ANGELITA HABR GAMA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: potential pitfalls of a multicentre observational study(2018) PEREZ, R. O.; HABR-GAMA, A.; JULIAO, G. P. Sao; VAILATI, B. B.
- Putting down the scalpel in rectal cancer management - a historical perspective(2018) PEREZ, R. O.; HABR-GAMA, A.The surgical management of rectal cancer has evolved from a disease without any possibility of cure in the early 1700s where surgical management consisted of the palliative drainage of disease related abscesses to the present day where surgical cure is not only possible but also possible with sphincter or even organ preservation. Prof Habr-Gama's lecture describes the evolution of the surgical management of rectal cancer and the current focus on organ preservation.
- Not Taking ""No"" for an Answer(2018) HABR-GAMA, Angelita
- Contact X-Ray Brachytherapy in Organ Preservation for Rectal Cancer(2018) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; PEREZ, Rodrigo O.
conferenceObject INTRATUMORAL HETEROGENEITY IN RECTAL CANCER - THE EFFECTS OF NEOADJUVANT CHEMORADIATION.(2018) PEREZ, R.; JULIAO, G. Pagin Sao; VAILATI, B. Borba; FERNANDEZ, L. M.; BETTONI, F.; MASOTTI, C.; ASPRINO, P. Fontes; HABR-GAMA, A.; GAMA-RODRIGUES, J.; GALANTE, P.; CAMARGO, A. Aranha- eContact Radiation Therapy for Achieving Organ Preservation in Rectal Cancer After Standard Neoadjuvant Chemoradiation: Looking for a Place in the Sun(2018) HABR-GAMA, Angelita; PEREZ, Rodrigo O.
- Alternative treatment to surgery for rectal cancer(2018) HABR-GAMA, Angelita; FERNANDEZ, Laura Melina; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; PEREZ, Rodrigo OlivaThe traditional concept of rectal cancer management has changed significantly over the last few years. Although surgical resection remains central the treatment of distal rectal cancer by proctectomy and total mesorectal excision (TME), there has been increased interest in organ preservation strategies. Neoadjuvant chemoradiation (nCRT) may result in significant tumor regression and complete pathological response may be observed in up to 42% of patients. In order to avoid the morbidity, mortality and functional consequences of major surgery, selected patients with clinical and radiological evidence of significant tumor regression after nCRT have been managed non-operatively with strict follow-up (Watch & Wait Strategy-WW) with acceptable outcomes and minimal functional consequences. In addition, close surveillance may allow early detection of local recurrences and salvage alternatives with no oncological compromise.
- The proper treatment for the complete responder after neoadjuvant therapy(2018) HABR-GAMA, A.; BRUZZI, M. S.; MORICI, M. L.; JULIãO, G. P. São; PEREZ, R. O.The incorporation of new treatment modalities has significantly increased the complexity of decision-making for patients with locally advanced rectal cancer. Neoadjuvant chemoradiation (CRT) is considered one of the preferred treatment strategies for these patients. In addition, this treatment strategy may lead to significant tumor regression, ultimately leading to complete pathological response in up to 42% of patients. The assessment of tumor response following CRT and prior to radical surgery may identify patients with complete clinical response that could be managed nonoperatively with strict follow-up (watch and wait strategy) and thus avoiding unnecessary postoperative morbidity, including long-term urinary, sexual, and fecal continence dysfunctions and the frequent need for temporary or definitive stomas. Avoiding immediate surgery for patients with complete clinical response may provide good long-term oncological outcomes and excellent functional results. In addition, close surveillance may allow early detection of local recurrences with salvage options avoiding any oncological compromise. This chapter deals with critical issues in appropriate selection of patients, details in follow-up, and management of local recurrences following a nonoperative approach to a patient with complete clinical response following neoadjuvant CRT. © Springer Japan 2018.
- The Estimate of the Impact of Coccyx Resection in Surgical Field Exposure During Abdominal Perineal Resection Using Preoperative High-Resolution Magnetic Resonance(2018) JULIAO, Guilherme Pagin Sao; ORTEGA, Cinthia D.; VAILATI, Bruna Borba; COUTINHO, Francisco A. B.; ROSSI, Gustavo; HABR-GAMA, Angelita; FERNANDEZ, Laura Melina; ARAUJO, Sergio Eduardo Alonso; BROWN, Gina; PEREZ, Rodrigo OlivaObjective To estimate the improvement in surgical exposure by removal of the coccyx, during abdomino-perineal resection (APR), in rectal cancer patients. Methods Retrospective study of 29 consecutive patients with rectal cancer was carried out. Using MR T2 sagittal series, the solid angle was estimated using the angle determined by the anterior resection margin and the tip of coccyx (no coccyx resection) or the tip of last sacral vertebra (coccyx resection). The solid angle provides an estimate of the tridimensional surface area provided by an original angle resulting in the best estimate of the surgeon's view/exposure to the critical dissecting point of choice (anterior rectal wall). The difference (""Gain"") in surgical field exposure by removal of the coccyx was compared by the solid angle variation between the two estimates (with and without the coccyx). Results Routine removal of the coccyx determines an average 42% (95% CI 27-57%) gain in surgical field exposure area facing the anterior rectal wall at the level of the prostate/vagina by the surgeon. Fifteen (51%) patients had >= 30% (median) estimated gain in surgical field exposure by coccygectomy. There was no association between BMI, age or gender and estimated gain in surgical field exposure area. Conclusions Routine removal of the coccyx during APR may result in an average increase in 42% in surgical field exposure during APR's perineal dissection. Precise estimation of surgical field exposure gain by removal of the coccyx may be predicted by MR sagittal series for each individual patient.
- Effect of Akt activation and experimental pharmacological inhibition on responses to neoadjuvant chemoradiotherapy in rectal cancer(2018) KOYAMA, F. C.; RAMOS, C. M. Lopes; LEDESMA, F.; ALVES, V. A. F.; FERNANDES, J. M.; VAILATI, B. B.; JULIAO, G. P. Sao; HABR-GAMA, A.; GAMA-RODRIGUES, J.; PEREZ, R. O.; CAMARGO, A. A.Background: Neoadjuvant chemoradiotherapy (CRT) is one of the preferred initial treatment strategies for locally advanced rectal cancer. Responses are variable, and most patients still require surgery. The aim of this study was to identify molecular mechanisms determining poor response to CRT.& para;& para;Methods: Global gene expression and pathway enrichment were assessed in pretreatment biopsies from patients with non-metastatic cT2-4 NO-2 rectal cancer within 7 cm of the anal verge. Downstream Akt activation was assessed in an independent set of pretreatment biopsies and in colorectal cancer cell lines using immunohistochemistry and western blot respectively. The radiosensitizing effects of the Akt inhibitor MK2206 were assessed using clonogenic assays and xenografts in immunodeficient mice.& para;& para;Results: A total of 350 differentially expressed genes were identified, of which 123 were upregulated and 199 downregulated in tumours from poor responders. Mitochondrial oxidative phosphorylation (P <0.001) and phosphatidylinositol signalling pathways (P <0.050) were identified as significantly enriched pathways among the set of differentially expressed genes. Deregulation of both pathways is known to result in Akt activation, and high immunoexpression of phosphorylated Akt S473 was observed among patients with a poor histological response (tumour regression grade 0-2) to CRT (75 per cent versus 48 per cent in those with a good or complete response; P = 0.016). Akt activation was also confirmed in the radioresistant cell line SW480, and a 50 per cent improvement in sensitivity to CRT was observed in vitro and in vivo when SW480 cells were exposed to the Akt inhibitor MK2206 in combination with radiation and 5-fluorouracil.& para;& para;Conclusion: Akt activation is a key event in the response to CRT. Pharmacological inhibition of Akt activation may enhance the effects of CRT.