Adjuvant chemoradiotherapy with procarbazine, lomustine, and vincristine (PCV) or temozolomide for 1p/19q Co-deleted anaplastic oligodendroglioma: a systematic review and network meta-analysis Monica D’Alma Costa Santos, Natasha Maranhão Vieira Rodrigues, Franceliny Gibram, Felipe Araujo Gouhie, Ana Carolina Pinheiro Campos, Danielle Varin de Assis, Cleiton Formentin, Olavo Feher, Alice Roxo Nobre de Souza e Silva, Samir Abdallah Hanna, Caroline Chung, Caroline Chaul Barbosa, Fabio Ynoe Moraes, Marcos Vinicius Calfat Maldaun BMC Cancer, 2025 INTRODUCTION: Anaplastic oligodendrogliomas are rare diffuse gliomas. Although radiotherapy (RT) combined with procarbazine, lomustine, and vincristine (PCV) has been the historical standard, temozolomide (TMZ) has been increasingly used. OBJECTIVE: To compare the efficacy of RT combined with PCV versus RT combined with TMZ in adult with anaplastic oligodendroglioma. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to March 2025. Eligible studies included patients with 1p/19q-codeleted anaplastic oligodendroglioma treated with RT + PCV, RT + TMZ, or RT alone. Studies comparing RT alone to RT + PCV or RT + TMZ were used to create indirect comparisons, with RT as a common comparator. A frequentist network meta-analysis with a random-effects model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS). Risk of bias was assessed with RoB 2 and ROBINS-I. The protocol was registered in PROSPERO (CRD420251012169). No funding was received. RESULTS: Eight studies comprising 2,416 patients were included. The network meta-analysis, compared with RT alone, RT + PCV significantly improved OS (HR: 0.617; 95% CI 0.465-0.819; p = 0.0009), and PFS (HR: 0.547; 95% CI 0.415-0.721; p < 0.0001), while RT + TMZ showed a trend toward improved OS (HR: 0.913; 95% CI 0.666-1.252; p = 0.421) and PFS (HR: 1.270; 95% CI 0.870-1.855; p = 0.215), without statistical significance. In the comparison between RT + PCV and RT + TMZ, RT + PCV demonstrated superior OS (HR: 0.676; 95% CI, 0.585-0.781; p < 0.0001) and better PFS (HR: 0.431; 95% CI, 0.325-0.570; p < 0.0001). Limitations include the small number of randomized trials directly comparing key outcomes, and the fact that most studies predated current molecular diagnostic criteria, with toxicity data often reported in heterogeneous populations. CONCLUSION: In patients with anaplastic oligodendroglioma, RT combined with PCV provides superior survival outcomes compared to radiotherapy combined with TMZ.
Stereotactic Body Radiosurgery Associated With Rectal Displacement using Gelfoam for Sacral Chordomas: Preliminary Report of 3 Cases Samir Abdallah Hanna, Thiago Dieb Ristum Vieira, Fernanda Hayashida Yoshimoto, Eduardo Samir Cipriano Hanna, William Gemio Jacobsen Teixeira, Douglas Kenji Narazaki, Wellington Furtado Pimenta Neves-Junior, Rodrigo Ramella Munhoz, Marcos Vinícius Calfat Maldaun, João Luis Fernandes da Silva, Gustavo Nader Marta Advances in Radiation Oncology, 2025 Purpose: The treatment of sacral chordomas remains challenging because of high recurrence rates, postoperative complications, and limited effective radiation therapy options. We report a small case series of sacral chordoma treated exclusively with photon-based stereotactic body radiation therapy (SBRT), incorporating rectal displacement via tomography-guided radiointerventional interposition of a Gelfoam-based solution. This novel combination has not been previously described in the literature. Methods and Materials: Patients with biopsy-confirmed sacral conventional chordomas were included. All patients underwent SBRT with rectal displacement, receiving a single 24-Gy fraction. Treatment parameters and planning details are outlined. Results: Between 2022 and 2024, 3 patients were analyzed. Two were treatment-naïve, whereas 1 had recurrent disease. The median age was 62 years (range, 57-70). After a median follow-up of 21 months (range, 3-32), the local control rate was 100%; there were no treatment-related clinically significant adverse events (including gastrointestinal/rectal toxicities), except for 1 patient who experienced transient pain. The average dose-gradient of 1.4 Gy/mm toward the rectum because of displacement, leading to a potential reduction of the rectal dose by approximately 7 to 14 Gy. Conclusions: This small case series suggests that SBRT with rectal using a Gelfoam-based solution is a feasible and well-tolerated approach for sacral chordoma treatment. Further prospective studies with larger cohorts and extended follow-up are warranted to validate these findings and assess long-term efficacy and safety.
Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis Samir Abdallah Hanna, Bruna Salani Mota, Fabio Ynoe de Moraes, Gustavo Nader Marta, Heloísa de Andrade Carvalho, Rachel Riera Sao Paulo Medical Journal, 2025 BACKGROUND: Radiation therapy (RT) is a standard treatment for non-metastatic breast cancer and is associated with acute and late toxicities. Intensity-modulated RT (IMRT) may decrease toxicity and is convenient for patients. OBJECTIVES: To assess the efficacy and safety of IMRT in women with early stage breast cancer. DESIGN AND SETTING: Systematic review study; Multi-institutional centers. METHODS: Seven databases were searched. Randomized controlled trials (RCT) comparing IMRT with any “non-IMRT” strategies were included. Primary outcomes were local control and acute toxicity. Cochrane Handbook was use to plan and conduct the review, and PRISMA 2020 was used to report results. RESULTS: Five RCT involving 2,556 women (n = 1,283 IMRT; n = 1,274 control arm) were included. Baseline characteristics were similar between trials and arms. Local relapse-free survival rates were not different (hazard-ratio [HR] 0.62; 95%confidence interval [CI] -0.38 to 1.62; P > 0.05); however, IMRT reduced the overall acute toxicity (RR 0.69, 95%CI 0.58 to 0.82; P < 0.00001) and acute moist desquamation (risk-ratio [RR] 0.71, 95%CI 0.60 to 0.82; P < 0.00001). Lymphedema and pneumonitis rates, and survival outcomes were not affected by IMRT. The 2-year telangiectasia rate was decreased with IMRT (RR 0.66, 95%CI 0.47 to 0.93; P = 0.02); however, edema, pain, pigmentation, or fibrosis remained unaffected. IMRT did not improve cosmesis. CONCLUSIONS: IMRT improved acute toxicity and lowered telangiectasia rates, without affecting oncological and aesthetic outcomes. SYSTEMATIC REVIEW REGISTRATION: This review was registered at Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD010420. https://doi.org/10.1002/14651858.CD010420.
Wallerian degeneration of the corticospinal tract following multimodal high-grade glioma treatment: a case series and recommendations for radiotherapy planning Monica D'Alma Costa Santos, Natasha Maranhão Vieira Rodrigues, Franceliny Gibram, Julia Brunelli, Ana Carolina Pinheiro Campos, Anselmo Mancini, Olavo Feher, Gustavo Nader Marta, Samir Abdallah Hanna, Caroline Chung, Fabio Ynoe Moraes, Marcos Vinicius Calfat Maldaun Frontiers in Oncology, 2025 Introduction Wallerian Degeneration of the Corticospinal Tract (WDCT) is a scarcely reported complication of multimodal treatment for high-grade gliomas, which, despite its potential clinical impact, may lead to severe motor dysfunction and impair quality of life. Methodology This retrospective case series describes 13 adult patients with high-grade gliomas treated between 2018 and 2023 who developed imaging findings consistent with WDCT after receiving multimodal treatment. Clinical and radiological data were collected from medical records; a standardized imaging follow-up or functional scoring system was not applied. Tractography was retrospectively available for two cases, enabling its incorporation into radiotherapy planning system for CST precise delineation and corresponding dose estimation. Results WDCT was identified in 13 out of 192 high-grade glioma patients (6.8%). Diagnosis was based on T2/FLAIR hyperintensity along the ipsilateral CST with compatible clinical symptoms. Three cases developed WDCT after reirradiation, and seven (53.8%) had received bevacizumab prior to diagnosis: two during disease progression, two for the treatment of radionecrosis, and three as prophylaxis. Clinical symptomatology was detailed to 11 patients, 72.7% presented with hemiparesis, and 36.4% had seizures. In two cases, retrospective dose-volume analysis revealed CST mean doses ranging from 25.81 Gy to 42.83 Gy. Conclusions This retrospective series highlights WDCT as a potentially underrecognized complication in glioma patients undergoing multimodal treatment. While etiology is likely multifactorial, radiotherapy may play a contributing role. CST delineation, when tractography is available, may support individualized treatment planning, enable better assessment of dose exposure, and help identify patients at higher risk of motor decline. Further prospective studies are warranted to define dose thresholds and assess functional outcomes.
Hypofractionated whole and partial breast irradiation: Brazilian Society of Radiotherapy (SBRT) consensus Nilceana Maya Aires Freitas, Arthur Accioly Rosa, Marcus Simoes Castilho, Samir Abdallah Hanna, Conceição Souza Campos, Heloisa De Andrade Carvalho, Guilherme Rocha Melo Gondim, Pedro Henrique da Rocha Zanuncio, Claudia Regina Scaramello Hadlich Willis Fernandez, Wilson José De Almeida Junior, Allisson Bruno Barcelos Borges, Fernando Mariano Obst, Jean Teixeira Paiva, Lilian Dantonino Faroni, André Campana, Cecilia Félix Penido Mendes de Sousa, Ruffo Freitas-Junior, Andre Mattar, Cristiano Augusto Andrade de Resende, Rodrigo Leite, Gustavo Nader Marta Reports of Practical Oncology and Radiotherapy, 2025 Background: Breast cancer is the most common cancer in women worldwide, with 73,610 new cases expected annually in Brazil between 2023 and 2025. Post-operative radiation therapy (PORT) is a critical component of treatment, and recent advances have allowed for shorter treatment times that can help overcome shortages in low- and middle-income countries. The Brazilian Society of Radiotherapy (SBRT) updated its consensus on hypofractionated whole-breast radiotherapy and included recommendations for partial breast irradiation. Materials and methods: The SBRT convened a national panel of experts to develop updated recommendations. Using a modified Delphi method, the panel reached a consensus through structured rounds of voting. Recommendations were categorized based on the strength of available evidence. Results: The consensus supports hypofractionation, which offers shorter, cost-effective treatment schedules, and partial breast irradiation (PBI), which targets high-risk areas while sparing healthy tissue. Despite high-quality evidence, adopting these techniques has been inconsistent. The panel's recommendations provide evidence-based guidance to clinicians, tailored to the Brazilian context, emphasizing safety and efficacy. Conclusion: The updated SBRT consensus presents hypofractionation and PBI as practical alternatives to conventional radiation therapy, offering improved access and reduced costs. These recommendations aim to guide clinicians in adopting these approaches and help address barriers to access.
AI tool for predicting MGMT methylation in glioblastoma for clinical decision support in resource limited settings Felipe Cicci Farinha Restini, Tarraf Torfeh, Souha Aouadi, Rabih Hammoud, Noora Al-Hammadi, Maria Thereza Mansur Starling, Cecília Felix Penido Mendes Sousa, Anselmo Mancini, Leticia Hernandes Brito, Fernanda Hayashida Yoshimoto, Nildevande Firmino Lima-Júnior, Marcello Moro Queiroz, Ula Lindoso Passos, Camila Trolez Amancio, Jorge Tomio Takahashi, Daniel De Souza Delgado, Samir Abdallah Hanna, Gustavo Nader Marta, Wellington Furtado Pimenta Neves-Junior Scientific Reports, 2024 Glioblastoma is an aggressive brain cancer with a poor prognosis. The O6-methylguanine-DNA methyltransferase (MGMT) gene methylation status is crucial for treatment stratification, yet economic constraints often limit access. This study aims to develop an artificial intelligence (AI) framework for predicting MGMT methylation. Diagnostic magnetic resonance (MR) images in public repositories were used for training. The algorithm created was validated in data from a single institution. All images were segmented according to widely used guidelines for radiotherapy planning and combined with clinical evaluations from neuroradiology experts. Radiomic features and clinical impressions were extracted, tabulated, and used for modeling. Feature selection methods were used to identify relevant phenotypes. A total of 100 patients were used for training and 46 for validation. A total of 343 features were extracted. Eight feature selection methods produced seven independent predictive frameworks. The top-performing ML model was a model post-Least Absolute Shrinkage and Selection Operator (LASSO) feature selection reaching accuracy (ACC) of 0.82, an area under the curve (AUC) of 0.81, a recall of 0.75, and a precision of 0.75. This study demonstrates that integrating clinical and radiotherapy-derived AI-driven phenotypes can predict MGMT methylation. The framework addresses constraints that limit molecular diagnosis access.
Discordance Between the Initial Diagnosis of Sarcomas and Subsequent Histopathological Revision and Molecular Analyses in a Sarcoma Reference Center in Brazil Carlos Diego H. Lopes, Marcello M. Queiroz, Luana A.F. Sampaio, André Perina, Eduardo Akaishi, Frederico Teixeira, Fábio de O. Ferreira, Samir A. Hanna, João Luís F. da Silva, Luiz Guilherme C.A. De Lima, Claudia Regina G.C.M. de Oliveira, Rodrigo R. Munhoz JCO Global Oncology, 2024 PURPOSE To investigate the discordance in sarcoma diagnoses between nonspecialized institutions following revision by dedicated sarcoma pathologists at a reference center in Brazil and the relevance of molecular pathology in this context. METHODS We conducted a retrospective analysis of sarcoma samples initially analyzed at outside laboratories and subsequently reviewed by two specialized pathologists between January 2014 and December 2020. After obtaining demographic and tumor characteristics, pathology results were matched and classified as complete discordance (CD; benign v malignant, sarcoma v other malignancies), partial concordance (similar diagnosis of connective tumor, but different grade/histological subtype/differentiation), and complete concordance (CC). The concordance for histology or grade, and the role of molecular assessments supporting the diagnosis were also independently determined. Statistical analyses were conducted through the kappa coefficient of agreement and adherence by χ2 test, χ2 test by Person, and Fisher exact test. RESULTS In total, 197 cases were included, with samples obtained predominately from male patients (57.9%) and localized/primary tumors (86.8%). Following revision, the most frequent final diagnoses were undifferentiated pleomorphic sarcoma (17.8%), well-differentiated/dedifferentiated liposarcoma (8.6%), and leiomyosarcoma (7.6%). CD was found in 13.2%, partial discordance in 45.2%, and CC in 41.6% of reviews ( P < .001). We found a concordance for histology or grade of 53.5% ( P < .001) and 51.8% ( P < .001), respectively. Molecular assessments, comprising next-generation sequencing panels (79.5%) and fluorescent in situ hybridization (20.5%), were performed in 44 (22.3%) cases, with findings classified as of diagnostic relevance in 31.8%. CONCLUSION In nearly 60% of the cases, the initial sarcoma diagnosis was modified when revised by a reference center and dedicated pathologists, assisted by molecular pathology techniques. These results justify the assembly of referral networks in countries with limited health care resources.
PET/CT-based dose-escalated definitive radiotherapy in cervical cancer: a single-institution series Samir A. Hanna, Alice R.N.S. Silva, Leticia Hernandes De Brito, Gabriela Silva Moreira De Siqueira, Tatiana Midori Martins Teles Alves, Daniela De Freitas, Rudinei Linck, José Carlos Sadalla, Sergio Mancini Nicolau, Carlos Buchpiguel, Jesus Paula Carvalho Reports of Practical Oncology and Radiotherapy, 2024
Brazilian pediatric patients with gliomas: treatment characteristics and survival outcomes Maria Thereza Mansur Starling, Allan Andresson Lima Pereira, Gustavo Viani, Wellingson Silva Paiva, Iuri Santana Neville, Felipe Cicci Farinha Restini, Andre Guimaraes Gouveia, Cecilia Félix Penido Mendes de Sousa, Marcos Vinícius Calfat Maldaun, Felix Hendrik Pahl, Samir A. Hanna, Fabio Ynoe Moraes, Gustavo Nader Marta Reports of Practical Oncology and Radiotherapy, 2024
Vestibulocochlear Delineation for Vestibular Schwannoma Treated With Radiation Therapy Felipe Cicci Farinha Restini, Leticia Hernandes Brito, Fernanda Hayashida Yoshimoto, Ana Paula Alves Pereira, David Rodrigues Ferreira Neto, Vitor Cunha Gomes, Beatriz Cunha Nascimento, Anselmo Mancini, Tatiana Midori Martins Telles Alves, Maria Thereza Mansur Starling, Guilherme Wilson Otaviano Garcia Chaves, Ula Lindoso Passos, Gustavo Nader Marta, Samir Abdallah Hanna Advances in Radiation Oncology, 2023
Principles of Radiation Oncology Alice Roxo Nobre de Souza e Silva, Fernanda Hayashida Yoshimoto, João Luis Fernandes da Silva, Letícia Hernandes de Brito, Samir Abdallah Hanna Oncodermatology an Evidence Based Multidisciplinary Approach to Best Practices, 2023
Would the STRASS study be an "unbroken" paradigm for retroperitoneal sarcomas? Samir Abdallah Hanna, Alice Roxo Nobre de Souza e Silva, Tomás Yokoo Teodoro de Souza, Felipe Cicci Farinha Restini, David Rodrigues Ferreira Neto, Letícia Hernandes de Brito, Ana Paula Alves Pereira, João Luis Fernandes da Silva, Maria Thereza Mansur Starling Revista Da Associacao Medica Brasileira, 2021
Stereotactic ablative radiation therapy for spinal metastases: experience at a single Brazilian institution Gustavo Nader Marta, Fernando F. De Arruda, Fabiana A. Miranda, Alice R.N.S. Silva, Wellington F.P. Neves-Junior, Anselmo Mancini, Samir A. Hanna, Carlos E.C.V. Abreu, João Luis F. Da Silva, Jose Eduardo V. Nascimento, Cecília Maria K. Haddad K. Haddad, Fabio Y. Moraes, Rafael Gadia Reports of Practical Oncology and Radiotherapy, 2021
Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas Ranyell M. S. S. B. Spencer, Veridiana P. de Camargo, Maria L. G. Silva, Fabio F. E. Pinto, Felipe D'Almeida Costa, Wagner S. Cequeira, Rodrigo R. Munhoz, Celso A. Mello, Rafael A. Schmerling, Waldec J. D. Filho, Tharcisio M. Coelho, Alexandre V. A. Ambrosio, Elton T. T. Leite, Samir A. Hanna, Sueli A. Nakagawa, Andre M. Baptista, Rodrigo N. Pinheiro, Jadivan L. de Oliveira, Marcelo Sá de Araújo, Raphael L. C. de Araujo, Gustavo A. Laporte, Claudio de Almeida Quadros, Alexandre F. de Oliveira, Ademar Lopes Journal of Surgical Oncology, 2020
Recommendations for radiotherapy during the novel coronavirus pandemic Maria Thereza Mansur Starling, Alice Roxo Nobre de Souza e Silva, Ana Paula Alves Pereira, David Rodrigues Ferreira Neto, Felipe Cicci Farinha Restini, Letícia Hernandes de Brito, Tomás Yokoo Teodoro de Souza, Samir Abdallah Hanna Revista Da Associacao Medica Brasileira, 2020
Recommendations for hypofractionated whole-breast irradiation Nilceana Maya Aires Freitas, Arthur Accioly Rosa, Gustavo Nader Marta, Samir Abdalla Hanna, Rodrigo de Morais Hanriot, Allisson Bruno Barcelos Borges, Guilherme Rocha Melo Gondim, Antonio Cassio Assis Pellizzon, Igor Moreira Veras, Wilson José de Almeida Júnior, Claudia Regina Scaramello Hadlich Willis Fernandez, Eronides Salustiano Batalha Filho, Marcus Simões Castilho, Felipe Quintino Kuhnen, Rosa Maria Xavier Faria Najas, Renato José Affonso Júnior, André Campana Correia Leite, Homero Lavieri Martins Ribeiro, Ruffo Freitas Junior, Harley Francisco de Oliveira Revista Da Associacao Medica Brasileira, 2018
In Reply to Leung Fabio Ynoe de Moraes, Gustavo Nader Marta, Samir Abdallah Hanna, Elton Trigo Teixiera Leite, Robson Ferrigno, João Luis Fernandes da Silva, Heloisa de Andrade Carvalho International Journal of Radiation Oncology Biology Physics, 2015
Brazil's challenges and opportunities Fabio Ynoe de Moraes, Gustavo Nader Marta, Samir Abdallah Hanna, Elton Trigo Teixeira Leite, Robson Ferrigno, João Luis Fernandes da Silva, Heloisa de Andrade Carvalho International Journal of Radiation Oncology Biology Physics, 2015
Treatment of abdominal tumors using radiotherapy E Weltman, GN Marta, HS Baraldi, L Pimentel, M Castilho, MAC Maia, MSFS Lundgren, MJ Chen, PERS Novaes, R Gadia, R Ferrigno, R Motta, SA Hanna, W Almeida Revista Da Associacao Medica Brasileira, 2015
Update of treatment of abdominal tumor using radiotherapy WM Bernardo, E Weltman, GN Marta, HS Baraldi, L Pimentel, M Castilho, MAC Maia, MSFS Lundgren, MJ Chen, PERS Novaes, R Gadia, R Ferrigno, R Motta, SA Hanna, W Almeida Revista Da Associacao Medica Brasileira, 2015
Mycosis fungoides: Case report treated with radiotherapy Gustavo Nader Marta, Carolina Bueno de Gouvêa, Stéfani Bertolucci Estevam Ferreira, Samir Abdallah Hanna, Cecília Maria Kalil Haddad, João Luis Fernandes da Silva Anais Brasileiros De Dermatologia, 2011
Early stage breast cancer and radiotherapy: Update Gustavo Nader Marta, Samir Abdallah Hanna, Eduardo Martella, João Luis Fernandes da Silva, Heloisa de Andrade Carvalho Revista Da Associacao Medica Brasileira, 2011
