ANGELITA HABR GAMA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
21 resultados
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Agora exibindo 1 - 10 de 21
- Consolidation chemotherapy during neoadjuvant chemoradiation (CRT) for distal rectal cancer leads to sustained decrease in tumor metabolism when compared to standard CRT regimen(2016) HABR-GAMA, Angelita; PEREZ, Rodrigo O.; JULIAO, Guilherme P. Sao; PROSCURSHIM, Igor; FERNANDEZ, Laura M.; FIGUEIREDO, Marleny N.; GAMA-RODRIGUES, Joaquim; BUCHPIGUEL, Carlos A.Background: Neoadjuvant CRT may lead to significant tumor regression in patients with rectal cancer. Different CRT regimens with consolidation chemotherapy may lead to increased rates of complete tumor regression. The purpose of this study was to understand tumor metabolic activity following two different neoadjuvant CRT regimens using sequential PET/CT imaging in two different intervals following RT. Methods: Patients with cT2-4 N0-2 M0 rectal cancer treated by standard CRT (54Gy and 2 cycles of 5FU-based chemotherapy) or extended CRT (54Gy and 6 cycles of 5FU-based chemotherapy) underwent sequential PET/CT imaging at baseline, 6 weeks and 12 weeks from radiation completion. Results: 99 patients undergoing standard CRT were compared to 12 patients undergoing CRT with consolidation chemotherapy. Patients treated with consolidation CRT had increased rates of complete clinical or pathological response (66 % vs. 23 %; p < 0.001). SUVmax variation between baseline and 6 weeks (88 % vs. 63 %; p < 0.001) and between baseline and 12 weeks (90 % vs. 57 %; p < 0.001) were significantly more pronounced among patients undergoing extended CRT with consolidation chemotherapy. An increase in SUVmax between 6 and 12 weeks was observed in 51 % of patients undergoing standard and 18 % of patients undergoing consolidation CRT (p = 0.04). Conclusions: Most of the reduction in tumor metabolism after neoadjuvant CRT occurs within the first 6 weeks from RT completion. In patients undergoing CRT with consolidation chemotherapy, tumors are less likely to regain metabolic activity between 6 and 12 weeks. Therefore, assessment of tumor response may be safely postponed to 12 weeks in patients undergoing extended CRT with consolidation chemotherapy.
- Implications of Akt inhibition for neoadjuvant radiotherapy: improving the rectal cancer treatment(2016) KOYAMA, Fernanda C.; RAMOS, Camila; HABR-GAMA, Angelita; ALVES, Venancio Avancini Ferreira; PEREZ, Rodrigo O.; CAMARGO, Anamaria Aranha
- A multi-centre randomized controlled trial investigating Consolidation Chemotherapy with and without oxaliplatin in distal rectal cancer and Watch & Wait(2023) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao D.; ORTEGA, Cinthia D.; VAILATI, Bruna Borba; ARAUJO, Sergio; JORGE, Thiago; SABBAGA, Jorge L.; ROSSI, Gustavo L.; D'ALPINO, Renata; KATER, Fabio Roberto; AGUILAR, Patricia Bailao; MATTACHEO, Adrian; PEREZ, Rodrigo OlivaBackground Neoadjuvant chemoradiation(nCRT) has been considered the preferred initial treatment strategy for distal rectal cancer. Advantages of this approach include improved local control after radical surgery but also the opportunity for organ preserving strategies (Watch and Wait-WW). Consolidation chemotherapy(cCT) regimens using fluoropyrimidine-based with or without oxalipatin following nCRT have demonstrated to increase complete response and organ preservation rates among these patients. However, the benefit of adding oxaliplatin to cCT compared to fluoropirimidine alone regimens in terms of primary tumor response remains unclear. Since oxalipatin-treatment may be associated with considerable toxicity, it becomes imperative to understand the benefit of its incorporation into standard cCT regimens in terms of primary tumor response. The aim of the present trial is to compare the outcomes of 2 different cCT regimens following nCRT (fluoropyrimidine-alone versus fluoropyrimidine + oxaliplatin) for patients with distal rectal cancer.Methods In this multi-centre study, patients with magnetic resonance-defined distal rectal tumors will be randomized on a 1:1 ratio to receive long-course chemoradiation (54 Gy) followed by cCT with fluoropyrimidine alone versus fluoropyrimidine + oxaliplatin. Magnetic resonance(MR) will be analyzed centrally prior to patient inclusion and randomization. mrT2-3N0-1 tumor located no more than 1 cm above the anorectal ring determined by sagittal views on MR will be eligible for the study. Tumor response will be assessed after 12 weeks from radiotherapy(RT) completion. Patients with clinical complete response (clinical, endoscopic and radiological) may be enrolled in an organ-preservation program(WW). The primary endpoint of this trial is decision to organ-preservation surveillance (WW) at 18 weeks from RT completion. Secondary endpoints are 3-year surgery-free survival, TME-free survival, distant metastases-free survival, local regrowth-free survival and colostomy-free survival.Discussion Long-course nCRT with cCT is associated with improved complete response rates and may be a very attractive alternative to increase the chances for organ-preservation strategies. Fluoropyrimidine-based cCT with or without oxaliplatin has never been investigated in the setting of a randomized trial to compare clinical response rates and the possibility of organ-preservation. The outcomes of this study may significantly impact clinical practice of patients with distal rectal cancer interested in organ-preservation.
conferenceObject Immediate surgery or clinical follow-up after complete response?(2014) HABR-GAMA, A.- Local Recurrence After Complete Clinical Response and Watch and Wait in Rectal Cancer After Neoadjuvant Chemoradiation: Impact of Salvage Therapy on Local Disease Control(2014) HABR-GAMA, Angelita; GAMA-RODRIGUES, Joaquim; JULIAO, Guilherme P. Sao; PROSCURSHIM, Igor; SABBAGH, Charles; LYNN, Patricio B.; PEREZ, Rodrigo O.Purpose: To review the risk of local recurrence and impact of salvage therapy after Watch and Wait for rectal cancer with complete clinical response (cCR) after chemoradiation therapy (CRT). Methods and Materials: Patients with cT2-4N0-2M0 distal rectal cancer treated with CRT (50.4-54 Gy + 5-fluorouracil-based chemotherapy) and cCR at 8 weeks were included. Patients with cCR were enrolled in a strict follow-up program with no immediate surgery (Watch and Wait). Local recurrence-free survival was compared while taking into account Watch and Wait strategy alone and Watch and Wait plus salvage. Results: 90 of 183 patients experienced cCR at initial assessment after CRT (49%). When early tumor regrowths (up to and including the initial 12 months of follow-up) and late recurrences were considered together, 28 patients (31%) experienced local recurrence (median follow-up time, 60 months). Of those, 26 patients underwent salvage therapy, and 2 patients were not amenable to salvage. In 4 patients, local re-recurrence developed after Watch and Wait plus salvage. The overall salvage rate for local recurrence was 93%. Local recurrence-free survival at 5 years was 69% (all local recurrences) and 94% (after salvage procedures). Thirteen patients (14%) experienced systemic recurrence. The 5-year cancer-specific overall survival and disease-free survival for all patients (including all recurrences) were 91% and 68%, respectively. Conclusions: Local recurrence may develop in 31% of patients with initial cCR when early regrowths (<= 12 months) and late recurrences are grouped together. More than half of these recurrences develop within 12 months of follow-up. Salvage therapy is possible in >= 90% of recurrences, leading to 94% local disease control, with 78% organ preservation. (C) 2014 Elsevier Inc.
- Transanal Endoscopic Microsurgery (TEM) Following Neoadjuvant Chemoradiation for Rectal Cancer: Outcomes of Salvage Resection for Local Recurrence(2016) PEREZ, Rodrigo Oliva; HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; PROSCURSHIM, Igor; FERNANDEZ, Laura Melina; AZEVEDO, Rafael Ulysses de; VAILATI, Bruna B.; FERNANDES, Felipe Alexandre; GAMA-RODRIGUES, JoaquimTransanal endoscopic microsurgery (TEM) has been considered an alternative for selected patients with rectal cancer following neoadjuvant chemoradiation (CRT). Immediate total mesorectal completion for all patients with unfavorable pathological features would result in unnecessary protectomies in a significant proportion of patients. Instead, salvage total mesorectal excision (TME) could be restricted for patients developing local recurrence. The aim of the present study is to determine oncological outcomes of salvage resection for local recurrences following CRT and TEM. Consecutive patients undergoing TEM following neoadjuvant CRT for rectal cancer were reviewed. Patients with ""near"" complete response to CRT (a parts per thousand currency sign3 cm; ycT1-2N0) were offered TEM. Salvage surgery was attempted in the event of a local recurrence. A total of 53 patients were managed by CRT followed by TEM. Unfavorable pathological features were present in 36 patients (68 %). None of the patients underwent immediate completion TME. There were 12 patients who developed local recurrence resulting in a 2-year local recurrence-free survival of 77 % (95 % CI, 53-100 %). Of these patients, 9 developed exclusively local recurrences, and all had at least 1 unfavorable pathological feature in the specimen after TEM (100 %). Eight patients (8 of 9) underwent salvage resection (abdominoperineal resection [APR] in 87 %) with CRM+ in 7 of 8 patients (87 %). Four patients developed local re-recurrence after a median 36 months of follow-up. The 2-year local re-recurrence free survival was 60 %. Salvage resection for local recurrence following CRT and TEM is associated with high rates of R1 resection (CRM+) and local re-recurrence. Immediate completion of TME should be considered for patients with unfavorable pathological features after TEM.
- What more do we want from neoadjuvant treatment strategies in rectal cancer?(2015) HABR-GAMA, Angelita; FERNANDEZ, Laura M.; PEREZ, Rodrigo O.
- Fragmented pattern of tumor regression and lateral intramural spread may influence margin appropriateness after TEM for rectal cancer following neoadjuvant CRT(2014) PEREZ, Rodrigo O.; HABR-GAMA, Angelita; SMITH, Fraser M.; KOSINSKI, Lauren; JULIAO, Guilherme P. Sao; GRZONA, Esteban; RAWET, Viviane; VIANNA, Maria Regina; PROSCURSHIM, Igor; LYNN, Patricio Bernardo; GAMA-RODRIGUES, JoaquimBackground The main tenets of local excision of rectal cancer following neoadjuvant chemoradiation (CRT) are that the mucosal scar represents the main focus of residual disease and a solid conglomerate around this rather than being scattered (fragmented) through the bowel wall. Methods Retrospective review of a prospective cohort of patients with residual rectal ycT1-2N0 adenocarcinoma with small residual tumors (<= 3 cm) following CRT who underwent transanal endoscopic microsurgery (TEM) with 1-cm margins around the residual mucosal abnormality was performed. Distribution and morphology (solid vs. fragmented) of tumor spread were studied and correlated to postoperative oncological outcomes. Results Thirty patients were included. Twenty percent (n = 6) were ypT1, 60% (n = 18) were ypT2, and 20% (n = 6) were ypT3 tumors. Fragmentation was present in 37%. The mean distance between foci of residual scattered tumor was 3.6 +/- 2.0 mm. Lateral spread under normal mucosa was present in 19 specimens (53%; mean extension 4.8 +/- 2.4 mm). With a median follow up of 32 months, none of these findings impacted upon development of recurrence. Conclusions Both occult lateral spread and fragmented tumor patterns are common findings after CRT. Despite the potential of occult spread to mislead surgeon choice of resection margin, its presence did not influence oncological outcome in this series. J. Surg. Oncol. 2014 109:853-858. (c) 2014 Wiley Periodicals, Inc.
conferenceObject International validation of the Immunoscore-biopsy (ISB) to guide selection and monitoring of patients treated with watch-and-wait (WW) strategy for rectal cancer.(2022) PAGES, Franck; SISSY, Carine El; KIRILOVSKY, Amos; CUSTERS, Petra; DIZDAREVIC, Edina; LAGORCE, Christine; CASTILLO-MARTIN, Mireia; BERG, Jose van den; ISEAS, Soledad; LORIA, Fernando Sanchez; GERARD, Jean-Pierre; DIMOFTE, Gabriel; PEREZ, Rodrigo O.; HABR-GAMA, Angelita; FIGUEIREDO, Nuno; HANSEN, Torben; CHALABI, Myriam; GALON, Jerome; BEETS, Geerard; ZEITOUN, Guy- A new paradigm for rectal cancer: Organ preservation: Introducing the International Watch & Wait Database (IWWD)(2015) BEETS, G. L.; FIGUEIREDO, N. L.; HABR-GAMA, A.; VELDE, C. J. H. van de
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