; ASSUNCAO, Bruna Morhy Borges Leal; NOVIS, Yana; TESTA, Laura; ALENCAR FILHO, Aristoteles Comte de; CRUZ, Cecilia Beatriz Bittencourt Viana; PEREIRA, Juliana; GARCIA, Diego Ribeiro; NOMURA, Cesar Higa; ROCHITTE, Carlos Eduardo; MACEDO, Ariane Vieira Scarlatelli; MARCATTI, Patricia Tavares Felipe; MATHIAS JUNIOR, Wilson; WIERMANN, Evanius Garcia; VAL, Renata do; FREITAS, Helano; COUTINHO, Anelisa; MATHIAS, Clarissa Maria de Cerqueira; VIEIRA, Fernando Meton de Alencar Camara; SASSE, Andre Deeke; ROCHA, Vanderson; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
- Quality of life of locally advanced cervical cancer patients after neoadjuvant chemotherapy followed by chemoradiation versus chemoradiation alone (CIRCE trial): a randomized phase II trial(2020) ARRUDA, Fernanda Nunes de; COSTA, Samantha da; BONADIO, Renata; DORNELLAS, Abraao; PEREIRA, Daniela; BOCK, Geertruida H. de; DIZ, Maria Del Pilar EstevezObjective The CIRCE trial (NCT 01973101) investigated the efficacy, safety, and quality of life of the addition of neoadjuvant chemotherapy with cisplatin and gemcitabine to standard chemoradiation for locally advanced cervical cancer (stages IIB-IVA). The impact of both treatment arms on quality of life is reported in the present study. Methods Patients completed the European Organization of Research and Treatment of Cancer questionnaire QLQ-C30 and CX24 before treatment and at 3, 6, 9, and 12 months after treatment. Linear mixed models were fitted to analyze differences in quality of life over time and between groups. Differences in mean quality of life scales >10 points and p<0.05 were considered clinically relevant and statistically significant, respectively. Inclusion criteria were: (1) histological diagnosis of locally advanced invasive carcinoma of the uterine cervix, International Federation of Gynecology and Obstetrics stages IIB-IVA; (2) signed informed consent to participate in the CIRCE trial; and (3) answered at least one quality of life questionnaire. Excluded were patients who did not complete any quality of life questionnaire. Relevant exclusion criteria for the CIRCE trial included Eastern Cooperative Oncology Group performance status >2 and peripheral neuropathy >2. Mann-Whitney U tests were performed to assess differences between groups in quality of life at baseline. To evaluate differences between treatment arms, linear mixed models were fitted using the transformed quality of life scores as a dependent variable and time of follow-up and study arm as factors. Results A total of 107 patients were enrolled (n=55 neoadjuvant chemotherapy arm; n=52 chemoradiation arm). Quality of life compliance rates were higher for the chemoradiation group at every assessment time (ranging from 75-86.5% in the chemoradiation arm vs 55-81.8% in the neoadjuvant chemotherapy arm). For quality of life results at baseline, no statistically significant difference between the groups was seen. For both groups, most scales showed improvements over time, except for worsening of the summary score, sexual enjoyment, peripheral neuropathy, and menopausal symptoms. For chemoradiation, body image was lower (p<0.001) and patients presented more lymphedema (p<0.001) and sexual worry (p<0.001) at 12 months compared with baseline. Comparing study arms, neoadjuvant chemotherapy showed significantly lower scores in the menopausal symptoms scale (p=0.03) and higher scores for sexual/vaginal functioning (p=0.01). At 12 months, clinical differences were seen only for body image and menopausal symptoms scale, with neoadjuvant chemotherapy presenting better body image scores and a lower burden of menopausal symptoms. Conclusion After treatment for locally advanced cervical cancer, patients improved in most quality of life aspects. However, worsening was observed in sexual enjoyment, peripheral neuropathy, and menopausal symptoms. To improve patients' quality of life, efforts should be made to prevent and treat these long term effects of locally advanced cervical cancer treatment.
bookPart Assistência integral ao paciente oncológico(2022) SANTOS, Érickson Borges; DIZ, Maria Del Pilar EstevezbookPart Câncer de ovário(2015) CAIRES, Inacelli Queiroz de Souza; TESTA, Laura; MAK, Milena Perez; DIZ, Maria Del Pilar Estevez; ABDO FILHO, Elias- Cost effectiveness of the cancer prevention program for carriers of the BRCA1/2 mutation(2018) RAMOS, Marcelo Cristiano de Azevedo; FOLGUEIRA, Maria Aparecida Azevedo Koike; MAISTRO, Simone; CAMPOLINA, Alessandro Goncalves; SOAREZ, Patricia Coelho de; BOCK, Geertruida Hendrika de; NOVAES, Hillegonda Maria Dutilh; DIZ, Maria Del Pilar EstevezOBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study's cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country's health policies.
- Frequency of CDH1 germline variants and contribution of dietary habits in early age onset gastric cancer patients in Brazil(2019) GUINDALINI, Rodrigo Santa Cruz; CORMEDI, Marina Candido Visontai; MAISTRO, Simone; PASINI, Fatima Solange; BRANAS, Priscila Cristina Abduch Adas; SANTOS, Liliane dos; PEREIRA, Glaucia Fernanda de Lima; BOCK, Geertruida Hendrika de; SACCARO, Daniela Marques; KATAYAMA, Maria Lucia Hirata; FARAJ, Sheila Friedrich; SAFATLE-RIBEIRO, Adriana; RIBEIRO JUNIOR, Ulysses; DIZ, Maria Del Pilar Estevez; GOUVEA, Ana Carolina Ribeiro Chaves de; CHAMMAS, Roger; FOLGUEIRA, Maria Aparecida Azevedo KoikeIntroduction The contribution of CDH1 germline variants to gastric cancer burden among young adults is unknown in Brazil. We aimed to evaluate the frequency of CDH1 germline variants and the diet/lifestyle habits in early age onset gastric cancer (EOGC, <= 55 years old) patients. Methodology From 2013 to 2015, a total of 88 unrelated and consecutive patients diagnosed with EOGC were enrolled. All CDH1 exons and intronic boundaries were sequenced, and large genomic rearrangements were screened by MLPA. CDH1 transcription analysis was performed for variants that could potentially induce an effect on splicing. The diet and lifestyle habits of EOGC patients were compared to Brazilian population diet and lifestyle, obtained from governmental databases. Results Of 88 patients, the mean age at EOGC diagnosis was 39 years and 55% fulfilled the criteria for hereditary diffuse gastric cancer. The majority of the tumors were diffuse (74%) and poorly differentiated (80%). In total, 4 novel missense variants of uncertain significance (VUS) were identified: c.313T>A, c.387G>T, c.1676G>A, and c.1806C>A. The MLPA results revealed no rearrangements and CDH1 transcription analysis for variants of interest were inconclusive. EOGC patients had a higher red (OR:2.6, 95%CI:1.4-4.9) and processed (OR:3.1, 95%CI:1.6-6.0) meat intake and higher fruit consumption (OR:0.4, 95%IC:0.3-0.7) compared to eating habits of the Brazilian population. Conclusions No unequivocal pathogenic germline CDH1 variants were identified in Brazilian EOGC patients. Dietary habits may be associated with the EOGC development.
bookPart Estadiamento do câncer(2016) DIZ, Maria Del Pilar Estevez; CASTRIA, Tiago Biachi de