HELOISA DE ANDRADE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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Agora exibindo 1 - 10 de 14
- Lung cancer in Brazil(2018) ARAUJO, Luiz Henrique; BALDOTTO, Clarissa; CASTRO JR., Gilberto de; KATZ, Artur; FERREIRA, Carlos Gil; MATHIAS, Clarissa; MASCARENHAS, Eldsamira; LOPES, Gilberto de Lima; CARVALHO, Heloisa; TABACOF, Jaques; MARTINEZ-MESA, Jeovany; VIANA, Luciano de Souza; CRUZ, Marcelo de Souza; ZUKIN, Mauro; MARCHI, Pedro De; TERRA, Ricardo Mingarini; RIBEIRO, Ronaldo Albuquerque; LIMA, Vladmir Claudio Cordeiro de; WERUTSKY, Gustavo; BARRIOS, Carlos HenriqueLung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.
- 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.
- 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.
- History of radiotherapy in the treatment of uterine cervix cancer: an overview(2023) CARVALHO, Heloisa de Andrade; MAURO, Geovanne Pedro
- Reirradiation for locally recurrent breast cancer(2017) MARTA, Gustavo Nader; HIJAL, Tarek; CARVALHO, Heloisa de AndradeThe aim of this study is to review the current status of reirradiation therapy (Re-RT) for locally recurrent breast cancer. The overall outcome of breast/chest wall Re-RT is difficult to assess because of the wide range of different treatments that a patient may have undergone and the patient's individual features. The local control and complete response rates were reported to be 43-96% and 41-71%, respectively. The combination of Re-RT and hyperthermia seems to be related to improved outcomes. Toxicity rates vary between studies, and Re-RT is generally well tolerated. Re-RT may be considered an option for patients with breast cancer relapse after prior irradiation. Further studies are needed to determine the best irradiation volume and treatment modality for patients with locally recurrent disease.
- Lung Cancer and the COVID-19 pandemic: Recommendations from the Brazilian Thoracic Oncology Group(2020) BALDOTTO, Clarissa; GELATTI, Ana; ACCIOLY, Arthur; MATHIAS, Clarissa; MASCARENHAS, Eldsamira; CARVALHO, Heloisa; FARONI, Lilian; ARAUJO, Luiz Henrique; ZUKIN, Mauro; GADIA, Rafael; TERRA, Ricardo Mingarini; HADDAD, Rui; LIMA, Vladmir Cordeiro de; CASTRO-JUNIOR, Gilberto deNew cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.
- Effects of 3D image-guided brachytherapy compared to 2D conventional brachytherapy on clinical outcomes in patients with cervical cancer: A systematic review and meta-analyses(2021) SUZUMURA, Erica Aranha; GAMA, Layse Martins; JAHN, Beate; CAMPOLINA, Alessandro Goncalves; CARVALHO, Heloisa de Andrade; SOAREZ, Patricia Coelho dePURPOSE: To assess the effects of three-dimensional image-guided brachytherapy (3D BT) compared to bi-dimensional BT (2D BT) on clinical outcomes in patients with cervical cancer. METHODS AND MATERIALS: We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL, Web of Science, and LILACS for studies assessing the effects of 3D BT versus 2D BT on clinical outcomes. Two reviewers independently screened retrieved citations, extracted data and assessed risk of bias from eligible studies. Hazard ratios (HR) were calculated from Kaplan-Meier curves considering the number of events, their timing and the followup of censored patients. We conducted meta-analyses of HR using the inverse-variance random-effects method. Risk Difference (RD) for toxicities were pooled using the Mantel-Haenszel random-effects method. We used the GRADE system to rate the certainty of evidence. RESULTS: Twenty observational studies involving 4287 patients were included. The meta analyses assessing the effect of 3D BT versus 2D BT on overall survival resulted in a HR of 0.78 (95%CI 0.62-0.98), HR of 0.75 (95%CI 0.62-0.90) for pelvic disease-free survival, HR of 0.93 (95%CI 0.81-1.06) for metastatic disease-free survival, and HR of 0.77 (95%CI 0.59-0.99) for local control. Grade 3-4 global and gastrointestinal toxicities were, respectively, 9% lower (95%CI 6% to 11%) and 5% lower (95%CI 2% to 8%) in patients receiving 3D BT versus 2D BT. Certainty of evidence was very low for all assessed outcomes. CONCLUSIONS: Our study may suggest a benefit of 3D BT over conventional 2D BT on important clinical outcomes.
- Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions(2016) MORAES, Fabio Ynoe de; TAUNK, Neil Kanth; LAUFER, Ilya; NEVES-JUNIOR, Wellington Furtado Pimenta; HANNA, Samir Abdallah; CARVALHO, Heloisa de Andrade; YAMADA, YoshiyaMany cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.
- Systematic review of economic evaluations on stereotactic ablative radiotherapy (SABR) compared to other radiotherapy techniques or surgical procedures for early-stage non-small cell lung cancer(2023) MAIA, Fernando Henrique de Albuquerque; ROZMAN, Luciana Martins; CARVALHO, Heloisa de Andrade; SOAREZ, Patricia Coelho deBackgroundStereotactic ablative radiotherapy (SABR) is recommended as first-choice treatment to inoperable early-stage non-small cell lung cancer (NSCLC). However, it is not widely adopted in developing countries, and its cost-effectiveness is unclear. We aimed to perform a systematic review of full economic evaluations (EE) that compared SABR with other radiotherapy or surgical procedures to assess the results and methodological approach.MethodsThe protocol was registered on PROSPERO (CRD42021241640). We included full EE studies with early-stage NSCLC in which one group was submitted to SABR. Studies that were partial EE, included advanced NSCLC or other neoplasm were excluded. We performed the last search on June 2021 in Medline, EMBASE and other databases. The reporting quality were assessed by CHEERS checklist. The main characteristics of each study were tabulated, and the results were presented by a narrative synthesis.ResultsWe included nine studies. Three compared radiotherapy techniques, in which SABR was found to be dominant or cost-effective. Six compared SABR with surgery, and in this group, there was not a unanimous decision. All included only direct healthcare costs but varied about categories included. The parameters used in the model-based studies were highly heterogeneous using mixed data from various sources. The items properly reported varied from 29 to 67%.ConclusionsThe studies were all from developed countries and lacked in reporting quality. We recommend that developing countries produce their own studies. More strict alignment to reporting guidelines and use of robust evidence as model parameters are also advised.
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.