ANGELITA HABR GAMA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
43 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 43
- 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.
- 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.
- 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.
conferenceObject WATCH AND WAIT APPROACH FOLLOWING EXTENDED NEOADJUVANT CHEMORADIATION FOR DISTAL RECTAL CANCER - ARE WE GETTING CLOSER TO ANAL CANCER MANAGEMENT?(2013) HABR-GAMA, A.; PEREZ, R.; SABBAGA, J.; AGUILAR, P.; GAMA-RODRIGUES, J.; NADALIN, W.; PROSCURSHIM, I.; LYNN, P.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. Aranha- 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.
conferenceObject 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 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.- 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