ANGELITA HABR GAMA

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Departamento de Gastroenterologia, Faculdade de Medicina - Docente

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  • article 95 Citação(ões) na Scopus
    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.
  • conferenceObject
    LAPAROSCOPIC LATERAL-NODE DISSECTION FOR RECTAL CANCER SEE ONE, DO ONE AND TEACH ONE?
    (2019) PEREZ, R.; JULIAO, G. Pagin Sao; VAILATI, B. Borba; ORDONEZ, C. M. Cabrera; AZEVEDO, J.; HABR-GAMA, A.; FERNANDEZ, L.; KONISHI, T.
  • article 101 Citação(ões) na Scopus
    Organ Preservation in cT2N0 Rectal Cancer After Neoadjuvant Chemoradiation Therapy The Impact of Radiation Therapy Dose-escalation and Consolidation Chemotherapy
    (2019) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; SABBAGA, Jorge; AGUILAR, Patricia Bailao; FERNANDEZ, Laura Melina; ARAUJO, Sergio Eduardo Alonso; PEREZ, Rodrigo Oliva
    Objective: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. Background: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients. Methods: Patients with distal and nonmetastatic cT2N0 rectal cancer managed by neoadjuvant CRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5-FU-based chemotherapy) were compared with those undergoing extended CRT (54 Gy and 6 cycles of 5-FUbased chemotherapy). Patients were assessed for tumor response at 8 to 10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (""Watch and Wait""). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Results: Thirty-five patients underwent standard and 46 patients extended CRT. Patients undergoing extended CRT were more likely to undergo organ preservation and avoid definitive surgical resection at 5years (67% vs 30%; P = 0.001). After development of a cCR, surgery-free survival is similar between extended and standard CRT groups at 5 years (78% vs 56%; P = 0.12). Conclusions: Dose-escalation and consolidation chemotherapy leads to increased long-term organ-preservation rates among cT2N0 rectal cancer. After achievement of a cCR, the risk for local recurrence and need for salvage surgery is similar, irrespective of the CRT regimen.
  • conferenceObject
  • article 13 Citação(ões) na Scopus
    Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study
    (2019) AREZZO, A.; SECCO, G. Lo; PASSERA, R.; ESPOSITO, L.; GUERRIERI, M.; ORTENZI, M.; BUJKO, K.; PEREZ, R. O.; HABR-GAMA, A.; STIPA, F.; PICCHIO, M.; RESTIVO, A.; ZORCOLO, L.; COCO, C.; RIZZO, G.; MISTRANGELO, M.; MORINO, M.
    Background An organ-preserving strategy may be a valid alternative in the treatment of selected patients with rectal cancer after neoadjuvant radiotherapy. Preoperative assessment of the risk for tumor recurrence is a key component of surgical planning. The aim of the present study was to increase the current knowledge on the risk factors for tumor recurrence. Methods The present study included individual participant data of published studies on rectal cancer surgery. The literature was reviewed according to according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data checklist (PRISMA-IPD) guidelines. Series of patients, whose data were collected prospectively, having neoadjuvant radiotherapy followed by transanal local excision for rectal cancer were reviewed. Three independent series of univariate/multivariate binary logistic regression models were estimated for the risk of local, systemic and overall recurrence, respectively. Results We identified 15 studies, and 7 centers provided individual data on 517 patients. The multivariate analysis showed higher local and overall recurrences for ypT3 stage (OR 4.79; 95% CI 2.25-10.16 and OR 6.43 95% CI 3.33-12.42), tumor size after radiotherapy > 10 mm (OR 5.86 95% CI 2.33-14.74 and OR 3.14 95% CI 1.68-5.87), and lack of combined chemotherapy (OR 3.68 95% CI 1.78-7.62 and OR 2.09 95% CI 1.10-3.97), while ypT3 was the only factor correlated with systemic recurrence (OR 5.93). The analysis of survival curves shows that the overall survival is associated with ypT and not with cT. Conclusions Local excision should be offered with caution after neoadjuvant chemoradiotherapy to selected patients with rectal cancers, who achieved a good response to neoadjuvant chemoradiotherapy.
  • conferenceObject
    METFORMIN AS AN ALTERNATIVE TO 5FU AS RADIOSENSITIZER FOR RECTAL CANCER MANAGEMENT - RESULTS OF IN VITRO AND IN VIVO TREATMENT OF COLORECTAL CANCER CELL LINES.
    (2019) PEREZ, R.; VAILATI, B. Borba; JULIAO, G. Pagin Sao; ASPRINO, P. Fontes; CAMARGO, A. Aranha; HABR-GAMA, A.; COSTA, E. T.
  • article 2 Citação(ões) na Scopus
    Response to Comment on ""Organ Preservation for cT2N0 Distal Rectal Cancer-Are There Any Better Surgical Alternatives Without Chemoradiation?''
    (2019) HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VAILATI, Bruna B.; FERNANDEZ, Laura M.; ARAUJO, Sergio E. A.; SABBAGA, Jorge; AGUILAR, Patricia B.; PEREZ, Rodrigo O.
  • article 25 Citação(ões) na Scopus
    Organ Preservation Among Patients With Clinically Node-Positive Rectal Cancer: Is It Really More Dangerous?
    (2019) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; FERNANDEZ, Laura M.; ORTEGA, Cinthia D.; FIGUEIREDO, Nuno; GAMA-RODRIGUES, Joaquim; PEREZ, Rodrigo Oliva
    BACKGROUND: Select patients with complete clinical response to chemoradiation have been managed without radical surgery. The presence of radiologic evidence of nodal metastases at baseline could be a risk factor for local tumor regrowth, more advanced stage at the time of recurrence, and worse distant metastases-free survival. OBJECTIVE: The purpose of this study was to compare the outcomes of patients with baseline node-positive and node-negative cancer after neoadjuvant chemoradiation and complete clinical response managed nonoperatively. DESIGN: This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation. PATIENTS: Consecutive patients with clinical and radiologic evidence of complete clinical response at 8 to 10 weeks were managed nonoperatively and enrolled in a strict follow-up program (watch and wait). Patients with incomplete clinical response or tumor regrowth after initial complete clinical response were referred to surgery. MAIN OUTCOMES MEASURES: Surgery-free and distant metastases-free survival were compared between patients according to nodal status at baseline. RESULTS: A total of 117 patients with node-positive and 218 with node-negative cancer at baseline were reviewed. Overall, 62 (53.0%; node positive) and 135 (61.9%; node negative) achieved a complete clinical response and were managed nonoperatively (p = 0.13). Patients with baseline node-positive cancer had similar rates of pathologic nodal metastases at the time of recurrence. Five-year surgery-free (39.7% vs 46.8%; p = 0.2) and distant metastases-free survival (77.5% vs 80.5%; p = 0.49) were similar between baseline node-positive and node-negative patients. LIMITATIONS: This was a retrospective study with a small sample size and possible inaccurate nodal staging. CONCLUSIONS: Patients with rectal cancer with node-positive cancer at baseline who develop a complete clinical response after neoadjuvant chemoradiation are not at increased risk for local tumor regrowth or development of more advanced disease at the time of recurrence. These patients seem to be safe candidates for organ-preserving strategies after achieving complete clinical response. See Video Abstract at http://links.lww.com/DCR/A902.