BRUNO MENDONCA PROTASIO DA SILVA
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- Coping with fluid restriction and the quality of life in hemodialysis patients with very low or no daily urine output(2014) SILVA, Luciana F.; LOPES, Gildete B.; CUNHA, Taline O.; PROTASIO, Bruno M.; PISONI, Ronald L.; JAMES, Sherman A.; LOPES, Antonio A.Purpose: Fluid restriction is crucial to prevent circulatory overload in maintenance hemodialysis (MHD) patients with very low urine volume, but fluid restriction may result in psychological distress. We studied MHD patients with urine volume <= 200 ml/day to investigate if their acceptance of fluid restriction was associated with their health-related quality of life (HRQOL). Methods: Cross-sectional study of 271 Brazilian adult MHD patients enrolled in the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). To assess the acceptance of fluid restriction, patients were asked about the extent of feeling bothered by living on this restriction. The KDQOL was used to determine HRQOL scores. Higher scores indicate better HRQOL with differences of >3.0 points considered clinically significant. Results: 52.4% reported being ""moderately to extremely"" bothered by fluid restriction and had lower scores for all HRQOL scales than patients less bothered by fluid restriction. The largest covariate-adjusted differences in HRQOL were 19.5 for emotional role (p<0.001), 15.1 for emotional well-being (p<0.001), and 14.1 for vitality (p<0.001). Adjusted differences were larger for mental component (7.53 points, p<0.001) than for physical component (2.07, p = 0.075) summaries. Conclusions: These results indicate that MHD patients with a lower level of acceptance of fluid restriction have poorer HRQOL, particularly in mental domains of HRQOL. The high prevalence of poor acceptance of fluid restriction in the present study underscores the need for interventions to improve acceptance of fluid restriction and determine if such interventions improve HRQOL of MHD patients with very low urine volume.
- Transient acute lateral wall ST elevation myocardial infarction caused by 'benign' circunflex coronary artery anomaly originating from the right coronary artery(2012) PROTASIO, B. M.; GUABIRU, A. T.; DORNELAS, G. De Oliveira; STANIAK, H. Lane; SHAROVSKY, R.; LOTUFO, P. A.; BITTENCOURT, M. S.
- 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, OlavoThe 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.
- Safety and Efficacy of a Modified FLOX Adjuvant Regimen for Patients With Stage III Colorectal Cancer Treated in the Community(2017) PROTASIO, Bruno Mendonca; MATUTINO, Adriana; LAGE, Liana Valente; SANTANA, Iuri; RAMOS, Ricardo; SABBAGA, Jorge; CAPARELI, Fernanda; SARAGIOTTO, Daniel; RIECHELMANN, Rachel; HOFF, Paulo M.The efficacy and safety of adjuvant modified FLOX (combination of oxaliplatin with a bolus regimen of fluorouracil) for patients with stage III colorectal cancer were analyzed retrospectively. A total of 267 patients were included, with a 74.9% rate of a 2-year disease-free survival and a Grade >= 3 toxicity rate of 36.7%. Age 70 years or older was associated with a higher risk of Grade >= 3 adverse events, suggesting that adjuvant oxaliplatin should be restricted to patients younger than 70 years. Background: The efficacy and safety of the combination of a fluoropyrimidine with oxaliplatin for patients with stage III colorectal cancer (CRC) have been evaluated in selected patients who took part in clinical trials. We evaluated the outcomes of FLOX (bolus fluorouracil [5-FU] combined with oxaliplatin) in patients with resected stage III CRC treated in the community in a large cancer center. Patients and Methods: We performed a retrospective unicenter cohort study of all consecutive stage III CRC patients who received adjuvant chemotherapy with an mFLOX (modified FLOX) regimen. The schedule consisted of 5-FU bolus 500 mg/m(2) and bolus of leucovorin 20 mg/m(2) per week for 6 consecutive weeks and oxaliplatin 85 mg/m(2) in a 2-hour infusion at weeks 1, 3, and 5, every 8 weeks. Logistic regression multivariate analyses were used to evaluate prognostic factors for relapse at 2 years, and to investigate potential predictors of Grade >= 3 toxicity. Results: A total of 267 consecutive patients were eligible and included. The median age was 59 years and pathological stage was mostly IIIB (68.2%). With a median follow-up of 24 months, n = 67 patients (25.1%) relapsed, representing a 74.9% rate of disease-free survival at 2 years. In multivariable analyses, urgent surgery (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.02-3.48; P =.042), angiolymphatic invasion (OR, 1.92; 95% CI, 1.05-3.52; P =.034), and any interruption or dose reduction of chemotherapy (OR, 2.37; 95% CI, 1.31-4.27; P =.004) were predictors of recurrence or death at 2 years. Nine patients (3.4%) died from any cause within 60 days of starting mFLOX. Grade >= 3 toxicity occurred in 98 (36.7%) patients, with diarrhea (n = 43; 16.1%) and neutropenia (n = 38; 15.3%) being the most frequent ones. Peripheral neurotoxicity Grade >= 3 occurred in 5 patients (1.8%). Age 70 years or older (OR, 5.85; 95% CI, 2.5-13.66; P <=.001) was independently associated with a higher risk of a Grade >= 3 adverse events. Conclusion: Results suggest that the effectiveness of combining oxaliplatin with bolus 5-FU in patients in the community is reasonably similar to that obtained in clinical trials. However, community patients presented a higher risk of death, especially for those who were older than 70 years. Adjuvant oxaliplatin should be used carefully and probably restricted to fit patients younger than 70 years in this setting.
- Prognostic Impact of Primary Tumor Sidedness in Stage III Colorectal Cancer: Real-World Evidence from a Brazilian Cohort(2024) PROTASIO, Bruno Medonca; CASTRIA, Tiago Biachi de; NATALINO, Renato; MANGONE, Flavia R.; SARAGIOTTO, Daniel Fernandes; SABBAGA, Jorge; HOFF, Paulo M.; CHAMMAS, RogerThe prognostic impact of primary tumor sidedness (PTS) in stage III CRC was analyzed retrospectively. Transverse colon tumors, multicentric tumors, and undetermined primary subsites were excluded, totaling 234 patients classified according to PTS: 95 on the right side (40.6%) and 139 on the left side (59.4%). The 5-year OS probabilities for right-sided and left-sided tumors were 67% (CI 95%; 58%-77%) and 82% (CI 95%; 75%-89%), respectively (HR: 2.02; 95% CI: 1.18-3.46; P = .010) Background: Primary tumor sidedness (PTS) is an independent prognostic factor in patients with metastatic colorectal cancer (CRC), with a worse prognosis for right-sided tumors. There are limited data on the prognostic impact of PTS in stage III CRC. The main objective of this study was to analyze the prognostic impact of PTS in stage III CRC. Patients and Methods: A retrospective and uni-institutional cohort study was performed in an oncology reference center. Patients with stage III CRC treated with a 5-fluorouracil and oxaliplatin-based chemotherapy regimen (mFLOX regimen) from October 2007 to February 2013 were included. The primary outcome was the probability of overall survival (OS) at 5 years stratified by PTS. Secondary outcomes were the probability of disease-free survival (DFS) at 5 years and an analysis of the prognostic impact of clinical and molecular biomarkers. Kaplan-Meier curves were used, and Cox models were used to evaluate prognostic factors associated with OS and DFS. Results: Overall, 265 patients were evaluated. Transverse colon tumors, multicentric tumors, and undetermined primary subsites were excluded, resulting in 234 patients classified according to PTS: 95 with right sidedness (40.6%) and 139 with left sidedness (59.4%). The median follow-up time was 66 months [interquartile range (IQR): 39-81]. The 5-year OS probabilities for right-sided and left-sided tumors were 67% (95% CI: 58%-77%) and 82% (75%-89%), respectively [hazard ratio (HR): 2.02, 95% CI: 1.18-3.46; P = .010]. The 5-year probabilities of DFS for right-sided and left-sided tumors were 58% (49%-69%) and 65% (58%-74%), respectively (HR: 1.29, 0.84-1.97; P = 0.248). Conclusion: These data suggest that there may be a worse prognosis (inferior OS at 5 years) for resected right-sided stage III CRC patients treated in the real world. However, these data need to be confirmed by prospective studies with a larger number of participants.