HELOISA DE ANDRADE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
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conferenceObject Trial Sponsorship, Self Reported Conflicts of Interest of Authors (COI) and Non-Drug Related Randomized Clinical Trial (rRCT) in Prostate Cancer(2014) MORAES, F.; LEITE, E.; SANTINI, F.; MARTA, G.; HANNA, S.; SILVA, J.; CARVALHO, H.- Laparoscopic Extrafascial Hysterectomy ( Completion Surgery) After Primary Chemoradiation in Patients With Locally Advanced Cervical Cancer(2014) FAVERO, Giovanni; PIEROBON, Juliana; GENTA, Maria Luiza; ARAUJO, Marcia Pereira; MIGLINO, Giovanni; DIZ, Maria Del Carmen Pilar; CARVALHO, Heloisa de Andrade; FUKUSHIMA, Julia Tizue; BARACAT, Edmund Chada; CARVALHO, Jesus PaulaObjective This study aimed to evaluate the feasibility and safety of laparoscopic extrafascial hysterectomy and bilateral salpingo-oophorectomy after primary chemoradiation (CRT) in patients with locally advanced cervical cancer (LACC) without evidence of nodal metastasis. Background Currently, the standard of care for patients with advanced cervical cancer is concurrent CRT. There is an unequivocal correlation between presence of residual disease and risk of local relapse. Nevertheless, the importance of hysterectomy in adjuvant setting remains controversial. Methods Prospective study with patients affected by bulky LACC (International Federation of Gynecology and Obstetrics stage IB2 up to IIB) treated initially with radical CRT who underwent laparoscopic surgery 12 weeks after therapy conclusion. Inclusion criteria were absence of signs for extrapelvic or nodal involvement on initial imaging staging, as well as complete clinical and radiologic response. Results From January 2011 to March 2013, 33 patients were endoscopically operated. The mean age was 44 years (range, 21-77 years). Histologic finding revealed squamous cell carcinoma in 19 (60%) cases and adenocarcinoma in 14 (40%) cases. International Federation of Gynecology and Obstetrics stages distribution were as follow: 1B2, n = 3 (9%); IIA, n = 4 (11%); and IIB, n = 26 (80%). The mean pretherapeutic tumor size was 5.2 cm (range, 4-10.2 cm). Estimated blood loss was 80 mL (range, 40-150 mL), and mean operative time was approximately 104 minutes (range, 75-130 minutes). No casualty or conversion to laparotomy occurred. Hospital stay was in average 1.7 days (range, 1-4 days). Significant complication occurred in 12% of the cases; 2 vaginal vault dehiscence, 1 pelvic infection, and 1 ureterovaginal fistula. Nine (27%) patients had pathologic residual disease, and in 78% of these cases, histologic finding was adenocarcinoma (P = -0.048). All patients had free margins. After median follow-up of 16 months, all women have no signs of local recurrence. Conclusions Laparoscopic extrafascial hysterectomy (completion surgery) after primary CRT in patients with apparent node-negative LACC is a feasible and safe strategy to improve tumor local control mainly in cases of adenocarcinoma.
- 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.
- 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.