RAFAEL CAIRES ALVINO DE LIMA
Índice h a partir de 2011
2
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
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conferenceObject Expression of ERCC1 protein (excision repair cross complementing group 1) in patients with invasive carcinoma of the uterine cervix (CC) undergoing definitive chemoradiation (CR)(2012) CAIRES, Inacelli Queiroz de Souza; CAIRES-LIMA, Rafael; COLOMBO, Renata; RAMOS, Clarissa C. A.; MACHADO, Karime Kalil; SIQUEIRA, Sheila Aparecida Coelho; CARVALHO, Heloisa de Andrade; FUKUSHIMA, Julia Tizue; ADRA, Thais Rodrigues; HOFF, Paulo M.; ESTEVEZ-DIZ, Maria Del PilarBackground: CC is the leading cause of cancer death among women in developing countries. ERCC1 protein participates in DNA repair through the nucleotide excision repair pathway, involved in resistance to platinum-based chemotherapy. Its value as a predictive marker of tumor response to treatment, progression or death is still unknown. We evaluated ERCC1 protein expression and clinical variables as a predictive marker of progression-free survival (PFS) and overall survival (OS) in patients (pts) with CC submitted to CR. Methods: Retrospective data analysis of pts with histological diagnosis of CC, treated with CR between 2004-2009. Platinum-based chemotherapy was administered weekly (x6) concurrent to external beam radiotherapy (EBRT) to the pelvis (39.6 – 45.0 Gy), parametrial boost (14.0 – 20.0 Gy) when indicated and high-dose rate brachytherapy (HDR) (28.0 – 30.0 Gy). ERCC1 expression was assessed by immunohistochemistry (IHC). Results: We analyzed 75 pts, median age was 55 years (range 24-76), the performance status (PS) was 0 or 1 at baseline in 50 pts (66%) and 63 had squamous histology (84%). Thirty-two were stage IIB (43%) and 19 were IIIB (25%). Sixty-five patients received cisplatin 40mg/m2/w (87%) and 9, carboplatin AUC2/w (12%), median of 6 cycles (range 2-9). Median RT and HDR doses were 59.4 Gy (range 40.4 to 60.3) and 28.0 Gy (range 14.0 – 37.5), respectively. Thirty-two pts were available by ERCC1 IHC and all expressed the marker. Median PFS and OS were 35.5 (95% CI – 13.8 - 57.6) and 81 (95% CI- 21.2 - 140.8) months, respectively. In multivariate analysis, receiving < 6 chemotherapy cycles and baseline Hb <10.0 were correlated with disease progression and death, HR 0.302; p 0.011 (95% CI- 0.012-0.762) and HR 0.6; p 0.00 (95% CI- 0.474 – 0.760), respectively. PS at baseline did not correlate with PFS or OS, HR 0.985; p 0.614 (95% CI 0.930 – 1.044). Conclusions: In this population, since all pts expressed the protein, ERCC1 expression couldn't discriminate patients who most benefit from CR. Interestingly, a minimum of 6 chemotherapy cycles and a baseline Hb ≥ 10.0 seem to have a prognostic value.conferenceObject Safety and efficacy of adjuvant modified FLOX for patients (pts) with stage III colorectal cancer (CRC) treated in the community.(2015) PROTASIO, Bruno Mendonca; MATUTINO, Adriana Reis Brandao; LAGE, Liana Valente; SANTANA, Iuri Amorim De; RAMOS, Ricardo Emanuel De Oliveira; CAIRES-LIMA, Rafael; CAIRES, Inacelli Queiroz De Souza; RIECHELMANN, Rachel Pimenta; SARAGIOTTO, Daniel Fernandes; SABBAGA, Jorge; HOFF, Paulo MarceloconferenceObject Cancer patients with ECOG-PS higher than 1: Who are those who benefit of palliative chemotherapy?(2013) CAIRES-LIMA, Rafael; PROTASIO, Bruno Mendonca; CAIRES, Inacelli Queiroz de Souza; ROCHA, Lucila Soares Da Silva; OLIVEIRA, Julia Andrade De; GUERRA, Raquel Bezerra; MAK, Milena Perez; HOFF, Paulo M.; CASTRO, GilbertoconferenceObject Prophylactic anticonvulsants in patients (pts) with primary brain tumor (PBT): Have we really agreed to a consensus?(2013) OLIVEIRA, Julia Andrade de; SANTANA, Iuri Amorim De; CAIRES, Inacelli Queiroz de Souza; CAIRES-LIMA, Rafael; MIRANDA, Vanessa Costa; PROTASIO, Bruno Mendonca; ROCHA, Lucila Soares Da Silva; BRAGA, Henrique Faria; MENCARINI, Ana Cristina Malacarne; TEIXEIRA, Manoel Jacobsen; CASTRO, Luiz Henrique Martins; FEHER, OlavoconferenceObject EGFR GENOTYPING AND EPIDEMIOLOGY, CLINICAL AND PATHOLOGICAL FEATURES IN 191 PATIENTS WITH METASTATIC PULMONARY ADENOCARCINOMA IN SAO PAULO - BRAZIL.(2013) CASTRO JR., Gilberto; TAKAHASHI, Tiago K.; CAIRES-LIMA, Rafael; PROTASIO, Bruno M.; MAIA, Manuel C. D. F.; SOARES, Ibere C.; ROITBERG, Felipe S. R.; MARINI, Andrea M.; MARTINS, Renata E.; TAKAGAKI, Teresa Y.; ARAUJO, Pedro H. X. N.; TERRA, Ricardo M.; SHIANG, Christina; SIQUEIRA, Sheila A. C.; MELLO, Evandro S.; ALVES, Venancio A.; HOFF, Paulo M.conferenceObject REFERRAL OF LUNG CANCER PATIENTS TO SPECIALIZED CLINICAL ONCOLOGY CARE: INSTITUTO DO CANCER DO ESTADO DE SAO PAULO 2010-2011(2012) CAIRES-LIMA, Rafael; TAKAHASHI, Tiago K.; MAK, Milena P.; ROITBERG, Felipe S. R.; TEIXEIRA, Carlos H. A.; MESQUITA, Cristiane S.; MARINI, Andrea M.; MARTINS, Renata E.; TAKAGAKI, Tereza Y.; ARAUJO, Pedro N.; FEHER, Olavo; HOFF, Paulo M.; CASTRO JR., Gilberto DeBackground: Lung cancer is the leading cause of death from malignancy in Western countries. To achieve better outcomes and improve quality of care, it is essential to know both patients and disease characteristics. Here we aim to describe epidemiological and tumor characteristics and their impact on survival outcomes, of patients admitted at Instituto do Câncer de Estado de São Paulo (ICESP) between January 2010 and July 2011. Methods: It is a retrospective, descriptive, and uninstitutional study, of patients diagnosed histologically with lung cancer, consecutively admitted at ICESP between January 2010 and July 2011. Overall survival was the main endpoint. Frequencies were compared using chi-square test. Survival was estimated using the Kaplan-Meier methods, and the curves were compared by the log-rank test. This study was approved by the local IRB. Results and Conclusion: 232 patients (pts) were included in this analysis: median age 65y (24-91), 57% male, 56% ECOG 0 - 1, and 83% previous or current smokers. Non small cell lung cancer (NSCLC) was the most common histologic type (213 pts, 92%). Small cell lung cancer (SCLC) was diagnosed in 18 pts (7.6%) and only one (0.4%) was a case of a carcinoid tumor. Regarding NSCLC histologic subtypes, adenocarcinoma was the most common (130 pts, 61%), followed by squamous cell carcinoma (63 pts, 30%) and large cell carcinoma (5 pts, 2%). In 17 pts (7%), it was not possible to determine the subtype, even with immunohistochemistry. In terms of staging, 155 pts (71%) with NSCLC presented metastatic disease (stage IV) at diagnosis, 27 pts (12%) were staged as IIIB, 15 pts (10%) IIIA, 8 pts (3.5%) II and 8 pts (3.5%) I. Among patients with SCLC, six (33%) had localized disease (LD) and 12 (67%) had extensive disease (ED). Analyzing only stage IV NSCLC pts, 123 (79%) were treated with first line chemotherapy, 56 (36%)with second line and 13 (8%) with third line systemic therapies; ECOG 0 - 2 NSCLC pts were more likely to be exposed to second-line therapies (46% vs 36%; p = 0.0002). In a median follow-up of 9.5 mo, median overall survival (mOS) was 9 mo for all pts in this analysis. Regarding NSCLC, in patients with stage I and II mOS was not reached (100% and 68% in 2 years for stage I and II, respectively). In patients with stage IIIA, IIIB and IV, the median OS was 15.2, 11.4 and 7 mo, respectively (p-trend = 0.0002). According to ECOG-PS, mOS was 11.3, 6.3, 4.1, and 2.2 mo for NSCLC pts with ECOG 1, 2, 3 and 4, respectively (p-trend < 0.0001). For SCLC pts, mOS was 12.9 mo among those with LD versus 4.9 mo in ED (HR 3.1; 95% CI 1.1 - 8.6; p = 0.02). Lung cancer survival rate remains poor. As expected, clinical stage and performance status were important prognostic factors. Primary prevention strategies (quitting smoking) and early diagnosis (screening) may be useful in this scenario.- Antiepileptic drug prophylaxis in primary brain tumor patients: is current practice in agreement to the consensus?(2014) OLIVEIRA, Julia Andrade de; SANTANA, Iuri A.; CAIRES, Inacelli Q. S.; CAIRES-LIMA, Rafael; MIRANDA, Vanessa Costa; PROTASIO, Bruno M.; ROCHA, Lucila S.; BRAGA, Henrique F.; MENCARINI, Ana M.; TEIXEIRA, Manoel Jacobsen; CASTRO, Luiz Henrique Martins; FEHER, OlavoThe role of antiepileptic drugs (AED) prophylaxis in primary brain tumor (PBT) seizure-na < ve patients remains unclear. Additionally, AED are associated with severe side effects, negative impact on cognition and drug interactions. Little is known about current practice regarding prophylactic AED use in PBT. We investigated its use in a tertiary care cancer center. We reviewed medical records of 260 patients registered in our center between 2008 and 2012, focusing on prophylactic AED use. A descriptive analysis was performed with SPSS IBM version 20.0. Median age was 44.5 years (11-83). Most patients had ECOG PS a parts per thousand currency sign1 (76.4 %). Among 141 seizure-na < ve patients, 70.2 % received an AED as primary prophylaxis (PP). Most commonly used drugs as PP were phenytoin (85.9 %), carbamazepine (6.1 %) and phenobarbital (5.1 %). In only 14 patients (14.1 %) AEDs were eventually discontinued, in a median time of 5.9 months (1.1-76.8 m). AED were used as PP in 60 % of low-grade gliomas, 73.3 % of anaplastic gliomas and 93.9 % of glioblastoma patients. Twenty-seven patients (27.3 %) on PP presented seizures, generally associated with tumor progression. Of the 42 seizure-na < ve patients not receiving AED prophylaxis, only two presented seizures, which occurred during or within the first week post-radiotherapy. In this cross-sectional study, prophylactic AED use in PBT was extremely high. Postoperatively, AED were discontinued in a minority of patients, mostly after a prolonged period. Current prophylactic AED use patterns in PBT are not in accordance with established guidelines.
conferenceObject Definitive chemoradiotherapy (CRT) for advanced cervical cancer (CC): Should it be different in elderly?(2013) CAIRES, I. Q. S.; CAIRES-LIMA, R.; BARROSO-SOUZA, R.; OLIVEIRA, J. A. De; SOUZA, K. T.; NEGRAO, M. V.; CARVALHO, H.; ABDO FILHO, E.; HOFF, P. M.; DIZ, M. D. P. E.conferenceObject PROGNOSTIC FACTORS AND TREATMENT OF CERVICAL CANCER (CC) IN ELDERLY(2012) CAIRES, I. Q. S.; LIMA, R. C. A. D.; BARROSO-SOUSA, R.; ANDRADE, E. M. P. D.; SILVA, J. R. D.; SANCHEZ, F. B.; HOFF, P. M.; DIZ, M.Background Cancer diagnostics in the elderly is increasing over the years. Although elderly represent less than 10% of CC patients (pts), they usually present more advanced disease and do't receive aggressive treatment. Methods Retrospective analysis of pts ≥ 70 years old with CC consecutively admitted at single institution from Aug/2002 up to Feb/2012. Primary endpoint was overall survival (OS). Secondary endpoint was assessment of prognostic factors for OS and treatment received. Survival was estimated using the Kaplan-Meier methods, the curves were compared by the log-rank test and frequencies with chi-square test. Results 70 pts were analyzed (7.5% of all CC pts). Median age was 76 years old (range, 70-91y). Squamous carcinoma was the most common histological type (61 pts, 87.1%), 57 (81.4%) were performance status (PS) 0 or 1 and 37 (52.5%) were eutrophic (Body Mass Index 18.5- 25 Kg/m2). In terms of initial staging, 14 pts (20%) were stage I, 30 pts (42.8%) II, 10 pts (14.2%) III, 14 pts (20%) IVa and 2 pts (2.8%) IVb. Regarding the treatment, 32 pts (45.7%) underwent chemoradiotherapy (CRT), 19 pts (27.1%) isolated radiotherapy (RT), 12 pts (17.1%) surgery and 7 pts (10%) best supportive care (BSC). Among CRT pts, 19 (59.3%) completed the full treatment (platinum-based chemotherapy administered for 6 weeks concomitantly with external radiotherapy in the pelvis, total dose of 45 Gy, and 4 inserts from 7 to 7.5 Gy of brachytherapy); 16 (50%) received cisplatin and 16 (50%) carboplatin. In a median follow up of 15.3 mo (range, 0.1- 79.8 mo), mean OS was 79.8 mo for all pts in this analysis. Hemoglobin level ≥ 10 mg/dL pretreatment correlated with better mOS (HR 0.10; IC95% 0.02 to 0.42; p = 0.002), while creatinine ≥ 1 mg/dL before the treatment (HR 8.1; IC95% 1.87 to 34.88; p = 0.005) was considered risk factor to mortality. Pts who received QRT, RT had better mOS (HR 0,18; IC 95% 0,06 to 0.54; p= 0.002). Age, PS, BMI and comorbidities (pneumopathy, cardiopathy, dementia) did't correlate with mOS. Conclusions CRT is feasible in the elderly. Pts submitted to QRT, RT had better survival than those who did not undergo treatment and age alone can not be used to decide the conduct. Pts at baseline with Hb < 10 mg/dL and kidney disfunction had a poor prognosis.conferenceObject ERLOTINIB IN METASTATIC PULMONARY ADENOCARCINOMAS HARBOURING EGFR ACTIVATING MUTATIONS, IN SAO PAULO - BRAZIL(2013) CAIRES-LIMA, Rafael; PROTASIO, Bruno M.; TAKAHASHI, Tiago K.; MAK, Milena P.; NAKAZATO, Denyei; MESQUITA, Cristiane S.; TAKAGAKI, Teresa Y.; SOARES, Ibere C.; MELLO, Evandro S.; ALVES, Venancio A.; HOFF, Paulo M.; CASTRO JR., Gilberto