Hospital Do Cancer AC Camargo

São Paulo, Brazil

Hospital Do Cancer AC Camargo

São Paulo, Brazil
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Duprat J.P.,Hospital do Cancer AC Camargo | Landman G.,Hospital AC Camargo Post Graduation | Landman G.,Federal University of São Paulo | Salvajoli J.V.,Instituto Do Cancer Do Estado Of Sao Paulo Octavio Frias Of Oliveira Icesp | Brechtbuhl E.R.,Hospital do Cancer AC Camargo
Clinics | Year: 2011

Merkel cell carcinoma is a very rare and aggressive neoplasm. Due to its rarity, therapeutic guidelines are not well established, especially for regionally advanced disease. Articles in English, French, Italian, Portuguese, and Spanish from the last 20 years were identified in MEDLINE and reviewed. The key word ''Merkel'' was used for the search, relevant articles were selected, and their references were examined. The most important articles related to epidemiology, genesis and treatment were reviewed. The incidence of Merkel cell carcinoma is increasing due to the advancing age of the population, higher rates of sun exposure and an increasing number of immunocompromised individuals. With regard to etiology, the recently described Merkel Cell polyomavirus is thought to play a role. Either local or regional surgical intervention remains the standard of care, but adjuvant radiotherapy or radiotherapy as a primary treatment have been discussed as reasonable therapeutic options. An update on this rare neoplasia is essential because of its increasing incidence and changing treatment options. Copyright © 2011 CLINICS.


Chaux A.,Institute Patologia e Investigacion | Tamboli P.,University of Texas M. D. Anderson Cancer Center | Ayala A.,University of Texas M. D. Anderson Cancer Center | Soares F.,Hospital Do Cancer Ac Camargo | And 3 more authors.
Modern Pathology | Year: 2010

Most penile cancers are squamous cell carcinomas, but there are several subtypes with different clinicopathologic, viral, and outcome features. We are presenting 45 cases of a distinctive morphological variant of penile squamous cell carcinoma composed of mixed features of warty and basaloid carcinomas. This tumor was earlier recognized in a recent viral study and showed a high association with human papillomavirus infection. However, clinicopathologic features are not well known. In this multi-institutional study, patients mean age was 62 years. Most tumors (64%) invaded multiple anatomical compartments, including glans, coronal sulcus, and, especially, inner foreskin mucosa. Tumor size ranged from 2 to 12 cm (mean 5.5 cm). Three morphological patterns were recognized: (1) the most common, observed in two-thirds of the cases was that of a typical condylomatous tumor on surface and basaloid features in deep infiltrative nests; (2) in 15% of the cases, there were non-papillomatous invasive carcinoma nests with mixed basaloid and warty features; and (3) unusually, predominantly papillomatous. Invasion of penile erectile tissues was frequent, either corpus spongiosum or cavernosum (47% each). Tumors limited to lamina propria were rare. Most tumors were of high grade (89%). Vascular and perineural invasion were found in about one-half and one-quarter of cases, respectively. Associated penile intraepithelial neoplasia was identified in 19 cases and mostly showed basaloid, warty-basaloid, or warty features. Inguinal nodal metastases were found in 11/21 patients with groin dissections. Invasion of corpora cavernosa, high histological grade, and presence of vascular/perineural invasion were more prevalent in metastatic cases. In 21 patients followed, the cancer-specific mortality rate was 33% with a mean survival time of 2.8 years. Warty-basaloid carcinomas are morphologically distinctive human papillomavirus-related penile neoplasms that, such as basaloid carcinomas, are biologically more aggressive than typical warty carcinoma from which they should be distinguished. © 2010 USCAP, Inc. All rights reserved.


Rosenblatt E.,International Atomic Energy Agency | Jones G.,Credit Valley Hospital | Sur R.K.,McMaster University | Sur R.K.,Juravinski Cancer Center | And 7 more authors.
Radiotherapy and Oncology | Year: 2010

Background: Whether the combination of high dose-rate brachytherapy (HDRBT) and External Beam Radiation Therapy (EBRT) is superior to HDRBT alone for the palliation of oesophageal cancer has only been explored in a previous IAEA pilot randomized trial. Methods: Two hundred and nineteen patients were randomized to adding EBRT or not, after receiving two fractions of HDRBT within 1 week. Each HDRBT consisted of 8 Gy prescribed at 1 cm from source centre. Patients randomized to EBRT received 30 Gy in 10 fractions. The primary outcome was dysphagia-relief experience (DRE). Additional outcomes included various scores, performance status, weight and adverse events. A majority of charts, imaging and radiotherapy plans were externally audited. Results: Median follow-up was 197 days, with a median OS of 188 days and an 18% survival rate at 1 year. DRE was significantly improved with combined therapy, for an absolute benefit of +18% at 200 days from randomization (p = 0.019). In longitudinal regression analyses, scores for dysphagia (p = 0.00005), odynophagia (p = 0.006), regurgitation (p = 0.00005), chest pain (p = 0.0038) and performance status (p = 0.0015) were all significantly improved. In contrast, weight, toxicities and overall survival were not different between study arms. Conclusion: Symptom improvement occurs with the addition of EBRT to standard HDRBT. The combination is well tolerated and relatively safe. © 2010 Elsevier Ireland Ltd. All rights reserved.


Bando S.Y.,University of Sao Paulo | Alegro M.C.,University of Sao Paulo | Amaro E.,University of Sao Paulo | Silva A.V.,University of Sao Paulo | And 5 more authors.
PLoS ONE | Year: 2011

Background: Prolonged febrile seizures constitute an initial precipitating injury (IPI) commonly associated with refractory mesial temporal lobe epilepsy (RMTLE). In order to investigate IPI influence on the transcriptional phenotype underlying RMTLE we comparatively analyzed the transcriptomic signatures of CA3 explants surgically obtained from RMTLE patients with (FS) or without (NFS) febrile seizure history. Texture analyses on MRI images of dentate gyrus were conducted in a subset of surgically removed sclerotic hippocampi for identifying IPI-associated histo-radiological alterations. Methodology/Principal Findings: DNA microarray analysis revealed that CA3 global gene expression differed significantly between FS and NFS subgroups. An integrative functional genomics methodology was used for characterizing the relations between GO biological processes themes and constructing transcriptional interaction networks defining the FS and NFS transcriptomic signatures and its major gene-gene links (hubs). Co-expression network analysis showed that: i) CA3 transcriptomic profiles differ according to the IPI; ii) FS distinctive hubs are mostly linked to glutamatergic signalization while NFS hubs predominantly involve GABAergic pathways and neurotransmission modulation. Both networks have relevant hubs related to nervous system development, what is consistent with cell genesis activity in the hippocampus of RMTLE patients. Moreover, two candidate genes for therapeutic targeting came out from this analysis: SSTR1, a relevant common hub in febrile and afebrile transcriptomes, and CHRM3, due to its putative role in epilepsy susceptibility development. MRI texture analysis allowed an overall accuracy of 90% for pixels correctly classified as belonging to FS or NFS groups. Histological examination revealed that granule cell loss was significantly higher in FS hippocampi. Conclusions/Significance: CA3 transcriptional signatures and dentate gyrus morphology fairly correlate with IPI in RMTLE, indicating that FS-RMTLE represents a distinct phenotype. These findings may shed light on the molecular mechanisms underlying refractory epilepsy phenotypes and contribute to the discovery of novel specific drug targets for therapeutic interventions. © 2011 Bando et al.


Boing A.F.,Federal University of Santa Catarina | Antunes J.L.F.,Federal University of Santa Catarina | Antunes J.L.F.,University of Sao Paulo | de Carvalho M.B.,Hospital Heliopolis | And 6 more authors.
Journal of Epidemiology and Community Health | Year: 2011

Background A higher burden of head and neck cancer has been reported to affect deprived populations. This study assessed the association between socioeconomic status and head and neck cancer, aiming to explore how this association is related to differences of tobacco and alcohol consumption across socioeconomic strata. Methods We conducted a case-control study in São Paulo, Brazil (1998e2006), including 1017 incident cases of oral, pharyngeal and laryngeal cancer, and 951 sexand age-matched controls. Education and occupation were distal determinants in the hierarchical approach; cumulative exposure to tobacco and alcohol were proximal risk factors. Outcomes of the hierarchical model were compared with fully adjusted ORs. Results Individuals with lower education (OR 2.27; 95% CI 1.61 to 3.19) and those performing manual labour (OR 1.55; 95% CI 1.26 to 1.92) had a higher risk of disease. However, 54% of the association with lower education and 45% of the association with manual labour were explained by proximal lifestyle exposures, and socioeconomic status remained significantly associated with disease when adjusted for smoking and alcohol consumption.


De Sa V.K.,University of Sao Paulo | Olivieri E.,Hospital Do Cancer AC Camargo | Parra E.R.,University of Sao Paulo | Ab'Saber A.M.,University of Sao Paulo | And 5 more authors.
Human Pathology | Year: 2012

Heterogeneity of hyaluronidase (HYAL) expression has been identified in tumors and shows promise as an indicator of disease progression. The expression profile of alternatively spliced forms of HYAL was evaluated in tumors and normal lung tissue from 69 resected tumors of patients with adenocarcinomas and squamous cell carcinomas. HYAL1-wild-type (wt) and variants 1 to 5, HYAL2-wt, and HYAL3-wt, and variants 1 to 3 were identified by polymerase chain reaction and direct sequencing. Different proportions of the 3 HYAL-wt and variants were expressed in tumor and normal lung tissues. HYAL1-wt was associated with a poorer prognosis and HYAL3-v1 with a better prognosis. HYAL splice variants are associated with histology and outcome, suggesting that strategies aimed at modulating their levels may be effective for lung cancer treatment. © 2012 Elsevier Inc. All rights reserved.


PubMed | Hospital Do Cancer Ac Camargo
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

17556 Objectives: Primary mediastinal B-cell Lymphoma (PMBL) is recognized as a separate entity in the WHO classification. Treatment for PMBL is based on a combination of conventional dose chemotherapy, high dose chemotherapy and radiation therapy. The best strategy is still undefined. We conducted a retrospective analysis of patients with PBML to identify clinical prognostic factors.A retrospective analysis of 43 patients treated at Hospital do Cancer AC Camargo, Sao Paulo, Brazil, between 1989 and 2004. All patients had previous diagnosis of diffuse large B-cell lymphoma, with positive CD20 on neoplastic cells. A predominant anterior mediastinal lesion should be present. Induction chemotherapy regimens were grouped in first generation (CHOP/CHOP-like), third generation (PromaceCytabon/MACOP) and other (pediatric regimens, COP).Age ranged from 16 to 82 years-old, 30 females and 13 male. Age < 35 yo was associated with a better prognosis (5 years OS - 56% 34%, p = 0.048). Among clinical variables, female gender, stage IA-IIB, IPI 0-1, normal LDH, absence of mediastinal bulky disease were associated with better prognosis, although not statistically significant. Response rate to first generation regimens was: 37% CR (11/29), 24% PR (7/29) and 24% PD (7/29). Four patients were treated with Third generation regimens with 2 CR and 2 PR. 20 out of 25 patients with PR or CR to first line chemotherapy received mediastinal radiation therapy. More than 65% of patients had a follow up of 5 years or more. With a median follow up of 22.3 months, projected 5 year OS was 47% and for the responders the median PFS was 8,4 months. No difference in OS and PFS was observed among the three chemotherapy groups.Our analysis showed that response rate to first line regimens was around 60% and 25% of patients were primarily refractory to CHOP regimen. Age younger than 35 years old was associated with a better prognosis. 5 years overall survival was 45% and is in accordance with the literature. Although recent studies have demonstrated biological similarities between PMBL and Hodgkins Lymphoma, the prognosis of PMBL is less favorable than HL. Better understanding of the disease will help in developing more appropriate therapeutic strategies for PMBL. No significant financial relationships to disclose.


PubMed | Hospital Do Cancer Ac Camargo
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

9039 Background: To report on treatment results and prognostic factors of young patients with Hodgkins disease treated with chemotherapy (CT) followed by low dose radiotherapy (RT).This retrospective series analysed 166 patients under 18 years old, treated from January 1985 to December 2003. Median age was 10 years (range 2-18). The male to female ratio was 2,3:1. Adenomegalia was the most frequent complaint (68%), and the time of symptom duration was smaller than 6 months in 55% of the patients. In histological analysis Nodular Sclerosis was the most prevalent type (43%) followed by Mixed Celularity (41%). The disease was restricted to two nodal group ( stage II) in 60% and to adjacent groups in 55% (stage III). The most frequent site of metastasis ware the bone marrow (38%) and lungs (42%). Standard treatment consisted of chemotherapy (drug combination varied according to treatment protocols vigent). Radiotherapy consisted of 21 Gy dose in 17 fractions in most part of patients (90.2%), delivered to involved field or mantle field. 13,86% patients did not receive RT.The OS and EFS in 10 years were 88.6% and 82.4%.Survival according to clinical stage as 94.4%, 94.25%, 90.6% and 71.5% for stages I to IV (p=0.0215). The OS in 90.5% of patients who received RT and in 75.6% of patients who did not (p=0.001). Multivariate analysis showed presence of B symptoms and low platelet count to be associated with a worse prognosis.This study shows that combining chemotherapy and low dose RT is an effective treatment for HL in childhood, providing high rates of cure and disease control (88.6% in 10 years), and that so far it is not possible to abdicar RT. And yet, attention to platelet count should be payed in order to improve survival. Also, B symptom presenting children may be involved in more aggressive protocols so survival can be improved. As the disease is highly curable, any data of long term follow-up should be presented in order to better direct therapy, improving outcome and lowering side effects. No significant financial relationships to disclose.


PubMed | Hospital Do Cancer Ac Camargo
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

18600 Background: Lymphangitis of the lungs is an uncommon type of metastasis, mainly in breast, lung and gastric cancers, and has major impact in quality of life and an unfavorable prognosis. Survival is very poor: 50% in 3 and 15% in 6 months. Our objective was to evaluate prospectively quality of life in cancer patients with pulmonary lymphangitis, under palliative care.Patients with pulmonary lymphangitis, diagnosed either by lung biopsy (major criteria) or 3 minor criteria (cyto or histotologically proven cancer, clinical picture and image exam) were followed in 3 tertiary services, in a cohort series study. Primary end point was quality of life (QoL), measured with questionnaires in the beginning of the study and monthly afterwards (Saint George Respiratory Questionnaire -SGRQ- and Medical Outcomes Study 36-Item Short-Form Health Survey -SF36). Clinical and complementary aspects were also followed, in addition to treatment and outcome.Thirty-seven patients were included from Aug/2004 to Jan/2006 - 23 female and 14 male; age from 41 to 84 (mean: 62) years. Primary tumors were: lung (20), breast (11), esophagus (2), pancreas, rectum and bone. Of those patients, 33 were able to respond QoL questionnaires in the beginning of follow-up and monthly thereafter. Median follow-up was of one month (range: 0-13); at the moment, 9 patients are still alive. Median survival was 2.5 months (range: 0,1-33), with 38% with a survival of at least 6 months. In general, QoL was poor, but improved after palliative care. Notice that values get higher as QoL improves in SF-36; however, they get lower as QoL improves in SGRQ - values were 61.5, 50.5, 61.7, and 47.5% for SGRQ and 38.1, 32.1, 32.8, 61.6 for SF36 in 0, 1, 3 and 6 months, respectively. Palliative care included: corticosteroids (65%), oxygen (51%), opioids (51%), diuretics (47%), inhalations with beta2-agonists and/or ipatropium (57%), chemo and/or hormonotherapy (51%), physical therapy (43%), antidepressants and benzodiazepines (37% each), thoracocentesis (35%), and blood transfusions.Even though QoL is poor and survival is short for patients with cancer lymphangitis in lungs, some improvement is possible with active palliative care. No significant financial relationships to disclose.


PubMed | Hospital Do Cancer Ac Camargo
Type: Journal Article | Journal: Journal of vascular surgery. Venous and lymphatic disorders | Year: 2016

Aortic and vena caval reconstruction associated with tumor resection is very rare. We describe a 22-year-old man with a retroperitoneal metastasis from a germ-cell tumor previously treated with chemotherapy who presented with a huge mass involving the infrarenal aorta and the inferior vena cava. He underwent retroperitoneal lymph node dissection with concomitant aortic and caval reconstruction that included customization of a new caval bifurcation. His postoperative recovery was uneventful, and he remained well 36 months after the operation. Complementary follow-up imaging examinations demonstrated that the aortic and venous interposition grafts were patent and that there was no local or distant disease recurrence.

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