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  • article
    The contribution of concentric electrode-evoked potentials and nociceptive withdrawal reflex to the routine neurophysiological assessment of neuropathic pain: cross-sectional study
    (2023) NUNES, Lucas Martins de Exel; KUBOTA, Gabriel Taricani; FERNANDES, Ana Mércia; CHUNG, Tae Mo; ANDRADE, Daniel Ciampi de
    ABSTRACT BACKGROUND AND OBJECTIVES: Conventional electrodiagnostic studies (EDX) are frequently used to support the diagnosis of peripheral neuropathic pain. However, routine EDX has poor diagnostic yield for identifying small fiber neuropathy, which may be cause of neuropathic pain in some patients. This study aimed to assess the gain in diagnostic yield brought by adding pain-related evoked potentials with concentric electrode (CN-PREP) and nociceptive withdrawal reflex (NWR) assessments to EDX. METHODS: Transversal observational accuracy study which included patients referred to routine EDX in a tertiary-care hospital who reported chronic neuropathic pain in their lower limbs. Besides routine EDX, subjects underwent CN-PREP and NWR assessments. Diagnostic yield and tolerability were examined and compared between test studies. RESULTS: The study enrolled 100 patients (54% female), with 57 ± 12 years. EDX was altered in 47% of all patients. The addition of CN-PREP alone, and NWR combined with CN-PREP increased diagnostic yield to 69% and 72%, respectively. CN-PREP proved to be well tolerable, while NWR was associated with higher test-related pain intensity and discontinuation rate (9% vs. 0%). Considering EDX as the reference test, CN-PREP sensitivity was 85.1% and specificity 58.5%. CONCLUSION: Combining CN-PREP with the routine EDX for patients with neuropathic pain is feasible and results in increased diagnostic yield. Conversely, the addition of NWR to the aforementioned tests provides little improvement to this yield and is less tolerable to the patient. Further studies are needed to determine the actual sensitivity and specificity of CN-PREP when compared to the gold-standard for small fiber neuropathy diagnosis, i.e. intraepidermal nerve fiber density assessment.
  • article 1 Citação(ões) na Scopus
    Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System
    (2023) SILVA, Anna Carolina Borges da; TOLEDO, Luis Gustavo Morato de; FERNANDES, Roni de Carvalho; ZIROLDO, Alan Rechamberg; SAWCZYN, Guilherme Vinicius; ALARCON, Shirlene Tettmann; LEWIN, Fabio
    BackgroundProstate cancer (PCa) is the most common malignant tumor in males and conventional imaging does not provide accurate primary staging. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) presents superior performance and strongly affects therapeutic choice.ObjectiveThe aim of this study was to evaluate the impact of PSMA PET, compared with conventional imaging methods, on the therapeutic approach in primary staging scenarios in patients with PCa treated at the Brazilian National Public Health System.MethodsOverall, 35 patients diagnosed with PCa were evaluated using PSMA after conventional staging imaging with multiparametric magnetic resonance (MMR) and/or total abdominal computed tomography (CT) scan and bone scintigraphy (BS). The PCa extension identified by PET was compared with conventional imaging; staging changes and the management impact were then determined. PET comparison with conventional imaging, staging, and decision-making changes was analyzed using descriptive statistics.ResultsPET revealed local disease (LD) in 15 (42.9%) patients, seminal vesicle invasion (SVI) in 5 (14.3%) patients, pelvic nodal impairment (PNI) in 7 (20%) patients, pelvic and distant nodes in 3 (8.6%) patients, pelvic nodes and bone metastasis in 4 (11.4%) patients, and pelvic and distant nodes and bone metastasis in 1 (2.8%) patient. Staging changes were observed in 60% of patients, with downstaging predominance (76.2%). Volume increase was identified in 11 (31.4%) patients (only 4 related to upstaging, 36.4%). The board changed management decisions for 60% of the patients. The main limitations of this study were the sample size and its retrospective nature.ConclusionsPSMA findings changed the management decisions in more than half of the patients, which made the majority eligible for locoregional treatment and avoided unnecessary procedures in the systemic disease scenario.
  • article 0 Citação(ões) na Scopus
    ASO Visual Abstract: Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System
    (2023) SILVA, Anna Carolina Borges da; TOLEDO, Luis Gustavo Morato de; FERNANDES, Roni de Carvalho; ZIROLDO, Alan Rechamberg; SAWCZYN, Guilherme Vinicius; ALARCON, Shirlene Tettmann; LEWIN, Fabio
  • article 0 Citação(ões) na Scopus
    Curative treatment for stage IIIC2 cervical cancer: what to expect?
    (2023) MAURO, Geovanne Pedro; CALHEIROS, Vinicius de Aquino; VONSOWSKI, Matheus Sorgi; AVELAR, Talita; CARVALHO, Heloisa de Andrade
    Background: Since the GOG125 study, treating radically patients with positive para-aortic lymph nodes has been a valid approach. Nevertheless, literature lacks data on how to better treat these patients since they are usually excluded from trials. In this study, we aimed to report the outcomes of patients with advanced cervical cancer and positive para-aortic lymph nodes (PAN) treated in a single tertiary/academic institution and try to identify variables that may impact survival. Materials and methods: We retrospectively reviewed patients with positive para-aortic lymph nodes treated in our institution. Demographic variables and treatment options were assessed and their impact on overall survival (OS), locorregional control, distant metastasis free survival, and para-aortic lymph node progression was analyzed. Results: We assessed 65 patients treated from April 2010 to May 2017. Median OS was 38.7 months. Median locorregional and para-aortic progression free survivals were not reached. Median distant metastasis progression-free survival was 64.3 months. Better ECOG performance status (p > 0.001), concurrent chemotherapy (p = 0.031), and brachytherapy (p = 0.02) were independently related to better overall survival. Conclusion: Patients with current stage IIIC2 cervix cancer may present long term survival. Treating positive PAN cervical cancer patients with concurrent chemoradiation including brachytherapy with curative intent should be standard. Poor PS and more advanced pelvic disease may represent a higher risk for worse outcomes. Distant metastases are still a challenge for disease control.
  • article 0 Citação(ões) na Scopus
    Pegivirus Detection in Cerebrospinal Fluid from Patients with Central Nervous System Infections of Unknown Etiology in Brazil by Viral Metagenomics
    (2024) CARMONA, Rita de Cassia Compagnoli; CILLI, Audrey; COSTA, Antonio Charlys da; REIS, Fabricio Caldeira; LEAL, Elcio; SANTOS, Fabiana Cristina Pereira dos; MACHADO, Braulio Caetano; LOPES, Cristina Santiago; AFONSO, Ana Maria Sardinha; TIMENETSKY, Maria do Carmo Sampaio Tavares; CADAR, Daniel
    Metagenomic next-generation sequencing (mNGS) methodology serves as an excellent supplement in cases where diagnosis is challenging to establish through conventional laboratory tests, and its usage is increasingly prevalent. Examining the causes of infectious diseases in the central nervous system (CNS) is vital for understanding their spread, managing outbreaks, and effective patient care. In a study conducted in the state of Sao Paulo, Brazil, cerebrospinal fluid (CSF) samples from 500 patients with CNS diseases of indeterminate etiology, collected between 2017 and 2021, were analyzed. Employing a mNGS approach, we obtained the complete coding sequence of Pegivirus hominis (HPgV) genotype 2 in a sample from a patient with encephalitis (named IAL-425/BRA/SP/2019); no other pathogen was detected. Subsequently, to determine the extent of this virus's presence, both polymerase chain reaction (PCR) and/or real-time PCR assays were utilized on the entire collection. The presence of the virus was identified in 4.0% of the samples analyzed. This research constitutes the first report of HPgV detection in CSF samples in South America. Analysis of the IAL-425 genome (9107 nt) revealed a 90% nucleotide identity with HPgV strains from various countries. Evolutionary analyses suggest that HPgV is both endemic and extensively distributed. The direct involvement of HPgV in CNS infections in these patients remains uncertain.
  • article 0 Citação(ões) na Scopus
    (2024) KASSAR, Liliana de Meira Lins; SENNA, Joao Paulo; WAYLA, Karoline; ARAUJO, Luiza Karla R. P.; PEREIRA, Benedito J.; ABENSUR, Hugo; ELIAS, Rosilene M.
  • article 1 Citação(ões) na Scopus
    Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective
    (2024) PITOIA, Fabian; SCHEFFEL, Rafael Selbach; CALIFANO, Ines; GAUNA, Alicia; TALA, Hernan; VAISMAN, Fernanda; GONZALEZ, Alejandro Roman; HOFF, Ana Oliveira; MAIA, Ana Luiza
    Radioiodine (RAI) refractory differentiated thyroid cancer is an uncommon and challenging situation that requires a multidisciplinary approach to therapeutic strategies. The definition of RAI-refractoriness is usually a clear situation in specialized centers. However, the right moment for initiation of multikinase inhibitors (MKI), the time and availability for genomic testing, and the possibility of prescribing MKI and selective kinase inhibitors differ worldwide.Latin America (LA) refers to the territories of the world that stretch across two regions: North America (including Central America and the Caribbean) and South America, containing 8.5% of the world's population. In this manuscript, we critically review the current standard approach recommended for patients with RAI refractory differentiated thyroid cancer, emphasizing the challenges faced in LA. To achieve this objective, the Latin American Thyroid Society (LATS) convened a panel of experts from Brazil, Argentina, Chile, and Colombia. Access to MKI compounds continues to be a challenge in all LA countries. This is true not only for MKI but also for the new selective tyrosine kinase inhibitor, which will also require genomic testing, that is not widely available. Thus, as precision medicine advances, significant disparities will be made more evident, and despite efforts to improve coverage and reimbursement, molecular-based precision medicine remains inaccessible to most of the LA population. Efforts should be undertaken to alleviate the discrepancies between the current state-of-the-art care for RAI-refractory differentiated thyroid cancer and the present situation in Latin America.
  • article 0 Citação(ões) na Scopus
    The Predictive Value of Sepsis Scores for In-Hospital Mortality in Patients with Left-Sided Infective Endocarditis
    (2024) ALMEIDA, Bianca Leal de; STRABELLI, Tania Mara Varejao; BITTENCOURT, Marcio Sommer; OLIVEIRA, Vitor Falcao de; GUALANDRO, Danielle Menosi; MANSUR, Alfredo Jose; TARASOUCHI, Flavio; POCEBON, Lucas; PAIXAO, Milena; GOLDEMBERG, Flora; SALOMAO, Reinaldo; SICILIANO, Rinaldo Focaccia
    Background: As infective endocarditis has particular characteristics compared to other infectious diseases, it is not clear if sepsis scores are reported with good accuracy in these patients. The aim of this study is to evaluate the accuracy of the qSOFA and SOFA scores to predict mortality in patients with infective endocarditis. Methods: Between January 2010 and June 2019, 867 patients with suspected left-sided endocarditis were evaluated; 517 were included with left-sided infective endocarditis defined as ""possible"" or ""definite"" endocarditis, according to the Modified Duke Criteria. ROC curves were constructed to assess the accuracy of qSOFA and SOFA sepsis scores for the prediction of in-hospital mortality. Results: The median age was 57 years, 65% were male, 435 (84%) had pre-existing heart valve disease, and the overall mortality was 28%. The most frequent etiologies were Streptococcus spp. (36%), Enterococcus spp. (10%), and Staphylococcus aureus (9%). The sepsis scores from the ROC curves used to predict in-hospital mortality were qSOFA 0.601 (CI95% 0.522-0.681) and SOFA score 0.679 (CI95% 0.602-0.756). A sub-group analysis in patients with and without pre-existing valve disease for SOFA >= 2 showed ROC curves of 0.627 (CI95% 0.563-0.690) and 0.775 (CI95% 0.594-0.956), respectively. Conclusions: qSOFA and SOFA scores were associated with increased in-hospital mortality in patients with infective endocarditis. However, as accuracy was relatively lower compared to other sites of bacterial infections, we believe that this score may have lower accuracy when predicting the prognosis of patients with IE, because, in this disease, the patient's death may be more frequently linked to valvular and cardiac dysfunction, as well as embolic events, and less frequently directly associated with sepsis.
  • article 3 Citação(ões) na Scopus
    Plasma metabolomics of oral squamous cell carcinomas based on NMR and MS approaches provides biomarker identification and survival prediction
    (2023) POLACHINI, Giovana Mussi; CASTRO, Tialfi Bergamin de; SMARRA, Luis Fabiano Soares; HENRIQUE, Tiago; PAULA, Carlos Henrique Diniz de; SEVERINO, Patricia; LOPEZ, Rossana Veronica Mendoza; CARVALHO, Andre Lopes; ZERI, Ana Carolina de Mattos; SILVA, Ismael Dale Cotrim Guerreiro; TAJARA, Eloiza H.
    Metabolomics has proven to be an important omics approach to understand the molecular pathways underlying the tumour phenotype and to identify new clinically useful markers. The literature on cancer has illustrated the potential of this approach as a diagnostic and prognostic tool. The present study aimed to analyse the plasma metabolic profile of patients with oral squamous cell carcinoma (OSCC) and controls and to compare patients with metastatic and primary tumours at different stages and subsites using nuclear magnetic resonance and mass spectrometry. To our knowledge, this is the only report that compared patients at different stages and subsites and replicates collected in diverse institutions at different times using these methodologies. Our results showed a plasma metabolic OSCC profile suggestive of abnormal ketogenesis, lipogenesis and energy metabolism, which is already present in early phases but is more evident in advanced stages of the disease. Reduced levels of several metabolites were also associated with an unfavorable prognosis. The observed metabolomic alterations may contribute to inflammation, immune response inhibition and tumour growth, and may be explained by four nonexclusive views-differential synthesis, uptake, release, and degradation of metabolites. The interpretation that assimilates these views is the cross talk between neoplastic and normal cells in the tumour microenvironment or in more distant anatomical sites, connected by biofluids, signalling molecules and vesicles. Additional population samples to evaluate the details of these molecular processes may lead to the discovery of new biomarkers and novel strategies for OSCC prevention and treatment.
  • article 0 Citação(ões) na Scopus
  • article 0 Citação(ões) na Scopus
  • article 0 Citação(ões) na Scopus
    Prevalence of DICER1 variants in large multinodular goiter: thyroid function, clinical and imaging characteristics
    (2024) MIRANDA, Lara Judith Cabral; DANILOVIC, Debora L. S.; VANDERLEI, Felipe Augusto Brasileiro; TAVARES, Marcos Roberto; NETO, Nicolau Lima; CAMARGO, Rosalinda Yossie Asato de; MARUI, Suemi
    Objective: Mutations in DICER1 are found in differentiated thyroid carcinoma (DTC) and in multinodular goiter (MNG) at a younger age with other tumors, which characterizes DICER1 syndrome. DICER1 is one driver to DTC; however, it is also found in benign nodules. We speculated that patients with mutations in DICER1 may present long-lasting MNG. Our aim was to investigate the frequency of DICER1 variants in patients with MNG. Subjects and methods: Patients who submitted to total thyroidectomy due to large MNG with symptoms were evaluated. DICER1 hotspots were sequenced from thyroid nodule samples. To confirm somatic mutation, DNA from peripheral blood was also analyzed. Results: Among 715 patients, 154 were evaluated with 56.2 +/- 12.3 years old (28-79) and the thyroid volume was 115.7 +/- 108 mL (16.2-730). We found 11% with six DICER1 variations in a homo or heterozygous state. Only rs12018992 was a somatic DICER1 variant. All remaining variants were synonymous and likely benign, according to the ClinVar database. The rs12018992 was previously described in an adolescent with DTC, measuring 13 mm. There were no significant differences according to gender, familial history of goiter, age, thyroid volume, TSH and TI -RADS classification between DICER1 carriers. Free T4 were lower in patients with DICER1 polymorphisms (13.77 +/- 1.8 vs. 15.44 +/- 2.4 pmol/L, p = 0.008), regardless of TSH levels. Conclusions: We conclude that germline DICER1 variants can be found in 11% of large goiters but no second -hit somatic mutation was found. DICER1 is one driver to thyroid lesion and a second -hit event seems unnecessary in the MNG development.
  • article 13 Citação(ões) na Scopus
    Phase 3 Trial of Selpercatinib in Advanced RET-Mutant Medullary Thyroid Cancer
    Background Selpercatinib, a highly selective, potent RET inhibitor, has shown efficacy in advanced RET-mutant medullary thyroid cancer in a phase 1-2 trial, but its efficacy as compared with approved multikinase inhibitors is unclear.Methods We conducted a phase 3, randomized trial comparing selpercatinib as first-line therapy with the physician's choice of cabozantinib or vandetanib (control group). Eligible patients had progressive disease documented within 14 months before enrollment. The primary end point in the protocol-specified interim efficacy analysis was progression-free survival, assessed by blinded independent central review. Crossover to selpercatinib was permitted among patients in the control group after disease progression. Treatment failure-free survival, assessed by blinded independent central review, was a secondary, alpha-controlled end point that was to be tested only if progression-free survival was significant. Among the other secondary end points were overall response and safety.Results A total of 291 patients underwent randomization. At a median follow-up of 12 months, median progression-free survival as assessed by blinded independent central review was not reached in the selpercatinib group and was 16.8 months (95% confidence interval [CI], 12.2 to 25.1) in the control group (hazard ratio for disease progression or death, 0.28; 95% CI, 0.16 to 0.48; P<0.001). Progression-free survival at 12 months was 86.8% (95% CI, 79.8 to 91.6) in the selpercatinib group and 65.7% (95% CI, 51.9 to 76.4) in the control group. Median treatment failure-free survival as assessed by blinded independent central review was not reached in the selpercatinib group and was 13.9 months in the control group (hazard ratio for disease progression, discontinuation due to treatment-related adverse events, or death, 0.25; 95% CI, 0.15 to 0.42; P<0.001). Treatment failure-free survival at 12 months was 86.2% (95% CI, 79.1 to 91.0) in the selpercatinib group and 62.1% (95% CI, 48.9 to 72.8) in the control group. The overall response was 69.4% (95% CI, 62.4 to 75.8) in the selpercatinib group and 38.8% (95% CI, 29.1 to 49.2) in the control group. Adverse events led to a dose reduction in 38.9% of the patients in the selpercatinib group, as compared with 77.3% in the control group, and to treatment discontinuation in 4.7% and 26.8%, respectively.Conclusions Selpercatinib treatment resulted in superior progression-free survival and treatment failure-free survival as compared with cabozantinib or vandetanib in patients with RET-mutant medullary thyroid cancer. (Funded by Loxo Oncology, a subsidiary of Eli Lilly; LIBRETTO-531 number, NCT04211337.)
  • article 0 Citação(ões) na Scopus
    Gluteoplasty With Lumbar Gluteal Flap Associated With Liposuction and Fat Grafting: A Safe Technique for Massive Weight Loss Patients
    (2024) ALVES, Helio Ricardo Nogueira; NICOLAS, Gregory
    Background Weight loss leads to excessive flaccidity, volume loss, and tissue descent in the gluteal region. Translated autologous flaps during lower body lifting have been utilized in patients; they address sagging tissue and the lack of volume. However, sometimes use of these autologous flaps does not provide adequate gluteal projection, and a second procedure with fat injection may be required.Objectives The authors describe their technique of a lower body lift with a lumbosacral flap in association with liposuction and lipofilling for gluteoplasty.Methods A prospective series of 23 post-bariatric surgery individuals who underwent a lower body lift with lumbosacral flap gluteal augmentation, liposuction, and lipofilling between January 2021 and September 2022 were described. The satisfaction rate and complications were assessed 6 months postoperatively with a validated questionnaire (BODY-Q scale).Results The patients had a mean age of 38.18 (range, 28-56 years) and median body mass index of 26. Four patients with dehiscence were diagnosed and treated conservatively. All wound breakdowns were observed in the paramedian plane of the torsoplasty. No reoperations were performed. The mean satisfaction percentage of the BODY-Q scale transformed score was 97.5.Conclusions A technique for a lower body lift with buttock augmentation combined with liposuction and fat grafting was presented. In future studies other techniques to maximize gluteal contouring should be investigated.
  • article 22 Citação(ões) na Scopus
    First-Line Selpercatinib or Chemotherapy and Pembrolizumab in RET Fusion-Positive NSCLC
    (2023) ZHOU, Caicun; SOLOMON, Benjamin; LOONG, Herbert H.; PARK, Keunchil; PEROL, Maurice; ARRIOLA, Edurne; NOVELLO, Silvia; HAN, Baohui; ZHOU, Jianying; ARDIZZONI, Andrea; MAK, M. Perez; SANTINI, Fernando C.; ELAMIN, Yasir Y.; DRILON, Alexander; WOLF, Juergen; PAYAKACHAT, Nalin; UH, Minji K.; RAJAKUMAR, Deborah; HAN, Hongmei; PURI, Tarun; SOLDATENKOVA, Victoria; LIN, A. Bence; LIN, Boris K.; GOTO, Koichi
    BackgroundSelpercatinib, a highly selective potent and brain-penetrant RET inhibitor, was shown to have efficacy in patients with advanced RET fusion-positive non-small-cell lung cancer (NSCLC) in a nonrandomized phase 1-2 study.MethodsIn a randomized phase 3 trial, we evaluated the efficacy and safety of first-line selpercatinib as compared with control treatment that consisted of platinum-based chemotherapy with or without pembrolizumab at the investigator's discretion. The primary end point was progression-free survival assessed by blinded independent central review in both the intention-to-treat-pembrolizumab population (i.e., patients whose physicians had planned to treat them with pembrolizumab in the event that they were assigned to the control group) and the overall intention-to-treat population. Crossover from the control group to the selpercatinib group was allowed if disease progression as assessed by blinded independent central review occurred during receipt of control treatment.ResultsIn total, 212 patients underwent randomization in the intention-to-treat-pembrolizumab population. At the time of the preplanned interim efficacy analysis, median progression-free survival was 24.8 months (95% confidence interval [CI], 16.9 to not estimable) with selpercatinib and 11.2 months (95% CI, 8.8 to 16.8) with control treatment (hazard ratio for progression or death, 0.46; 95% CI, 0.31 to 0.70; P<0.001). The percentage of patients with an objective response was 84% (95% CI, 76 to 90) with selpercatinib and 65% (95% CI, 54 to 75) with control treatment. The cause-specific hazard ratio for the time to progression affecting the central nervous system was 0.28 (95% CI, 0.12 to 0.68). Efficacy results in the overall intention-to-treat population (261 patients) were similar to those in the intention-to-treat-pembrolizumab population. The adverse events that occurred with selpercatinib and control treatment were consistent with those previously reported.ConclusionsTreatment with selpercatinib led to significantly longer progression-free survival than platinum-based chemotherapy with or without pembrolizumab among patients with advanced RET fusion-positive NSCLC. (Funded by Eli Lilly and others; number, NCT04194944.)
  • article 0 Citação(ões) na Scopus
    Current Status of Cancer Rehabilitation in Latin America
    (2024) VILLALOBOS, Vanessa Ucles; SILVA, Ana Carolina Mendez; BELMONTE, Gema Herrera; RUIZ, Judith del Rosario Bermudez; MOJICA, Yudi Milena Rodriguez; BRITO, Christina May Moran de; FIGUEIREDO, Victor; MERIDA, Patricia Rosales; SANTANDER, Blanca Irene Acuna; FLORES, Jonathan Ortiz; LUCIANI, Monica; SIERRA, Leonardo; TAGLE, Maritza Martinez; MONCHEZ, Georgina Granados; MARTINEZ, Licellot; JIMENEZ, Merly Monica Rivero; FLORES, Every Nataly Casas; SATO, Koyi; LEON, Erika Lissette Perez De; GOMEZ, Juan Carlos Leal; SINCAL, Edin Geovanny Xicay; PONCE, Flor de Maria Perez; QUAN, Martha Lolany Perez Ramirez de; DUARTE, Claudia Morales; RAMIREZ, Jose Emilio Albizures; CHAVEZ, Sigrid Yerena Lemus
    Purpose of ReviewThis article provides an overview of access, advancements, and obstacles in the field of cancer rehabilitation in Latin America.Recent FindingsSince cancer rehabilitation is a relatively new service for Latin American countries, there is a noticeable lack of economic, human, and other resources available to carry out the optimal program. This study aims to highlight the current state in order to find solutions to the identified challenges.SummaryCancer and its treatment contribute to significant patient morbidity and mortality with physical and mental late effects. Cancer rehabilitation provides care and interventions to mitigate these functional impairments and improve quality of life. There are significant increases in global cancer incidence and number of survivors, which necessitates an increase in cancer rehabilitation services. Currently, in our countries, there are substantial political, economic, and educational challenges that are barriers to growth in these services.
  • article 8 Citação(ões) na Scopus
    Endoscopic ultrasonography-guided gastroenterostomy versus uncovered duodenal metal stenting for unresectable malignant gastric outlet obstruction (DRA-GOO): a multicentre randomised controlled trial
    (2024) TEOH, Anthony Yuen Bun; LAKHTAKIA, Sundeep; TARANTINO, Ilaria; PEREZ-MIRANDA, Manuel; KUNDA, Rastislav; MALUF-FILHO, Fauze; DHIR, Vinay; BASHA, Jahangeer; CHAN, Shannon Melissa; LIGRESTI, Dario; MA, Mark Tsz Wah; SERNA-HIGUERA, Carlos de la; YIP, Hon Chi; NG, Enders Kwok Wai; CHIU, Philip Wai Yan; ITOI, Takao
    Background Endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) is a novel endoscopic method to palliate malignant gastric outlet obstruction. We aimed to assess whether the use of EUS-GE with a double balloon occluder for malignant gastric outlet obstruction could reduce the need for reintervention within 6 months compared with conventional duodenal stenting. Methods The was an international, multicentre, randomised, controlled trial conducted at seven sites in Hong Kong, Belgium, Brazil, India, Italy, and Spain. Consecutive patients (aged >= 18 years) with malignant gastric outlet obstruction due to unresectable primary gastroduodenal or pancreatobiliary malignancies, a gastric outlet obstruction score (GOOS) of 0 (indicating an inability in intake food or liquids orally), and an Eastern Cooperative Oncology Group performance status score of 3 or lower were included and randomly allocated (1:1) to receive either EUS-GE or duodenal stenting. The primary outcome was the 6-month reintervention rate, defined as the percentage of patients requiring additional endoscopic intervention due to stent dysfunction (ie, restenosis of the stent due to tumour ingrowth, tumour overgrowth, or food residue; stent migration; or stent fracture) within 6 months, analysed in the intention-to-treat population. Prespecified secondary outcomes were technical success (successful placement of a stent), clinical success (1-point improvement in gastric outlet obstruction score [GOOS] within 3 days), adverse events within 30 days, death within 30 days, duration of stent patency, GOOS at 1 month, and quality-of-life scores. This study is registered with (NCT03823690) and is completed. Findings Between Dec 1, 2020, and Feb 28, 2022, 185 patients were screened and 97 (46 men and 51 women) were recruited and randomly allocated (48 to the EUS-GE group and 49 to the duodenal stent group). Mean age was 695 years (SD 126) in the EUS-GE group and 648 years (130) in the duodenal stent group. All randomly allocated patients completed follow-up and were analysed. Reintervention within 6 months was required in two (4%) patients in the EUS-GE group and 14 (29%) in the duodenal stent group [p=00020; risk ratio 015 [95% CI 004-061]). Stent patency was longer in the EUS-GE group (median not reached in either group; HR 013 [95% CI 008-022], log-rank p<00001). 1-month GOOS was significantly better in the EUS-GE group (mean 241 [SD 07]) than the duodenal stent group (191 [09], p=0012). There were no statistically significant differences between the EUS-GE and duodenal stent groups in death within 30 days (ten [21%] vs six [12%] patients, respectively, p=0286), technical success, clinical success, or quality-of-life scores at 1 month. Adverse events occurred 11 (23%) patients in the EUS-GE group and 12 (24%) in the duodenal stent group within 30 days (p=100); three cases of pneumonia (two in the EUS-GE group and one in the duodenal stent group) were considered to be procedure related Interpretation In patients with malignant gastric outlet obstruction, EUS-GE can reduce the frequency of reintervention, improve stent patency, and result in better patient-reported eating habits compared with duodenal stenting, and the procedure should be used preferentially over duodenal stenting when expertise and required devices are available.
  • article 0 Citação(ões) na Scopus
    Expanding Cervical Cancer Screening in Mozambique: Challenges Associated With Diagnosing and Treating Cervical Cancer
    (2023) BATMAN, Samantha; RANGEIRO, Ricardina; MONTEIRO, Eliane; CHANGULE, Dercia; DAUD, Siro; RIBEIRO, Magda; TSAMBE, Edgar; BILA, Celso; OSMAN, Nafissa; CARRILHO, Carla; NEVES, Andrea; ATIF, Hira; JESUS, Celda De; MARIANO, Arlete; MORETTI-MARQUES, Renato; VIEIRA, Marcelo; FONTES-CINTRA, Georgia; LOPES, Andre; BATWARE, Jean Claude; LUIS, Elvira; GROVER, Surbhi; BAKER, Ellen; MONTEALEGRE, Jane; CASTLE, Philip E.; JERONIMO, Jose; CHIAO, Elizabeth; LORENZONI, Cesaltina; SCHMELER, Kathleen; SALCEDO, Mila P.
    PURPOSE Mozambique has one of the highest burdens of cervical cancer globally. Treatment options are few as most women present with advanced disease, and there are limited trained health professionals and health care resources. The objective of this study was to describe the outcomes of women diagnosed with invasive cancer as part of the Mozambican women undergoing cervical cancer screening with human papillomavirus (HPV) testing in conjunction with family planning services (MULHER) study. MATERIALS AND METHODS Women age 30-49 years were prospectively enrolled in the MULHER study and offered screening with primary HPV testing followed by treatment of screenpositive women with thermal ablation or excision as appropriate. Women with cervical examination findings suspicious for cancer were referred to one of the three gynecologic oncologists in the country. RESULTS Between January 2020 and January 2023, 9,014 women underwent cervical cancer screening and 30 women were diagnosed with cervical cancer. In this cohort, four patients (13.3%) had early-stage disease, 18 (60.0%) had locally advanced disease, one (3.3%) had distant metastatic disease, and seven (23.3%) did not have staging information available. Five patients (16.6%) died without receiving oncologic treatment, and seven patients (23.3%) are still awaiting treatment. Of the remaining 18 patients, three (17.6%) underwent surgery and four (23.5%) received radiotherapy. Eleven (36.7%) patients received only chemotherapy. CONCLUSION As cervical screening programs are implemented in low-resource settings, there will likely be an increase in the number of women diagnosed with invasive cervical cancer. Our results in Mozambique demonstrate the need to increase access to advanced surgery, radiation, and palliative care services.
  • article 1 Citação(ões) na Scopus
    Systemic therapies for salivary gland carcinomas: an overview of published clinical trials
    (2024) SILVA, Luan Cesar; PEREZ-DE-OLIVEIRA, Maria Eduarda; PEDROSO, Caique Mariano; LEITE, Amanda Almeida; SANTOS-SILVA, Alan Roger; LOPES, Marcio Ajudarte; CASTRO JUNIOR, Gilberto de; MARTINS, Manoela Domingues; WAGNER, Vivian Petersen; KOWALSKI, Luiz Paulo; SQUARIZE, Cristiane Helena; CASTILHO, Rogerio Moraes; VARGAS, Pablo Agustin
    Background: There is no consensus about effective systemic therapy for salivary gland carcinomas (sgcs). Our aim was summarized the clinical trials assessing the systemic therapies (ST) on sgcs. Material and Methods: Electronic searches were carried out through MEDLINE/pubmed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases, and gray literature. Results: Seventeen different drugs were evaluated, and the most frequent histological subtype was adenoid cystic carcinoma (n=195, 45.5%). Stable disease, observed in 11 ST, achieved the highest rate in adenoid cystic carcinoma treated with sunitinib. The highest complete (11.1%) and partial response (30.5%) rates were seen in androgen receptor -positive tumors treated with leuprorelin acetate. Conclusions: Despite all the advances in this field, there is yet no effective evidence -based regimen of ST, with all the clinical trials identified showing low rates of complete and partial responses. Further, translational studies are urgently required to characterize molecular targets and effective ST.