HELOISA DE ANDRADE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- 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.
- PROGRAD - An observational study of the prognosis of inpatients evaluated for palliative radiotherapy(2018) CHEN, Andre Tsin Chih; MAURO, Geovanne Pedro; GABRIELLI, Flavia; CHAVES, Cristiane de Lacerda Goncalves; CASTRO, Igor; VASCONCELOS, Karina Moutinho; REIS, Milena; SARAIVA, Thalita; CARVALHO, Heloisa Andrade deBackground and purpose: Low-and-middle-income countries have resource constraints and waiting lists for radiotherapy (RT). In this context, we sought to determine the survival of inpatients evaluated for palliative RT in a large referral cancer center in Brazil. Material and methods: From November 2014 through December 2015, we enrolled 333 inpatients with palliative RT evaluation requests in this prospective observational study. We applied Palliative Prognostic Index (PPI) and Survival Prediction Score using Number of Risk Factors (NRF). Primary end-point was overall survival. Secondary endpoints were survival by PPI and NRF. (ClinicalTrials.gov number, NCT02312791). Results: Median survival (MS) for the entire cohort was 73 days. PPI <= 2 had MS of 120 days; PPI 2.5-4 had MS of 55 days (HR 1.84; 95% CI, 1.07-3.16); PPI >4 had MS of 39 days (HR 3.45; 95% CI, 2.07-5.74) (p<.0001). NRF 0-1 had MS of 129 days; NRF 2 had MS of 73 days (HR 1.74; 95% CI 0.89-3.38); NRF 3 had MS of 40 days (HR 2.95; 95% CI, 1.50-5.78) (p<.0001). Conclusion: Inpatients with palliative RT requests seem to have an overall poor survival. PPI and NRF can define subgroups with different prognosis. This could help hospitals and healthcare systems to standardize criteria for prioritization and contribute for fairness.
- Results of high dose-rate brachytherapy boost before 2D or 3D external beam irradiation for prostate cancer(2011) NEVIANI, Cristiano Beck; MIZIARA, Miguel Abrao; CARVALHO, Heloisa de AndradeBackground and purpose: To evaluate biochemical control and treatment related toxicity of patients with localized adenocarcinoma of the prostate treated with high dose-rate brachytherapy (HDRB) combined with conventional 2D or 3D-conformal external beam irradiation (EBI). Material and methods: Four-hundred and three patients treated between December 2000 and March 2004. HDRB was delivered with three fractions of 5.5-7 Gy with a single implant, followed by 45 Gy delivered with 2D or 3D conformal EBI. Results: The median follow-up was 48.4 months. Biochemical failure (BF) occurred in 9.6% according to both ASTRO and Phoenix consensus criteria. Mean time to relapse was 13 and 26 months, respectively. The 5-year BF free survival using the ASTRO criteria was 94.3%, 86.9% and 86.6% for the low, intermediate and high risk groups, respectively; using Phoenix criteria, 92.4%, 88.0% and 85.3%, respectively. The only predictive factor of BF in the multivariate analysis by both ASTRO and Phoenix criteria was the presence of prostate nodules detected by digital palpation, and patients younger than 60 years presented a higher chance of failure using Phoenix criteria only. Conclusions: Treatment scheme is feasible and safe with good efficacy.
conferenceObject Quality of life and sexual function of men who have sex with other men treated for anal cancer(2020) MAURO, G. P.; VASCONCELOS, K. G. M. D. C.; CARVALHO, H. D. A.conferenceObject Quality of life among men who have sex with other men treated for anal cancer: Impact of HIV status(2020) MAURO, G. P.; VASCONCELOS, K. G. M. D. C.; CARVALHO, H. D. A.- 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.
- 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.
- 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.
- Accelerated partial irradiation for breast cancer: Systematic review and meta-analysis of 8653 women in eight randomized trials (vol 114, pg 42, 2015)(2015) MARTA, Gustavo Nader; MACEDO, Cristiane Rufino; CARVALHO, Heloisa de Andrade; HANNA, Samir Abdallah; SILVA, Joao Luis Fernandes da; RIERA, Rachel