FLAVIO ROBERTO TAKEDA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- Induction Chemotherapy for Locally Advanced Esophageal Cancer(2020) HARADA, Guilherme; BONADIO, Renata Rodrigues da Cunha Colombo; ARAUJO, Frederico Cantarino Cordeiro de; VICTOR, Carolina Ribeiro; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, Ivan; TAKEDA, Flavio Roberto; CASTRIA, Tiago Biachi deBackground Concurrent chemoradiotherapy followed by surgery is the standard treatment for locally advanced esophageal cancer (EC), and the role of induction chemotherapy (IC) remains unclear. We aimed to study if the addition of IC to standard treatment increases the rate of pathologic complete response (pCR). Methods We assembled a retrospective analysis of patients (pts) diagnosed with locally advanced EC and treated with preoperative chemoradiotherapy followed by esophagectomy (CRT+S), preceded or not by IC, between 2009 and 2017. Patients' characteristics, tumor variables, and treatment outcomes were evaluated. The Kaplan-Meier method was used to estimate overall survival and the Cox proportional hazard model to evaluate prognostic factors. Results One hundred and three patients were studied, with a median age of 62 years (range 37-84). Seventy-five patients (73%) were male, 67 (65%) had squamous cell carcinoma, and 31 (30%) had adenocarcinoma. Forty-three patients (41.7%) received IC followed by CRT+S (IC+CRT+S). The most frequent IC consisted of paclitaxel and platinum chemotherapy (90%), and the median number of cycles was 2. All patients received CRT+S. Concurrent chemotherapy was a combination of paclitaxel and platinum in 94 patients (91%). There was no statistically significant difference in pCR between the IC group and the standard CRT+S group. The pCR was 41.9% and 46.7% in the IC+CRT+S and CRT+S groups (p = 0.628), respectively. In the multivariate analysis, pCR was an independent prognostic factor for time to treatment failure (TTF) (HR 0.35, p = 0.021), but not for overall survival (OS) (p = 0.863). The factor that significantly affected OS in the multivariate analysis was positive lymph node (HR 5.9, 95%, p = 0.026). Conclusions Our data suggest that the addition of IC to standard CRT + S does not increase the pCR rate in locally advanced EC. No difference in OS was observed between pts. that received or not IC. Regardless of the treatment received, pts. achieving a pCR presented improved TTF.
conferenceObject Robotic-assisted (RAMIE) x thoracoscopic esophagectomy (MIE): Comparison on safety and lymph nodal dissection in 181 cases.(2018) SALLUM, Rubens Antonio Aissar; TAKEDA, Flavio Roberto; SANTO, Marco Aurelio; CECCONELLO, Ivan- Safety and Effectiveness of Chemotherapy for Metastatic Esophageal Cancer in a Community Hospital in Brazil(2019) VICTOR, Carolina Ribeiro; FUJIKI, Femanda Kaori; TAKEDA, Flavio Roberto; HOFF, Paulo Marcelo Gehm; CASTRIA, Tiago Biachi dePURPOSE Despite epidemiologic and molecular differences between esophageal and stomach cancers, most published studies have included patients with either disease in a metastatic scenario. We evaluated the safety and effectiveness of chemotherapy in patients with metastatic esophageal cancer in the community setting. PATIENTS AND METHODS We performed a retrospective cohort study of patients with synchronous metastatic esophageal cancer treated at a public hospital between 2008 and 2016. Patients were grouped according to a prescribed chemotherapy protocol: platinum and taxane (group A); platinum and irinotecan (group B); platinum and fluoropyrimidine (group C); and without platinum (group D). RESULTS Of the 1,789 patients with esophageal cancer treated, we included 397 with metastatic disease at presentation. Squamous cell carcinoma was the most frequent histology (78.8%). Median overall survival (OS) was 7 months (95% CI, 6.15 to 7.85 months). Chemotherapy was administered to 285 patients, who reached a median OS of 9.0 months (95% CI, 8.0 to 9.9 months); for 112 patients who did not receive treatment, median OS was 3 months (95% CI, 2.3 to 3.7 months; P < .001). The most used combination was platinum plus irinotecan (A; 55.5%). Disease control with in groups A, B, C, and D was 39.2%, 30.1%, 53% and 14.3%, respectively. Patients in group C reached a median OS of 17 months (95% CI, 13.1 to 20.8 months; P = .034). No differences were observed in median OS obtained with other protocols (9 months). The toxicity profile was different according to chemotherapy, with more severe events (hematologic, diarrhea, and number of days hospitalized) occurring in group B. CONCLUSION Platinum plus paclitaxel or platinum plus irinotecan provided similar OS in community patients, although patients receiving irinotecan experienced more severe events. In the adenocarcinoma population, a fluoropyrimidine plus platinum-based regimen, although less frequently used, had a more favorable toxicity profile, with superior median OS and disease control. J Global Oncol. (C) 2019 by American Society of Clinical Oncology
conferenceObject Liver Irradiation Increases Relapse-Free Survival in Adjuvant Gastric Cancer Treatment(2013) VASCONCELOS, K.; CHEN, A. T. C.; HONG, C. B. C.; NAKAZATO, D.; STELKO, G.; HOFF, P. M. G.; TAKEDA, F. R.; ZILBERSTEIN, B.; RIBEIRO JUNIOR, U.; NADALIN, W.- Prognostic Value of Tumor Regression Grade Based on Ryan Score in Squamous Cell Carcinoma and Adenocarcinoma of Esophagus(2020) TAKEDA, Flavio Roberto; TUSTUMI, Francisco; OBREGON, Carlos de Almeida; YOGOLARE, Gustavo Goncalves; NAVARRO, Yasmin Peres; SEGATELLI, Vanderlei; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanPurposes Tumor regression grade (TRG) of the primary tumor after neoadjuvant therapy is one of the most sensitive prognostic factors among patients with locally advanced esophageal cancer, although no TRG system is fully accepted. The Ryan score was proposed in 2005 to evaluate TRG in rectal cancer and could be adaptable for pathological evaluation of esophageal cancer. The objective of this study is to evaluate the prognostic value of the Ryan score for esophageal cancer in the setting of trimodal therapy. Methods We performed a retrospective cohort study in which patients with locally advanced esophageal cancer, submitted to neoadjuvant therapy followed by surgical resection, were selected. One hundred thirty-four patients were selected. All tissue specimens were assessed as per the TRG system proposed by Ryan et al. Survival curves were assessed by the Kaplan-Meier method and log-rank test. Chi-square test or likelihood-ratio test was used for absolute and relative variables. Kruskal-Wallis and analysis of variance tests were used to assess significant differences on a continuous dependent variable by a categorical independent variable. Results Of the 134 included patients, 94 (70.1%) had squamous cell carcinoma, and 40 (29.9%) adenocarcinoma. Ryan score was correlated with histological type (p < 0.001), and clinical (p = 0.044) and pathological (p < 0.001) staging. Mean follow-up was 31.1 months. Multivariate analysis showed that Ryan score can safely predict survival, and systemic and lymphatic recurrence (p < 0.05). Conclusions Ryan score is an effective system to evaluate TRG and can predict risk for lymph node or distant metastasis, overall survival, and disease-free survival.
- Transhiatal laparoscopic esophagectomy with extended lymphadenectomy guided by green-indocyanine imaging for adenocarcinoma of the esophagogastric junction(2020) TAKEDA, Flavio Roberto; RIBEIRO JUNIOR, Ulysses; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanIntroduction: Surgical treatment for adenocarcinoma of the esophagogastric junction (AEGJ) has been long-established, from resection margins to the extension of lymphadenectomy [1,2,4]. The addition of cyanine dye, namely indocyanine green (ICG), to identify suspicious lymph nodes (LN) and evaluate organ vascularization may improve results and outcomes [3]. Video: A 58-year-old female patient with Siewert type II AEGJ was administered mFLOX neoadjuvant treatment. After three cycles, she underwent surgical treatment. The day before surgery, an upper endoscopy was performed to inject 0.2 ml ICG 0.5 cm from the proximal and distal tumor margins. The patient underwent laparoscopic transhiatal esophagectomy with extended lymphadenectomy due to a 4 cm distal esophagus compromised margin. We describe the primary steps of the procedure and demonstrate the role of the ICG in the lymphadenectomy. Results: Surgery was carried out lapamscopically with a cervical approach (McKeown access), and posterior mediastinal gastric tube reconstruction and cervical gastroplasty were performed. During the standard lymphadenectomy, we observed an ICG-positive LN in station 10, which was found positive in the subsequent pathology examination. After these findings, we performed an extended lymphadenectomy through the splenic hilum. The final pathologic assessment was T3N2 (two perigastric and one positive LN at station 10 among 60 retrieved LN). The operative time was 360 min. The patient started a liquid diet on the seventh postoperative day, and she was discharged on the tenth postoperative day. Conclusions: ICG may be helpful to guide both extended lymphadenectomy and distal margin evaluation in transhiatal lapamscopic esophagectomy.
- Anatomical topography of the tumor is related to prognostic survival in adenocarcinoma of esophagogastric junction?: Multivariable analysis.(2019) TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; RIBEIRO, Ulysses; CASTRIA, Tiago Bianchi de; TUSTUMI, Francisco; ROCHA, Julio Rafael Mariano; CECCONELLO, Ivan
- ASO Author Reflections: Evaluation of Tumor Regression After Neoadjuvant Chemoradiotherapy in Esophageal Carcinoma-How to Do It?(2020) TAKEDA, Flavio Roberto; TUSTUMI, Francisco; CECCONELLO, Ivan
- Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of gastric cancer(2020) PEIXOTO, Renata D'Alpino; ROCHA-FILHO, Duilio R.; WESCHENFELDER, Rui F.; REGO, Juliana F. M.; RIECHELMANN, Rachel; COUTINHO, Anelisa K.; FERNANDES, Gustavo S.; JACOME, Alexandre A.; ANDRADE, Aline C.; MURAD, Andre M.; MELLO, Celso A. L.; MIGUEL, Diego S. C. G.; GOMES, Diogo B. D.; RACY, Douglas J.; MORAES, Eduardo D.; AKAISHI, Eduardo H.; CARVALHO, Elisangela S.; MELLO, Evandro S.; MALUF FILHO, Fauze; COIMBRA, Felipe J. F.; CAPARELI, Fernanda C.; ARRUDA, Fernando F.; VIEIRA, Fernando M. A. C.; TAKEDA, Flavio R.; COTTI, Guilherme C. C.; PEREIRA, Guilherme L. S.; PAULO, Gustavo A.; RIBEIRO, Heber S. C.; LOURENCO, Laercio G.; CROSARA, Marcela; TONETO, Marcelo G.; OLIVEIRA, Marcos B.; OLIVEIRA, Maria de Lourdes; BEGNAMI, Maria Dirlei; FORONES, Nora M.; YAGI, Osmar; ASHTON-PROLLA, Patricia; AGUILLAR, Patricia B.; AMARAL, Paulo C. G.; HOFF, Paulo M.; ARAUJO, Raphael L. C.; PAULA FILHO, Raphael P. Di; GANSL, Rene C.; GIL, Roberto A.; PFIFFER, Tulio E. F.; SOUZA, Tulio; JR, Ulysses Ribeiro; JESUS, Victor Hugo F.; JR, Wilson L. Costa; PROLLA, GabrielGastric cancer is among the ten most common types of cancer worldwide. Most cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of gastric carcinomas. The Brazilian Group of Gastrointestinal Tumors (GTG) invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy and follow-up, which was followed by presentation, discussion, and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of gastric carcinomas in several scenarios and clinical settings.
- The value of cellular components of blood in the setting of trimodal therapy for esophageal cancer(2020) TUSTUMI, Francisco; TAKEDA, Flavio Roberto; VIYUELA, Mateus Silva; CRUZ JUNIOR, Jurandir Batista da; BRANDAO, Antonio Adolfo Guerra Soares; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanBackground Inflammation status plays an important role in the natural history of malignancy. Consequently, hematological markers of systemic inflammation may predict prognosis in neoplasms. This study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by esophagectomy for cancer in predicting prognosis. Methods A cohort of 149 patients was analyzed. Cellular components of blood were assessed before neoadjuvant therapy (A); before surgery (B); and 3 to 5 months after surgery (C); for the following outcomes: pathological response, overall survival (OS), and disease-free survival (DFS). Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. Results Low hematocrit (Ht) (C) (HR, 0.85; 95% CI, 0.79-0.92) and high neutrophil-to-lymphocyte ratio (NLR) (C) (HR, 1.07; 95% CI, 1.07-1.10) were related to poor OS. Low Hb (C) (HR, 0.72; 95% CI, 0.58-0.88), red cell distribution width (RDW) (C-A) (HR, 1.16; 95% CI, 1.02-1.31), and NLR (C-A) (1.06; 95% CI, 1.03-1.09) were related to poor DFS. RDW (B-A) (HR, 1.15; 95% CI, 1.08-1.22), RDW (C) (HR, 1.12; 95% CI, 1.04-1.2), NLR (C) (HR, 1.12; 95% CI, 1.08-1.17) were related to systemic recurrence. Conclusion Variables of routine blood count are easily assessable and their changes throughout trimodal therapy for esophageal carcinoma provide important information for cancer patient's prognosis.