Navegando por Palavras-chave "Chemotherapy"

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    Acupuntura e a cinesioterapia sobre a sensibilidade cutânea de pacientes com câncer de mama submetidas à quimioterapia com paclitaxel: estudo clínico randomizado
    (Universidade Federal de São Paulo, 2023-11-21) Luz, Roberta Pitta Costa [UNIFESP]; Facina, Gil [UNIFESP]; Nazário, Afonso Celso Pinto [UNIFESP]; Haddad, Cinira Assad Simão; http://lattes.cnpq.br/0266384667983727; http://lattes.cnpq.br/5999034606911576; http://lattes.cnpq.br/1029334251705417; http://lattes.cnpq.br/1907017865270272
    OBJETIVO: Comparar a sensibilidade cutânea de mãos e pés, nas pacientes com diagnóstico de câncer de mama submetidas a ciclos de quimioterapia. MÉTODOS: Ensaio clínico randomizado, controlado, paralelo e aberto. Critérios de inclusão: mulheres submetidas à quimioterapia com paclitaxel a partir do 1º ciclo, tanto neoadjuvante quanto adjuvante e nos estádios clínicos de I a III. Critérios de Exclusão: mulheres com metástase à distância ou com doenças pré-existentes tais como: doenças reumatológicas, com limitações de movimentos dos membros e faziam uso de dispositivos para auxílio da marcha e as que realizaram acupuntura nos últimos três meses. Foi realizado um atendimento uma vez por semana, por dez semanas consecutivas. Divisão dos grupos: o Grupo Stiper (GS), técnica não invasiva, utilizada para estimular acupontos nos meridianos do corpo. Grupo Agulha (GA) técnica com agulhas, estéreis e descartáveis, para estimulação de pontos de acupuntura definidos para esse estudo. Grupo Cinesioterapia (GC) realizou exercícios de reabilitação em membros superiores e membros inferiores, adicionado ao treino de propriocepção e de equilíbrio. Os Grupos GS e GA, realizaram acupuntura nos mesmos acupontos: (B11Dazhu, SI14 Jianwaishu, CV12 Zhongwan, GB34 Yanglingquan, SP6 Sanyinjiao, LR3 Taichong), com frequência de 1 vez por semana, por 10 semanas seguidas e com duração de 30 minutos. Empregou-se o estesiômetro, para se avaliar a sensibilidade cutânea de membros superiores e inferiores. RESULTADOS: Selecionou-se 102 mulheres com diagnóstico de câncer de mama, sendo excluídas 39 pacientes, logo, foram incluídas e randomizadas 63 voluntárias que foram alocadas em três grupos GS (n=26), GA(n=18) e GC (n=19). As medidas dos pés (lados Direito/Esquerdo), apresentaram modificações nos três grupos, com variação de 1,00 até 2,00, o que corresponde a alteração de sensibilidade leve. Foram analisadas as medidas de não inferioridade, adotadas no grupo padrão de comparação que foi à Cinesioterapia. As medidas de sensibilidade dos Grupos GS e GA foram mensuradas pelo estesiômetro e comparadas com à cinesioterapia. Na Medida T1 D, o GS apresentou resultado maior no início. No entanto, após a intervenção, o GS apresentou resultado significativamente menor que o GC (p<0,01). As outras variáveis da sensibilidade, não apresentaram significância estatística, ou seja, demostrou equivalências entre GS e GA em relação à Cinesioterapia. O questionário FACIT-G analisou a qualidade de vida geral entre os grupos, pré e pós-intervenções, resultado sem significância estatística. O questionário Taxane total, mostrou piora significativa nas medidas pré e pós-intervenção, porém sem efeito sobre neuropatia. O questionário TaxS avaliou pré e pós-intervenção, com o valor p<0,03**. CONCLUSÕES: Conclui-se que as terapias experimentais: acupuntura com Stiper ou Agulha foram equivalentes à Cinesioterapia terapia adotada como padrão. A Qualidade de vida apresentou redução nos domínios, mostrando que autopercepção se altera durante a quimioterapia.
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    Additive effect of P10 immunization and chemotherapy in anergic mice challenged intratracheally with virulent yeasts of Paracoccidioides brasiliensis
    (Elsevier B.V., 2008-10-01) Marques, Alexandre F.; Silva, Marcelo B. da; Juliano, Maria A. P. [UNIFESP]; Munhoz, Julian E.; Travassos, Luiz R. [UNIFESP]; Taborda, Carlos Pelleschi [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Paracoccidioidomycosis is a systemic granulomatous disease manifested in the acute/subacute or chronic forms. the anergic cases of the acute/subacute form are most severe, leading to death threatening conditions. Drug treatment is required to control the disease but the response in anergic patients is generally poor. A 15-mer peptide from the major diagnostic antigen gp43, named P10, induces a T-CD4(+) helper-1 immune response in mice of different haplotypes and protects against intratracheal challenge with virulent P. brasiliensis. Presently, P10 immunization and chemotherapy were associated in an attempt to improve antifungal treatment in Balb/c mice made anergic by adding dexamethasone to the drinking water. the combined drug/peptide treatment significantly reduced the lung CFUs in infected anergic mice, largely preserved lung alveolar structure and prevented fungal dissemination to liver and spleen. Results recommend that a P10-based vaccine should be associated to chemotherapy for improved treatment of paracoccidioidomycosis aiming especially at anergic cases. (C) 2008 Elsevier Masson SAS. All rights reserved.
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    Agente único versus combinação de agentes quimioterápicos durante a radioterapia pré-operatória para o tratamento do câncer de reto ressecável: revisão sistemática de ensaios clínicos randomizados
    (Universidade Federal de São Paulo (UNIFESP), 2016-09-27) Resende, Heloisa Magda [UNIFESP]; Silva, Edina Mariko Koga da [UNIFESP]; http://lattes.cnpq.br/0262292376123164; http://lattes.cnpq.br/7279033081732789; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Colorectal cancer represents the third more common neoplasms and acconts for 49.190 deaths for year in the United States. Almost two-thirds of the large intestine tumors are the colon and a third is about the rectum, including anus. Surgery is curative basis of the treatment of rectal cancer. Total mesorectal excision reduces the local recurrence rate, improving the prognosis, but a lot of investment in research has been done to improve the overall results, which are very impacted by still high relapse rates in the distance. Currently rectal cancer is covered with neoadjuvant radiotherapy and chemotherapy fluoropyrimidine-based, followed by surgery, however the distance the recurrence rate is around 30%. chemotherapy regimens in combination of two drugs, similar to what has been used in metastatic and adjuvant therapy have improved the prognosis and have been tested in neoadjuvant character. Objectives: To compare outcomes of patients (overall survival, disease-free survival, and toxicity) between two chemotherapy regimens for patients with rectal cancer stage II and III will receive neoadjuvant treatment with radiotherapy and chemotherapy. Interventions were radiotherapy, fluoropyrimidine and additional drugs, excluding biological agents. The control arm was radiotherapy and chemotherapy with a single agent (fluoropyrimidine) SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE and LILACS (last search onSeptember 2014). Completed searching through lists of references, record of "clinical trials" and manual search for relevant papers. There was no language restriction. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing single-agent chemotherapy (fluoropyrimidine) versus the combination of chemotherapeutic agents (fluoropyrimidine more other agent including but not limited to oxaliplatin) during the pre-operative treatment in patients with rectal unresectable cancer . Collection and analysis of data: Two reviewers (HMR, EMKS) independently extracted data and assessed the quality of RCT. When necessary we request additional information and clarifications to the authors about the published data. Main results: Four RCTs were included totaling 3875 patients with resectable rectal cancer. RCTs were classified between low to moderate risk of bias. In the preoperative period the participants of these RCTs were randomized to receive chemotherapy and radiotherapy both with fluoropyrimidine or a combination of agents (fluoropyrimidine and a second agent). The only study that has reported data of overall survival and progression-free found no differences between the groups compared. For complete pathological response (ypCR) there was a statistically significant difference favoring the experimental group OR = 1.23 (95% CI: 1:04, 1:46), but there were also significantly more acute toxicity in this arm OR = 2.07 (95% CI: 1.31, 3.27). The control group had greater adherence to treatment radiotherapy and chemotherapy, OR = 0:32 (95% CI: 12:14, 0.75) and OR = 0:24 (95% CI: 0.07 to 0.77), respectively. There was no difference between groups with respect to mortality within 60 days, postoperative morbidity, resection margin, abdominal-perineal resection and Hartmann procedure. AUTHORS 'CONCLUSIONS: There is low quality evidence that patients with resectable rectal cancer who receive combination chemotherapy agents preoperatively have no benefit in overall survival and progression-free. There is high quality evidence that combination of chemotherapeutic agents with oxaliplatin can improve local tumor control in these patients, but the regime also cause greater toxicity. Therefore the existing evidence to date does not support the use of oxaliplatin in this context. The publications of more progress in studies of survival data will contribute to further analysis.
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    Alterações na expressão do antígeno nuclear de proliferação celular e dos receptores de estrogênio e de progesterona provocadas pela quimioterapia primária no carcinoma de mama
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2003-09-01) Depes, Daniella De Batista [UNIFESP]; Souza, Maria Angela De [UNIFESP]; Ribalta, Julisa Chamorro Lascasas [UNIFESP]; Alves, Maria Teresa de Seixas [UNIFESP]; Kemp, Claudio [UNIFESP]; Lima, Geraldo Rodrigues De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    ABSTRACT PURPOSE: to evaluate the changes in the cell phenotype determined by primary chemotherapy. METHODS: we evaluated the expression of proliferating cells of nuclear antigen (PCNA) and the estrogen (RE) and progesterone (RP) receptors in 17 stage II breast cancer patients before and after chemotherapy by immunohistochemistry. The values were compared with menopausal status, tumoral clinical response and with axillary lymph node status. RESULTS: there was a significant decrease in the average index of anti-PCNA-stained cells before (time A) and after (time B) chemotherapy (p=0.041). Responder patients displayed a significant decrease in PCNA levels [time A=53.1 and time B= 30.7 (p=0.011)]. A similar trend was observed in patients with histologic grade GII/GIII [time A=63.1 and time B=38.7 (p=0.049)]. There was no significant difference in PCNA expression regarding menopause status and axillary lymph node involvement. There was a significant decrease in RE after chemotherapy in the premenopausal patients [time A=60.3 and time B=24.1 (p=0.027)] and in those who showed a therapeutic response [time A=59.1 and time B=37.9 (p=0.030)]. We observed a significant increase in RP after chemotherapy in the postmenopausal patients [time A=35.3 and time B=58.3 (p=0.023)]. There was no relationship between hormone receptors and axillary lymph nodes. CONCLUSIONS: the decrease in PCNA levels in patients with high histologic grade, in RE in premenopausal patients, and both, PCNA and RE, in the tumors with clinical response after chemotherapy shows that the drugs acted on proliferating cells, and therefore PCNA can be used as a parameter of treatment response.
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    Alterações oculares induzidas pela quimioterapia
    (Conselho Brasileiro de Oftalmologia, 2007-08-01) Chaves, Alessandra Pinheiro [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Antineoplastic agents offer an increase in the patients' survival rates, but may induce side effects in different organs and tissues. Mucositis is one of the most common side effects during chemotherapy with certain agents. The ocular toxicity induced by these drugs may manifest as changes in the ocular surface and in the tear film. The purpose of this research was to study the ocular surface changes induced by chemotherapy and to establish their clinical correlation with the chemotherapy and mucositis. The 39 selected patients underwent a full ophthalmological examination and supplementary tests. We compared 2 groups of patients: with (case) and without mucositis (control). Statistical analysis was performed with the Statistical Package for Social Sciences software. Mucositis was identified in 51.4% of the patients after chemotherapy. The brakeup time showed a statistically significant decrease after chemotherapy (p<0.0001). Punctate epitheliopathy was seen in 78.4% of cases. Schirmer test results did not show significant changes pre x post-chemotherapy. Chemotherapy may induce tear film changes, as shown in this study by the brakeup time, Schirmer test and biomicroscopy. Chemotherapy-induced mucositis involves also the conjunctival mucosa, which was subjectively characterized by the ocular symptoms and proved in our study by impression cytology and microbiology.
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    Alterações Orais Tardias em Pacientes Submetidos a Radioterapia e/ou Quimioterapia em Cabeça e Pescoço
    (Universidade Federal de São Paulo (UNIFESP), 2011-02-22) Deboni, Aline Lima da Silva [UNIFESP]; Segreto, Helena Regina Comodo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To assess the late oral complications (LOC) in non surgical head and neck cancer (HNC) patients, submitted to radiotherapy (RT) with or without chemotherapy (chemo). Materials and Methods: The average follow-up for HNC patients was 17.1 months. Five hundred fifteen charts from patients treated for HNC between 2005 and 2009 were reviewed and 41 non surgical HNC patients met the inclusion criteria. Salivary glands function was assessed using a simplified new grading system (NGSX) (Esibruch et al. 2003) and sialometry. Late effects were assessed using the Common Toxicity Criteria (CTC) - Radiotherapy and Oncology Group /European Organization for Research and Treatment of Cancer (RTOG/EORTC) - Late Radiation Morbidity Scale. Data were submitted to statistical analysis. Results: There was a predominance of mild LOC complications among the variables studied. A statistical correlation was found for both unstimulated/stimulated salivary flow rates and the average CTC – RTOG/EORTC grades for the mucous membrane. The low salivary flow rates (<0.03 mL/min e <0.09 mL/min) were identified as a potential risk factor (p <0.005) and an independent predictor for mucous membrane toxicity (for ≥2 grades). A significant correlation was also found between objective NGSX scores (p = 0.001) and CTC – RTOG/EORTC grades for salivary glands. Eighty five percent of the patients were classified as suffered from hyposalivation as well as 58,7% considered the dryness in the mouth the most debilitating complication. Conclusions: Considering the late effects assessed, the majority of patients presented mild graduation (0 and 1) according to CTC – RTOG/EORTC criteria; the demographic, tumor and treatment variables were not statistically significant for the development and severity of late oral complication; the salivary hipofunction increased from 4.3 to 8.3 times the RR for the occurrence of severe late mucosal reaction; xerostomia was considered the most debilitating complication after treatment. Data show the role of salivary hypofunction as an independet predictor for the severity of late mucous membrane complication.
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    Análise integrada de genes e miRNAs diferencialmente expressos em carcinomas de ovário seroso de alto grau de pacientes com distintas respostas à quimioterapia
    (Universidade Federal de São Paulo (UNIFESP), 2021) Melo, Natalia Cruz E [UNIFESP]; Rocha, Rafael Malagoli [UNIFESP]; Universidade Federal de São Paulo
    OBJECTIVE: This study intended to evaluate the action of acupuncture on myelodepression in women with breast cancer during treatment with anthracyclines and quality of life, before and after chemotherapy. METHODS: The population of this study was composed of women newly diagnosed with breast cancer at the UNIFESP Mastology outpatient clinic and with indication for chemotherapy with anthracyclines. Patients were randomized into two groups: the Acupuncture Group (GA) and the Control Group (CG). All participants, before and at the end of treatment with anthracyclines and at the end of it, answered the quality of life questionnaire (FACT-G) and were monitored for leukocyte and neutrophil levels in peripheral blood as an indicator of the level of spinal depression. The GA underwent intervention with Acupuncture for up to 10 sessions, starting before the first infusion of chemotherapy and continuing throughout the treatment. The points were used: GV14, CV6, ST36, SP6, KI3, GB39. RESULTS: A total of 26 women were randomized into 2 groups: GA (10) and CG (16). Of these, 7 (26.92%) received a dense dose indication (according to the service protocol) and, therefore, received the granulocyte stimulating factor G- CSF from the first cycle. Thus, for the analysis of the protective effect of acupuncture on the myeloprotective medulla, 2 women from GA and 5 from GC were excluded. The Quality of Life (QOL) analysis was performed for the total sample and also in the subgroups that received G-CSF. The need for secondary prophylaxis with G-CSF occurred in 72.7% (08/11) in the control group and in 12% (08/01) in the acupuncture group (p-value = 0.009). Regarding quality of life (QOL), the initial and final FACT-G showed a difference between the groups, where the mean GA at the end rose from 80.68 to 90.12 (p-value = 0.004) and in the CG mean fell from 81.95 to 70.59 (p-value = 0.003) .In the analysis of subgroups that used G-CSF, the QoL of women in GA showed better QoL (p-value = 0.036). CONCLUSION: Based on the results presented, acupuncture showed efficiency in the prophylaxis of myelosuppression induced by chemotherapy with anthracyclines and increased the quality of life of women during treatment, including those who needed G-CSF.
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    The antineoplastic busulphan impairs peritubular and Leydig cells, and vitamin B-12 stimulates spermatogonia proliferation and prevents busulphan-induced germ cell death
    (Elsevier France-Editions Scientifiques Medicales Elsevier, 2017) Sasso-Cerri, Estela; Oliveira, Barbara; de Santi, Fabiane [UNIFESP]; Beltrame, Flavia L. [UNIFESP]; Caneguim, Breno H. [UNIFESP]; Cerri, Paulo S.
    Busulphan (Bu), an alkylating agent used for bone marrow and spermatogonial stem cell transplantation (SSCT), impairs Sertoli (SC) cells, which are necessary for the spermatogonial stem cell (SSC) homing during transplantation. As Leydig (LC) and peritubular myoid (PMC) cells are essential for SC support and maintenance of spermatogonial niche, we evaluated the impact of Bu on the LC and PMC structural integrity. Vitamin B-12 (B-12) has demonstrated beneficial effects against drug-induced testicular changes; thus, we also examined whether this vitamin is able to stimulate spermatogonia mitotic activity and prevent Bu-induced germ cell death. Rats received 10 mg/kg of Bu in the 1st and 4th days, and daily B-12 supplementation during Bu treatment and for 6 days after the last injection of Bu (Bu-6d), totaling 10 days of treatment. Other animals received the same treatment as Bu-6d, and B12 supplementation (Bu + 7dB(12)) or saline (Bu + 7dS) for 7 more days, totaling 17 days of treatment. Serum testosterone levels were measured. In the historesin-embedded testis sections, the seminiferous tubule and epithelial areas were measured, and the number of spermatogonia and PMC was quantified. Actin and 17 beta-HSD6 immunofluorescence was detected, and the number of TUNEL-positive LC and germ cells was computed. In Bu-6d, PMC number reduced, and a weak actin immunoexpression and death in these cells was observed. The testosterone levels reduced, and the interstitial tissue showed a weak 17 beta-HSD6 immunoexpression and increased number of TUNEL-positive LC. In Bu + 7dB(12), the number of spermatogonia was higher than in Bu-6d and Bu + 7dS, and the number of TUNEL-positive germ cells was significantly lower than in Bu + 7dS. Bu exerts a harmful impact on PMC and LC, reducing the testosterone levels. Vitamin B-12 prevents significantly Bu-induced germ cell death and stimulates spermatogonia proliferation, being a useful strategy for the enrichment of SSC in vitro and an adjuvant therapy for spermatogenesis recovery in oncologic patients.
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    Avaliação da efetividade e toxicidade do quimioterápico vinorelbina em crianças e adolescentes com gliomas de baixo grau não ressecáveis e/ou em progressão
    (Universidade Federal de São Paulo (UNIFESP), 2015-09-14) Cappellano, Andrea Maria [UNIFESP]; Petrilli, Antonio Sergio [UNIFESP]; Caran, Eliana Maria Monteiro [UNIFESP]; http://lattes.cnpq.br/1783139918188371; http://lattes.cnpq.br/7171708417124895; http://lattes.cnpq.br/0520505516654413; Universidade Federal de São Paulo (UNIFESP)
    Introdução: O manejo dos gliomas de baixo grau não ressecáveis e/ou em progressão permanece controverso. As opções de tratamento incluem quimioterapia, geralmente precedido por um período de observação, na tentativa de adiar ou mesmo evitar a radioterapia e a ressecção cirúrgica extensa. Dentro deste contexto realizou-se um protocolo institucional no IOP/GRAACC/UNIFESP com vinorelbina, um alcaloide da vinca semissintético, com o objetivo de avaliar a resposta ao tratamento, a sobrevida e seu perfil de toxicidade. Pacientes e métodos: De julho de 2007 a maio de 2013, 41 pacientes com tratamento prévio (10) e recém-diagnosticados (31) foram tratados com vinorelbina na dose de 30 mg/m² nos dias 0, 8 e 22 por 18 ciclos. Os critérios de resposta incluíam as imagens de ressonância nuclear magnética e a avaliação física e oftalmológica, quando aplicável. Em relação às toxicidades, estas foram avaliadas segundo os critérios de terminologia comum para eventos adversos. Resultados: Com média de idade de 6,4 anos os locais primários dos tumores foram: 27 em vias ópticas/hipotálamo (1 disseminado), 7 em tronco cerebral, 3 em hemisfério cerebral, 2 em cerebelo, 1 intramedular e 1 gliomatose cerebral. Quatro pacientes apresentavam diagnóstico de neurofibromatose tipo 1 e três de síndrome diencefálica. Vinte e oito pacientes realizaram cirurgia, sendo glioma grau I em 21 casos e grau II em sete. Dezessete pacientes (42,5%) apresentaram resposta objetiva e em 23 doença estável. A toxicidade mais significativa foi hematológica, com neutropenia grau 3/4 em nove pacientes, ocorrendo apenas dois casos de neutropenia febril. Nenhuma toxicidade gastrointestinal grau 3/4 foi observada e apenas um caso de neurotoxicidade grau 3. Com seguimento médio de 56 meses, a sobrevida livre de progressão em 3 e 5 anos foi de 49,4% (I.C. a 95%: 33,2%; 65,4%) e 36,8% (I.C. a 95%: 20,7%; 52,9%), respectivamente e a global em 3 e 5 anos de 81,8%(I.C. a 95%: 69,6%; 94,0%). Conclusão: Os resultados sugerem ser o quimioterápico vinorelbina uma opção de tratamento para gliomas de baixo grau não ressecáveis e/ou em progressão demonstrando efetividade e baixa toxicidade.
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    Avaliação da qualidade de vida e toxicidades em pacientes com câncer colorretal tratados com quimioterapia adjuvante baseada em fluoropirimidinas
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2006-06-01) Roque, Vanessa Maria Nunes [UNIFESP]; Forones, Nora Manoukian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: The colorectal cancer is the fourth cause of cancer in Brazil and 5-fluorouracil is the drug most commonly used in the adjuvant or palliative treatment of this disease. AIM - Evaluating in patients with colorectal cancer and chemotherapy, the toxicity and the quality of life. PATIENTS AND METHODS: From March 2001 and May 2003, 45 patients treated with colorectal cancer treated with 5-fluourouracil and folinic acid were followed closely during six cycles. The gastrointestinal and hematologic toxicity was analysed making use of the chart Recommendations for the Graduation of Acute and Subacute Toxicity. After the end of each cycle of chemotherapy, the results were registered according to the respectives degrees that vary from 0 to 4. The quality of life was researched through the WHOQOL bref (World Health Organization Quality of Life) questionary that consists of 26 questions and 4 domains: physical, psychological, social relations and environmental, in the beginning, on the 3rd and 6th cycles of treatment. RESULTS: Among the 45 patients, 28 were male, the average age was 58.4 years old (from 34 to 79 years old). According to the International Union Against Cancer classification, 34 patients (75.6%) had tumors stage II or III and 11 had tumors stage IV (24.4%), 64.4% were in the colon. In 57.7% the chemotherapy was adjuvant and in the others palliative. The toxicities more commonly found were nauseas (42%), diarrhea (38%), and neutropenia (15.7%). There was no significant difference among the degrees of toxicity in the different cycles as well as among the patients in adjuvant or palliative treatment. Significant alterations was found among the quality of life in the physical and psychological domains when the 1st and the 2nd or the 1st and the 3rd application of the test were done. Alterations of the quality of life were also found in the social domain when the first evaluation was compared with the last one. There was no difference between the quality of life and the treatment.
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    Avaliação de marcadores cardíacos em pacientes com câncer de mama recebendo tratamento antineoplásico: uma revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2021) Soares, Tiago Nunes Da Silva [UNIFESP]; Pereira, Edimar Cristiano [UNIFESP]; Universidade Federal de São Paulo
    Cardiac markers are important biochemical indicators in the diagnosis of heart and coronary insufficiency, and it is through them that we can measure the damage to cardiac fibers resulting from these diseases. Recent research has shown that the levels of these biomarkers are altered in individuals who have neoplasms under chemotherapy treatment without these patients having any clinical manifestations. It is also known that one of the main adverse effects in treatment with antineoplastic agents is cardiotoxicity. The objective of this work was to carry out a systematic review of the main cardiac biomolecular markers in scientific publications bases and to verify how their levels present in individuals with breast cancer, as well as to analyze the influence of antineoplastic treatment in the circular levels of these markers as a resulting from the effects of cardiac damage on patient therapy and which are good predictors of cardiovascular diseases related to chemotherapy treatment. For this, three databases were used, namely: Medline, Lilacs and Cochrane. In these databases, systematic searches of publications were carried out between the years 2010 and 2020 using the descriptors "Mesh" or the equivalent in the chosen database. After searching the scientific publication in the databases, the duplicates were removed and the other publications were selected against the following eligibility criteria: studies only with breast cancer patients who received any type of chemotherapy treatment; studies that evaluated the following cardiac biomarkers: Troponin, pro-BNP / NT-pro-BNP, myoglobin, CK-MB, fibrinogen, and D-dimer; publications which the study design were clinical trials or observational studies; articles available in English, Spanish or Portuguese language. At the end, 31 published articles were obtained for analysis in which cardiac markers ultra-sensitive Troponin I and T, myoglobin, and NT-proBNP showed to be the best predictors of cardiotoxicity for breast cancer patient under chemotherapy.
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    Avaliação dos resultados de cateteres totalmente implantáveis para quimioterapia (região cervical e braquial) em pacientes oncológicos
    (Universidade Federal de São Paulo, 2024-07-03) Toledo, Marina Gonzalez de [UNIFESP}; Nazario, Afonso Celso Pinto [UNIFESP]; Sotelo, Fábio José Bonafé; http://lattes.cnpq.br/2379192786356080; http://lattes.cnpq.br/0266384667983727; http://lattes.cnpq.br/9479531821295218
    Introdução: Os dispositivos venosos totalmente implantáveis (DVTIs) ou ports, são essenciais para pacientes com neoplasia maligna que necessitam de quimioterapia e outros tratamentos parenterais de longa duração. Por serem totalmente implantáveis possibilitaram melhor qualidade de vida, maior durabilidade, menor taxa de infecção e outras complicaveis quando comparados aos demais dispositivos. O implante através da veia jugular interna tem sido a via preferencial de inserção, entretanto seu uso vem sendo debatido nos últimos anos devido a sua associação com complicavéis graves como pneumotórax, hemotórax, punção de artéria subclávia e artéria carótida. Uma alternativa para evitar essas complicações é a utilização de dispositivos venosos totalmente implantáveis de inserção periférica no braço, procedimento menos invasivo e com melhor resultado estético. Método: Estudo prospectivo no qual foram avaliados 36 pacientes com doença neoplásica oriundos do ambulatório de cirurgia vascular do Hospital Ipiranga – UGA II (público) e do Hospital Santa Catarina – Paulista (privado), submetidos ao implante de port através de acesso cervical ou braquial, de acordo com as indicações médicas e a preferÍncia do paciente. Estes pacientes foram submetidos ao procedimento e acompanhados por um perÌodo de 6 meses entre junho de 2018 á dezembro de 2023. Os desfechos primários avaliados foram: tempo do procedimento, complicavéis e desconforto do paciente no período intra-operatório e após 10 dias, 1 mês e 6 meses do procedimento. A avaliação do grau de satisfação foi realizada ao término do estudo com base na aplicação de um questionário específico. Resultados: Em todos os casos o procedimento foi concluido com sucesso e o funcionamento adequado dos cateteres foi confirmado. As complicações observadas nos pacientes com acesso braquial (dezenove casos) incluíram três casos de hematoma local, um caso de tromboflebite assintomática, um caso de infecção de loja subcutânea e um caso de dor ao esticar o braço. Todas essas complicações foram resolvidas sem a necessidade de procedimentos cirúrgicos. Houve um caso de extrusão por provável reação alérgica ao quimioterápico com necessidade de retirada precoce do port. Nos pacientes com acesso cervical (dezessete casos) foram observados dois casos de cateteres com mau funcionamento, sendo um deles com necessidade de retirada precoce do port, e mais um caso de infecção de loja subcutânea não responsiva ao tratamento clínico, sendo realizada também a retirada precoce do port. A maioria dos pacientes preferiram implantação do cateter no braço, contudo houve maior praticabilidade do acesso cervical pelo maior calibre venoso nesta topografia e disponibilidade do material adequado. Dos trinta e três pacientes que mantiveram o port por 6 meses e foram submetidos ao questionár·io de qualidade de vida (quinze pacientes com acesso cervical e dezoito pacientes com acesso braquial), trinta e dois recomendariam o implante do cateter para outra pessoa. Conclusão: A implantação do port através do acesso braquial e cervical não o apresentaram complicações graves, e os pacientes demonstraram elevada satisfação geral.
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    Biomonitoramento citogenético em células da mucosa bucal em mulheres diagnosticadas com câncer de mama e submetidas a quimioterapia após mastectomia
    (Universidade Federal de São Paulo (UNIFESP), 2016-02-12) Souza, Ana Carolina Flygare [UNIFESP]; Ribeiro, Daniel Araki [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Breast Cancer (CA) is the second most common neoplasm in the population around the world and it is very common in women, second only to skin cancer nonmelanoma. In Brazil, it is the leading cause of death in women between 40 and 69 years old. In addition to surgery, one of the most current therapies for CA is chemotherapy. Despite the increasing advances in the protocols for chemotherapy, there are still some remaining risks, closely related to further genetic damage in eukaryotic cells. Thus, the aim of this study was to evaluate possible cytotoxic and mutagenic effects caused by chemotherapy in women undergoing mastectomy for treatment of breast cancer.This study was cross-sectional and consisted of 42 women participants aged from 18 to 70 years old, allocated according to the diagnosis and stage of therapy for CA: control group (healthy) (n=15) , chemotherapy group (n=11) and post-chemotherapy group (n=16). Cytotoxicity and mutagenicity were evaluated by micronucleus test in buccal mucosa cells. Statistically significant increases (p<0.05) in the frequency of micronuclei were detected in the chemotherapy groups and post-chemotherapy compared to matched controls. The group undergoing chemotherapy there was also a statistically significant increase (p<0.05) in the frequency of karyorrhexis when compared to control or post-chemotherapy groups. In summary, chemotherapy induced mutagenicity and citotoxicity in oral mucosa cells, being the mutagenicity persistent, even after ending the CA therapy. However, it can be considered that women with breast CA undergoing chemotherapy comprising a risk group for the development of a second tumor.
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    Cancer treatment in determination of hearing loss
    (Assoc brasileira otorrinolaringologia & cirurgia cervicofacial, 2016) de Oliveira, Priscila Feliciano; Oliveira, Camila Silva; Andrade, Joice Santos; do Carmo Santos, Tamara Figueiredo; de Oliveira-Barreto, Aline Cabral [UNIFESP]
    Introduction: Chemotherapy and radiotherapy in oncology have repercussions in hearing health, and can damage structures of the inner ear. These repercussions usually, result in a bilateral and irreversible hearing loss. Objective: To identify sensorineural hearing toss cases with complaints of tinnitus and difficulty in speech understanding and investigate their relationship with the types of chemotherapy and radiotherapy the patients received. Methods: Cross-sectional, clinical, observational, analytical, historical cohort study of 58 subjects treated in a public hospital in the state of Sergipe, diagnosed with neoplasia. The subjects were submitted to anamnesis, conventional pure tone audiometry, and speech recognition threshold. Results: Of the 116 ears, 25.9% presented sensorioneural hearing loss characterized by changes in high frequencies. There was a positive correlation between hearing loss and the association of chemotherapy and radiotherapy (p= 0.035
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    Chance of psychiatric morbidity amongst recently diagnosed cancer outpatients attending a chemotherapy unit
    (Associação Brasileira de Divulgação Científica, 2005-09-01) Chaves, Ana Cristina [UNIFESP]; Pinto, Renata Novaes [UNIFESP]; Lourenço, Maria Teresa Duarte Pereira da Cruz [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital A.C. Camargo
    The prevalent rate of psychiatry morbidity amongst patients with cancer reported in various studies ranges from 5 to 50%, a variation that can be attributed to differences in sample size, the disease itself and treatment factors. The objectives of the present study were to determine the frequency of psychiatric morbidity amongst recently diagnosed cancer outpatients and try to identify which factors might be related to further psychological distress. Two hundred and eleven (70.9%) female patients and 87 (29.1%) male patients from the chemotherapy unit of the Cancer Hospital A.C. Camargo (São Paulo) completed a questionnaire that featured data on demographic, medical and treatment details. The Self Reporting Questionnaire (SRQ-20) was administered to the patients to determine their personal psychiatric morbidity. Seventy-two patients (25.8%) scored> or = 8 in the SRQ-20, the cut-off point for a patient to be considered a psychiatric case. When the low and high scoring groups were compared no differences were detected regarding age, marital status, tumor site, sex, or previous treatment. Nonetheless, patients in the lowest social class and those who were bedridden less than 50% of the time had a significantly higher probability of being a psychiatric case. Regarding help-seeking behavior in situations in which they had doubts or were frightened, about 64% of the total sample did not seek any type of support and did not talk to anyone. This frequency of psychiatric morbidity agrees with data from the cancer literature. According to many investigators, the early detection of a comorbid psychiatric disorder is crucial to relieve a patient's suffering.
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    Comparison between hybrid MOPPABV and ABVD chemotherapy protocols for Hodgkin's lymphoma in public hospitals of the largest South American city-a retrospective 14-year study
    (Springer, 2009-07-01) Souza, E. M. [UNIFESP]; Baiocchi, Otavio Carvalho Guimarães [UNIFESP]; Zanichelli, M. A. [UNIFESP]; Alves, A. C. [UNIFESP]; Oliveira, J. S. R. [UNIFESP]; Higienopolis São Paulo; Universidade Federal de São Paulo (UNIFESP)
    The behavior of Hodgkin's lymphoma (HL) is different in developing countries, perhaps due to differences in epidemiology and population access to health care. We performed a retrospective study comparing the efficacy of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPPABV) versus adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy protocols as first-line therapy for HL in a Brazilian population. A hundred and eighty-six HL patients were retrospectively analyzed regarding their first-line treatment with MOPPABV and ABVD at two public hospitals in SA o pound Paulo, Brazil. Eligible patients were either previously untreated or at first relapse after being treated with only radiotherapy with confirmed HL diagnosis. At a median follow-up of 9 years, complete remission is 89.5 and 85.9 (P = 0.3), overall survival 93.8% and 89.6% (P = 0.68), disease-free survival 85.6% and 81.6% (P = 0.41), and relapse ratios 20.9% and 26.4% (P = 0.17) for ABVD and MOPPABV, respectively. Extended-field radiation therapy postchemotherapy was mostly used in the MOPPABV group. There were three cases of secondary neoplasm (colon adenocarcinoma, myeloid chronic leukemia, and non-Hodgkin's lymphoma), all associated with MOPPABV. ABVD and MOPPABV protocols as first-line treatment for HL resulted in similar therapeutic outcomes and did not influence overall survival, disease-free survival, and relapse ratio. MOPPABV was related to a higher risk of secondary malignancy and, therefore, ABVD should be considered a better option for HL therapy. These findings corroborate recent data in literature.
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    Correlação entre os genes p53 e HIF-1-Alfa por técnica de imuno-histoquímica para avaliar os tumores de mulheres com câncer de ovário que obtiveram resposta positiva ou negativa ao tratamento com quimioterapia
    (Universidade Federal de São Paulo (UNIFESP), 2020-03-05) Escani, Juliana Cahale [UNIFESP]; Rocha, Rafael Malagoli [UNIFESP]; http://lattes.cnpq.br/0319099107474192; http://lattes.cnpq.br/2938366458915364; Universidade Federal de São Paulo
    Introduction: Ovarian cancer is considered one of the most lethal gynecological cancers for women. This cancer has four stages and can originate from different cell types. There are some factors that can lead to a higher risk of ovarian cancer such as family history, age and obesity. In contrast, there are some preventive factors for this cancer like a diet rich in healthy foods and physical activity. The absence of specific symptoms of this cancer leads to a delay in diagnosis, causing, in most cases, a late diagnosis of the cancer at a more advanced stage. Some tumor markers are related to ovarian cancer, such as p53 antibody. Objective: This study was intended to evaluate the correlation between immunohistochemical results of p53 antibody with clinical, demographic and anatomopathological data of the patients. Methods: A TMA (Tissue Microarray) was constructed with samples from 138 patients with high-grade serous epithelial ovarian cancer with stage III for analysis of the antibody. P53 antibody have been previously validated by immunohistochemistry. After validation, immunohistochemical was used to analyze the p53 protein in the TMA slide. Results: Results were statistically analyzed. The average age of patients diagnosed with ovarian cancer was 59 years. From 103 patients of the final p53 analysis, 70 patients were treatment sensitive and 26 patients were resistant. Only 10 patients had blood vascular invasion. Conclusion: The immunohistochemical results for the p53 antibody were directly related to age, sensitivity to adjuvant chemotherapy, relapse, death, mitosis in 10 fields and disease-free survival. Besides that, some clinical aspects were related to each other, such as, patients resistant to adjuvant chemotherapy presented high amount of mitoses in 10 fields.
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    Cyclooxygenase-2 and vascular endothelial growth factor expression in 5-fluorouracil-induced oral mucositis in hamsters: evaluation of two low-intensity laser protocols
    (Springer, 2009-11-01) Fontana Lopes, Nilza Nelly [UNIFESP]; Plapler, Helio [UNIFESP]; Chavantes, Maria Cristina; Lalla, Rajesh V.; Yoshimura, Elisabeth Mateus; Seixas Alves, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Univ Connecticut
    The aim of this study was to investigate the mechanisms whereby low-intensity laser therapy may affect the severity of oral mucositis.A hamster cheek pouch model of oral mucositis was used with all animals receiving intraperitoneal 5-fluorouracil followed by surface irritation. Animals were randomly allocated into three groups and treated with a 35 mW laser, 100 mW laser, or no laser. Clinical severity of mucositis was assessed at four time-points by a blinded examiner. Buccal pouch tissue was harvested from a subgroup of animals in each group at four time-points. This tissue was used for immunohistochemistry for cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), and factor VIII (marker of microvessel density) and the resulting staining was quantified.Peak severity of mucositis was reduced in the 35 mW laser group as compared to the 100 mW laser and control groups. This reduced peak clinical severity of mucositis in the 35 mW laser group was accompanied by a significantly lower level of COX-2 staining. the 100 mW laser did not have an effect on the severity of clinical mucositis, but was associated with a decrease in VEGF levels at the later time-points, as compared to the other groups. There was no clear relationship of VEGF levels or microvessel density to clinical mucositis severity.The tissue response to laser therapy appears to vary by dose. Low-intensity laser therapy appears to reduce the severity of mucositis, at least in part, by reducing COX-2 levels and associated inhibition of the inflammatory response.
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    DNA damage in lymphocytes and buccal mucosa cells of children with malignant tumours undergoing chemotherapy
    (Springer, 2008-06-01) Minicucci, Eliana Maria; Ribeiro, Daniel Araki [UNIFESP]; Camargo, Beatriz de; Costa, Maria C.; Ribeiro, Lucia Regina; Salvadori, Daisy Maria Favero; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); AC Camargo Hosp
    The aim of the present study was to evaluate DNA damage (micronucleus) in cytokinesis-blocked lymphocytes and exfoliated buccal mucosa cells from children with malignant tumours and under chemotherapy. Micronucleated cells (MNCs) were assessed from children before and during chemotherapy. A total of 21 healthy children (controls), matched for gender and age, were used as control. the results pointed out higher frequencies of micronucleated lymphocytes in children with malignant tumour before any therapy when compared to healthy probands. Furthermore an increase of micronucleated lymphocytes during chemotherapy was detected when compared to the data obtained before chemotherapy. No statistically significant increases of MNCs were noticed in buccal mucosa cells at any of the timepoints evaluated. Taken together, these data indicate that the presence of malignant tumours may increase the frequency of DNA damage in circulating lymphocytes, these cells being more sensitive for detecting chromosome aberrations caused by anti-cancer drugs.
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    Doxorubicin caused severe hyperglycaemia and insulin resistance, mediated by inhibition in AMPk signalling in skeletal muscle
    (Wiley-Blackwell, 2016) de Lima Junior, Edson Alves; Yamashita, Alex Shimura; Pimentel, Gustavo Duarte; De Sousa, Luis G. O.; Santos, Ronaldo Vagner Thomatieli dos [UNIFESP]; Goncalves, Cinara Ludvig; Streck, Emilio Luiz; de Lira, Fabio Santos; Rosa Neto, Jose Cesar
    Background Cancer is considered the second leading cause of death in the world, and for the treatment of this disease, pharmacological intervention strategies are frequently based on chemotherapy. Doxorubicin (DOX) is one of the most widely used chemotherapeutic agents in clinical practice for treating a number of solid tumours. The treatment with DOX mimics some effects of cancer cachexia, such as anorexia, asthenia, decreases in fat and skeletal muscle mass and fatigue. We observed that treatment with DOX increased the systemic insulin resistance and caused a massive increase in glucose levels in serum. Skeletal muscle is a major tissue responsible for glucose uptake, and the positive role of AMPk protein (AMP-activated protein kinase) in GLUT-4 (Glucose Transporter type 4) translocation, is well established. With this, our aim was to assess the insulin sensitivity after treatment with DOX and involvement of AMPk signalling in skeletal muscle in this process. Methods We used Wistar rats which received a single dose of doxorubicin (DOX group) or saline (CT group) intraperitoneally at a dose of 15mg/kg b.w. The expression of proteins involved in insulin sensitivity, glucose uptake, inflammation, and activity of electron transport chain was assessed in extensor digitorum longus muscle, as well as the histological evaluation. In vitro assays were performed in L6 myocytes to assess glucose uptake after treatment with DOX. Agonist of AMPk [5-aminoimidazole-4-carboxamide (AICAR)] and the antioxidant n-acetyl cysteine were used in L6 cells to evaluate its effect on glucose uptake and cell viability. Results The animals showed a significant insulin resistance, hyperglycaemia, and hyperinsulinemia. A decrease in the expression of AMKP and GLUT-4 was observed in the extensor digitorum longus muscle. Also in L6 cells, DOX leads to a decrease in glucose uptake, which is reversed with AICAR. Conclusions DOX leads to conditions similar to cachexia, with severe glucose intolerance both in vivo and in vitro. The decrease of AMPk activity of the protein is modulated negatively with DOX, and treatment with agonist of AMPk (AICAR) has proved to be a possible therapeutic target, which is able to recover glucose sensitivity in skeletal muscle.