ANDRESSA ABNADER MACHADO
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Projetos de Pesquisa
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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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article Pancreatic Metastasis from Papillary Thyroid Carcinoma: A Case Report(2020) MACHADO, Andressa A.; LENZ, Luciano; DOMINGUES, Regina B.; LIMA, Gustavo R. A.; JOSINO, Iatagan R.; CORDERO, Martin A. C.; V, Adriana Safatle-Ribeiro; MARTINS, Bruno C.; PENNACCHI, Caterina M. P. S.; GUSMON, Carla C.; PAULO, Gustavo A.; LIMA, Marcelo S.; BABA, Elisa R.; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; MALUF-FILHO, FauzeIntroduction differentiated thyroid carcinoma presents with distant metastasis in 4% of cases, usually occurring in the lungs, bones and thoracic lymph nodes. Pancreatic involvement is extremely rare, with few cases reported in the literature. Case report A 47-years-old female patient presented abdominal pain. She had a history of papillary thyroid carcinoma surgically resected in 2009. After 10 years, computed tomography revealed hepatic lesions suggestive of secondary involvement and a solid mass in the pancreatic head. Endoscopic ultrasound fine-needle aspiration was performed in a heterogeneous hypoechoic mass located at pancreatic head. Cell block with immunohistochemistry was positive for thyroglobulin, suggesting papillary thyroid carcinoma metastasis. The patient still survives at present, treating metastasis with Cabozantinib. Conclusion endoscopic ultrasound fine-needle aspiration is a minimally invasive and accurate method of sampling lesions of the pancreas. In combination with clinical history and immunohistochemistry, can confirm diagnosis and define management.- Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer(2023) JOSINO, Iatagan R.; MARTINS, Bruno C.; MACHADO, Andressa A.; LIMA, Gustavo R. de A.; CORDERO, Martin A. C.; POMBO, Amanda A. M.; SALLUM, Rubens A. A.; JR, Ulysses Ribeiro; BARON, Todd H.; MALUF-FILHO, FauzeBackground/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMSERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. Methods: This retrospective study was performed at the Instituto do Cancer do Estado de Sao Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. Results: Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15-5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01- 4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26-0.85; p=0.01). No difference was observed in overall survival. Conclusions: The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.
conferenceObject DIAGNOSTIC EVALUATION OF CLINICAL COMPLETE RESPONSE BY PROBE-BASED CONFOCAL ENDOMICROSCOPY AFTER NEOADJUVANT CHEMORADIATION FOR LOCALLY ADVANCED RECTAL ADENOCARCINOMA(2020) SAFATLE-RIBEIRO, Adriana V.; MARQUES, Carlos F.; PIRES, Clelma Batista; ARRAES, Livia; MEIRELLES, Luciana; BABA, Elisa R.; MACHADO, Andressa A.; CORONEL, Martin A.; LIMA, Gustavo R.; JOSINO, Iatagan; ARAUJO, Diogo; PELEGRINELLI-ZAIDAN, Evelise; GUSMON, Carla C.; LIMA, Marcelo S. de; PENNACCHI, Caterina; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; MARTINS, Bruno da Costa; PAULO, Gustavo A. de; LENZ, Luciano; COTTI, Guilherme C.; NAHAS, Caio Sergio R.; NAHAS, Sergio C.; RIBEIRO, Ulysses; MALUF-FILHO, Fauze- Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer(2023) MACHADO, Andressa A.; MARTINS, Bruno C.; JOSINO, Iatagan R.; CHEN, Andre T. C.; HONG, Carlos B. C.; SANTOS, Alisson L. D. R.; LIMA, Gustavo R. A.; CORDERO, Martin A. C.; V, Adriana Safatle-Ribeiro; PENNACCHI, Caterina; GUSMON, Carla C.; PAULO, Gustavo A.; LENZ, Luciano; LIMA, Marcelo S.; BABA, Elisa R.; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; SALLUM, Rubens A. A.; JR, Ulysses Ribeiro; MALUF-FILHO, FauzeSelf-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.
- TC-325 hemostatic powder in the management of upper gastrointestinal malignant bleeding: a randomized controlled trial(2022) MARTINS, Bruno Costa; MACHADO, Andressa Abnader; SCOMPARIN, Rodrigo Corsato; PAULO, Gustavo Andrade; SAFATLE-RIBEIRO, Adriana; GEIGER, Sebastian Naschold; LENZ, Luciano; LIMA, Marcelo Simas; PENNACCHI, Caterina; RIBEIRO, Ulysses; BARKUN, Alan N.; MALUF-FILHO, FauzeBackground and study aims Upper gastrointestinal bleeding (UGIB) from malignancy is associated with high rebleeding and mortality rates. Recently, TC-325 powder has shown promising results in the treatment of UGIB, including malignant bleeding. The aim of this study was to compare the efficacy of TC-325 versus best clinical management. Patients and methods From August 2016 to February 2020, all patients with evidence of UGIB from malignancy were randomized to receive TC-325 therapy or control group, in which endoscopic treatment was not mandatory. Exclusion criteria were hemoglobin drop without overt bleeding and UGIB from non-tumor origin. The primary outcome was 30-day mortality. Secondary outcomes were 30-day rebleeding, blood transfusion and length of hospital stay. Results Sixty-two patients were randomized, three were excluded and 59 were included in the final analysis (TC-325 group = 28; control = 31). Groups were similar at baseline. Active bleeding was observed in 22 patients in the TC-325 group and 19 in the control group (P=0.15). Successful initial hemostasis with TC-325 was achieved in all cases. Additional therapy (radiotherapy, surgery or arterial embolization) was equally performed in both groups (42.9% vs 58.1 %; P=0.243). There were no differences in 30-day mortality (28.6% vs. 19.4%, P=0.406) or 30-day rebleeding rates (32.1 % vs. 19.4%, P=0.26). Logistic regression identified no significant predictors of rebleeding. Age, Eastern Cooperative Oncology Group (ECOG) score 3 to 4 and AIMS65 score > 1 predicted greater mortality. Conclusions TC-325 was effective in achieving immediate hemostasis in malignant gastrointestinal bleeding but did not reduce 30-day mortality, 30-day rebleeding, blood transfusion or length of hospital stay. Age, ECOG 3-4, and AIMS65 > 1 were predictive factors of mortality.