CINTHIA DENISE ORTEGA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Baseline T Classification Predicts Early Tumor Regrowth After Nonoperative Management in Distal Rectal Cancer After Extended Neoadjuvant Chemoradiation and Initial Complete Clinical Response(2017) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; GAMA-RODRIGUES, Joaquim; VAILATI, Bruna Borba; ORTEGA, Cinthia; FERNANDEZ, Laura Melina; ARAUJO, Sergio Eduardo Alonso; PEREZ, Rodrigo OlivaBACKGROUND: Selected patients with rectal cancer and complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively with acceptable outcomes. However, approximate to 20% of these patients will develop early tumor regrowth. Identification of these patients could select candidates for more intensive follow-up. OBJECTIVE: The purpose of this study was to investigate the influence of baseline radiological T classification on recurrences after a complete clinical response managed nonoperatively after chemoradiation. DESIGN: This was a retrospective review of a prospective collected database. SETTINGS: The study was conducted at a single center. PATIENTS: Patients with distal rectal cancer (cT2-4N0-2M0) undergoing extended chemoradiation (54 Gy + 5-fluorouracil-based chemotherapy) were eligible. Patients were reassessed for tumor response at 10 weeks after radiation completion. Patients with complete clinical response (clinical, radiological, and endoscopic) were managed nonoperatively and strictly followed. MAIN OUTCOMES MEASURES: Complete clinical response rates, early tumor regrowth rates (<12 mo), local recurrence-free survival, and distant metastases-free survival were measured. RESULTS: A total of 91 consecutive patients with rectal cancer underwent extended chemoradiation. Sixty-one patients developed initial complete clinical response (67%). cT2 patients developed similar initial complete clinical response rates compared with cT3/T4 (72% vs 63%; p = 0.403). Early tumor regrowths were more frequent among baseline cT3/4 when compared with cT2 patients (30% vs 3%; p = 0.007). There were no differences in late local recurrences (p = 0.593) or systemic recurrences (p = 0.387). Local recurrence-free survival was significantly better for cT2 patients at 1 year (96% vs 69%; p = 0.009). After Cox regression analysis, baseline T stage was an independent predictor of improved local recurrence-free survival at 1 year (p = 0.03; OR = 0.09 (95% CI, 0.01-0.81)). LIMITATIONS: This study was limited by its small sample size, retrospective nature, and short follow-up. CONCLUSIONS: cT2 patients who develop complete clinical response after extended chemoradiation managed nonoperatively are less likely to develop early tumor regrowths when compared with cT3/4 patients. cT3/4 patients should undergo more intensive follow-up after a complete clinical response to allow for early detection of early regrowths.
conferenceObject OBSERVATION VERSUS SURGICAL RESECTION IN PATIENTS WITH RECTAL CANCER WHO ACHIEVED COMPLETE CLINICAL RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY: PRELIMINARY RESULTS OF A RANDOMIZED TRIAL (NCT02052921).(2015) NAHAS, S.; NAHAS, C.; RIBEIRO JUNIOR, U.; MARQUES, C. Sparapan; COTTI, G. C.; IMPERIALE, A.; ORTEGA, C.; AZAMBUJA, R.; CHEN, A.; HOFF, P.; CECCONELLO, I.- Metformin Use in Patients With Rectal Cancer Undergoing Neoadjuvant Chemoradiation: The New Magic Bullet?(2020) PEREZ, Rodrigo Oliva; FERNANDEZ, Laura M.; ORTEGA, Cinthia D.
conferenceObject T <= 2N0, TRG1-2 IN POST CHEMORADIATION THERAPY MRI: WHAT IT CAN PREDICT?(2017) NAHAS, C.; NAHAS, S.; BUSTAMANTE, L.; MARQUES, C.; IMPERIALE, A.; COTTI, G.; AZAMBUJA, R.; ORTEGA, C.- Organ Preservation Among Patients With Clinically Node-Positive Rectal Cancer: Is It Really More Dangerous?(2019) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; FERNANDEZ, Laura M.; ORTEGA, Cinthia D.; FIGUEIREDO, Nuno; GAMA-RODRIGUES, Joaquim; PEREZ, Rodrigo OlivaBACKGROUND: Select patients with complete clinical response to chemoradiation have been managed without radical surgery. The presence of radiologic evidence of nodal metastases at baseline could be a risk factor for local tumor regrowth, more advanced stage at the time of recurrence, and worse distant metastases-free survival. OBJECTIVE: The purpose of this study was to compare the outcomes of patients with baseline node-positive and node-negative cancer after neoadjuvant chemoradiation and complete clinical response managed nonoperatively. DESIGN: This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation. PATIENTS: Consecutive patients with clinical and radiologic evidence of complete clinical response at 8 to 10 weeks were managed nonoperatively and enrolled in a strict follow-up program (watch and wait). Patients with incomplete clinical response or tumor regrowth after initial complete clinical response were referred to surgery. MAIN OUTCOMES MEASURES: Surgery-free and distant metastases-free survival were compared between patients according to nodal status at baseline. RESULTS: A total of 117 patients with node-positive and 218 with node-negative cancer at baseline were reviewed. Overall, 62 (53.0%; node positive) and 135 (61.9%; node negative) achieved a complete clinical response and were managed nonoperatively (p = 0.13). Patients with baseline node-positive cancer had similar rates of pathologic nodal metastases at the time of recurrence. Five-year surgery-free (39.7% vs 46.8%; p = 0.2) and distant metastases-free survival (77.5% vs 80.5%; p = 0.49) were similar between baseline node-positive and node-negative patients. LIMITATIONS: This was a retrospective study with a small sample size and possible inaccurate nodal staging. CONCLUSIONS: Patients with rectal cancer with node-positive cancer at baseline who develop a complete clinical response after neoadjuvant chemoradiation are not at increased risk for local tumor regrowth or development of more advanced disease at the time of recurrence. These patients seem to be safe candidates for organ-preserving strategies after achieving complete clinical response. See Video Abstract at http://links.lww.com/DCR/A902.
conferenceObject CAN MRI PREDICT PATHOLOGIC RESPONSE OF RECTAL CANCER AFTER NEOADJUVANT TREATMENT?(2014) NAHAS, C.; NAHAS, S.; ORTEGA, C.; AZAMBUJA, R.; JOAQUIM, H.; MARQUES, C.; RIBEIRO, U.; BUSTAMANTE, L. L.; HOFF, L. P.; CECCONELLO, I.