HELOISA DE ANDRADE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
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- Trial sponsorship and self-reported conflicts of interest in breast cancer radiation therapy: An analysis of prospective clinical trials(2017) LEITE, Elton T. T.; MORAES, Fabio Y.; MARTA, Gustavo N.; TAUNK, Neil K.; VIEIRA, Marina T. L.; HANNA, Samir A.; SILVA, Joao Luis F.; CARVALHO, Heloisa A.Purpose: We aim to assess any association between study and self-reported conflict of interest (COI) or trial sponsorship in breast cancer radiation clinical trials. Materials and methods: We searched PubMed for all clinical trials (CTs) published between 09/2004 and 09/2014 related to breast cancer. We included only radiotherapy CTs with primary clinical endpoints. We classified eligible trials according to the funding source, presence or absence of conflict of interest, study conclusion and impact factor (IF). Results: 1,603 CTs were retrieved. 72 randomized clinical trials were included for analysis. For-profit (PO), not for profit organization (nP0), none and not reported sponsorship rates were 9/72 (12.5%), 35/72 (48.6%), 1/72 (1.4%), 27/72 (37.5%), respectively. Present, absent or not reported COI were found in 6/72 (8.3%), 43/72 (59.7%) and 23/72 (32%) of the CI's, respectively. Conclusion was positive, neutral and negative in 57/72 (79.1%), 9/72 (12.5%) and 6/72 (8.4%) of the trials, respectively. Positive conclusion was reported in 33/44 (75%) funded trials (PO and nP0) and 5/6 (83.3%) CTs with reported COI. On univariate analysis no association with funding source (P=0.178), COI (P=0.678) or trial region (P=0.567) and trial positive conclusion was found. Sponsored trials (HR 4.50, 95CI-0.1.23-16.53;P=0.0023) and positive trials (HR 4.78, 95CI- 1.16-19.63;P=0.030) were more likely to be published in higher impact factor journals in the multivariate analysis. Conclusions: nP0 funding was reported in almost 50% of the evaluated CTs. No significant association between study conclusion and funding source, COI or trial region was identified. Sponsored trials and positive trials were more likely to be published in higher impact factor journals.
- 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.
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.- Applying PET-CT for predicting the efficacy of SBRT to inoperable early-stage lung adenocarcinoma: A Brazilian case-series(2022) MORAES, Fabio Y.; V, Carlos E. C. Abreu; SIQUEIRA, Gabriela S. M.; HADDAD, Cecilia K.; DEGRANDE, Fabiana A. M.; HOPMAN, Wilma M.; NEVES-JUNIOR, Wellington F. P.; GADIA, Rafael; CARVALHO, Heloisa A.Background Stereotactic body radiotherapy (SBRT) is a treatment option for early-stage inoperable primary lung cancer. Here we report a thorough description of the prognostic value of pre-SBRT SUVmax for predicting the efficacy of SBRT in early-stage lung adenocarcinoma. Methods This is a retrospective study of consecutive cases of early-stage inoperable lung adenocarcinoma, staged with PET-CT, treated with SBRT between 2007 and 17. Kaplan-Meier (KM) curves were used to assess overall survival and compare time to event between those with PET-CT SUVmax values <= 5.0 and those > 5. Fisher's Exact tests and the Mann-Whitney U were used to compare the patient and clinical data of those with SUVmax <= 5.0 and > 5.0, and those with and without any failure. Findings Amongst 50 lung carcinoma lesions, from 47 patients (34 (68%)-T1a or < T1b), estimated median overall survival from the KM was 44.9 months (95% confidence interval 35.5- 54.3). Five experienced a local failure, which was inadequate for detecting differences between those with PET-CT SUVmax <= 5.0 and those > 5 (p = 0.112). In addition, 5 experienced a regional failure and 4 a distant failure. Higher PET-CT SUVmax values before SBRT were associated with an increased risk of any failure (36% versus 0%, p = 0.0040 on Fisher's Exact test) and faster time to event (p = 0.010, log rank test). Both acute and late toxicities profile were acceptable. Interpretation Patients with early-stage inoperable lung adenocarcinoma present good clinical outcomes when treated with SBRT. We raised the hypothesis that the value of PET-CT SUVmax before SBRT may be an important predictive factor in disease control.
- Comesis in patients with breast neoplasia submitted to the hypofractionated radiotherapy with of intensity-modulated beam(2018) MIRANDA, Fabiana Accioli; VIEIRA, Marina Tamm Lannes; MORAES, Fabio Ynoe de; MARTA, Gustavo Nader; CARVALHO, Heloisa de Andrade; HANNA, Samir AbdallahOBJECTIVE: To assess the cosmetic satisfaction of patients diagnosed with breast cancer submitted to the hypofractionated radiotherapy with IMRT (hIMRT) technique and its correlation with dosimetric data of the radiotherapy planning. MATERIALS AND METHODS: The retrospective cohort study that assessed women with a diagnosis of malignant breast neoplasia submitted to the conservative treatment or radical mastectomy and treated with hIMRT. In the period between August 2007 to December 2014, in a philanthropic/private institution, 170 records were selected. The cosmetic assessment was corned out by means of the Harvard/RTOG/NSABP scale with one-year minimum range after treatment. The collected dosimetric data were: breast/chest wall volume, volume that received 95% (V95%) and 107% (V107%) of the prescribed dose. RESULTS: The volume of the treated breasts ranged from 169 to 2.103 ml (median = 702; IQR: 535 to 914 ml). Median V95% was 86.7% (54.6-96.6%; IQR: 80.0% to 90.6%); eight (5.7%) patients had V95% higher than 95%. Median V107% was 0% (0%-16.3%; IQR: 0.0% to 0.3% and 13); 9.3% patients had V107% higher than 2%. One hundred and thirty-three (78.2%) patients responded to the cosmetic assessment: 99 (74.4%) considered the cosmetic results excellent. Significant associations between cosmetic assessment and breast volume (p=0.875), V95% (p=0.294) e V107% (p=0.301) were not found. CONCLUSION: The cosmetic results showed favorable when using hIMRT, and the lack of correlation with usual the dosimetric data illustrates the capacity of hIMRT to minimize the heterogeneity of the dose in this endpoint, even in voluminous breasts.
- Stereotactic Body Radiation Therapy for Biopsy-Proven Primary Non-Small-Cell Lung Cancer: Experience of Patients With Inoperable Cancer at a Single Brazilian Institution(2018) V, Carlos E. C. Abreu; MORAES, Fabio Y.; MIRANDA, Fabiana A.; SIQUEIRA, Gabriela S. M.; GADIA, Rafael; HADDAD, Cecilia K.; CARVALHO, Heloisa A.Purpose Stereotactic body radiation therapy (SBRT) has emerged as a treatment option for patients with non-small-cell lung cancer (NSCLC). We report the clinical outcomes and toxicity for patients with inoperable primary NSCLC treated with SBRT. Methods Between 2007 and 2015, 102 consecutive lung lesions were treated with SBRT at our center, of which 59 primary NSCLC lesions (from 54 patients with inoperable disease) were retrospectively reviewed (43 lesions were excluded because of metastases or because there was no biopsy specimen). We report infield local control (LC) per SBRT target, regional or distant failure-free survival, and overall survival (OS) per patient, using Kaplan-Meier estimates. Serious toxicity was retrospectively scored using Common Terminology Criteria for Adverse Events, version 4. Results Most of the 54 patients were men (n = 41; 76%), median age was 75 years; stage IA (n = 36; 66%) and adenocarcinoma (n = 43; 80%) were the most common stage and histologic diagnosis, respectively. Five patients had two lung lesions. A median of three fractions (range, 3 to 5 fractions) and a total median dose of 54 Gy (range, 45 to 60 Gy) per lesion were prescribed. The median follow-up was 17.8 months (range, 4 to 56.4 months). The 2-year rates of LC, regional or distant failure-free survival, and OS were 89.1% (95% CI, 72.2% to 96%), 79% (95% CI, 59.8% to 89.8%), and 80% (95% CI, 64% to 89.8%), respectively. Grade 3 to 4 toxicities were observed in two patients (3%): grade 3 pneumonitis (n = 1) and grade 4 skin toxicity (n = 1). Conclusion SBRT results in high rates of 2-year LC, regional or distant failure-free survival, and OS with low rates of severe toxicity in patients with inoperable primary NSCLC disease. (C) 2018 by American Society of Clinical Oncology