ANGELITA HABR GAMA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- Rectal Cancer and Organ-Preservation: Safety First, Then the King(2023) FERNANDEZ, Laura M.; JULIAO, Guilherme P. Sao; RENEHAN, Andrew G.; BEETS, Geerard L.; PAPOILA, Ana L.; VAILATI, Bruna B.; KRANENBARG, Elma Meershoek-Klein; ROODVOETS, Annet G. H.; FIGUEIREDO, Nuno L.; VELDE, Cornelis J. H. van de; HABR-GAMA, Angelita; PEREZ, Rodrigo O.
- Baseline T Classification Predicts Early Tumor Regrowth After Nonoperative Management in Distal Rectal Cancer After Extended Neoadjuvant Chemoradiation and Initial Complete Clinical Response(2017) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; GAMA-RODRIGUES, Joaquim; VAILATI, Bruna Borba; ORTEGA, Cinthia; FERNANDEZ, Laura Melina; ARAUJO, Sergio Eduardo Alonso; PEREZ, Rodrigo OlivaBACKGROUND: Selected patients with rectal cancer and complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively with acceptable outcomes. However, approximate to 20% of these patients will develop early tumor regrowth. Identification of these patients could select candidates for more intensive follow-up. OBJECTIVE: The purpose of this study was to investigate the influence of baseline radiological T classification on recurrences after a complete clinical response managed nonoperatively after chemoradiation. DESIGN: This was a retrospective review of a prospective collected database. SETTINGS: The study was conducted at a single center. PATIENTS: Patients with distal rectal cancer (cT2-4N0-2M0) undergoing extended chemoradiation (54 Gy + 5-fluorouracil-based chemotherapy) were eligible. Patients were reassessed for tumor response at 10 weeks after radiation completion. Patients with complete clinical response (clinical, radiological, and endoscopic) were managed nonoperatively and strictly followed. MAIN OUTCOMES MEASURES: Complete clinical response rates, early tumor regrowth rates (<12 mo), local recurrence-free survival, and distant metastases-free survival were measured. RESULTS: A total of 91 consecutive patients with rectal cancer underwent extended chemoradiation. Sixty-one patients developed initial complete clinical response (67%). cT2 patients developed similar initial complete clinical response rates compared with cT3/T4 (72% vs 63%; p = 0.403). Early tumor regrowths were more frequent among baseline cT3/4 when compared with cT2 patients (30% vs 3%; p = 0.007). There were no differences in late local recurrences (p = 0.593) or systemic recurrences (p = 0.387). Local recurrence-free survival was significantly better for cT2 patients at 1 year (96% vs 69%; p = 0.009). After Cox regression analysis, baseline T stage was an independent predictor of improved local recurrence-free survival at 1 year (p = 0.03; OR = 0.09 (95% CI, 0.01-0.81)). LIMITATIONS: This study was limited by its small sample size, retrospective nature, and short follow-up. CONCLUSIONS: cT2 patients who develop complete clinical response after extended chemoradiation managed nonoperatively are less likely to develop early tumor regrowths when compared with cT3/4 patients. cT3/4 patients should undergo more intensive follow-up after a complete clinical response to allow for early detection of early regrowths.
- Achieving a Complete Clinical Response After Neoadjuvant Chemoradiation That Does Not Require Surgical Resection: It May Take Longer Than You Think!(2019) HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; FERNANDEZ, Laura M.; VAILATI, Bruna B.; ANDRADE, Andres; ARAUJO, Sergio E. A.; GAMA-RODRIGUES, Joaquim; PEREZ, Rodrigo O.BACKGROUND: Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed by organ-preserving strategies and acceptable long-term outcomes. Controversy still exists regarding optimal timing for the assessment of tumor response after neoadjuvant chemoradiation. OBJECTIVE: The purpose of this study was to estimate the time interval for achieving complete clinical response using strict endoscopic and clinical criteria after a single neoadjuvant chemoradiation regimen. DESIGN: This was a retrospective review of consecutive patients managed by 54-Gy and consolidation 5-fluorouracil-based chemotherapy. Assessment of response was performed at 10 weeks after radiation. Patients with suspected complete clinical response were offered watch-and-wait strategy and reassessment every 6 to 8 weeks until achievement of strict criteria of complete clinical response or overt residual cancer. SETTINGS: This study was conducted at a single tertiary care center. PATIENTS: Patients with complete clinical response who underwent a successful watch-and-wait strategy until last follow-up were eligible. Dates of radiation completion and achievement of strict endoscopic and clinical criteria (mucosal whitening, teleangiectasia, and no ulceration or irregularity) were recorded. Patients with incomplete response or with initial complete clinical response followed by local recurrence or regrowth were excluded. MAIN OUTCOMES MEASURES: The distribution of time intervals between completion of radiation and achievement of strict complete clinical response was measured. Patients who achieved early complete clinical response (<= 16 wk) were compared with late complete clinical response (>16 wk). RESULTS: A total of 49 patients achieved complete clinical response and were successfully managed nonoperatively. A median interval of 18.7 weeks was observed for achieving strict complete clinical response. Only 38% of patients achieved complete clinical response between 10 and 16 weeks from radiation completion. Patients with earlier cT status (cT2/T3a) achieved a complete clinical response significantly earlier when compared with those patients with more advanced disease (T3b-d/4; 19 vs 26 wk; p = 0.03). LIMITATIONS: This was a retrospective study with a small sample size. CONCLUSIONS: Assessment at 10 to 16 weeks may detect a minority of patients who achieve complete clinical response without additional recurrence after neoadjuvant chemoradiation. Patients suspected for a complete clinical response should be considered for reassessment beyond 16 weeks before definitive management when considered for a watch and wait strategy. See Video Abstract at http://links.lww.com/DCR/A901.
- Local Regrowth and the Risk of Distant Metastases Among Patients Undergoing Watch-and-Wait for Rectal Cancer: What Is the Best Control Group? Multicenter Retrospective Study(2024) JULIAO, Guilherme Pagin Sao; FERNANDEZ, Laura M.; VAILATI, Bruna Borba; HABR-GAMA, Angelita; AZEVEDO, Jose M.; SANTIAGO, Ines A.; PARES, Oriol; PARVAIZ, Amjad; VENDRELY, Veronique; RULLIER, Anne; RULLIER, Eric; DENOST, Quentin; PEREZ, Rodrigo OlivaBACKGROUND:A proportion of rectal cancer patients who achieve a clinical complete response may develop local regrowth. Although salvage appears to provide appropriate local control, the risk of distant metastases is less known.OBJECTIVE:To compare the risk of distant metastases between patients who achieve a clinical complete response (watch-and-wait strategy) and subsequent local regrowth and patients managed by surgery after chemoradiation.DESIGN:Retrospective multicenter cohort study.SETTINGS:This study used data of patients from 3 institutions who were treated between 1993 and 2019.PATIENTS:Patients with initial clinical complete response (after neoadjuvant therapy) followed by local regrowth and patients with near-complete pathological response (<= 10%) after straightforward surgery after chemoradiation were included.MAIN OUTCOME MEASURES:Univariate and multivariate analyses were performed to identify risk factors for distant metastases. Kaplan-Meier curves were created (log-rank test) to compare survival outcomes. Analyses were performed using time zero as last day of radiation therapy or as date of salvage resection in the local regrowth group.RESULTS:Twenty-one of 79 patients with local regrowth developed distant metastases, whereas only 10 of 74 after upfront total mesorectal excision following neoadjuvant chemoradiation therapy (p = 0.04). Local regrowth and final pathology (ypT3-4) were the only independent risk factors associated with distant metastases. When using date of salvage resection as time zero, distant metastases-free survival rates were significantly inferior for patients with local regrowth (70% vs 86%; p = 0.01).LIMITATIONS:Small number of patients, many neoadjuvant therapies, and selection bias.CONCLUSIONS:Patients undergoing watch-and-wait strategy who develop local regrowth are at higher risk for development of distant metastases compared to patients with near-complete pathological response managed by upfront surgery after chemoradiation. See Video Abstract
- Impact of Organ-Preserving Strategies on Anorectal Function in Patients with Distal Rectal Cancer Following Neoadjuvant Chemoradiation(2016) HABR-GAMA, Angelita; LYNN, Patricio B.; JORGE, J. Marcio N.; JULIAO, Guilherme P. Sao; PROSCURSHIM, Igor; GAMA-RODRIGUES, Joaquim; FERNANDEZ, Laura M.; PEREZ, Rodrigo O.BACKGROUND: Organ-preserving strategies have been considered for patients with distal rectal cancer and complete or near-complete response to neoadjuvant chemoradiation to avoid the functional consequences of radical surgery. Transanal endoscopic microsurgery and no immediate surgery (watch and wait) have been considered in selected patients. OBJECTIVE: The aim of this study is to compare anorectal function following these 2 organ-preserving strategies (transanal endoscopic microsurgery and watch and wait) for rectal cancer with complete or near-complete response to neoadjuvant chemoradiation. DESIGN: This study is based on the comparison of prospectively collected data. SETTINGS: This study was conducted at a single center. PATIENTS: Consecutive patients with distal rectal cancer undergoing neoadjuvant chemoradiation (50.4-54 Gy and 5-fluorouracil-based chemotherapy) were prospectively studied. Patients with complete clinical response were managed by watch and wait. Patients with near-complete response (<= 3 cm, ycT1-2N0) were managed by transanal endoscopic microsurgery. MAIN OUTCOME MEASURES: Functional outcomes were determined by anorectal manometry and Fecal Incontinence Index and Quality of Life assessment. RESULTS: Two groups of patients were included in the study. Twenty-nine patients with near-complete response undergoing transanal endoscopic microsurgery and 53 with complete response after watch and wait were assessed. Baseline features were similar between groups. Patients undergoing transanal endoscopic microsurgery had worse resting/squeeze pressures (p = 0.004) and rectal capacity (p = 0.002). In addition, their incontinence scores (2.3 vs 6.5; p < 0.001) and quality-of-life questionnaire responses (in all domains; p <= 0.01) were significantly worse in comparison with patients undergoing watch and wait. LIMITATIONS: This study was limited by the small sample size and the absence of baseline anorectal function information. CONCLUSIONS: Nonoperative management of patients with complete clinical response following chemoradiation results in better anorectal function in comparison with patients with near-complete response managed by transanal endoscopic microsurgery. In the absence of clinically detectable residual cancer, this latter approach may result in significant worsening of anorectal function.
- Not Taking ""No"" for an Answer(2018) HABR-GAMA, Angelita
- Management of adenomas within the area of rectal cancer that develop complete pathological response(2015) HABR-GAMA, Angelita; VIANNA, Maria Regina; JULIAO, Guilherme P. Sao; RAWET, Viviane; GAMA-RODRIGUES, Joaquim; PROSCURSHIM, Igor; ALVES, Jacyara; FERNANDEZ, Laura M.; PEREZ, Rodrigo O.
- Salvage Surgery Following Organ Preservation With Local Regrowth After Watch and Wait: Picture Still Unclear Reply(2021) FERNANDEZ, Laura M.; FIGUEIREDO, Nuno L.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VIEIRA, Pedro; VAILATI, Bruna B.; NASIR, Irfan; PARES, Oriol; SANTIAGO, Ines; CASTILLO-MARTIN, Mireia; CARVALHO, Carlos; PARVAIZ, Amjad; PEREZ, Rodrigo O.
- Salvage Surgery With Organ Preservation for Patients With Local Regrowth After Watch and Wait: Is It Still Possible?(2020) FERNANDEZ, Laura M.; FIGUEIREDO, Nuno L.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VIEIRA, Pedro; VAILATI, Bruna B.; NASIR, Irfan; PARES, Oriol; SANTIAGO, Ines; CASTILLO-MARTIN, Mireia; CARVALHO, Carlos; PARVAIZ, Amjad; PEREZ, Rodrigo OlivaBACKGROUND: Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively. Thirty percent of these patients may develop a local regrowth, and salvage resection with radical surgery is usually recommended. However, selected patients could be offered additional organ preservation by local excision. We hypothesized that patients with baseline T2 who underwent neoadjuvant therapy (for the specific purpose of achieving a complete clinical response) were more likely to harbor recurrent disease at an earlier stage and amenable to organ preservation strategies (local excision) when compared with T3/T4 (undergoing neoadjuvant chemoradiation for oncologic reasons). OBJECTIVE: The purpose of this study was to compare patients with local regrowth requiring salvage resection according to their baseline stage. DESIGN: This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation. SETTINGS: The study included 2 independent tertiary centers with institutional watch-and-wait organ preservation programs. PATIENTS: Consecutive patients with distal rectal cancer (cT2-4N1-2M0) managed by watch and wait and local regrowth from 2 institutions were included. MAIN OUTCOMES MEASURES: Final pathologic features and surgical and oncologic outcomes were compared according to baseline staging. RESULTS: A total of 73 of 257 patients experienced local regrowth. cT2 presented similar to ypT, ypN, R0, and abdominal perineal resection rates (p> 0.05) at the time of salvage when compared with cT3 to cT4. Patients with cT2 at baseline were more likely to undergo an organ preservation procedure for salvage (56.2% vs 26.5%;p= 0.03). Overall and disease-free survival after salvage were similar between groups irrespective of the type of surgery for the regrowth. LIMITATIONS: Retrospective study, small sample size, and possible inaccurate baseline staging. CONCLUSIONS: Although patients with baseline cT2 rectal cancer had similar pathologic stage at the time of recurrence, these patients were more likely to continue an organ preservation pathway after local regrowth through transanal local excision when compared with cT3 to cT4. Despite differences in the use of radical salvage resection, there were no differences in oncologic outcomes.
- Should We Give Up The Search for a Clinically Useful Gene Signature for the Prediction of Response of Rectal Cancer to Neoadjuvant Chemoradiation?(2016) PEREZ, Rodrigo O.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VAILATI, Bruna B.; FERNANDEZ, Laura M.; GAMA-RODRIGUES, Joaquim; CAMARGO, Anamaria A.