CINTHIA DENISE ORTEGA
Projetos de Pesquisa
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Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina
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article 1 Citação(ões) na Scopus T <= 2N0 TRG1-2 in Post-Chemoradiation Therapy MRI: What can it Predict?(2019) NAHAS, Caio Sergio Rizkallah; NAHAS, Sergio Carlos; BUSTAMANTE-LOPEZ, Leonardo; SPARAPAN, Carlos Marques Frederico; ORTEGA, Cinthia; AZAMBUJA, Rodrigo; JR, Ulysses Ribeiro; COTTI, Guilherme Cutait; IMPERIALE, Antonio Rocco; CECCONELLO, IvanBackground: Total mesorectal excision is the standard radical operation after neoadjuvant chemoradiotherapy for patients with middle/low locally advanced rectal cancer. However, it carries significant rates of morbidity, sexual/urinary dysfunction, fecal impairment and permanent stoma. The ability to identify patients with a complete or nearly-complete response could help steer patients to less-invasive surgery or a watch-and-wait strategy. Objective: To assess the ability to predict good responders and a favorable prognosis among rectal cancer patients by post-chemoradiation therapy MRI. Patients: Consecutive patients stage T3-4N0M0 or T(any)N+M0 located within 10cm from the anal verge were enrolled. Patients were staged and re-staged 8.8 weeks after the completion of chemoradiation by digital exam, colonoscopy, pelvic-MRI, and thorax and abdominal CT scans. All patients underwent total mesorectal excision with curative intent. Results: Of the total 309 patients, 275 were eligible, and 199 (72.4%) of these were stage III. Restaging-MRI identified 59 (21.4%) T <= 2N0/TRG1-2. Specimen pathologic evaluation revealed 43 (15.6%) patients with a complete pathologic response. Estimates of the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRIyT=2N0/TRG1-2 for the identification of ypT0N0 were 79.7%, 84.5%, 53.5%, 39%, and 90.7%, respectively. Estimates for the identification of ypN0 were 48.4%, 27.8%, 92%, 88.1%, and 48.4%, respectively. In a multivariate analysis, the only pre-CRT/MRI variables that were associated with an increased risk of lymph node involvement at the specimen were N+ (OR=2.22) and extramural vascular invasion (OR=2.28). MRI yT <= 2N0/TRG1-2 patients showed improved estimated 5-year disease-free survival, but no difference in estimated 5-year survival. Conclusion: Although MRIyT <= 2N0/TRG1-2 cannot predict all cases of a complete pathologic response, it can effectively predict a low rate of lymph node involvement and a better prognosis in patients who undergo total mesorectal excision.- CT Staging to Triage Selection of Patients With Poor-Prognosis Rectal Cancer for Neoadjuvant Treatment(2019) ORTEGA, Cinthia D.; ROCHA, Manoel S.OBJECTIVE. The purpose of this study was to evaluate CT as a screening tool for determining high risk of local recurrence of rectal tumors in a scenario of limited MRI availability. MATERIALS AND METHODS. Data were retrospectively analyzed for 180 consecutively registered patients with rectal adenocarcinoma and no previous treatment who underwent baseline CT and MRI staging within 30 days of each other. Two radiologists independently reviewed CT and MR images. CT scans were interpreted in multiplanar reformation. High risk of local recurrence was based on the MRI reference standard: T3cd (more than 5 mm of mesorectal fat infiltration) or T4 disease, N2 nodal status, mesorectal fascia involvement, extramural venous invasion, or positive pelvic sidewall nodes. The performance of CT for determination of high risk of local tumor recurrence was evaluated. RESULTS. Among the 180 patients 128 (71%) met MRI criteria for high risk of local recurrence. CT sensitivity was 84.4% (108/128) and specificity was 78.8% (41/52). The positive predictive value (PPV) of any high-risk CT feature was 90.7% (108/119). When T status was considered, the sensitivity of CT was 75.2% (79/105), specificity was 90.7% (68/75), and PPV was 91.9% (79/86). When tumors within 5.0 cm of the anal verge were excluded, sensitivity was 89.5% (51/57), specificity was 85.7% (24/28), and PPV was 92.7% (51/55). Using CT for disease staging could reduce MRI use by 66%. CONCLUSION. Tumors at high risk of local recurrence can be identified with CT without baseline MRI. Use of CT rather than MRI could markedly reduce costs of baseline staging and shorten time to initiation of neoadjuvant treatment.
- Role of magnetic resonance imaging in organ-preserving strategies for the management of patients with rectal cancer(2019) ORTEGA, Cinthia D.; PEREZ, Rodrigo O.Total mesorectal excision has been the most effective treatment strategy adopted to reduce local recurrence rates among patients with rectal cancer. The morbidity associated with this radical surgical procedure led surgeons to challenge the standard therapy particularly when dealing with superficial lesions or good responders after neoadjuvant radiotherapy, to which radical surgery may be considered overtreatment. In this subset of patients, less invasive procedures in an organ-preserving strategy may result in good oncological and functional outcomes. In order to tailor the most appropriate treatment option, accurate baseline staging and reassessment of tumor response are relevant. MRI is the most robust tool for the precise selection of patients that are candidates for organ preservation; therefore, radiologists must be familiar with the criteria used to guide the management of these patients. The purpose of this article is to review the relevant features that radiologists should know in order to provide valuable information during the multidisciplinary discussion and ultimate management decision.
- Organ Preservation Among Patients With Clinically Node-Positive Rectal Cancer: Is It Really More Dangerous?(2019) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; FERNANDEZ, Laura M.; ORTEGA, Cinthia D.; FIGUEIREDO, Nuno; GAMA-RODRIGUES, Joaquim; PEREZ, Rodrigo OlivaBACKGROUND: Select patients with complete clinical response to chemoradiation have been managed without radical surgery. The presence of radiologic evidence of nodal metastases at baseline could be a risk factor for local tumor regrowth, more advanced stage at the time of recurrence, and worse distant metastases-free survival. OBJECTIVE: The purpose of this study was to compare the outcomes of patients with baseline node-positive and node-negative cancer after neoadjuvant chemoradiation and complete clinical response managed nonoperatively. DESIGN: This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation. PATIENTS: Consecutive patients with clinical and radiologic evidence of complete clinical response at 8 to 10 weeks were managed nonoperatively and enrolled in a strict follow-up program (watch and wait). Patients with incomplete clinical response or tumor regrowth after initial complete clinical response were referred to surgery. MAIN OUTCOMES MEASURES: Surgery-free and distant metastases-free survival were compared between patients according to nodal status at baseline. RESULTS: A total of 117 patients with node-positive and 218 with node-negative cancer at baseline were reviewed. Overall, 62 (53.0%; node positive) and 135 (61.9%; node negative) achieved a complete clinical response and were managed nonoperatively (p = 0.13). Patients with baseline node-positive cancer had similar rates of pathologic nodal metastases at the time of recurrence. Five-year surgery-free (39.7% vs 46.8%; p = 0.2) and distant metastases-free survival (77.5% vs 80.5%; p = 0.49) were similar between baseline node-positive and node-negative patients. LIMITATIONS: This was a retrospective study with a small sample size and possible inaccurate nodal staging. CONCLUSIONS: Patients with rectal cancer with node-positive cancer at baseline who develop a complete clinical response after neoadjuvant chemoradiation are not at increased risk for local tumor regrowth or development of more advanced disease at the time of recurrence. These patients seem to be safe candidates for organ-preserving strategies after achieving complete clinical response. See Video Abstract at http://links.lww.com/DCR/A902.
bookPart Abdome, gastrointestinal e vascular(2019) CARNEIRO, Hugo Costa; ORTEGA, Cinthia Denise; LEãO FILHO, Hilton; TAVARES, Ralph; SCATIGNO NETO, André; ROCHA, Manoel de Souza