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V Kouloulias,
J Kouvaris,
A Zygogianni,
E Mosa,
J Georgakopoulos,
P Theodosiadis,
C Antypas,
K Platoni,
M Tolia,
I Beli,
D Alonistiotis,
M Dilvoi,
G Patatoukas,
C Asimakopoulos,
E Efstathopoulos, N Kelekis
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ABSTRACT: To evaluate the efficacy, the feasibility as well as the acute and late toxicity of orbital radiotherapy in patients with Graves' ophthalmopathy.
Between 2002 and 2011, we retrospectively evaluated 17 patients (7 males, 10 females) diagnosed with Graves' orbitopathy that were treated with external three-dimensional conformal radiotherapy. The median age of the patients was 58 years. Patient symptoms included pain (17/17), proptosis (14/17), redness of the eyelid (17/17) and extraocular muscle dysfunction with decreased eye movements (16/17). The mean clinical activity score (CAS) was 8.65 ± 1.87. Corticosteroids were used in all the patients. A dose of 20 Gy in 10 daily fractions was prescribed. The primary endpoints were the assessment of the therapeutic impact, the safety of the treatment and the acute toxicity of irradiation.
The median follow-up was 15 months. Stabilization of the disease without recurrence was achieved in 12/17 patients. At the end of radiotherapy, the CAS regressed to 4.82 ± 2.24 (P < 0.001, Wilcoxon test). However, in smokers, the CAS decreased significantly slower and to a lower extent than that in non-smokers (P = 0.008, log-rank test). Extraocular motility and pain behind the globe were improved in 14/17 and 16/17 patients, respectively. Five patients developed recurrent signs and symptoms and they underwent surgical decompression, all of them being smokers. However, mortality was not reported. None of the patients developed retinopathy, while cataract and chronic dry eyes were observed in 2/17 and 6/17 patients, respectively.
Orbital radiotherapy for Graves' disease is a well-established treatment option, even if patients have failed previously with other treatment modalities such as corticosteroids and surgical decompression.
Head & Neck Oncology 01/2013; 5(2):12. · 3.13 Impact Factor
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ABSTRACT: Hyperthermia is an effective modality for the treatment of cancer, which is mainly used in conjunction with radiotherapy as this combined treatment offers a better clinical outcome. There are many ways that hyperthermia can be applied and depends on the kind of tumor of the patients. The great advantage of this method is that it is tolerable for the majority of patients without severe toxicity. Many clinical trials have been realized in order to prove that hyperthermia in addition to radiotherapy offers an advantage in the survival and local control of patients in comparison to radiotherapy alone. Many studies have also investigated if exists any correlation between the thermal parameters of hyperthermia and the clinical outcome. This is a review of these studies and it concerns superficial hyperthermia for superficial tumors-melanoma, head and neck, breast cancer-and intracavitary hyperthermia for rectal cancer, esophageal cancer and prostate carcinoma.
Clinical and Translational Oncology 11/2012; · 1.33 Impact Factor
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A Guida,
V Kouloulias,
J Kouvaris,
E Mosa,
J Georgakopoulos,
K Platoni,
O Papadopoulos,
E Papadavid,
A Zygogianni,
D Rigoppoulos,
C Antypas,
I Beli,
F Karantonis, N Kelekis
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ABSTRACT: To evaluate efficacy and acute and chronic toxicity of a hypofractionated irradiation schedule in elderly patients with basal cell carcinoma (BCC) of the skin.
Between February 2005 and November 2011, 42 retrospectively selected patients diagnosed with skin BCC of the head and neck area were treated with three-dimensional conformal radiotherapy (3DCRT) as an adjuvant therapy. Radiotherapy schedule was 5 × 600 cGy once weekly. Acute and late radiotherapy skin toxicity and cosmetic outcome were assessed in long-term follow up according to European Organization Research Treatment of Cancer/Radiotherapy Oncology Group (EORTC/RTOG) criteria, while cosmesis was evaluated by a plastic surgery expert.
Patients' median age was 78 years, while median follow up was 15 months. Only two local recurrences were observed at 15 and 32 months, respectively, post-3DCRT. Grade I, II and III acute skin toxicity was observed in 30/42, 9/42 and 2/42 patients, respectively. Late toxicity as grade I and II was observed in 14/42 and 2/42 patients, respectively. 'Excellent' or 'good' cosmesis was achieved in 30/42 and 12/42 patients, respectively.
Our irradiation schedule achieved very high local control rate with very good cosmetic and functional results, and it could be an alternative radiotherapy treatment for elderly patients with BCC of the head and neck area.
Head & Neck Oncology 01/2012; 4(5):88. · 3.13 Impact Factor
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European journal of gynaecological oncology 01/2012; 33(4):411-413. · 0.47 Impact Factor
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ABSTRACT: Bone metastasis secondary to vulvar carcinoma is an infrequent clinical entity. Only ten cases have been published in the literature. We describe a case of squamous vulvar carcinoma, that presented with cervical vertebral involvement, as a part of distant spread.
A 69-year-old woman presented with radicular pain and a painful cervical mass. MRI of the cervical spine was performed, showing an osteolytic lesion with spinal cord compression.
This case was unique in presenting vertebral metastasis eight months after chemotherapy and radiotherapy.
European journal of gynaecological oncology 01/2012; 33(4):411-3. · 0.47 Impact Factor
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ABSTRACT: To illustrate quantitative discomanometry's (QD) diagnostic efficacy and predictive value in discogenic-pain evaluation in a prospective study correlating intradiscal pressure values with pain reduction after percutaneous image-guided technique (i.e., percutaneous decompression, PD).
During the last 3 years, 36 patients [21 male and 15 female (mean age 36 ± 5.8 years)] with intervertebral disc hernia underwent QD before PD. Under absolute sterilization and fluoroscopy, a mixture of contrast medium and normal saline (3:1 ratio) was injected. A discmonitor performed a constant rate injection and recorded pressure and volume values, thus producing the relative pressure-volume curve. PD was then performed. Pain reduction and improved mobility were recorded at 3, 12, and 24 months after PD using clinical evaluation and a numeric visual scale (NVS; 0 to 10 units).
Mean pain values of 7.5 ± 1.9 (range 4 to 8) NVS units were recorded before PD; these decreased to 2.9 ± 2.44 at 3 months, 1.0 ± 1.9 at 12 months, and 1.0 ± 1.9 NVS units at 24 months after PD. Recorded correlations (pressure, volume, significant pain-reduction values) with bilateral statistical significance included a maximum injected volume of 2.4 ml (p = 0.045), P (o) < 14 psi [initial pressure required to inject 0.1 ml of the mixture inside the disc (p = 0.05)], P (max) ≤ 65 psi [greatest pressure value on the curve (p = 0.018)], and P (max) - P (o) ≤ 47 psi (p = 0.038). Patients meeting these pressure or volume cut-off points, either independently or as a total, had significant pain reduction (>4 NVS units) after PD. No complications were noted.
QD is an efficient technique that may have predictive value for discogenic pain evaluation. It might serve as a useful tool for patient selection for intervertebral disc therapies.
CardioVascular and Interventional Radiology 08/2011; 35(5):1145-53. · 2.09 Impact Factor
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ABSTRACT: Total Skin Electron Beam (TSEB) irradiation is considered as the treatment of choice for cutaneous T-cell lymphoma internationally, for either curative purposes or palliative care. An attempt for the first application of this external radiation therapy technique in Greece took place at the Radiation Therapy Unit of 2(nd) Department of Radiology of University of Athens at University General Hospital "Attikon". TSEB modality was developed on a linear accelerator VARIAN Clinac 2100C. To create a uniform and sufficiently large field (≈200 cm × 80 cm) at SSD=380 cm, two symmetrical 6 MeV electron beams are combined with 17.5° tilts concerning the horizontal direction. An immobilization system was constructed to support patient during treatment and to modulate the composite electron field. Irradiation procedure demands a standing patient that takes, in total, six treatment positions. For the confirmation of treatment suitability and the determination of physical features of the clinical electron field, specific measurements were carried out using a parallel-plate ionization chamber and TLDs at water equivalent plastic and anthropomorphic phantoms. Measurements at the referred conditions showed a homogeneous total field with intensity variation of ±2% in the longitudinal axis and ±4% at horizontal axis. The mean energy of the composite field (E¯(o)) is 3.4 MeV, the most probable energy (E(p,0)) is 4.4 MeV and the half-value depth in water (R(50)) is 1.5 g/cm(2). The maximum X-ray background of the TSEB field is 2.1% at head and feet. The above results lead us to conclude that TSEB treatment using "Six-dual-field" technique can be applied in our department safely.
Physica Medica 04/2011; 28(2):174-82. · 1.07 Impact Factor
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ABSTRACT: Hypofractionated irradiation has an established role in the palliative treatment of patients with advanced medically inoperable non - small cell lung cancer (NSCLC ) and poor performance status. Also hypofractionated radiotherapy merits careful consideration in the curative treatment of patients with Stage I and II disease using contemporary technology. The biological effect of radiation on tumours is increased as the overall treatment time is shortened. Hypofractionated field radiotherapy offers acceptable palliation with minimal toxicity. The rates of palliation for hemoptysis , chest pain , cough and dyspnea reported from studies with very short regimen ( 8,5 Gy x 2 ), are comparable to those of other trials that used more protracted palliative treatment . The observed toxicity is minimal, and no cases of oesophagitis, pneumonitis, or radiation myelopathy developed. The minimal toxicity is a reflection of both the low biologic total dose and the tight RT design. Therefore the radiation side effects appear to be related to the technique of RT delivered rather than the patient's PS. Hence, widely believed dogmas concerning the tolerance of critical structures to conventionally fractionated doses, such as the dose-volume effect, total dose, and time (latency) dependency, has to be re-evaluated for hypofractionated radiation therapy. As well there is data suggesting that the small stages I - II NSCLC are likely to benefit from hypofractionated regimens too. Hypofractionated stereotactic radiotherapy is a new technically complex approach to the treatment of early-stage nonsmall cell lung cancer. It is capable to deliver much higher doses to the cancer than is possible with standard techniques, and as a result, rates of tumour control are high and similar to what can be achieved by surgical resection. Refinements of technique and dose as well as randomized data are required before stereotactic radiotherapy can be endorsed as a standard of care for patients with inoperable peripherally located T1 non small cell lung cancer. A clear advantage of the very short hypofractionated palliative regimen is that it allows patients with a short expected survival time to spend more of their remaining time away from the hospital.
05/2010; 5(2):103-11. · 1.07 Impact Factor
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ABSTRACT: Computed tomography (CT) coronary angiography has been widely used since the introduction of 64-slice scanners and dual-source CT technology, but high radiation doses have been reported. Prospective ECG-gating using a 'step-and-shoot' axial scanning protocol has been shown to reduce radiation exposure effectively while maintaining diagnostic accuracy. 256-slice scanners with 80 mm detector coverage have been currently introduced into practice, but their impact on radiation exposure has not been adequately studied. The aim of this study was to assess radiation doses associated with CT coronary angiography using a 256-slice CT scanner. Radiation doses were estimated for 25 patients scanned with either prospective or retrospective ECG-gating. Image quality was assessed objectively in terms of mean CT attenuation at selected regions of interest on axial coronary images and subjectively by coronary segment quality scoring. It was found that radiation doses associated with prospective ECG-gating were significantly lower than retrospective ECG-gating (3.2 +/- 0.6 mSv versus 13.4 +/- 2.7 mSv). Consequently, the radiogenic fatal cancer risk for the patient is much lower with prospective gating (0.0176% versus 0.0737%). No statistically significant differences in image quality were observed between the two scanning protocols for both objective and subjective quality assessments. Therefore, prospective ECG-gating using a 'step-and-shoot' protocol that covers the cardiac anatomy in two axial acquisitions effectively reduces radiation doses in 256-slice CT coronary angiography without compromising image quality.
Physics in Medicine and Biology 09/2009; 54(17):5209-22. · 2.83 Impact Factor
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ABSTRACT: We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults.
Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated.
Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%).
A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.
Skeletal Radiology 12/2008; 38(4):363-9. · 1.54 Impact Factor
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ABSTRACT: Percutaneous radiofrequency thermal ablation (RFA) has been used to treat primary and secondary liver tumors under ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) guidance for the past decade [Park et al., Radiol Clin North Am 38:545-561, 2000; Siperstein and Gotomirski, Cancer J 6:S293-S301, 2000; Kelekis et al., Eur Radiol 13:1100-1105, 2003]. RFA is a low-cost, minimally invasive treatment that has recently attracted attention for treating tumors in different solid organs with promising results [Dupuy and Goldberg, J Vasc Interv Radiol 12:1135-1148, 2001; Friedman et al., Cardiovasc Intervent Radiol 27:427-434, 2004]. It can be provided with minimal hospitalization, and experienced practitioners have reported low complication rates [Dupuy and Goldberg, J Vasc Interv Radiol 12:1135-1148, 2001; Livraghi et al., Radiology 226:441-451, 2003]. Patients with lung malignancies (primary lung cancer or pulmonary metastases), who cannot be operated, might be candidates for RFA treatment. It can also be used in association with other treatments (i.e., chemotherapy, radiotherapy) for better disease control. Combination of the above with RFA may help reduce morbidity and mortality. Many ways to apply energy to the tumor exist (monopolar and bipolar RFA, microwave, laser, brachytherapy). In this review we will focus on expandable monopolar systems, which despite their deficiencies are the most popular in the interventional radiology sector.
European Radiology 12/2006; 16(11):2471-82. · 3.22 Impact Factor
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ABSTRACT: The blood-brain barrier is a major obstacle for the chemotherapeutic drugs to effectively reach primary or secondary brain tumours. Stealth liposomal drugs are highly accumulated in tumoural tissues. In the present study we investigated the relative accumulation of(99m)Tc-DTPA radiolabelled stealth liposomal doxorubicin (Caelyx) in 10 patients with metastatic brain tumours and five patients with brain glioblastoma undergoing radiotherapy. Patients with metastatic brain lesions were treated with 10 consecutive fractions of radiotherapy (whole brain, 3 Gy/fraction, day 1-12) followed by a booster dose of 9 Gy (3 Gy/fraction, day 21-23). Caelyx, at a dose of 25 mg mg(-2)was given on day 1 and on day 21. Radiolabelled Caelyx accumulation was 13-19 times higher in the glioblastomas and 7-13 times higher in the metastatic lesions, as compared to the normal brain. The drug accumulation in the tumoural areas was 40-60% of the accumulation in the bone marrow of the skull bones. The normal brain radioactivity was <4% of the bone marrow, confirming an important shielding effect of the blood-brain barrier in the normal but not in the tumoural tissue. Four of 10 patients with metastatic lesions showed a complete response in CT-scan performed 2 months following therapy. There was no severe toxicity related to radiotherapy or to chemotherapy noted. It is concluded that stealth liposomal drugs selectively overcome the blood-brain barrier in the tumoural areas. The clinical importance of this observation is now under investigation.
British Journal of Cancer 12/2000; 83(10):1281-6. · 5.04 Impact Factor
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ABSTRACT: We report the treatment of a bleeding renal artery pseudoaneurysm by transcatheter embolization. The patient, a 30 years old woman, developed macroscopic hematuria following renal biopsy. The presence of a leaking pseudoaneurysm of the lower pole segmental artery was confirmed by left selective renal angiogram; subsequently successful transcatheter embolization was performed using a 5.0 french Cobra catheter and 3 mm steel coils.
International angiology: a journal of the International Union of Angiology 07/1994; 13(2):170-2. · 1.65 Impact Factor
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ABSTRACT: The results of selective transcervical tubal recanalisation by means of a catheter in 20 patients with tubal occlusions are reported and discussed. The advantages of tubal recanalisation under DSA are stressed. In 18 (90%) of the 20 patients treated, it was possible to recanalize at least one tube. Nine of these 18 women (50%) became pregnant during the period of observation, averaging 12 months. Selective transcervical recanalisation of obstructive tubes is a rapid, reliable, cheap and hardly invasive treatment of sterility, when compared with laparoscopy or laparotomy. In the majority of patients it makes surgery unnecessary.
RöFo - Fortschritte auf dem Gebiet der R 05/1991; 154(4):354-6. · 2.76 Impact Factor
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ABSTRACT: Radiotherapy is widely used to treat patients with prostate cancer. Using conventional x-ray simulation is often difficult to accurately localize the extent of the tumor, to cover exactly the lymph nodes at risk and shield the organs at risk. We report on the results of a study comparing target localization with conventional and virtual simulation.
One hundred prostate cancer patients underwent both conventional and virtual simulation. The conventional simulation films were compared with digitally reconstructed radiographs (DDRs) produced from the computed tomography (CT) data. All patients underwent target localization for radical prostate radiotherapy. The treatment fields were initially marked with a conventional portal film on linear accelerator (LINAC), plain x-ray film and available diagnostic imaging. Each patient then had a CT and these simulated treatment fields were reproduced within the virtual simulation planning system. The treatment fields defined by the clinicians using each modality were compared in terms of field area and implications for target coverage.
Virtual simulation showed significantly greater clinical tumor volume coverage and less normal tissue volume irradiated compared with conventional simulation (p <0.001).
CT localization and virtual simulation allow more accurate definition of the clinical target volume. This could enable a reduction in geographical misses, reducing at the same time treatment-related toxicity.
Journal of B.U.ON.: official journal of the Balkan Union of Oncology 16(2):309-15. · 0.61 Impact Factor
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ABSTRACT: radiotherapy is widely used to treat patients with prostate cancer. Using conventional x-ray simulation is often difficult to accurately localize the extent of the tumor, to cover exactly the lymph nodes at risk and shield the organs at risk. We report the initial results of a study conducted to compare target localization with conventional and virtual simulation.
fifty patients with prostate cancer underwent target localization for radical prostate radiotherapy using conventional and virtual simulation. The treatment fields were initially marked with a conventional portal film on LINAC, plain x-ray film and available diagnostic imaging. Each patient then had a computed tomography (CT) and these simulated treatment fields were reproduced within the virtual simulation planning system. The treatment fields defined by the clinicians using each modality were compared in terms of field area and implications for target coverage.
there was significantly greater clinical tumor volume coverage using virtual simulation compared with conventional simulation and less normal tissue volume irradiated (p<0.001).
CT localization and virtual simulation allow for more accurate definition of the clinical target volume. This could enable a reduction in geographical misses, while also reducing treatment-related toxicity.
Journal of B.U.ON.: official journal of the Balkan Union of Oncology 15(4):684-9. · 0.61 Impact Factor
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ABSTRACT: Fistulous communication between the splenic artery and the vein is rare. We present one such case.
A 50 year old woman was admitted to the hospital complaining of abdominal pain and diarrhea, both unrelated to the meals. Physical examination, laboratory testing, computed tomography, and aortogram were performed.
The patient was treated by surgical resection of splenic artery and vein, as well as with splenectomy. Pathological examination showed a 5x5 cm aneurysm of the splenic artery that was connected to the splenic vein through a fistulous tract.
Hepato-gastroenterology 42(4):352-5. · 0.66 Impact Factor
