HELOISA DE ANDRADE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
12 resultados
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- Patterns of post-operative radiotherapy in breast cancer patients after neoadjuvant chemotherapy(2017) LOPES, K. M.; FREITAS, T. B. De; CARVALHO, H. A.; PEREIRA, A. A.; SILVA, S. B.; STUART, S. R.; MANO, M. S.; FILASSI, J. R.; MARTA, G. N.
- Breast irradiation and lactation: a review(2013) LEAL, Sarah Campos; STUART, Silvia Radwanski; CARVALHO, Heloisa de AndradeThe incidence of breast cancer in premenopausal women is increasing and many of them still remain fertile after treatment. Allied to the current tendency to postpone pregnancy, it is expected that an increasing number of patients undergoing conservative treatment for breast cancer will get pregnant. Anatomical and histopathological aspects and the probability of lactation and breast feeding after breast irradiation are reviewed in this article. Lactation is possible after radiotherapy, present in at least 50% of the patients, but in reduced volume. This perspective is more correlated to the type of surgery and radiation dose used. Biochemical changes were observed in irradiated breast milk. Breastfeeding in the contralateral breast is not affected.
- Effects of locoregional radiotherapy in patients with metastatic breast cancer(2016) MAURO, Geovanne Pedro; CARVALHO, Heloisa de Andrade; STUART, Silva Radwanski; MANO, Max Senna; MARTA, Gustavo NaderObjectives: This study aims to assess the clinical outcomes of patients with metastatic breast cancer (MBC) who underwent local radiation therapy (RT) for the primary site. Material and methods: Between 2005 and 2013, we retrospectively evaluated patients with MBC who received breast or chest wall RT with or without regional lymph node irradiation. Results: 2761 patients with breast cancer were treated with RT. Of them, 125 women with stage IV breast carcinoma were included. The median follow-up was 15 months (ranging from 3.8 to 168 months), when 54.7% of the patients had died; local progression was observed in 22.8% of the patients. The mean overall survival (OS) and local progression free survival (LoPFS) were 23.4 +/- 2.4 months and 45.1 +/- 2.9 months, respectively. Three-and five-year overall survival rates were, respectively, 21.2% and 13.3%. Local progression free survival was the same, 67.3%, at three and five years, respectively. Karnofsky Performance Status (KPS) (p = 0.015), number of metastatic sites (p = 0.031), RT dose (p = 0.0001) and hormone therapy (p = 0.0001) were confirmed as independent significant variables correlated with OS. The variables that were independently correlated with LoPFS were the number of previous chemotherapy lines (p = 0.038) and RT dose (p = 0.0001). Conclusion: RT of the primary site in patients with MBC is well tolerated. The factors that presented positive impact on survival were good KPS, low disease burden (1-3 metastatic sites), and the use of hormone therapy.
- Implementation of image-guided brachytherapy (IGBT) for patients with uterine cervix cancer: a tumor volume kinetics approach(2016) CARVALHO, Heloisa de Andrade; MENDEZ, Lucas Castro; STUART, Silvia Radwanski; GUIMARAES, Roger Guilherme Rodrigues; RAMOS, Clarissa Cerchi Angotti; PAULA, Lucas Assad de; SALES, Camila Pessoa de; CHEN, Andre Tsin Chih; BLASBALG, Roberto; BARONI, Ronald HuebPurpose: To evaluate tumor shrinking kinetics in order to implement image-guided brachytherapy (IGBT) for the treatment of patients with cervix cancer. Material and methods: This study has prospectively evaluated tumor shrinking kinetics of thirteen patients with uterine cervix cancer treated with combined chemoradiation. Four high dose rate brachytherapy fractions were delivered during the course of pelvic external beam radiation therapy (EBRT). Magnetic resonance imaging (MRI) exams were acquired at diagnosis (D), first (B1), and third (B3) brachytherapy fractions. Target volumes (GTV and HR-CTV) were calculated by both the ellipsoid formula (VE) and MRI contouring (VC), which were defined by a consensus between at least two radiation oncologists and a pelvic expert radiologist. Results: Most enrolled patients had squamous cell carcinoma and FIGO stage IIB disease, and initiated brachytherapy after the third week of pelvic external beam radiation. Gross tumor volume volume reduction from diagnostic MRI to B1 represented 61.9% and 75.2% of the initial volume, when measured by VE and VC, respectively. Only a modest volume reduction (15-20%) was observed from B1 to B3. Conclusions: The most expressive tumor shrinking occurred in the first three weeks of oncological treatment and was in accordance with gynecological examination. These findings may help in IGBT implementation.
- Can we predict who will benefit from the deep inspiration breath hold (DIBH) technique for breast cancer irradiation?(2023) STUART, Silvia Radwanski; POCO, Joao Guilherme; RODRIGUES, Marcus Vinicius S. P.; ABE, Ricardo Y.; CARVALHO, Heloisa A.Background: The objective was to explore the clinical use of an ""in-house"" prototype developed to monitor respiratory motion to implement the deep inspiration breath hold technique (DIBH), compare dosimetric differences, and assess whether simple anatomic metrics measured on free breathing (FB) computed tomography scan (CT) can help in selecting patients that would benefit the most from the technique. Materials and methods: A prospective study was conducted on patients with left breast cancer with an indication of adjuvant radiotherapy for breast only. Treatment simulation consisted of four series of CTs: the first during FB and three in DIBH to assess the reproducibility and stability of apnea. Contouring was based on the RTOG atlas, and planning was done in both FB and DIBH. Dosimetric and geometric parameters were assessed and compared between FB and DIBH. Results: From June 2020 to December 2021, 30 patients with left breast cancer were recruited. Overall, the DIBH technique presented a mean dose reduction of 24% in the heart and 30% in the left anterior descendent coronary artery (LAD) (p < 0.05). The only geometric parameter correlated to a 30% dose reduction in the mean heart dose and LAD doses was the anterolateral distance from the heart to the chest wall of at least 1.5 cm measured on FB (p < 0.0001). Conclusion: The prototype enabled the use of the DIBH technique with dose reductions in the heart and LAD. The benefit of the DIBH technique can be predicted on FB CT by measuring the distance between the heart and chest wall at the treatment isocenter.
- What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery(2018) FREITAS, Thiago Brasileiro de; LIMA, Kennya Medeiros Lopes de Barros; CARVALHO, Heloisa de Andrade; MARQUES, Patricia de Azevedo; MATTOS, Fabio Teixeira Belfort; FONSECA, Alexandre Siqueira Franco; MUNHOZ, Alexandre Mendonca; FILASSI, Jose Roberto; STUART, Silvia R.; MARTA, Gustavo NaderPurpose/objective(s): To evaluate the role of surgical clips placement in the definition of boost treatment volume. Materials/methods: Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by cry Boost minus CTV Quadrant. Results: A total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52 cc, CTV Boost:36.59 cc, CTV Quadrant:285.07 cc, Cry NT:210.1 cc and CTV MISS:13.57 cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the Cry Quadrant and in 473% (117), partially inside. Among patients with any CFV MISS, 803% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CFV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue. Conclusion: Surgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.
bookPart 0 Citação(ões) na Scopus MANAGEMENT OF EARLY BREAST CANCER(2020) CARVALHO, H. A.; STUART, S. R.; MARTA, G. N.; LIM, F.; WAN, B. A.; SILVA, M. F.This chapter is an overview of the current policies in the management of early breast cancer in Latin America, based on relevant papers published over the last ten years in the literature. We examine the recommendations for breast cancer diagnosis and staging, and treatment for Stage 0 through Stage IIB (T1-2, N0-1) disease. Early stage breast cancer management by the radiation oncologist may be as simple as considering breast conservative surgery followed by irradiation of the whole breast as the standard of care. However, in daily practice, different scenarios of the same disease may represent a challenge, mostly regarding regional lymph node irradiation in the presence of risk factors versus avoiding adjuvant irradiation. Each department should develop guidelines based on a multidisciplinary approach and tailor radiotherapy not only in the indication, but also in the definition of the radiation targets and respective doses. © 2020 by Nova Science Publishers, Inc. All rights reserved.- Impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer(2018) SUESADATA, Milena Mako; CARVALHO, Heloisa de Andrade; ALBUQUERQUE, Andre Luis Pereira de; SALGE, Joao Marcos; STUART, Silvia Radwanski; TAKAGAKI, Teresa YaeObjetivo: Avaliar o impacto da radioterapia torácica na função respiratória e capacidade de exercício em pacientes com câncer de mama. Métodos: Pacientes com câncer de mama com indicação de radioterapia torácica após tratamento cirúrgico e quimioterápico foram submetidas a TCAR, avaliação respiratória e avaliação da capacidade de exercício antes da radioterapia torácica e três meses após o término do tratamento. Foram realizados teste de força muscular respiratória, medição da mobilidade torácica e prova de função pulmonar completa para a avaliação respiratória; realizou-se teste de exercício cardiopulmonar para avaliar a capacidade de exercício. A dose total de radioterapia foi de 50,4 Gy (1,8 Gy/fração) na mama ou na parede torácica, incluindo ou não a fossa supraclavicular (FSC). Histogramas dose-volume foram calculados para cada paciente com especial atenção para o volume pulmonar ipsilateral que recebeu 25 Gy (V25), em números absolutos e relativos, e a dose pulmonar média. Resultados: O estudo incluiu 37 pacientes. Após a radioterapia, observou-se diminuição significativa da força muscular respiratória, mobilidade torácica, capacidade de exercício e resultados da prova de função pulmonar (p < 0,05). A DLCO permaneceu inalterada. A TCAR mostrou alterações relacionadas à radioterapia em 87% das pacientes, o que foi mais evidente nas pacientes submetidas à irradiação da FSC. O V25% correlacionou-se significativamente com a pneumonite por radiação. Conclusões: Em nossa amostra de pacientes com câncer de mama, a radioterapia torácica parece ter causado perdas significativas na capacidade respiratória e de exercício, provavelmente por causa da restrição torácica; a irradiação da FSC representou um fator de risco adicional para o desenvolvimento de pneumonite por radiação.
- impact of breast radiation therapy on complications after alloplastic breast reconstruction(2017) CHAVES, C. D. L. G.; CARVALHO, H. D. A.; SARAIVA, T. D. C.; FUZISAKI, T. T.; MARTA, G. N.; CASAGRANDE, R.; MUNHOZ, A.; BRASIL, J. A.; STUART, S. R.
- Complications after breast reconstruction with alloplastic material in breast cancer patients submitted or not to post mastectomy radiotherapy(2021) STUART, Silvia Radwanski; MUNHOZ, Alexandre Mendonca; CHAVES, Cristiane L. G.; MONTAG, Eduardo; CORDEIRO, Thalita C. S.; FUZISAKI, Tatiana Taba; MARTA, Gustavo N.; CARVALHO, Heloisa A.Background and purpose: Breast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material. Materials and methods: Retrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications. Results: 251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23-9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60-4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97-11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048-0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26-9.99, p = 0.016) were related to late complications. Conclusions: The overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.