HELOISA DE ANDRADE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
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- The role of radiotherapy in urinary bladder cancer: current status(2012) MARTA, Gustavo Nader; HANNA, Samir Abdallah; GADIA, Rafael; CORREA, Sebastiao Francisco Miranda; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de AndradeThe role of radiotherapy (RT) in the treatment of urinary bladder cancer has undergone several modifications along the last decades. In the beginning, definitive RT was used as treatment in an attempt to preserve the urinary bladder; however, the results were poor compared to those of radical surgery. Recently, many protocols have been developed supporting the use of multi-modality therapy, and the concept of organ preservation began to be reconsidered. Although phase III randomized clinical studies comparing radical cystectomy with bladder preservation therapies do not exist, the conservative treatment may present low toxicity and high indexes of complete response for selected patients. The aim of this study was to review the literature on the subject in order to situate RT in the current treatment of urinary bladder cancer.
- Brazil's Challenges and Opportunities(2015) MORAES, Fabio Ynoe de; MARTA, Gustavo Nader; HANNA, Samir Abdallah; LEITE, Elton Trigo Teixeira; FERRIGNO, Robson; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de Andrade
- Long-Term Results of Intraoperative Radiation Therapy for Early Breast Cancer Using a Nondedicated Linear Accelerator(2023) HANNA, Samir Abdallah; BEVILACQUA, Jose Luiz Barbosa; BARROS, Alfredo Carlos Simo Dornellas de; ANDRADE, Felipe Eduardo Martins de; PIATO, Jose Roberto Morales; PELOSI, Edilson Lopes; MARTELLA, Eduardo; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de Andrade; JACOMO, Alfredo LuizPurpose: To present the long-term results of intraoperative radiation therapy (IORT) for early breast cancer using a nondedicated linear accelerator. Methods and Materials: The eligibility criteria were biopsy-proven invasive carcinoma, age >= 40 years, tumor size <= 3 cm, and N0M0. We excluded multifocal lesions and sentinel lymph node involvement. All patients had previously undergone breast magnetic resonance imaging. Breast-conserving surgery with margins and sentinel lymph node evaluation using frozen sections were performed in all cases. If there were no margins or involved sentinel lymph nodes, the patient was transferred from the operative suite to the linear accelerator room, where IORT was delivered (21 Gy). Results: A total of 209 patients who were followed up for >= 1.5 years from 2004 to 2019 were included. The median age was 60.3 years (range, 40-88.6), and the mean pT was 1.3 cm (range, 0.2-4). There were 90.5% pN0 cases (7.2% of micrometastases and 1.9% of macrometastases). Ninety-seven percent of the cases were margin free. The rate of lymphovascular invasion was 10.6%. Twelve patients were negative for hormonal receptors, and 28 patients were HER2 positive. The median Ki-67 index was 29% (range, 0.1-85). Intrinsic subtype stratification was as follows: luminal A, 62.7% (n = 131); luminal B, 19.1% (n = 40); HER2 enriched 13.4% (n = 28); and triple negative, 4.8% (n = 10). Within the median follow-up of 145 months (range, 12.8-187.1), the 5-year, 10-year, and 15-year overall survival rates were 98%, 94.7%, and 88%, respectively. The 5-year, 10-year, and 15-year disease-free rates were 96.3%, 90%, and 75.6%, respectively. The 15-year local recurrence-free rate was 76%. Fifteen local recurrences (7.2%) occurred throughout the follow-up period. The mean time to local recurrence was 145 months (range, 12.8-187.1). As a first event, 3 cases of lymph node recurrence, 3 cases of distant metastasis, and 2 cancer-related deaths were recorded. Tumor size >1 cm, grade III, and lymphovascular invasion were identified as risk factors. Conclusions: Despite approximately 7% of recurrences, we may infer that IORT may still be a reasonable option for selected cases. However, these patients require a longer follow-up as recurrences may occur after 10 years. (c) 2023TheAuthor(s).
- Brazil's Challenges and Opportunities Reply(2015) MORAES, Fabio Ynoe de; MARTA, Gustavo Nader; HANNA, Samir Abdallah; LEITE, Elton Trigo Teixiera; FERRIGNO, Robson; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de Andrade
- Intraoperative Radiation Therapy in Early Breast Cancer Using a Linear Accelerator Outside of the Operative Suite: An ""Image-Guided"" Approach(2014) HANNA, Samir Abdallah; BARROS, Alfredo Carlos Simoes Dornellas de; ANDRADE, Felipe Eduardo Martins de; BEVILACQUA, Jose Luiz Barbosa; PIATO, Jose Roberto Morales; PELOSI, Edilson Lopes; MARTELLA, Eduardo; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de AndradePurpose: To present local control, complications, and cosmetic outcomes of intraoperative radiation therapy (IORT) for early breast cancer, as well as technical aspects related to the use of a nondedicated linear accelerator. Methods and Materials: This prospective trial began in May of 2004. Eligibility criteria were biopsy-proven breast-infiltrating ductal carcinoma, age >40 years, tumor <3 cm, and cN0. Exclusion criteria were in situ or lobular types, multicentricity, skin invasion, any contraindication for surgery and/or radiation therapy, sentinel lymph node involvement, metastasis, or another malignancy. Patients underwent classic quadrantectomy with intraoperative sentinel lymph node and margins evaluation. If both free, the patient was transferred from operative suite to linear accelerator room, and IORT was delivered (21 Gy). Primary endpoint: local recurrence (LR); secondary endpoints: toxicities and aesthetics. Quality assurance involved using a customized shield for chest wall protection, applying procedures to minimize infection caused by patient transportation, and using portal films to check collimator-shield alignment. Results: A total of 152 patients were included, with at least 1 year follow-up. Median age (range) was 58.3 (40-85.4) years, and median follow-up time was 50.7 (12-110.5) months. The likelihood of 5-year local recurrence was 3.7%. There were 3 deaths, 2 of which were cancer related. The Kaplan-Meier 5-year actuarial estimates of overall, disease-free, and local recurrence-free survivals were 97.8%, 92.5%, and 96.3%, respectively. The overall incidences of acute and late toxicities were 12.5% and 29.6%, respectively. Excellent, good, fair, and bad cosmetic results were observed in 76.9%, 15.8%, 4.3%, and 2.8% of patients, respectively. Most treatments were performed with a 5-cm collimator, and in 39.8% of the patients the electron-beam energy used was >= 12 MeV. All patients underwent portal film evaluation, and the shielding was repositioned in 39.9% of cases. No infection or anesthesia complications were observed. Conclusions: Local control with IORT was adequate, with low complication rates and good cosmetic outcomes. More than one-third of patients benefited from the ""image-guidance"" approach, and almost 40% benefited from the option of higher electron beam energies. (C) 2014 Elsevier Inc.
article 10 Citação(ões) na Scopus Câncer de mama estádio inicial e radioterapia: atualização(2011) MARTA, Gustavo Nader; HANNA, Samir Abdallah; MARTELLA, Eduardo; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de AndradeEarly stage breast cancer and radiotherapy: update Breast cancer (BC) is the most common malignancy among women. Therapeutic options are based on disease staging, histopathological characteristics, age, and others. The objective of the present study is to carry out an update of the concepts and definitions of radiotherapy (RT) in conservative treatment of early-stage breast cancer, with emphasis on indications, contraindications, RT dose fractionation schedules (classic, hypofractionated and partial breast irradiation), adjuvant RT in ductal carcinoma in situ (DCIS) and molecular predictors of recurrence. MEDLINE, SciELO and Cochrane databases were used for article selection. Adjuvant RI is indicated for patients with BC who underwent conservative breast surgery. In selected patients, hypofractionated or partial breast irradiation can be used. Adjuvant RT should be provided for all patients with DCIS. The correlation of RT and molecular predictors of local and systemic recurrence are not yet well-known.- Self-reported Conflicts of Interest and Trial Sponsorship of Clinical Trials in Prostate Cancer Involving Radiotherapy(2018) MORAES, Fabio Ynoe de; LEITE, Elton Trigo Teixeira; HAMSTRA, Dan A.; FENG, Felix Y.; ARRUDA, Fernando Freire; GADIA, Rafael; ABREU, Carlos Eduardo Cintra Vita; MARTA, Gustavo Nader; HANNA, Samir Abdallah; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de Andrade; SPRATT, Daniel E.Objectives: To examine the association between trial sponsorship and conflicts of interest (COI) with clinical trial conclusions for prostate cancer trials related to radiotherapy. Materials and Methods: The MEDLINE database was searched for all prostate cancer clinical trials published between 2004 and 2013 and identified 1396 studies. Two investigators independently identified trials published in the English language of >= 30 patients, and extracted relevant data. Clinical trials were classified according to trial characteristics, sponsorship source and type, COI, and study conclusion, and analyzed by univariable and multivariable logistic regression. Results: Of 240 eligible trials, 160 (67.5%) evaluated drugs without radiotherapy, 60 (25%) involved radiotherapy, and 18 (7.5%) involved procedures without radiotherapy. Of the 60 radiotherapy trials eligible for analysis, positive sponsorship and potential COI were present in 58.3% and 20% of trials, respectively. Study conclusions were positive, negative, or neutral in 78.3%, 5%, and 16.7% of trials, respectively. No association was found between positive conclusions and either industry support of potential COI. Positive conclusions were reported in 86.7% and 83.3% of trials with sponsorship and COI, respectively, as compared with 75.6% and 77.1% of those without sponsorship (P = 0.37) and COI (P = 0.64). Sponsorship was significantly associated with radiotherapy trials combined with drugs (odds ratio 5.5, P = 0.01) and higher-risk disease (odds ratio 4.71, P = 0.01). Conclusions: The presence of sponsorship was associated with radiotherapy trials involving drugs or studying higher-risk prostate cancer. However, there were no identified associations between study conclusion and sponsorship type or COI.
- Intensity-modulated radiation therapy for head and neck cancer: Systematic review and meta-analysis(2014) MARTA, Gustavo Nader; SILVA, Valter; CARVALHO, Heloisa de Andrade; ARRUDA, Fernando Freire de; HANNA, Samir Abdallah; GADIA, Rafael; SILVA, Joao Luis Fernandes da; CORREA, Sebastiao Francisco Miranda; ABREU, Carlos Eduardo Cintra Vita; RIERA, RachelBackground and purpose: Intensity-modulated radiation therapy (IMRT) provides the possibility of dose-escalation with better normal tissue sparing. This study was performed to assess whether IMRT can improve clinical outcomes when compared with two-dimensional (2D-RT) or three-dimensional conformal radiation therapy (3D-CRT) in patients with head and neck cancer. Methods and materials: Only prospective phase III randomized trials comparing IMRT with 2D-RT or 3D-CRT were eligible. Combined surgery and/or chemotherapy were allowed. Two authors independently selected and assessed the studies regarding eligibility criteria and risk of bias. Results: Five studies were selected. A total of 871 patients were randomly assigned for 2D-RT or 3D-CRT.(437), versus IMRT (434). Most patients presented with nasopharyngeal cancers (82%), and stages III/IV (62.1%). Three studies were classified as having unclear risk and two as high risk of bias. A significant overall benefit in favor of IMRT was found (hazard ratio - HR = 0.76; 95% CI: 0.66, 0.87; p < 0.0001) regarding xerostomia scores grade 2-4, with similar loco-regional control and overall survival. Conclusions: IMRT reduces the incidence of grade 2-4 xerostomia in patients with head and neck cancers without compromising loco-regional control and overall survival.
- Accelerated partial irradiation for breast cancer: Systematic review and meta-analysis of 8653 women in eight randomized trials (vol 114, pg 42, 2015)(2015) MARTA, Gustavo Nader; MACEDO, Cristiane Rufino; CARVALHO, Heloisa de Andrade; HANNA, Samir Abdallah; SILVA, Joao Luis Fernandes da; RIERA, Rachel
- Accelerated partial irradiation for breast cancer: Systematic review and meta-analysis of 8653 women in eight randomized trials(2015) MARTA, Gustavo Nader; MACEDO, Cristiane Rufino; CARVALHO, Heloisa de Andrade; HANNA, Samir Abdallah; SILVA, Joao Luis Fernandes da; RIERA, RachelBackground and purpose: Accelerated partial breast irradiation (APBI) is the strategy that allows adjuvant treatment delivery in a shorter period of time in smaller volumes. This study was undertaken to assess the effectiveness and outcomes of APBI in breast cancer compared with whole-breast irradiation (WBI). Material and methods: Systematic review and meta-analysis of randomized controlled trials of WBI versus APBI. Two authors independently selected and assessed the studies regarding eligibility criteria. Results: Eight studies were selected. A total of 8653 patients were randomly assigned for WBI versus APBI. Six studies reported local recurrence outcomes. Two studies were matched in 5 years and only one study for different time of follow-up. Meta-analysis of two trials assessing 1407 participants showed significant difference in the WBI versus APBI group regarding the 5-year local recurrence rate (HR = 4.54, 95% CI: 1.78-11.61, p = 0.002). Significant difference in favor of WBI for different follow-up times was also found. No differences in nodal recurrence, systemic recurrence, overall survival and mortality rates were observed. Conclusions: APBI is associated with higher local recurrence compared to WBI without compromising other clinical outcomes.