Browsing by Autor "Mari Uyeda"

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Clinical pathological features and radiotherapy treatment for adenoid cystic carcinoma of the head and neck
(2024) Gabriel Maluf; Alberto Domingues Vianna; Maria Graziela Kenupp; Mari Uyeda
Adenoid Cystic Carcinoma (ACC) is a slow-growing, locally invasive malignant tumour, with a deceptively benign histological appearance, a high probability of local recurrence and distant metastasis. The tumour comprises basaloid cells with small, angular and hyperchromatic nuclei and scarce cytoplasm arranged into three significant prognostic patterns: cribriform, tubular, and solid. In some tumours, dedifferentiation to a high-grade form occurs. The authors have reviewed numerous studies which have attempted to demonstrate accurate histological prognostic features, but these have often produced conflicting results. The literature review suggests that Analysis of microarray and gene expression profiles provided new potential diagnostic and prognostic markers. However, tumor grade, lymph node metastasis, invasion of major nerves, and resection margin status continue to be the most consistent predictors of prognosis. The optimal treatment of ACC has not yet been fully established, although most studies advocate using surgical excision and postoperative radiotherapy. Careful tumor staging and grading with documentation of perineural invasion and margin status remain important prognostic tools. ACC has been incurable, and most patients will eventually succumb to local recurrence, distant metastasis, or both. The clinical course of the disease can be surprisingly heterogeneous, with some patients surviving decades and others surviving only months. The combination of surgery and radiotherapy in the postoperative period has shown the best locoregional disease control. Contribution to Evidence-Based healthcare: This review contributes to a better understanding of the treatment of patients diagnosed with cystic adenocarcinoma of the head and neck, with regard to treatment with curative radiotherapy, as part of the proposed treatment or even to reduce the effects of the disease.
Impact of Adjuvant Radiotherapy on Survival of Patients with Stage I-II Endometrial Cancer
(2026) Mari Uyeda; Maluf Gabriel; Kenupp Maria Graziela de fátima Alvarez
Introduction: Endometrial cancer is the most common gynecological neoplasm in developed countries. Most cases are diagnosed early, and surgical treatment is usually curative. The role of adjuvant radiotherapy is controversial, especially for patients with intermediate or high-risk factors. The increasing variety of therapies and emphasis on personalized treatment underscore the need to critically assess the impact of radiotherapy on patient outcomes. Therefore, this study aims to evaluate the impact of adjuvant radiotherapy on clinical outcomes in patients with endometrial cancer who have intermediate or high-risk factors. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered on the PROSPERO platform. A literature search was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Lilacs, and SciELO. The search covered publications up to August 2025. Controlled descriptors (MeSH) and free keywords were used, combined with Boolean operators. Original studies with clinical data on patients undergoing adjuvant radiotherapy, published in Portuguese, English, or Spanish, were included. Results: After screening and evaluating the full texts, 12 studies were included, totaling 18,975 patients. The studies analyzed different radiotherapy modalities, such as external beam radiotherapy, vaginal brachytherapy, and combination therapy with chemotherapy. The results demonstrated that adjuvant radiotherapy significantly contributes to reducing locoregional recurrence and improving disease-free survival, especially in patients with risk factors such as high tumor grade, lymphovascular invasion, or malignant peritoneal cytology. Vaginal brachytherapy showed similar efficacy to external beam radiotherapy in many cases, with less toxicity. Recent studies propose selective treatment deintensification and the use of molecular profiles to guide radiotherapy indications, as evidenced in the PORTEC-4a clinical trial. Conclusions: Adjuvant radiotherapy plays a relevant role in the management of early-stage endometrial cancer and should be indicated selectively based on clinical, histological, and molecular criteria.
Patients with Colorectal Cancer
(2024) Maria Graziela Kenupp; Alberto Domingues Vianna; Mari Uyeda; Gabriel Maluf
Abstract:Background: Colorectal cancer (CRC) is one of the most common cancers in the Western world, with approximately 1.2 million people diagnosed worldwide each year. Most CRCs are sporadic, resulting from chromosome instability and dysplasia of adenomas to carcinomas. At the same time, the hereditary syndromes of familial adenomatous polyposis (FAP) and hereditary nonpolyposis colpos (HNPCC) arise due to germline mutations in the APC gene and the microsatellite instability pathway. Dysbiosis and associated chronic inflammation have previously been implicated in inflammatory bowel disease, irritable bowel syndrome, and type 2 diabetes mellitus. They are now known to facilitate carcinogenesis in CRC through genetic and epigenetic mechanisms. The dysbiotic bacterium primarily implicated in CRC is Fusobacterium nucleatum, associated with microsatellite instability and lymph node metastasis in clinical trials. Recent clinical studies have also suggested that they may affect prognosis, which, if established, could potentially signal a new frontier in the diagnosis, evaluation and therapeutic management of CRC. Objectives: To systematically review the literature to gather evidence investigating the associations between gut microbiota and CRC, colorectal adenomas, CRC tumour site, CRC stage, prognosis and survival, and the effect of current therapy performed for the treatment of CRC. Methodology: A systematic review of the published literature. Results: 53 studies were considered relevant for inclusion, covering a total of 5167 CRC patients, of which 3754 were tested through mucosal tissue samples, 1072 through stool samples and 341 through a combination. Conclusion: There is a significant association between gut microbiome and CRC, with emphasis on Fusobacterium (genus) and F. nucleatum (species). This association appears to exist more in advanced stages of the tumour and/or adenoma and is often associated with worse prognosis and shorter survival.Keywords: Colorectal cancer, familial adenomatous polyposis, Fusobacterium nucleatum, intestinal microbiota