HELOISA DE ANDRADE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
15 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.
- 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.
- Biochemical control of prostate cancer with iodine-125 brachytherapy alone: experience from a single institution(2012) AMADEI, Larissa Pereira da Ponte; SILVA, Joao Luis Fernandes; HANNA, Samir Abdallah; HADDAD, Cecilia Maria Kalil; NESRALLAH, Adriano Joao; CARVALHO, Heloisa AndradeBrachytherapy is an adequate option as monotherapy for localised prostate cancer. The objective of this study was to evaluate and compare biochemical failure free survival (BFFS) after low-dose-rate brachytherapy (LDRB) alone for patients with prostate cancer using ASTRO and Phoenix criteria, and detect prognostic factors. Data on 220 patients treated between 1998 and 2002 with LDRB were retrospectively analysed. Neoadjuvant hormone therapy was used in 74 (33.6%) patients. Median follow-up was 53.5 months (24-116). Five year BFFS was 83.0% and 83.7% using, respectively, the ASTRO and Phoenix criteria. Low -and intermediate-risk patients presented, respectively, 86.7% and 77.8% 5-year BFFS using the ASTRO definition (p=0.069), and 88.5% and 78.6% considering the Phoenix criteria (p=0.016). Bounce was observed in 66 (30%) patients. Multivariate analysis detected PSA at diagnosis < 10 ng/ml and less than 50% positive biopsy fragments as favourable prognostic factors, regarding BF using both criteria. For the Phoenix criteria, also Gleason score < 7 and low-risk group were identified as independent favourable prognostic factors. LDRB alone should be considered mostly for low-risk patients. PSA level was a strong independent prognostic factor. We support the use of the Phoenix criteria for detection of BF in patients submitted to LDRB alone.
- 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.
- Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy(2016) LEITE, Elton Trigo Teixeira; UGINO, Rafael Tsuneki; SANTANA, Marco Antônio; FERREIRA, Denis Vasconcelos; LOPES, Maurício Russo; PELOSI, Edilson Lopes; SILVA, João Luis Fernandes da; CARVALHO, Heloisa de AndradeAbstract Objective: To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods: This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results: Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion: Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique.
- Impact of COVID-19 pandemic on a daily-based outpatient treatment routine: experience of a radio-therapy department of a tertiary public/university hospital in Brazil(2020) CARVALHO, Heloisa de Andrade; VASCONCELOS, Karina Gondim Moutinho C.; GOMES, Herbeni Cardoso; SALVAJOLI, Joao VictorOBJECTIVES: To report the impact of the COVID-19 pandemic on patient attendance at a radiotherapy department two months after the implementation of specific policies regarding the pandemic. METHODS: The proposed treatment schemes, favoring hypofractionated schedules, and COVID-19 management strategies regarding irradiation are presented. Attendance after two months of implementation of these policies was measured and compared with that during the same period in 2019. RESULTS: A 10% reduction in the number of treated patients and a 26% reduction in the number of sessions was observed. The main impact was a decrease in the treatment of benign diseases and gastrointestinal tumors, with a general increase in breast cancer treatments. Eighteen (1.7%) patients were confirmed as having COVID-19 during radiotherapy in April and May 2020, three of whom were hospitalized, and one patient died because of COVID-19. Among the 18 patients, 12 had their treatments interrupted for at least 15 days from symptom appearance. CONCLUSION: There was a decrease in the number of treated patients in our radiotherapy department, with a greater decrease in the total number of sessions. This indicated, overall, a smaller number of fractions/patients treated, despite our efforts to maintain the treatment routine. We had several patients who were infected with COVID-19 and one related death during treatment in the first few months of the pandemic in Sao Paulo Brazil.
- 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.
- Effect of Light Emitted by Diode as Treatment of Radiodermatitis(2022) CAMARGO, Cristina Pires; CARVALHO, H. A.; GEMPERLI, R.; TABUSE, Cindy Lie; SANTOS, Pedro Henrique Gianjoppe dos; GONCALES, Lara Andressa Ordonhe; REGO, Carolina Lopo; SILVA, B. M.; TEIXEIRA, M. H. A. S.; FEITOSA, Y. O.; VIDEIRA, F. H. P.; CAMPELLO, G. A.Radiotherapy can cause radiodermatitis in 85-90% in oncologic patients. There are several therapeutic alternatives to treat radiodermatitis with variable results. A new option is the use of light emitted-diode (LED) to treat this condition. We analyzed twenty male Wistar rats weighing 200-250 g. All the animals underwent a radiotherapy session. After 15 days, the animals were divided into four groups: control (no treatment) and LED 630 nm, 850 nm, 630 + 850 nm. The LED treatment was applied every two days until the 21 days). We analyzed the macroscopic aspect of radiodermatitis before and after treatment. After this phase, samples were collected for histological (HE). Macro and microscopic analysis indicated positive effects with exposure to light, especially with the association between wavelengths 630 and 850 nm, resulting in a reduction in the severity of radiodermatitis to grade 2-2.5. In the histological analysis, photobiomodulation increased the division and migration of cells in the basal layer of the epidermis, demonstrating the regenerative potential of this treatment in the effects of radiotherapy, increasing the speed of epithelialization of the lesion. This study suggested that the association of 630 + 850 nm improved radiodermatitis regeneration.
- 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.