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Start Over Author "Viggiano, M." Topic hydatidiform mole
5 results on '"Viggiano, M."'

1. Influence of COVID-19 pandemic on molar pregnancy and postmolar gestational trophoblastic neoplasia: An observational study.

Author

Campos V, Paiva G, Padron L, Freitas F, Pedrotti LG, Sun SY, Viggiano M, Oliveira L, Rohr L, Madi JM, Arrym TP, Oliveira P, Dos Santos Esteves APV, Junior JA, Filho JR, Elias KM, Horowitz NS, Braga A, and Berkowitz RS

Subjects
Pregnancy, Female, Humans, Pandemics, Retrospective Studies, Cross-Sectional Studies, Chorionic Gonadotropin, COVID-19 epidemiology, Hydatidiform Mole epidemiology, Hydatidiform Mole therapy, Gestational Trophoblastic Disease epidemiology
Abstract

Objective: To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID-19 pandemic., Design: Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross-sectional analysis, with application of a questionnaire., Setting: Six Brazilian Reference Centres on gestational trophoblastic disease., Population: 2662 patients with MP/postmolar GTN treated from March-December/2015-2020 were retrospectively evaluated and 528 of these patients answered a questionnaire., Methods: Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross-sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID-19 pandemic compared with previous years., Main Outcome Measures: The incidence of MP/postmolar GTN., Results: Compared with the last 5 pre-pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID-19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be >10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90-3.29, P < 0.001), have a pre-evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38-2.28, P < 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01-3.43, P = 0.047) when compared with 2015-2019., Conclusions: Although the incidence of MP/postmolar GTN remained stable during the COVID-19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN., (© 2022 John Wiley & Sons Ltd.)

Published
2023
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2. Does a human chorionic gonadotropin level of over 20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole constitute an indication for chemotherapy for gestational trophoblastic neoplasia?

Author

Braga A, Biscaro A, do Amaral Giordani JM, Viggiano M, Elias KM, Berkowitz RS, and Seckl MJ

Subjects
Adult, Brazil, Female, Gestational Trophoblastic Disease pathology, Humans, Neoplasm Staging, Pregnancy, Risk Factors, Uterine Perforation pathology, Chorionic Gonadotropin blood, Gestational Trophoblastic Disease blood, Gestational Trophoblastic Disease drug therapy, Hydatidiform Mole complications, Hydatidiform Mole therapy
Abstract

Objective: To evaluate whether a human chorionic gonadotropin (hCG) level ≥20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole (CHM) is an appropriate indicator for initiating chemotherapy for the treatment of gestational trophoblastic neoplasia (GTN)., Study Design: Historical database review of 1228 women with CHM who received treatment and follow-up between January 2000 and June 2013 at four Brazilian trophoblastic disease centers. The primary outcome measure was the progression from CHM to GTN. The secondary outcomes were the occurrence of uterine perforation, staging of GTN, WHO/FIGO risk score, and treatment (use of single- or multiagent chemotherapy)., Results: An hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM, while occurring in only 6.1% of women, was the most important risk factor for the development of postmolar GTN (adjusted RR = 5.83; p < 0.01; CI: 3.47-9.79), with a sensitivity of 36.8%, a specificity of 98.6%, a positive predictive value of 80%, and a negative predictive value of 91.1%. On the other hand, there were no differences in postmolar GTN stage, prognostic score, or need for multiagent chemotherapy relative to hCG level ≥20,000 IU/L versus <20,000 IU/L., Conclusions: Although hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM was very predictive of development of post-molar GTN, delay in treatment until hCG plateau or increase did not affect outcomes, with no uterine perforations or treatment failures., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Published
2018
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3. Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6months after uterine evacuation?

Author

Braga A, Torres B, Burlá M, Maestá I, Sun SY, Lin L, Madi JM, Uberti E, Viggiano M, Elias KM, and Berkowitz RS

Subjects
Adolescent, Adult, Brazil, Case-Control Studies, Chemotherapy, Adjuvant, Cohort Studies, Cyclophosphamide administration & dosage, Dactinomycin administration & dosage, Etoposide administration & dosage, Female, Gestational Trophoblastic Disease, Humans, Hydatidiform Mole blood, Hydatidiform Mole pathology, Leucovorin administration & dosage, Methotrexate administration & dosage, Middle Aged, Neoplasm Staging, Pregnancy, Retrospective Studies, Treatment Outcome, Uterine Neoplasms blood, Uterine Neoplasms pathology, Vincristine administration & dosage, Young Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chorionic Gonadotropin blood, Hydatidiform Mole drug therapy, Uterine Neoplasms drug therapy, Vacuum Curettage, Watchful Waiting
Abstract

Objective: To compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6months after uterine evacuation., Methods: Retrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016., Results: At 6months from uterine evacuation, 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8months; p=0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6months; p<0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p=0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p=0.60). None of the women relapsed, and no deaths occurred in either group., Conclusion: In order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Published
2016
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4. Brazilian network for gestational trophoblastic disease study group consensus on management of gestational trophoblastic disease

Author

Braga, A., Souza, P. O., Dos Santos Esteves, A. P. V., Padrón, L., Uberti, E., Viggiano, M., Sun, S. Y., Izildinha Maestá, Elias, K. M., Horowitz, N., Berkowitz, R., Grillo, B., Botogoski, S. R., Madi, J. M., Cardoso, R. B., Costa, F. R. P., Filho, A. C., Filho, H. Z. B., Osanan, G. C., Gomes, D. A. Y., Lin, L. H., Pitorri, A., Silveira, E., Andrade, J. M., Sousa, C. B., Fernandes, K. G., Rezende-Filho, J., Junior, J. A., Cardoso, F. F. O., Asmar, F. T. C., Pesce, R. R. P., Moraes, V., Obeica, B., Mora, P., Gonçalves, V. C., Itaborahy, R. M. R., Resende, S. S., Dos Santos Júnior, J. A., Costa, A., Melo, E., Paiva, C. S. M., Silva, M. C., Melo, M. C. L., Martins, M. G., Menezes, M. P. N., Costa, O. L. N., Amorim, M. M. R., E Silva, J. M. M., Moraes, F. R. R., Brum, I. R., Macedo Lins, C. D., Da Luz, M. G. Q., Da Silva, N. C., Silva, R. C. A. F., Leal, E. A. S., Fluminense Federal University, Irmandade da Santa Casa de Misericordia Hospital, Goias Federal University, Sao Paulo Federal University, Universidade Estadual Paulista (UNESP), Harvard Medical School, Clinics Hospital of Parana Federal University, General Hospital of Caxias do Sul University, Carmela Dutra Maternity, Santa Casa Misericordia de Vitoria, Clinics Hospital of Espirito Santo Federal University, Clinics Hospital of Minas Gerais Federal University, Universidade Estadual de Campinas (UNICAMP), Universidade de São Paulo (USP), Maternity School of Dr Mario de Moraes Altenfelder Silva (Vila Nova Cachoeirinha), Guilherme Alvaro Hospital of Lusiada University Center, University Hospital of Jundiai Medical Faculty, Rio de Janeiro Federal University, Regional Hospital of Asa Norte Trophoblastic Disease Center, Julio Muller University Hospital of Mato Grosso Federal University Cuiaba, Regional Hospital of Mato Grosso do Sul. Campo Grande, University Hospital of Piaui Federal University, Pernambuco Institute of Maternal Child Health, Clinics Hospital of Pernambuco Federal University, Lauro Wanderley University Hospital of Paraiba Federal University, University Hospital of Alagoas Federal University, Januario Cicco Maternity School of Rio Grande do Norte University, Marly Sarney State Maternity, University Hospital of Sergipe Federal University, Climerio de Oliveira Maternity of Bahia Federal University, University Hospital of Campina Grande Federal University, Assis Chateaubriand Maternity School of Ceara Federal University, Dona Regina Maternity, Getulio Vargas University Hospital, Roraima General Hospital, Santa Casa de Misericordia do Para Foundation, Mae Luiza Women’s Hospital, Ary Pinheiro Hospital of Base, and Clinics Hospital of Acre

Subjects
Gestational trophoblastic disease, Rare cancers, Hydatidiform mole, Brazil
Abstract

Made available in DSpace on 2022-04-30T09:10:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 OBJECTIVE: To present the Brazilian Network for Gestational Trophoblastic Disease Study Group consensus on management of gestational trophoblastic disease (GTD). STUDY DESIGN: The modified Delphi technique was used in this study to obtain a consensus among Brazilian specialists on the treatment of GTD. For the 64 statements listed, each participant was asked to assign a Likert scale value according to their agreement. The RAND/UCLA method was used to define the level of consensus among the specialists. RESULTS: The response rate of the potential study participants after the 2 rounds was 40/47 (85%). Of the 64 statements presented, there was an agreement on 54/64 (84%). The situations of disagreement were as follows: 1/12 (8%) statements in the section on diagnosis of GTD, 5/10 (50%) statements in the section on treatment of hydatidiform mole (HM), 2/16 (12.5%) statements in the section on diagnosis of gestational trophoblastic neoplasia (GTN), 1/14 (7%) statements in the section on treatment and followup of GTN, and 1/5 (20%) statements in the section on appropriate time to allow pregnancy after HM and GTN. CONCLUSION: This guideline will serve to standardize the conduct among the Brazilian GTD reference centers as well as to guide the new specialized services that may arise and eventually to physicians who may need to treat cases of GTD. Rio de Janeiro Trophoblastic Disease Center Fluminense Federal University Porto Alegre Trophoblastic Disease Center Mario Totta Maternity Ward Irmandade da Santa Casa de Misericordia Hospital Goiania Trophoblastic Disease Center Clinics Hospital of Faculty of Medicine Goias Federal University Sao Paulo Trophoblastic Disease Center Sao Paulo Hospital Paulista School of Medicine Sao Paulo Federal University Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School Sao Paulo State University New England Trophoblastic Disease Center Department of Obstetrics and Gynecology Division of Gynecologic Oncology Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School Clinics Hospital of Parana Federal University General Hospital of Caxias do Sul University Carmela Dutra Maternity Santa Casa Misericordia de Vitoria Clinics Hospital of Espirito Santo Federal University Clinics Hospital of Minas Gerais Federal University Campinas University Clinics Hospital of Sao Paulo University Maternity School of Dr Mario de Moraes Altenfelder Silva (Vila Nova Cachoeirinha) Guilherme Alvaro Hospital of Lusiada University Center University Hospital of Jundiai Medical Faculty Rio de Janeiro Federal University Fluminense Federal University Regional Hospital of Asa Norte Trophoblastic Disease Center, Distrito Federal Julio Muller University Hospital of Mato Grosso Federal University Cuiaba Regional Hospital of Mato Grosso do Sul. Campo Grande University Hospital of Piaui Federal University Pernambuco Institute of Maternal Child Health Clinics Hospital of Pernambuco Federal University Lauro Wanderley University Hospital of Paraiba Federal University University Hospital of Alagoas Federal University Januario Cicco Maternity School of Rio Grande do Norte University Marly Sarney State Maternity University Hospital of Sergipe Federal University Climerio de Oliveira Maternity of Bahia Federal University University Hospital of Campina Grande Federal University Assis Chateaubriand Maternity School of Ceara Federal University Dona Regina Maternity Getulio Vargas University Hospital Roraima General Hospital Santa Casa de Misericordia do Para Foundation Mae Luiza Women’s Hospital Ary Pinheiro Hospital of Base Clinics Hospital of Acre Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School Sao Paulo State University

5. Centralized coordination of decentralized assistance for patients with gestational trophoblastic disease in Brazil: A viable strategy for developing countries

Author

Braga, A., Burlá, M., Freitas, F., Uberti, E., Viggiano, M., Sue Sun, Maestá, I., Elias, K. M., Berkowitz, R. S., Goldstein, D. P., Grillo, B., Madi, J. M., Costa, F. R. P., Filho, A. C., Filho, H. Z. B., Osanan, G. C., Gomes, D. A. Y., Lin, L. H., Pitorri, A., Silveira, E., Andrade, J., Fernandes, K. G., Rezendefilho, J., Amim Junior, J., Moraes, V., Gonçalves, V. C., Itaborahy, R. M. R., Resende, S. S., Dos Santos Júnior, J. A., Costa, A., Paiva, C. S. M., Silva, M. C., Melo, M. C. L., Martins, M. G., Nogueira Menezes, M. P., Costa, O. L. N., Amorim, M. M. R., E Silva, J. M. M., Deus, J., Lins, C. D. M., Brum, I. R., Da Luz, M. G. Q., Da Silva, N. C., Ferreira Silva, R. C. A., Leal, E. A. S., Fluminense Federal University, Irmandade da Santa Casa de Misericórdia Hospital, Goiás Federal University, São Paulo Federal University, Universidade Estadual Paulista (UNESP), Trophoblastic Tumor Registry, Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School, Clinics Hospital of Paraná Federal University, General Hospital of Caxias do Sul University, Carmela Dutra Maternity, Santa Casa Misericórdia de Vitoria, Clinics Hospital of Espírito Santo Federal University, Clinics Hospital of Minas Gerais Federal University, Universidade Estadual de Campinas (UNICAMP), Universidade de São Paulo (USP), Maternity School of Dr. Mário de Moraes Alten-felder Silva (Vila Nova Cachoeirinha), Guilherme Alvaro Hospital of Lusiada University Center, University Hospital of Jundiai Medical Faculty, Rio de Janeiro Federal University, Regional Hospital of Asa Norte Trophoblastic Disease Center, Júlio Müller University Hospital of Mato Grosso Federal University Cuiabá, Regional Hospital of Mato Grosso do Sul, University Hospital of Piaui Federal University, Instituto de Medicina Integral Professor Fernando Figueira, Lauro Wanderley University Hospital of Paraíba Federal University, University Hospital of Alagoas Federal University, Januário Cicco Maternity School of Rio Grande do Norte University, Maranhão Federal University, University Hospital of Sergipe Federal University, Climério de Oliveira Maternity of Bahia Federal University, University Hospital of Campina Grande Federal University, Assis Chateaubriand Maternity School of Ceará Federal University, Dona Regina Maternity, Roraima General Hospital, Getúlio Vargas University Hospital, Santa Casa de Misericórdia do Pará Foundation, Mãe Luiza Women’s Hospital, Ary Pinheiro Hospital of Base, and Clinics Hospital of Acre

Subjects
Gestational trophoblastic disease, Chemotherapy, Hydatidiform mole, Brazil, Gestational trophoblastic neoplasia, Molar pregnancy
Abstract

Made available in DSpace on 2022-05-02T14:14:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-06-01 OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease’s (GTD) formation of a network of regional care at specialized centers for women with GTD. STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided. RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%. CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases. Rio de Janeiro Trophoblastic Disease Center Maternity School of Rio de Janeiro Federal University and Antonio Pedro University Hospital Fluminense Federal University Porto Alegre Trophoblastic Disease Center Mario Totta Maternity Ward Irmandade da Santa Casa de Misericórdia Hospital Goiania Trophoblastic Disease Center Clinics Hospital of Faculty of Medicine Goiás Federal University São Paulo Trophoblastic Disease Center São Paulo Hospital Paulista School of Medicine São Paulo Federal University Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University New England Trophoblastic Disease Center Trophoblastic Tumor Registry Division of Gynecologic Oncology Department of Obstetrics and Gynecology Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School Clinics Hospital of Paraná Federal University General Hospital of Caxias do Sul University Carmela Dutra Maternity Santa Casa Misericórdia de Vitoria Clinics Hospital of Espírito Santo Federal University Clinics Hospital of Minas Gerais Federal University Campinas University Clinics Hospital of São Paulo University Maternity School of Dr. Mário de Moraes Alten-felder Silva (Vila Nova Cachoeirinha) Guilherme Alvaro Hospital of Lusiada University Center University Hospital of Jundiai Medical Faculty Rio de Janeiro Federal University Fluminense Federal University Regional Hospital of Asa Norte Trophoblastic Disease Center, Distrito Federal Júlio Müller University Hospital of Mato Grosso Federal University Cuiabá Regional Hospital of Mato Grosso do Sul University Hospital of Piaui Federal University Instituto de Medicina Integral Professor Fernando Figueira Lauro Wanderley University Hospital of Paraíba Federal University University Hospital of Alagoas Federal University Januário Cicco Maternity School of Rio Grande do Norte University Maternal Child Unity of University Hospital Maranhão Federal University University Hospital of Sergipe Federal University Climério de Oliveira Maternity of Bahia Federal University University Hospital of Campina Grande Federal University Assis Chateaubriand Maternity School of Ceará Federal University Dona Regina Maternity Roraima General Hospital Getúlio Vargas University Hospital Santa Casa de Misericórdia do Pará Foundation Mãe Luiza Women’s Hospital Ary Pinheiro Hospital of Base Clinics Hospital of Acre Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University

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