ANGELITA HABR GAMA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
7 resultados
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Agora exibindo 1 - 7 de 7
- 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.
conferenceObject NEOADJUVANT CHEMORADIATION MAY WORSEN RECTAL CANCER INTRATUMORAL HETEROGENEITY AMONG PATIENTS WHO DEVELOP INCOMPLETE RESPONSE TO TREATMENT.(2017) PEREZ, R.; HABR-GAMA, A.; BETTONI, F.; MASOTTI, C.; CORREA, B.; GALANTE, P.; JULIAO, G. Pagin Sao; VAILATI, B. Borba; GAMA-RODRIGUES, J.; AZEVEDO, R.; ARAUJO, S.; CAMARGO, A. AranhaconferenceObject DNA REPAIR GENES AND RESPONSE TO NEOADJUVANT CHEMORADIATION IN RECTAL CANCER: A PREDICTIVE SCORE TO IDENTIFY THE COMPLETE RESPONDER.(2017) PEREZ, R.; HABR-GAMA, A.; KOYAMA, F.; RESTREPO, J.; JULIAO, G. Pagin Sao; VAILATI, B. Borba; AZEVEDO, R.; ARAUJO, S.; CAMARGO, A. AranhaconferenceObject WATCH & WAIT AFTER COMPLETE CLINICAL RESPONSE TO NEOADJUVANT CRT: ARE CT3/4 TUMORS MORE LIKELY TO DEVELOP EARLY TUMOR RECURRENCE THAN CT2?(2017) HABR-GAMA, A.; JULIAO, G. Pagin Sao; VAILATI, B. Borba; ORTEGA, C.; FERNANDEZ, L.; ARAUJO, S.; AZEVEDO, R.; PEREZ, R.- Magnetic resonance imaging following neoadjuvant chemoradiation and transanal endoscopic microsurgery for rectal cancer(2017) JULIAO, G. P. Sao; ORTEGA, C. D.; VAILATI, B. B.; HABR-GAMA, A.; FERNANDEZ, L. M.; GAMA-RODRIGUES, J.; ARAUJO, S. E.; PEREZ, R. O.Aim Full-thickness local excision after neoadjuvant chemoradiotherapy (CRT) for patients with rectal cancer and incomplete clinical response has been a treatment strategy for organ preservation. Follow-up of these patients is challenging since anatomic distortion and postoperative changes may be clinically indistinguishable from tumour recurrence. MRI may have a role in detecting recurrence. The aim of this study was to describe the MRI findings during follow-up in patients having local excision following CRT with and without local recurrence. Method The data were collected retrospectively from a single centre. Fifty-three patients with rectal cancer who had full-thickness local excision after neoadjuvant CRT and near-complete response were eligible for the study. Patients with local recurrence were treated by radical salvage surgery. The main outcome was local MRI assessment findings during follow-up. Results Fifteen patients (five who developed local recurrence and 10 with no evidence of local recurrence) had MR images available for review and were included in the study. High signal intensity and thickening of the rectal wall were present in all patients with recurrent disease within the rectal wall. Overall, 80% of the patients with recurrence showed diffusion restriction. MRI mesorectal fascia status and circumferential resection margin showed agreement in all cases. A low signal intensity scar was seen in all patients without recurrent disease. Conclusion MRI shows high signal intensity and thickening of the rectal wall in recurrent disease in comparison to a low signal intensity fibrotic scar in non-recurrent disease. These findings may be useful in surveillance of these patients.
- Management of the Complete Clinical Response(2017) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; CASTRO, Ivana; RAFFAELE, DeboraOrgan preservation is considered in the management of selected patients with rectal cancer. Complete clinical response observed after neoadjuvant chemoradiation for rectal cancer is one of these cases. Patients who present complete clinical response are candidates to the watch-and-wait approach, when radical surgery is not immediately performed and is offered only to patients in the event of a local relapse. These patients are included in a strict follow-up, and up of 70% of them will never be operated during the follow-up. This strategy is associated with similar oncological outcomes as patients operated on, and the advantage of avoiding the morbidity associated to the radical operation. In this article we will discuss in detail the best candidates for this approach, the protocol itself, and the long-term outcomes.
conferenceObject HOW RELIABLE IS CT SCAN IN STAGING RIGHT COLON CANCER?(2017) FERNANDEZ, L.; PARLADE, A.; WASSER, E.; SILVA-SOUTHWICK, G. da; AZEVEDO, R.; PEREZ, R.; HABR-GAMA, A.; BERHO, M.; WEXNER, S.