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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- Quality of Life and Sexual Function of Men Who Have Sex With Men Treated for Anal Cancer: A Prospective Trial of a Neglected Population(2021) MAURO, Geovanne Pedro; VASCONCELOS, Karina Gondim Moutinho da Conceicao; CARVALHO, Heloisa de AndradeBackground: Anal cancer is a rare disease, more prevalent in women. Men who have sex with men (MSM) are a high-risk neglected population. Aim: The primary objective was to assess quality of life (QoL) and sexual function (SxF) among MSM treated with radical chemoradiation for anal cancer. Secondary objectives were to assess survivals and to describe the sexual habits of the target population. Methods: Prospective single institution trial of MSM who were treated for anal cancer with curative intent between 2015 and 2019. QoL and SxF were the primary end-points and were assessed by validated questionnaires and sexual inventory. Overall survival, locoregional relapse-free, distant metastases free, and colostomy-free survivals were evaluated. Outcomes: Quality of life and sexual function. Results: Nineteen patients were accrued between November 2015 and August 2019. Median age was 59.3 years. Stage III disease was 53.4% and mean tumor size was 5.4 cm. Fifteen (79.0%) patients were living with HIV (PLHIV). Median follow-up was 21.8 months. Mean overall survival, locoregional relapse-free survival, distant metastases-free survival, and colostomy-free survival were, respectively, 20.8, 17.2, 19.8 and 17.4 months. No median value was reached. QoL followed a trend among questionnaires with significantly worsened values by the end of treatment and a raise to maximum value by three months after treatment, followed by a stabilization reached at 12 months after treatment. IIEF questionnaire showed moderate erectile dysfunction among the population. Intercourse frequency followed QoL measures. Clinical Implications: In a MSM population with anal canal cancer, QoL and SxF followed the same pattern up to one year after treatment. Most patients had their SxF compromised during follow-up as shown by IIEF levels and sexual inventory. Strengths and Limitations: It is a single institution prospective trial with a limited sample size. Nevertheless, there are no studies addressing this minority population, quality of life or otherwise, making it unique and a special contribution for the literature. Conclusion: Anal cancer and its treatment represent a burden to MSM regarding QoL and SxF. (C) 2021, International Society of Sexual Medicine.
- Impact of radiation on tooth loss in patients with head and neck cancer: a retrospective dosimetric-based study(2021) GOMES-SILVA, Wagner; MORAIS-FARIA, Karina; RIVERA, Cesar; NAJAS, Gabriel Faria; MARTA, Gustavo Nader; VASCONCELOS, Karina Gondim Moutinho da Conceicao; CARVALHO, Heloisa de Andrade; CASTRO JR., Gilberto de; BRANDAO, Thais Bianca; EPSTEIN, Joel B.; SANTOS-SILVA, Alan RogerObjective. To characterize the dental adverse events after head and neck radiation therapy (HNRT) and to investigate the impact of regional radiation dose upon tooth loss outcomes. Study Design. A retrospective dosimetric-based analysis was conducted to assess dental events affecting post-HNRT extracted teeth and the impact of 3 different radiation doses ( 30 Gy, 30-60 Gy, and .001). The odds ratio for post-HNRT tooth extraction risk was approximately 3-fold higher for teeth exposed to 60 Gy (confidence interval, 1.56-5.35; P < .001), followed by an increased risk of delayed healing and osteoradionecrosis (ORN) in sites receiving doses above 50 Gy. Conclusions. Radiation caries was the major cause of dental extractions after HNRT, and the dosimetric analysis suggested that a high dose of radiation may negatively impact the dentition of survivors of head and neck cancer, increasing the risk of tooth loss and ORN. (Oral Surg Oral Med Oral Pathol Oral Radiol 2021;132:409-417)
- Light-emitting diode stimulates radiodermatitis recovery(2021) CAMARGO, Cristina Pires; CARVALHO, Heloisa Andrade; MALUF, Feres Camargo; SOUSA, Alexandre Agostinho da Cruz; PERIN, Paulo Otavio Maluf; PERIN, Marcela Maluf; MORAIS-BESTEIRO, Julio; GEMPERLI, RolfPurpose: To evaluate the effect of light-emitting diode (LED) in an experimental mod& of radiodermatitis. Methods: Ten male Wistar rats weighing 200-250 g were analyzed. Radiation was delivered in a single dose (20 Gy with Strontium-90 dermatological plaques), two areas per animal. After 15 days, they were divided into two groups: control group (n =5) and LED group (n =5), which was treated during 21 days later (LED 660 nm, 10 min in alternate days). The endpoints were radiodermatitis scale, histological analysis HE, Picrius Sirius and the gene expression of interleukin-10 (IL-10) and matrix metalloproteinase-9 (MMP-9). Results: The LED group showed a higher number of dermal appendages (p = 0.04) and angiogenesis (p = 0.007), a tendency towards higher IL-10 (p = 0.06) and an increase in MMP-9 (p = 0.004) when compared to the control group. Conclusion: This study suggested that the use of LED for radiodermatitis increased skin regeneration.
- 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.
- Safety and Feasibility Analysis of a Prospective Trial on Stereotactic Body Radiotherapy for Solitary Bone Plasmacytoma(2021) MAURO, Geovanne Pedro; NEFFA, Pedro Pereira; VILLAR, Rosangela Correa; MARTINEZ, Gracia Aparecida; CARVALHO, Heloisa de AndradeBackground: There have been reports on the use of hypofractionated stereotactic body radiotherapy (SBRT) for bone plasmacytomas, but no prospective data are available. We present the initial analysis of an ongoing prospective protocol on SBRT addressing the feasibility and safety of this treatment for solitary bone plasmacytomas. Patients and Methods: A prospective cohort of SBRT for solitary bone plasmacytoma was developed. Patients could receive different doses depending on the index bone, from single fraction for skull base lesions, 24 Gy in 3 fractions for spine lesions, and 30 Gy in 5 fractions for other bones. Overall survival, bone events, local control, and progression to multiple myeloma (MM) were measured and compared to our retrospective cohort of patients treated with conformal standard-dose radiotherapy. Quality of life was assessed via the EORTC QLQ-C30 questionnaire, and toxicities were assessed by the CTCAE v5.0 criteria. After 1 year or the inclusion of 5-10 patients, a feasibility and safety analysis was programmed. Results: Between April 2018 and April 2019, 5 patients were included. All were male, with a median age of 53.1 years. The median follow-up was 21.8 months. No patient had local progression, bone event, or died. Two patients had progressions to MM. The mean survival free of progression to MM was 18.6 months, compared to 19 months in the retrospective cohort; median values were not reached. There were no grade 3 toxicities. Conclusion: SBRT for plasmacytoma is safe and feasible. More robust data are awaited.
- 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.
- Feasibility of SBRT for hepatocellular carcinoma in Brazil - a prospective pilot study(2021) CHEN, Andre Tsin Chih; PAYAO, Fabio; CHAGAS, Aline Lopes; ALENCAR, Regiane Saraiva De Souza Melo; TANI, Claudia Megumi; VASCONCELOS, Karina Gondim Moutinho da Conceicao; ROCHA, Manoel De Souza; CARVALHO, Heloisa De Andrade; HOFF, Paulo Marcelo Gehm; CARRILHO, Flair JoseBackground: The aim of the study was to evaluate the feasibility and safety of stereotactic body radiotherapy (SBRT) for the treatment of hepatocellular carcinoma in Brazil. SBRT is an evolving treatment in HCC patients not candidates to other local therapies. Its adoption in clinical practice has been heterogeneous, with lack of data on its generalizability in the Brazilian population. Materials and methods: We conducted a prospective pilot study involving HCC patients after failure or ineligibility for transarterial chemoembolization. Patients received SBRT 30 to 50 Gy in 5 fractions using an isotoxic prescription approach. This study is registered at clinicaltrials.gov NCT02221778. Results: From Nov 2014 through Aug 2019, 26 patients received SBRT with 40 Gy median dose. Underlying liver disease was hepatitis C, hepatitis B and alcohol-related in, respectively, 50%, 23% and 19% of patients. Median lesion size was 3.8 cm (range, 1.5-10 cm), and 46% had multiple lesions. Thirty-two percent had tumor vascular thrombosis; median pretreatment alpha-fetoprotein (AFP) was 171.7 ng/mL (range, 4.2-5,494 ng/mL). 1y-local progression-free survival (PFS) was 86% (95% CI: 61% to 95%), with higher local control in doses >= 45Gy (p = 0.037; HR = 0.12). 1y-liver PFS, distant PFS and OS were, respectively, 52%, 77% and 79%. Objective response was seen in 89% of patients, with 3 months post-SBRT median AFP of 12 ng/mL (2.4-637 ng/mL). There were no grade 3 or 4 clinical toxicities. Grade 3 or 4 laboratory toxicities occurred in 27% of patients. Conclusion: SBRT is feasible and safe in patients unresponsive or ineligible for TACE in Brazil. Our study suggests doses >= 45 Gy yields better local control.
- Neoadjuvant stereotactic ablative radiotherapy (SABR) for soft tissue sarcomas of the extremities(2021) LEITE, Elton Trigo Teixeira; MUNHOZ, Rodrigo Ramella; CAMARGO, Veridiana Pires de; LIMA, Luiz Guilherme Cernaglia Aureliano de; REBOLLEDO, Daniel Cesar Seguel; MAISTRO, Carlos Eduardo Bravin; BUSNARDO, Fabio de Freitas; FERREIRA, Fabio de Oliveira; SALVAJOLI, Joao Victor; CARVALHO, Heloisa de AndradeBackground: Soft tissue sarcomas (STS) comprise a diverse group of mesenchymal malignancies that require multidisciplinary care. Although surgery remains the primary form of treatment for those with localized disease, radiation therapy (RT) is often incorporated either in the neo-or adjuvant setting. Given the development of modern RT techniques and alternative dosing schedules, stereotactic ablative radiotherapy (SABR) has emerged as a promising technique. However, the current role of SABR in the treatment of STS of the extremities remains uncertain. Methods and Materials: This was a single-center, prospective, single-arm phase II trial. Patients with localized STS who were candidates for limb-preservation surgery were included. Experimental treatment consisted of SABR with 40 Gy in 5 fractions, administered on alternate days, followed by surgery after a minimum interval of 4 weeks. The primary outcome was the rate of wound complication. Secondary outcomes included 2-year local control (LC), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) rates (and other toxicities). Results: Twenty-five patients were enrolled between October 2015 and November 2019 and completed the treatment protocol. The median rate of histopathologic regression was 65% (range 0-100) and 20.8% of tumors presented pathologic complete response (pCR). Wound complications were observed in 7/25 patients (28%). Three patients underwent disarticulation by vascular occlusion after plastic reconstruction and one patient was amputated by grade 3 limb dysfunction. After a median follow up of 20.7 months, the 2-year estimated risk of local recurrence, distant metastasis and cause-specific death were 0%, 44.7% and 10.6% respectively. Conclusions: Neoadjuvant SABR appears to improve the pCR for patients with eSTS, with acceptable rate of wound complications. Nevertheless, this benefit should be weighed against the risk of late of vascular toxicity with SABR regimen since, even in a short median follow-up, a higher rate of amputation than expected was observed. A larger sample size with longer follow-up is necessary to conclude the overall safety of this strategy.
- IBS-GEC ESTRO-ABS recommendations for CT based contouring in image guided adaptive brachytherapy for cervical cancer(2021) MAHANTSHETTY, Umesh; POETTER, Richard; BERIWAL, Sushil; GROVER, Surbhi; LAVANYA, Gurram; RAI, Bhavana; PETRIC, Primoz; TANDERUP, Kari; CARVALHO, Heloisa; HEGAZY, Neamat; MOHAMED, Sandy; OHNO, Tatsuya; AMORNWICHET, NapapatMR Imaging is regarded as the gold standard for Image Gudied Adaptive Brachytherapy (IGABT) for cervical cancer. However, its wide applicability is limited by its availability, logistics and financial implications. Use of alternative imaging like CTand Ultrasound (US) for IGABT has been attempted. In order to arrive at a systematic, uniform and international approach for CT based definition and contouring of target structures, GEC ESTRO, IBS and ABS agreed to jointly develop such recommendations based on the concepts and terms as published in the ICRU Report 89 . The minimum requirements are clinical examination & documentation, CT or MR imaging at diagnosis and at a minimum, CT imaging with the applicator in place. The recommendations are based on (i) assessment of the GTV at diagnosis and at brachytherapy, (ii) categorizing the response to external radiation into different clinical remission patterns, (iii) defining various clinico-radiological environments and (iv) definition & delineation of a target on CT imaging at the time of brachytherapy with the applicator in situ. CT based target contouring recommendations based on 4 remission categories within 8 defined environments, aim at improving the contouring accuracy for IGABT using CT, US and MRI as available. For each clinico-radiological environment, there is an attempt to minimize the specific uncertainties in order to arrive at the best possible contouring accuracy. Evaluating feasibility & reproducibility, to achieve a benchmark towards a gold standard MR IGABT and further clinical research including outcomes with CT Based IGABT will become the next steps. (c) 2021 The Authors.
- Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries(2021) MAHANTSHETTY, U.; LAVANYA, G.; GROVER, S.; AKINFENWA, C. A.; CARVALHO, H.; AMORNWICHET, N.Cervical cancer is one of the most common cancers in developing nations. It has had a tremendous impact on the lifetime of millions of women over the last century and continues to do so. In this collaborative clinicians' review, we highlight the incidence, treatment and clinical outcomes of cervical cancer in low-income (LICs) and low-and middle-income countries (LMICs) across Asia, South America, South Africa and Eastern Europe. With the cervical cancer burden and locally advanced cancers being high, the majority of LICs/LMICs have been striving to adhere to optimal evaluation and treatment guidelines. However, the huge gap in resource availability, rural versus urban disparity and access to resources have led to poor compliance to evaluation, treatment and post-treatment rehabilitation. To mitigate the overwhelming numbers, various treatment strategies like neoadjuvant chemotherapy, hypofractionation radiation schedules (both external and brachytherapy) have been attempted with no major success. Also, the compliance to concurrent chemoradiation in various regions is a major challenge. With the burden of advanced cancers, the lack of palliative care services and their integration in cancer care is still a reality.