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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...
March 6, 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
Rodrigo Oliva Perez, Angelita Habr-Gama, Guilherme Pagin São Julião, Igor Proscurshim, Laura Melina Fernandez, Rafael Ulysses de Azevedo, Bruna B Vailati, Felipe Alexandre Fernandes, Joaquim Gama-Rodrigues
BACKGROUND: Transanal endoscopic microsurgery (TEM) has been considered an alternative for selected patients with rectal cancer following neoadjuvant chemoradiation (CRT). Immediate total mesorectal completion for all patients with unfavorable pathological features would result in unnecessary protectomies in a significant proportion of patients. Instead, salvage total mesorectal excision (TME) could be restricted for patients developing local recurrence. The aim of the present study is to determine oncological outcomes of salvage resection for local recurrences following CRT and TEM...
April 2016: Annals of Surgical Oncology
G L Beets, N L Figueiredo, A Habr-Gama, C J H van de Velde
No abstract text is available yet for this article.
December 2015: European Journal of Surgical Oncology
Paola Carpinetti, Elisa Donnard, Fabiana Bettoni, Paula Asprino, Fernanda Koyama, Andrei Rozanski, Jorge Sabbaga, Angelita Habr-Gama, Raphael B Parmigiani, Pedro A F Galante, Rodrigo O Perez, Anamaria A Camargo
Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is the mainstay treatment for locally advanced rectal cancer. Variable degrees of tumor regression are observed after nCRT and alternative treatment strategies, including close surveillance without immediate surgery, have been investigated to spare patients with complete tumor regression from potentially adverse outcomes of radical surgery. However, clinical and radiological assessment of response does not allow accurate identification of patients with complete response...
November 10, 2015: Oncotarget
(no author information available yet)
No abstract text is available yet for this article.
January 2015: International Journal of Surgery
Camila Lopes-Ramos, Fernanda C Koyama, Angelita Habr-Gama, Anna Christina M Salim, Fabiana Bettoni, Paula F Asprino, Gustavo S França, Joaquim Gama-Rodrigues, Raphael B Parmigiani, Rodrigo O Perez, Pedro A F Galante, Anamaria A Camargo
Neoadjuvant chemoradiotherapy (nCRT) may lead to complete tumor regression in rectal cancer patients. Prediction of complete response to nCRT may allow a personalized management of rectal cancer and spare patients from unnecessary radical total mesorectal excision with or without sphincter preservation. To identify a gene expression signature capable of predicting complete pathological response (pCR) to nCRT, we performed a gene expression analysis in 25 pretreatment biopsies from patients who underwent 5FU-based nCRT using RNA-Seq...
June 2015: Cancer Genetics
Elisa R Donnard, Paola A Carpinetti, Fábio C P Navarro, Rodrigo O Perez, Angelita Habr-Gama, Raphael B Parmigiani, Anamaria A Camargo, Pedro A F Galante
Somatically acquired chromosomal rearrangements occur at early stages during tumorigenesis and can be used to indirectly detect tumor cells, serving as highly sensitive and tumor-specific biomarkers. Advances in high-throughput sequencing have allowed the genome-wide identification of patient-specific chromosomal rearrangements to be used as personalized biomarkers to efficiently assess response to treatment, detect residual disease and monitor disease recurrence. However, sequencing and data processing costs still represent major obstacles for the widespread application of personalized biomarkers in oncology...
May 2015: Genomics
Fraser McLean Smith, Christopher Rao, Rodrigo Oliva Perez, Krzysztof Bujko, Thanos Athanasiou, Angelita Habr-Gama, Omar Faiz
BACKGROUND: In elderly and comorbid patients with rectal cancer, radical surgery is associated with significant perioperative mortality. Data suggest that a watch-and-wait approach where a complete clinical response is obtained after neoadjuvant chemoradiotherapy might be oncologically safe. OBJECTIVE: This study aimed to determine whether patient age and comorbidity should influence surgeon and patient decision making where a complete clinical response is obtained...
February 2015: Diseases of the Colon and Rectum
Camila Miranda Lopes-Ramos, Angelita Habr-Gama, Bruna de Souza Quevedo, Natália Mariana Felício, Fabiana Bettoni, Fernanda Christtanini Koyama, Paula Fontes Asprino, Pedro Alexandre Galante, Joaquim Gama-Rodrigues, Anamaria Aranha Camargo, Rodrigo Oliva Perez, Raphael Bessa Parmigiani
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) followed by radical surgery is the preferred treatment strategy for locally advanced rectal cancer. However, complete tumor regression is observed in a significant proportion of patients after nCRT, making them ideal candidates for alternative treatment strategies to this considerably morbid procedure. Identification of such patients based on clinical findings (complete clinical response - cCR) is difficult mainly because it relies on subjective clinical and imaging studies...
2014: BMC Medical Genomics
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