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Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 12
  • conferenceObject
    Expression of ERCC1 protein (excision repair cross complementing group 1) in patients with invasive carcinoma of the uterine cervix (CC) undergoing definitive chemoradiation (CR)
    (2012) CAIRES, Inacelli Queiroz de Souza; CAIRES-LIMA, Rafael; COLOMBO, Renata; RAMOS, Clarissa C. A.; MACHADO, Karime Kalil; SIQUEIRA, Sheila Aparecida Coelho; CARVALHO, Heloisa de Andrade; FUKUSHIMA, Julia Tizue; ADRA, Thais Rodrigues; HOFF, Paulo M.; ESTEVEZ-DIZ, Maria Del Pilar
    Background: CC is the leading cause of cancer death among women in developing countries. ERCC1 protein participates in DNA repair through the nucleotide excision repair pathway, involved in resistance to platinum-based chemotherapy. Its value as a predictive marker of tumor response to treatment, progression or death is still unknown. We evaluated ERCC1 protein expression and clinical variables as a predictive marker of progression-free survival (PFS) and overall survival (OS) in patients (pts) with CC submitted to CR. Methods: Retrospective data analysis of pts with histological diagnosis of CC, treated with CR between 2004-2009. Platinum-based chemotherapy was administered weekly (x6) concurrent to external beam radiotherapy (EBRT) to the pelvis (39.6 – 45.0 Gy), parametrial boost (14.0 – 20.0 Gy) when indicated and high-dose rate brachytherapy (HDR) (28.0 – 30.0 Gy). ERCC1 expression was assessed by immunohistochemistry (IHC). Results: We analyzed 75 pts, median age was 55 years (range 24-76), the performance status (PS) was 0 or 1 at baseline in 50 pts (66%) and 63 had squamous histology (84%). Thirty-two were stage IIB (43%) and 19 were IIIB (25%). Sixty-five patients received cisplatin 40mg/m2/w (87%) and 9, carboplatin AUC2/w (12%), median of 6 cycles (range 2-9). Median RT and HDR doses were 59.4 Gy (range 40.4 to 60.3) and 28.0 Gy (range 14.0 – 37.5), respectively. Thirty-two pts were available by ERCC1 IHC and all expressed the marker. Median PFS and OS were 35.5 (95% CI – 13.8 - 57.6) and 81 (95% CI- 21.2 - 140.8) months, respectively. In multivariate analysis, receiving < 6 chemotherapy cycles and baseline Hb <10.0 were correlated with disease progression and death, HR 0.302; p 0.011 (95% CI- 0.012-0.762) and HR 0.6; p 0.00 (95% CI- 0.474 – 0.760), respectively. PS at baseline did not correlate with PFS or OS, HR 0.985; p 0.614 (95% CI 0.930 – 1.044). Conclusions: In this population, since all pts expressed the protein, ERCC1 expression couldn't discriminate patients who most benefit from CR. Interestingly, a minimum of 6 chemotherapy cycles and a baseline Hb ≥ 10.0 seem to have a prognostic value.
  • article 12 Citação(ões) na Scopus
    Carboplatin-based chemoradiotherapy in advanced cervical cancer: an alternative to cisplatin-based regimen?
    (2016) SEBASTIAO, Ana Morais; ROCHA, Lucila Soares da Silva; GIMENEZ, Rodrigo Darouche; BARROS, Laryssa Almeida Borges de; FUKUSHIMA, Julia Tizuko; SILVA, Samantha Cabral Severino da; MIRANDA, Vanessa da Costa; CAIRES, Inacelli Queiros de Souza; FREITAS, Daniela de; ABDO FILHO, Elias; DIZ, Maria Del Pilar Estevez
    Objective: To evaluate the results of treatment with cisplatin or carboplatin concomitant with radiotherapy (RT) in cases of locally advanced cervical cancer (CC). Methods: This study is a retrospective analysis of medical records of 184 patients with cervical cancer stage IIB-IVA who were treated at Instituto do Cancer do Estado de Sao Paulo from May 2008 to December 2012. All patients received complete pelvic region external-beam RT with weekly cisplatin (cis-RT, 40 mg/m(2); n = 159) or carboplatin (carbo-RT, AUC 2; n = 25), followed by high-dose-rate intracavitary brachytherapy (HDR-ICBT). Primary endpoint was progression free survival; secondary endpoints were overall survival and overall response rate, which includes complete and partial responses. Results: Five or more chemotherapy cycles were administered to 87.3% and 84% of the cis-RT- and carbo-RT- treated patients, respectively (p = 0.749). Estimated 3-years progression free survival was 59% in the cis-RT group vs 40% in the carbo-RT group (p = 0.249). Estimated 3-years overall survival was 70% in the cis-RT group vs 68% in the carbo-RT group (p = 0.298). Overall response rate (95.3% cis-RT vs 95.4% carbo-RT; p = 0.911) and grade >= 3 toxic effects (8.5% cis-RT vs 11.8% carbo-RT; p = 0.757) were similar. In multivariate analysis, only the overall response rate was a significant predictor of survival. Conclusions: Patients with advanced cervical cancer who are treated with carbo-RT have similar 3-years overall survival, progression free survival, overall response rate, and toxic effects when compared to cis-RT-treated patients. Carbo-RT may be an alternative treatment in patients that cannot receive cisplatin.
  • conferenceObject
    Safety and efficacy of adjuvant modified FLOX for patients (pts) with stage III colorectal cancer (CRC) treated in the community.
    (2015) PROTASIO, Bruno Mendonca; MATUTINO, Adriana Reis Brandao; LAGE, Liana Valente; SANTANA, Iuri Amorim De; RAMOS, Ricardo Emanuel De Oliveira; CAIRES-LIMA, Rafael; CAIRES, Inacelli Queiroz De Souza; RIECHELMANN, Rachel Pimenta; SARAGIOTTO, Daniel Fernandes; SABBAGA, Jorge; HOFF, Paulo Marcelo
  • bookPart
    Câncer de ovário
    (2015) CAIRES, Inacelli Queiroz de Souza; TESTA, Laura; MAK, Milena Perez; DIZ, Maria Del Pilar Estevez; ABDO FILHO, Elias
  • conferenceObject
    Cancer patients with ECOG-PS higher than 1: Who are those who benefit of palliative chemotherapy?
    (2013) CAIRES-LIMA, Rafael; PROTASIO, Bruno Mendonca; CAIRES, Inacelli Queiroz de Souza; ROCHA, Lucila Soares Da Silva; OLIVEIRA, Julia Andrade De; GUERRA, Raquel Bezerra; MAK, Milena Perez; HOFF, Paulo M.; CASTRO, Gilberto
  • conferenceObject
    Carboplatin-based chemoradiotherapy in advanced cervical cancer: An alternative to cisplatin-based regimen?
    (2014) SEBASTIAO, Ana Morals; ROCHA, Lucila Soares Da Silva; GIMENEZ, Rodrigo Darouche; CAIRES, Inacelli Queiroz De Souza; SILVA, Samantha Cabral Severino Da; BARROS, Laryssa Almeida Borges de; FUKUSHIMA, Julia Tizue; MIRANDA, Vanessa Costa; ABDO FILHO, Elias; FREITAS, Daniela; ESTEVEZ-DIZ, Maria Del Pilar
  • conferenceObject
    Prophylactic anticonvulsants in patients (pts) with primary brain tumor (PBT): Have we really agreed to a consensus?
    (2013) OLIVEIRA, Julia Andrade de; SANTANA, Iuri Amorim De; CAIRES, Inacelli Queiroz de Souza; CAIRES-LIMA, Rafael; MIRANDA, Vanessa Costa; PROTASIO, Bruno Mendonca; ROCHA, Lucila Soares Da Silva; BRAGA, Henrique Faria; MENCARINI, Ana Cristina Malacarne; TEIXEIRA, Manoel Jacobsen; CASTRO, Luiz Henrique Martins; FEHER, Olavo
  • article 7 Citação(ões) na Scopus
    Definitive chemoradiotherapy for advanced cervical cancer: should it be different in the elderly?
    (2015) CAIRES, Inacelli Queiroz de Souza; SOUZA, Karla Teixeira; NEGRAO, Marcelo Vailati; OLIVEIRA, Julia Andrade de; BARROSO-SOUSA, Romualdo; LIMA, Rafael Caires Alvino de; HOFF, Paulo Marcelo Gehm; DIZ, Maria del Pilar Estevez
    Background: Cervical cancer (CC) is the second most common cancer in Brazilian women, and approximately 10% of cases occur in elderly patients (pts). In this age group, disease is usually diagnosed in more advanced stages and oncological therapies are usually less intensive, due to comorbidities and impaired performance status. Methods: Retrospective analysis of pts >= 65 years old with CC admitted at a Brazilian University Cancer Center from August 2008 to February 2012. We performed a descriptive analysis of baseline performance status (PS), disease stage (FIGO), histology, body mass index (BMI), treatment received and overall survival, using the Kaplan-Meier method. Results: 900 medical records were analyzed and 75 pts (8%) fulfilled the inclusion criteria. Median age was 73.4 years old (+/- 5.5 years). Squamous cell carcinoma (SCC) was the most common histology (71 pts, 94.7%). 67 (89.3%) had PS 0 or 1 and 52 pts (69.3%) were eutrophic (BMI 18.5-25 kg/m(2)). At presentation, disease staging consisted of 18 pts (24%) stage I, 35 pts (46.7%) stage II, 8 pts (10.7%) stage III, 12 pts (16%) stage IVa and 2 pts (2.7%) stage IVb. 24 pts (32%) underwent surgery (hysterectomy, adnexectomy, pelvic and paraaortic lymphadenectomy). Adjuvant treatment with radiotherapy (RT) was performed in 13 pts (total dose of external RT in pelvis ranged from 39.6 to 45 Gy, parametrial boost ranged from 14 to 20 Gy and 4 inserts from 7 to 7.5 Gy of brachytherapy); 8 of them received concomitant platinum-based chemotherapy (CT). 30 pts underwent definitive CRT, 17 definitive RT, 1 palliative CT and 3 best supportive care. In the CRT group, 18 pts received cisplatin (CDDP 40 mg/m(2)/w/6w) and 12 carboplatin (AUC 2/w/6w). During definitive CRT, treatment was discontinued in 39% of pts who received CDDP and 25% of pts who received carboplatin, all due to treatment toxicities. CDDP was associated with more nefrotoxicity (5 pts, 28%) than carboplatin (1 Pt, 8.3%). The CDDP group also presented more radiodermatitis and stroke. However, myelosuppression and diarrhea were similar in both groups. After a 26.1-month follow-up, median OS was not reached. Conclusions: Despite advanced age, more than 60% of pts underwent complete CRT treatment. Thus, age should not be the only factor to guide therapeutic decisions in CC. Carboplatin was better tolerated than CDDP in CRT group, but prospective trials are necessary to evaluate the best treatment option in this population.
  • conferenceObject
    Retrospective analysis of prognostic factors in patients undergoing surgical resection for multiple brain metastases
    (2014) PETITTO, Carlos; LAGE, Liana Valente; CAIRES, Inacelli Queiroz De Souza; SOUZA, Karla T.; FEDE, Angelo Bezerra de Souza; FEHER, Olavo; HOFF, Paulo M.; CAMARGO, Verldlana; MENCARINI, Ana; MUNHOZ, Rodrigo Ramella; TEIXEIRA, Manoel Jacobsen; LEPSKI, Guilherme
  • article 16 Citação(ões) na Scopus
    Antiepileptic drug prophylaxis in primary brain tumor patients: is current practice in agreement to the consensus?
    (2014) OLIVEIRA, Julia Andrade de; SANTANA, Iuri A.; CAIRES, Inacelli Q. S.; CAIRES-LIMA, Rafael; MIRANDA, Vanessa Costa; PROTASIO, Bruno M.; ROCHA, Lucila S.; BRAGA, Henrique F.; MENCARINI, Ana M.; TEIXEIRA, Manoel Jacobsen; CASTRO, Luiz Henrique Martins; FEHER, Olavo
    The role of antiepileptic drugs (AED) prophylaxis in primary brain tumor (PBT) seizure-na < ve patients remains unclear. Additionally, AED are associated with severe side effects, negative impact on cognition and drug interactions. Little is known about current practice regarding prophylactic AED use in PBT. We investigated its use in a tertiary care cancer center. We reviewed medical records of 260 patients registered in our center between 2008 and 2012, focusing on prophylactic AED use. A descriptive analysis was performed with SPSS IBM version 20.0. Median age was 44.5 years (11-83). Most patients had ECOG PS a parts per thousand currency sign1 (76.4 %). Among 141 seizure-na < ve patients, 70.2 % received an AED as primary prophylaxis (PP). Most commonly used drugs as PP were phenytoin (85.9 %), carbamazepine (6.1 %) and phenobarbital (5.1 %). In only 14 patients (14.1 %) AEDs were eventually discontinued, in a median time of 5.9 months (1.1-76.8 m). AED were used as PP in 60 % of low-grade gliomas, 73.3 % of anaplastic gliomas and 93.9 % of glioblastoma patients. Twenty-seven patients (27.3 %) on PP presented seizures, generally associated with tumor progression. Of the 42 seizure-na < ve patients not receiving AED prophylaxis, only two presented seizures, which occurred during or within the first week post-radiotherapy. In this cross-sectional study, prophylactic AED use in PBT was extremely high. Postoperatively, AED were discontinued in a minority of patients, mostly after a prolonged period. Current prophylactic AED use patterns in PBT are not in accordance with established guidelines.