ANGELITA HABR GAMA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
7 resultados
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conferenceObject CONSOLIDATION CHEMOTHERAPY DURING EXTENDED CRT LEADS TO SUSTAINED DECREASE IN TUMOR METABOLISM WHEN COMPARED TO STANDARD CRT REGIMEN(2014) HABR-GAMA, A.; PEREZ, R.; JULIAO, G. Sao; LYNN, P.; GAMA-RODRIGUES, J.; PROSCURSHIM, I.; BUCHPIGUEL, C.- Predicting complete response to neoadjuvant CRT for distal rectal cancer using sequential PET/CT imaging(2014) PEREZ, R. O.; HABR-GAMA, A.; JULIAO, G. P. Sao; LYNN, P. B.; SABBAGH, C.; PROSCURSHIM, I.; CAMPOS, F. G.; GAMA-RODRIGUES, J.; NAHAS, S. C.; BUCHPIGUEL, C. A.Molecular imaging using positron emission tomography/computerized tomography (PET/CT) may add relevant incremental diagnostic information to standard structural cross-sectional imaging. Such information may allow identification of patients with rectal cancer that are more likely to develop complete tumor regression after neoadjuvant chemoradiation therapy (CRT). The objective of this report was to identify PET/CT features that are associated with a complete response after CRT. 99 cT2-4N0-2M0 distal rectal cancer patients (a parts per thousand currency sign7 cm from anal verge) were included in this prospective single center trial (NCT 00254683). Patients underwent baseline PET/CT followed by 54 Gy and 5-fluorouracil-based neoadjuvant CRT. After completion of therapy, patients underwent 6- and 12-week PET/CT. Clinical assessment of tumor response was performed at 12 weeks and was blinded to radiological information. Patients were treated according to clinical assessment. There were seven patients with a complete pathological response (pCR) and 16 with a complete clinical response (cCR) (23 complete responders). Comparison of pCR exclusively and non-pCR revealed that only baseline primary tumor standard uptake value (SUV) was a significant predictor of response. Comparison of complete responders (pCR or cCR) and non-complete responders showed that depth of rectal wall uptake at baseline PET/CT (p = 0.002) and variation between baseline and 12-week maximum standard uptake value (SUVmax) of primary tumor (p = 0.001) were independent predictors for complete response at multivariate analysis. A decrease > 67 % between baseline and 6-week or 76 % between baseline and 12-week SUVmax were associated with complete response (pCR or cCR; p = 0.02 and p < 0.001, respectively). Positron emission tomography/computerized tomography at baseline, 6 and 12 weeks, may provide information regarding patients with a higher likelihood of developing complete tumor regression following neoadjuvant CRT.
conferenceObject NOT ALL PATIENTS WITH BASELINE CT2N0 AND INCOMPLETE CLINICAL RESPONSE FOLLOWING NEOADJUVANT CRT ARE APPROPRIATE CANDIDATES FOR TEM AS A DEFINITIVE SURGICAL PROCEDURE.(2014) PEREZ, R.; HABR-GAMA, A.; LYNN, P.; JULIAO, G. Sao; PROSCURSHIM, I.; COELHO, A.; GAMA-RODRIGUES, J.- Transanal Local Excision for Distal Rectal Cancer and Incomplete Response to Neoadjuvant Chemoradiation - Does Baseline Staging Matter?(2014) PEREZ, Rodrigo O.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; PROSCURSHIM, Igor; COELHO, Augusto Q.; FIGUEIREDO, Marleny N.; FERNANDEZ, Laura M.; GAMA-RODRIGUES, JoaquimBACKGROUND: Local excision may offer the possibility of organ preservation for the management of select patients after neoadjuvant chemoradiation. The oncological outcomes of this strategy have been largely associated with the risk of nodal metastases. Therefore, in addition to final ypT status, baseline staging has been suggested to potentially influence the outcomes of this treatment modality. OBJECTIVE: The aim of this study is to compare the pathological and oncological outcomes of patients following neoadjuvant chemoradiation and incomplete clinical response managed by transanal endoscopic microsurgery according to baseline staging. DESIGN: This study is a retrospective review of prospectively collected data. SETTINGS: The study was conducted at a single center. PATIENTS: Forty-six patients with distal rectal cancer cT2-4N0- 2M0 underwent 5-fluorouracil-based neoadjuvant chemoradiation. Assessment of response was performed at least 8 weeks from radiotherapy completion. Patients with a complete clinical response were not operated on immediately. Patients with an incomplete clinical response were managed by surgery. Those with small (<= 3 cm) residual cancers (ycT1-2N0M0) were managed by transanal endoscopic microsurgery. MAIN OUTCOME MEASURES: Patients undergoing local excision following chemoradiation were compared according to baseline staging. RESULTS: Fifteen patients (32%) were cT2N0 at baseline. Final ypT status was ypT0 in 3 (20%) patients, ypT1 in 2 (13%) patients, ypT2 in 9 (60%) patients, and ypT3 in 1 (7%) patient. There were no differences in final ypT status in comparison with patients with baseline cT3-4 or cN+ undergoing chemoradiation followed by transanal endoscopic microsurgery (p = 0.38). Local recurrence was observed in 1 patient with baseline cT2N0 (7%) and in 7 patients (23%) with stage II and II (p = 0.18). LIMITATIONS: This study was limited by the short follow-up, its limited sample size, and its retrospective and nonrandomized nature. CONCLUSIONS: Patients with baseline cT2N0 that do not develop complete response to chemoradiation (ycT02N0; <= 3 cm) frequently present unfavorable pathological features for transanal local excision (ypT2 or 3 in >66%). In the presence of incomplete clinical response following chemoradiation, patients with baseline cT2N0 have pathological and oncological outcomes similar to patients with baseline stage II or II and are probably not ideal candidates for local excision (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A159).
conferenceObject INITIAL RESULTS OF A NEW BULKING AGENT FOR FECAL INCONTINENCE. A MULTICENTER STUDY(2014) ROSATO, G.; OLIVEIRA, L.; PICCININI, P.; HABR-GAMA, A.conferenceObject PREDICTION OF COMPLETE TUMOR REGRESSION OF RECTAL CANCER AFTER NEOADJUVANT CRT BY MIRNA EXPRESSION OF MIR-21-5P THAT TARGETS A MULTIDRUG RESISTANCE GENE(2014) RAMOS, C.; PARMIGIANI, R.; PEREZ, R.; HABR-GAMA, A.; GAMA-RODRIGUES, J.; QUEVEDO, B.; BETTONI, F.; KOYAMA, F.; FELICIO, N.; CAMARGO, A.conferenceObject THE USE OF PERSONALIZED BIOMARKERS FOR THE ASSESSMENT OF TUMOR RESPONSE AND DETERMINE FINAL MANAGEMENT IN RECTAL CANCER PATIENTS TREATED WITH NEOADJUVANT CHEMORADIATION(2014) CARPINETTI, P.; PEREZ, R.; HABR-GAMA, A.; GAMA-RODRIGUES, J.; DONNARD, E.; KOYAMA, F.; BETTONI, F.; PARMIGIANI, R.; GALANTE, P.; CAMARGO, A.