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Angelita Habr-Gama, Guilherme Pagin São Julião, Bruna Borba Vailati, Jorge Sabbaga, Patricia Bailão Aguilar, Laura Melina Fernandez, Sergio Eduardo Alonso Araújo, Rodrigo Oliva Perez
OBJECTIVE: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. BACKGROUND: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients...
July 24, 2017: Annals of Surgery
Camila M Lopes-Ramos, Bruna P Barros, Fernanda C Koyama, Paola A Carpinetti, Julia Pezuk, Nayara T S Doimo, Angelita Habr-Gama, Rodrigo O Perez, Raphael B Parmigiani
BACKGROUND: Genetic studies have largely concentrated on the impact of somatic mutations found in coding regions, and have neglected mutations outside of these. However, 3' untranslated regions (3' UTR) mutations can also disrupt or create miRNA target sites, and trigger oncogene activation or tumor suppressor inactivation. METHODS: We used next-generation sequencing to widely screen for genetic alterations within predicted miRNA target sites of oncogenes associated with colorectal cancer, and evaluated the functional impact of a new somatic mutation...
2017: PloS One
G P São Julião, A Habr-Gama, B B Vailati, R O Perez
No abstract text is available yet for this article.
June 19, 2017: Techniques in Coloproctology
Guilherme Pagin São Julião, Angelita Habr-Gama, Bruna Borba Vailati, Sergio Eduardo Alonso Araujo, Laura Melina Fernandez, Rodrigo Oliva Perez
In recent years, our understanding of rectal cancer has improved, including how locally advanced disease responds to chemotherapy and radiation. This has led to new innovations and advances in the treatment of rectal cancer, which includes organ-preserving strategies for responsive disease, and minimally invasive approaces for the performance of total mesorectal excision/protectomyh for persistently advanced disease. This article discusses new strategies for rectal cancer therapy, including Watch and Wait, local excision, minimally invasive proctectomy, and transanal total mesorectal excision particularly in the setting of preoperative multimodality treatment...
June 2017: Surgical Clinics of North America
Angelita Habr-Gama, Guilherme Pagin São Julião, Joaquim Gama-Rodrigues, Bruna Borba Vailati, Cinthia Ortega, Laura Melina Fernandez, Sérgio Eduardo Alonso Araújo, Rodrigo Oliva Perez
BACKGROUND: Selected patients with rectal cancer and complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively with acceptable outcomes. However, ≈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...
June 2017: Diseases of the Colon and Rectum
Angelita Habr-Gama, Guilherme Pagin São Julião, Rodrigo O Perez
No abstract text is available yet for this article.
June 1, 2017: JAMA Oncology
Aiwen Wu, Lin Wang, Changzheng Du, Yifan Peng, Yunfeng Yao, Jun Zhao, Tiancheng Zhan, Yong Cai, Yongheng Li, Yingshi Sun, Jiafu Ji
OBJECTIVE: To investigate the safety and efficacy of organ preservation surgery or "watch and wait" strategy for rectal cancer patients who are evaluated as clinical complete response(cCR) or near-cCR following neoadjuvant chemoradiotherapy (nCRT). METHOD: From March 2011 to June 2016, 35 patients with mid-low rectal cancers who were diagnosed as cCR or near-cCR following nCRT underwent organ preservation surgery with local excision or surveillance following "watch and wait" strategy in the Peking University Cancer Hospital...
April 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Guilherme P São Julião, Cinthia Denise Ortega, Bruna Borba Vailati, Angelita Habr-Gama, Laura Melina Fernandez, Joaquim Gama-Rodrigues, Sergio Eduardo Araujo, Rodrigo O Perez
AIM: Full thickness local excision after neoadjuvant chemoradiotherapy (CRT) for patients with rectal cancer and incomplete clinical response has been a treatment strategy for organ preservation. Follow up of these patients is challenging since anatomic distortion and postoperative changes may be clinically indistinguishable from tumor recurrence. Magnetic resonance imaging (MRI) may have a role in detecting recurrence. The aim of this study is to describe the MRI findings during follow-up in patients having local excision following CRT with and without local recurrence...
April 24, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Angelita Habr-Gama, Guilherme P São Julião, Adrian Mattacheo, Luiz Felipe de Campos-Lobato, Edgar Aleman, Bruna B Vailati, Joaquim Gama-Rodrigues, Rodrigo Oliva Perez
BACKGROUND: Abdominal perineal excision (APE) has been associated with a high risk of positive circumferential resection margin (CRM+) and local recurrence rates in the treatment of rectal cancer. An alternative extralevator approach (ELAPE) has been suggested to improve the quality of resection by avoiding coning of the specimen decreasing the risk of tumor perforation and CRM+. The aim of this study is to compare the quality of the resected specimen and postoperative complication rates between ELAPE and "standard" APE...
August 2017: World Journal of Surgery
Angelita Habr-Gama, Guilherme Pagin São Julião, Rodrigo Oliva Perez
No abstract text is available yet for this article.
March 2017: Lancet Oncology
Manfred P Lutz, John R Zalcberg, Rob Glynne-Jones, Theo Ruers, Michel Ducreux, Dirk Arnold, Daniela Aust, Gina Brown, Krzysztof Bujko, Christopher Cunningham, Serge Evrard, Gunnar Folprecht, Jean-Pierre Gerard, Angelita Habr-Gama, Karin Haustermans, Torbjörn Holm, Koert F Kuhlmann, Florian Lordick, Gilles Mentha, Markus Moehler, Iris D Nagtegaal, Alessio Pigazzi, Salvatore Pucciarelli, Arnaud Roth, Harm Rutten, Hans-Joachim Schmoll, Halfdan Sorbye, Eric Van Cutsem, Jürgen Weitz, Florian Otto
No abstract text is available yet for this article.
October 4, 2016: European Journal of Cancer
Jemma Bhoday, Fraser Smith, Muhammed R Siddiqui, Svetlana Balyasnikova, Robert I Swift, Rodrigo Perez, Angelita Habr-Gama, Gina Brown
BACKGROUND: Pathological complete response after chemoradiotherapy for rectal cancer occurs in 10% to 30% of patients. The best method to identify such patients remains unclear. Clinical assessment of residual mucosal abnormality is considered the most accurate method. In our institution, magnetic resonance tumor regression grade is performed as routine to assess response. OBJECTIVE: The purpose of this study was to compare the sensitivity of magnetic tumor regression grade against residual mucosal abnormality in detecting patients with a pathological complete response...
October 2016: Diseases of the Colon and Rectum
C Tyler Ellis, Karyn B Stitzenberg
No abstract text is available yet for this article.
August 15, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Rodrigo O Perez, Angelita Habr-Gama, Guilherme P São Julião, Bruna B Vailati, Laura M Fernandez, Joaquim Gama-Rodrigues, Anamaria A Camargo
No abstract text is available yet for this article.
September 2016: Diseases of the Colon and Rectum
Dalton A Dos Anjos, Rodrigo O Perez, Angelita Habr-Gama, Guilherme P São Julião, Bruna B Vailati, Laura M Fernandez, João B de Sousa, Carlos A Buchpiguel
BACKGROUND: Previous studies using PET/CT imaging have failed to accurately identify complete responders to neoadjuvant chemoradiation among patients with rectal cancer. The use of metabolic parameters alone or imprecise delineation of baseline and residual tumor volumes may have contributed for these disappointing findings. OBJECTIVE: The purpose of this study was to determine the accuracy of complete response identification in rectal cancer after neoadjuvant chemoradiation by sequential PET/CT imaging with a decrease in tumor metabolism and volume using optimal tumor volume delineation...
September 2016: Diseases of the Colon and Rectum
Fabiana Bettoni, Cibele Masotti, Angelita Habr-Gama, Bruna R Correa, Joaquim Gama-Rodrigues, Maria R Vianna, Bruna B Vailati, Guilherme P São Julião, Laura M Fernandez, Pedro A Galante, Anamaria A Camargo, Rodrigo O Perez
OBJECTIVE: Demonstrate intratumoral genetic heterogeneity in rectal cancer. BACKGROUND: Several clinical management decisions in rectal cancer may be influenced by pretreatment biopsy information. However, in the setting of significant intratumoral heterogeneity, biopsies may not be representative of the entirety of the tumor and limit the reliability of the information provided from them for clinical decision management. METHODS: Three fragments from a single rectal adenocarcinoma were chosen for whole-exome sequencing followed by mutation detection analysis...
January 2017: Annals of Surgery
Angelita Habr-Gama, Patricio B Lynn, J Márcio N Jorge, Guilherme P São Julião, Igor Proscurshim, Joaquim Gama-Rodrigues, Laura M Fernandez, Rodrigo O Perez
BACKGROUND: Organ-preserving strategies have been considered for patients with distal rectal cancer and complete or near-complete response to neoadjuvant chemoradiation to avoid the functional consequences of radical surgery. Transanal endoscopic microsurgery and no immediate surgery (watch and wait) have been considered in selected patients. OBJECTIVE: The aim of this study is to compare anorectal function following these 2 organ-preserving strategies (transanal endoscopic microsurgery and watch and wait) for rectal cancer with complete or near-complete response to neoadjuvant chemoradiation...
April 2016: Diseases of the Colon and Rectum
Angelita Habr-Gama, Rodrigo O Perez, Guilherme P São Julião, Igor Proscurshim, Laura M Fernandez, Marleny N Figueiredo, Joaquim Gama-Rodrigues, Carlos A Buchpiguel
BACKGROUND: Neoadjuvant CRT may lead to significant tumor regression in patients with rectal cancer. Different CRT regimens with consolidation chemotherapy may lead to increased rates of complete tumor regression. The purpose of this study was to understand tumor metabolic activity following two different neoadjuvant CRT regimens using sequential PET/CT imaging in two different intervals following RT. METHODS: Patients with cT2-4 N0-2 M0 rectal cancer treated by standard CRT (54Gy and 2 cycles of 5FU-based chemotherapy) or extended CRT (54Gy and 6 cycles of 5FU-based chemotherapy) underwent sequential PET/CT imaging at baseline, 6 weeks and 12 weeks from radiation completion...
February 24, 2016: Radiation Oncology
Marcos E Pozo, Sandy H Fang
In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leading cause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage III (node-positive) disease. For stage II and III colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality...
November 27, 2015: World Journal of Gastrointestinal Surgery
Jordan A Torok, Manisha Palta, Christopher G Willett, Brian G Czito
Surgery has long been the primary curative modality for localized rectal cancer. Neoadjuvant chemoradiation has significantly improved local control rates and, in a significant minority, eradicated all disease. Patients who achieve a pathologic complete response to neoadjuvant therapy have an excellent prognosis, although the combination treatment is associated with long-term morbidity. Because of this, a nonoperative management (NOM) strategy has been pursued to preserve sphincter function in select patients...
January 1, 2016: Cancer
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