VANESSA DA COSTA MIRANDA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients not candidates for optimal primary surgery: Safety and effectivenes(2013) MIRANDA, Vanessa Costa; FEDE, Angelo Bezerra de Sousa; ANJOS, Carlos Henrique Dos; SILVA, Juliana Ribeiro da; SANCHEZ, Fernando Barbosa; BESSA, Lyvia Rodrigues da Silva; CARVALHO, Jesus Paula; ABDO FILHO, Elias; FREITAS, Daniela; BARROS, Laryssa Almeida Borges de; SILVA, Samantha Cabral Severino da; ESTEVEZ-DIZ, Maria Del Pilar- Role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy cycles for high-grade serous ovarian carcinoma(2021) LOPES, Andre; GENTA, Maria L. N. D.; MIRANDA, Vanessa da Costa; ARANHA, Andrea; LOPEZ, Rossana V. M.; PIATO, Dariane S. A. M.; ANTON, Cristina; CARVALHO, Filomena M.; DIZ, Maria del Pilar Esteves; CARVALHO, Jesus P.Introduction We analyzed the role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy (NACT) cycles for advanced high-grade serous ovarian carcinoma. Materials and Methods We retrospectively reviewed patients with advanced ovarian carcinoma who underwent NACT with carboplatin-paclitaxel between 2008 and 2016. Patients were included only if they had FIGO IIIC-IVB high-grade serous carcinoma with clinically negative lymph nodes after six NACT cycles (carboplatin-paclitaxel) and underwent complete or near complete cytoreduction. Patients with partial lymphadenectomy or bulky nodes were excluded. Patients who underwent systematic pelvic and aortic lymphadenectomy and those who did not undergo lymph node dissection were compared. Progression-free and overall survivals were analyzed using the Kaplan-Meier method. Results Totally, 132 patients with FIGO IIIC-IVB epithelial ovarian carcinoma were surgically treated after NACT. Sixty patients were included (39 and 21 in the lymphadenectomy and nonlymphadenectomy group, respectively); 40% had suspicious lymph nodes before NACT. Patient characteristics, blood transfusion numbers, and complication incidence were similar between the groups. In the lymphadenectomy group, 12 patients (30.8%) had histologically positive lymph nodes and the surgical time was longer (229 vs. 164 min). The median overall survival in the lymphadenectomy and nonlymphadenectomy groups, respectively, was 56.7 (95% CI 43.4-70.1) and 61.2 (21.4-101.0) months (p = 0.934); the corresponding disease-free survival was 8.1 (6.2-10.1) and 8.3 (5.1-11.6) months (p = 0.878). Six patients exclusively presented with lymph node recurrence. Conclusions Systematic lymphadenectomy after six NACT cycles may have no influence on survival.
- Management of cervical cancer patients during the COVID-19 pandemic: a challenge for developing countries(2020) ESTEVEZ-DIZ, Maria del Pilar; BONADIO, Renata Colombo; MIRANDA, Vanessa Costa; CARVALHO, Jesus PaulaDuring the COVID-19 pandemic, health services worldwide are going through important adaptations to assist patients infected with COVID-19, at the same time as continuing to provide assistance to other potentially life-threatening diseases. Although patients with cancer may be at increased risk for severe events related to COVID-19 infection, their oncologic treatments frequently cannot be delayed for long periods without jeopardising oncologic outcomes. Considering this, a careful consideration for treatment management of different malignancies is required. Cervical cancer is concentrated mainly in low-middle income countries (LMICs), which face particular challenges during the COVID-19 pandemic due to the scarcity of health resources in many places. Although cervical cancer is the fourth cause of cancer death among women, it receives little attention from international Oncology societies and scientific research studies. In this review paper, we discuss the cervical cancer landscape and provide specialists recommendations for its management during the COVID-19 pandemic, particularly focused on LMICs' reality.
- Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy(2015) FAVERO, Giovanni; MACEROX, Nathalia; PFIFFER, Tatiana; KOEHLER, Christhardt; MIRANDA, Vanessa da Costa; DIZ, Maria Del Pilar Estevez; FUKUSHIMA, Julia Tizue; BARACAT, Edmund Chada; CARVALHO, Jesus PaulaBackground: Presently, the use of laparoscopy in advanced ovarian cancer (AOC) is extremely controversial. In the era of neoadjuvant chemotherapy (NACT), endoscopic debulking surgery could be a reasonable alternative for selected patients with primarily unresectable disease. Objectives: To evaluate the feasibility as well as the operative and oncologic safety of laparoscopic debulking surgery in patients with AOC submitted to NACT. Methods: This is a pilot observational study on initially unresectable, high-grade serous ovarian cancer treated with a sequence of 6 cycles of carboplatin and paclitaxel followed by debulking surgery performed by laparoscopy (group 1) or laparotomy (group 2). The inclusion criteria were clinical complete response, CA125 normalization, imaging without disease in critical areas, and optimal cytoreduction. Results: From January 2011 to March 2014, 21 patients were included. Ten women underwent laparoscopy and 11 laparotomy. No epidemiological or oncologic differences were observed between the groups. No surgery-related casualties, intraoperative complications, conversion to laparotomy, or excessive blood loss or transfusion was detected in the laparoscopic procedures. The mean time of operation was 292 min. The length of hospital stay averaged 3.6 days. Two women in group 1 developed relevant complications. After a mean follow-up of 20 months, the recurrence rates were similar, i.e. 80% in group 1 versus 88% in group 2. Although statistical significance was not reached, the mortality related to cancer was considerably higher (20 vs. 0%; p = 0.086) and the mean chemotherapy-free interval was markedly shorter in group 1 (13.3 vs. 20.5 months; p = 0.288). Conclusion: Laparoscopic optimal debulking surgery after NACT is feasible and effective in selected patients. Nevertheless, laparoscopy was substantially associated with inferior oncologic results. Endoscopic cytoreduction in AOC should be cautiously suggested until larger prospective trials confirm the observed results. (C) 2015 S. Karger AG, Basel
- HISTOPATHOLOGICAL RESPONSE ON CLINICORADIOLOGICAL PRESENTATION AND PROGNOSIS OF PATIENTS WITH ADVANCED HIGH GRADE SEROUS OVARIAN CARCINOMA TREATED WITH NEOADJUVANT CHEMOTHERAPY(2019) LOPES, A.; GENTA, M. L. Nogueira D.; MIRANDA, V. da Costa; LOPEZ, R. V. Mendonza; CARVALHO, F. Marino; CARVALHO, J. Paula
conferenceObject Laparoscopic versus laparotomic cytoreduction in patients with advanced ovarian cancer submitted to NACT: Evaluation of oncologic safety.(2014) FAVERO, Giovanni; MACEROX, Nathalia; PFIFFER, Tatiana; RIBEIRO, Altamiro; MIRANDA, Vanessa Costa; DIZ, Maria Del Pillar Estevez; BARACAT, Edmund Chada; CARVALHO, Jesus Paula- Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness(2014) MIRANDA, Vanessa da Costa; FEDE, Angelo Bezerra de Souza; ANJOS, Carlos Henrique dos; SILVA, Juliana Ribeiro da; SANCHEZ, Fernando Barbosa; BESSA, Lyvia Rodrigues da Silva; CARVALHO, Jesus de Paula; ABDO FILHO, Elias; FREITAS, Daniela de; DIZ, Maria del Pilar EstevezObjective. Three cycles of neoadjuvant chemotherapy (NACT) followed by interval debulking (ID) surgery is an alternative for patients with advanced ovarian cancer unresectable disease. This study aimed to determine the efficacy and safety of six cycles of NACT followed by cytoreduction. Methods. Retrospective analysis of all patients with advanced epithelial ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma treated with platinum based NACT between January 2008 and February 2012. Results. Eighty-two patients underwent NACT; 78% and 18.2% had extensive stage IIIC or IV disease at diagnosis, respectively. Their median age was 60 years (41-82). On histology, serous adenocarcinoma was found in 90.2%. Patients did not receive chemotherapy after debulking surgery. 35.4% suffered grade 3/4 toxicity; the most commonly observed toxicities were hematologic and nausea. After NACT, 23.1% experienced clinical complete response, 57.4% partial response, and 12.1% disease progression. Complete resection of all macroscopic and microscopic disease (R0) was performed in 63.7%. Surgical complications were uncommon; however, four (6.2%) patients needed a second procedure due to operative complications and 18 (27.3%) needed blood transfusion after debulking. Over a median follow-up period of 19.2 months, median overall survival and chemotherapy-free interval were 37.5 months (confidence interval not reached) and 16 months, respectively. Conclusion. Six cycles of neoadjuvant carboplatin and paclitaxel was safe and effective and did not increase perioperative or postoperative complications in patients with stage IIIC/IV disease who were unsuitable for optimal PDS. The overall survival of this cohort was higher than that of those treated with ID surgery.