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Fragkoulis C, Fragkiadis E, Sakellakis M, Pinitas A, Tzannis K, Gavalas N, Stamatakos P, Leventi A, Papadopoulos G, Stathouros G, Kostopoulou A, Makrydaki D, Giannopoulou E, Marialena D, Stravodimos K, Choreftaki T, Bamias A, Ntoumas K, Papatsoris A. Intravesical administration of durvalumab to patients with high risk non muscle invasive bladder cancer after BCG failure. A phase II trial by the Hellenic GU Cancer Group. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Papatsoris A, Fragkoulis C, Fragkiadis E, Pinitas A, Tzannis K, Gavalas N, Stravodimos K, Ntoumas K, Mitropoulos D, Constantinides K, Giannopoulou E, Bamias A, Deliveliotis C. A run-in phase clinical study for intravesical administration of durvalumab in patients with high-risk, non-muscle-invasive bladder cancer (NMIBC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tsironis G, Zakopoulou R, Koutsoukos K, Tzanis K, Varkarakis J, Papatsoris A, Stravodimos K, Kostouros E, Fragkoulis C, Choreftaki T, Filippiadis D, Fontara S, Dellis A, Ntai S, Zygogianni A, Ntoumas K, Constantinides CA, Korkolopoulou P, Dimopoulos MA, Bamias A. Neoadjuvant chemotherapy (NAC) with dose-dense gemcitabine/cisplatin (DDGC) in localized muscle-invasive bladder cancer (MIBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- George Tsironis
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Roubini Zakopoulou
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Koutsoukos
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - John Varkarakis
- Second Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece
| | - Athanasios Papatsoris
- Second Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece
| | - Kostas Stravodimos
- First University Urology Clinic, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymios Kostouros
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Fragkoulis
- Department of Urology, General Hospital of Athens "G.N.A. G. Gennimatas", Athens, Greece
| | - Theodosia Choreftaki
- Department of Pathology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Dimitrios Filippiadis
- Second Radiology Department, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Fontara
- First Department of Radiology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- First Department of Urology, Aretaieion Hospital, National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - Sparti Ntai
- Department of Radiology, Alexandra Hospital, Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Ntoumas
- Department of Urology, General Hospital of Athens "G.N.A. G. Gennimatas", Athens, Greece
| | | | - Penelope Korkolopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A. Dimopoulos
- Dept of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristotelis Bamias
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Bamias A, Tsantoulis P, Zilli T, Papatsoris A, Caparrotti F, Kyratsas C, Tzannis K, Stravodimos K, Chrisofos M, Wirth GJ, Skolarikos A, Mitropoulos D, Constantinides CA, Deliveliotis C, Iselin CE, Miralbell R, Dietrich PY, Dimopoulos MA. Outcome of patients with nonmetastatic muscle-invasive bladder cancer not undergoing cystectomy after treatment with noncisplatin-based chemotherapy and/or radiotherapy: a retrospective analysis. Cancer Med 2016; 5:1098-107. [PMID: 27004619 PMCID: PMC4924368 DOI: 10.1002/cam4.685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
Transurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy, or combinations can be used in patients with muscle‐invasive bladder cancer (MIBC) not undergoing cystectomy. Nevertheless, unfitness for cystectomy is frequently associated with unfitness for other therapeutic modalities. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin‐based chemotherapy. Selection criteria for the study were nonmetastatic MIBC, no cystectomy, no cisplatin‐based chemotherapy. Chemotherapy and/or radiotherapy should have been used aside from TURBT. Forty‐nine patients (median age 79), managed between April 2001 and January 2012, were included in this analysis. Median Charlson Comorbidity Index was 5, while 76% were unfit for cisplatin. Treatment included radiotherapy (n = 7), carboplatin‐based chemotherapy (n = 25), carboplatin‐based chemotherapy followed by radiotherapy (n = 10), and radiochemotherapy (n = 7). Five‐year event‐free rate was 26% (standard error [SE] = 7) for overall survival, 23% (SE = 7) for progression‐free survival, and 30 (SE = 8) for cancer‐specific survival (CSS). Patients who were treated with combination of radiotherapy and chemotherapy had significantly longer CSS compared to those treated with radiotherapy or chemotherapy only (5‐year CSS rate: 16% [SE 8] vs. 63% [SE 15], P = 0.053). Unfit‐for‐cystectomy patients frequently receive suboptimal nonsurgical treatment. Their outcome was poor. Combining chemotherapy with radiotherapy produced better outcomes and should be prospectively evaluated.
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Affiliation(s)
- Aristotle Bamias
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece
| | - Petros Tsantoulis
- Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Athanasios Papatsoris
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Francesca Caparrotti
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Christos Kyratsas
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Kimon Tzannis
- Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece
| | - Kostas Stravodimos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,1st Department of Urology, University of Athens, Athens, Greece
| | - Michael Chrisofos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Gregory J Wirth
- Department of Urology Department, Geneva University Hospital, Geneva, Switzerland
| | - Andreas Skolarikos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Dionysios Mitropoulos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,1st Department of Urology, University of Athens, Athens, Greece
| | - Constantinos A Constantinides
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,1st Department of Urology, University of Athens, Athens, Greece
| | - Charalambos Deliveliotis
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Christophe E Iselin
- Department of Urology Department, Geneva University Hospital, Geneva, Switzerland
| | - Raymond Miralbell
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva University Hospital, Geneva, Switzerland
| | - Meletios A Dimopoulos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece
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Bamias A, Tzannis K, Beuselinck B, Oudard S, Escudier B, Diosynopoulos D, Papazisis K, Lang H, Wolter P, de Guillebon E, Stravodimos K, Chrisofos M, Fountzilas G, Elaidi RT, Dimopoulos MA, Bamia C. Development and validation of a prognostic model in patients with metastatic renal cell carcinoma treated with sunitinib: a European collaboration. Br J Cancer 2013; 109:332-41. [PMID: 23807171 PMCID: PMC3721408 DOI: 10.1038/bjc.2013.341] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/07/2013] [Accepted: 06/09/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Accurate prediction of outcome for metastatic renal cell carcinoma (mRCC) patients receiving targeted therapy is essential. Most of the available models have been developed in patients treated with cytokines, while most of them are fairly complex, including at least five factors. We developed and externally validated a simple model for overall survival (OS) in mRCC. We also studied the recently validated International Database Consortium (IDC) model in our data sets. METHODS The development cohort included 170 mRCC patients treated with sunitinib. The final prognostic model was selected by uni- and multivariate Cox regression analyses. Risk groups were defined by the number of risk factors and by the 25th and 75th percentiles of the model's prognostic index distribution. The model was validated using an independent data set of 266 mRCC patients (validation cohort) treated with the same agent. RESULTS Eastern Co-operative Oncology Group (ECOG) performance status (PS), time from diagnosis of RCC and number of metastatic sites were included in the final model. Median OS of patients with 1, 2 and 3 risk factors were: 24.7, 12.8 and 5.9 months, respectively, whereas median OS was not reached for patients with 0 risk factors. Concordance (C) index for internal validation was 0.712, whereas C-index for external validation was 0.634, due to differences in survival especially in poor-risk populations between the two cohorts. Predictive performance of the model was improved after recalibration. Application of the mRCC International Database Consortium (IDC) model resulted in a C-index of 0.574 in the development and 0.576 in the validation cohorts (lower than those recently reported for this model). Predictive ability was also improved after recalibration in this analysis. Risk stratification according to IDC model showed more similar outcomes across the development and validation cohorts compared with our model. CONCLUSION Our model provides a simple prognostic tool in mRCC patients treated with a targeted agent. It had similar performance with the IDC model, which, however, produced more consistent survival results across the development and validation cohorts. The predictive ability of both models was lower than that suggested by internal validation (our model) or recent published data (IDC model), due to differences between observed and predicted survival among intermediate and poor-risk patients. Our results highlight the importance of external validation and the need for further refinement of existing prognostic models.
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Affiliation(s)
- A Bamias
- Department of Clinical Therapeutics, University of Athens, Athens, Greece.
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Tsavaris N, Kosmas C, Skopelitis H, Dimitrakopoulos A, Kopteridis P, Bougas D, Stravodimos K, Mitropoulos D, Alamanis C, Giannopoulos A. Methotrexate-Paclitaxel-Epirubicin-Carboplatin (M-TEC) Combination Chemotherapy in Patients with Advanced Bladder Cancer: An Open Label Phase II Study. J Chemother 2013. [DOI: 10.1179/joc.2005.17.4.444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bamias A, Tsantoulis P, Zilli T, Koutsoukos K, Caparrotti F, Liontos M, Roth A, Lykka M, Stravodimos K, Chrisofos M, Papatsoris A, Efstathiou E, Wirth GJ, Mitropoulos D, Constantinides CA, Deliveliotis C, Iselin CE, Miralbell R, Dietrich PY, Dimopoulos MA. Outcome of patients with nonmetastatic, muscle-invasive bladder cancer (MIBC), not undergoing cystectomy, after treatment with non-cisplatin-based chemotherapy and/or radiotherapy: A retrospective analysis. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15619 Background: Τransurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy or combinations can be used in patients with MIBC not undergoing cystectomy, but the optimal treatment is yet unknown. Cisplatin-based chemotherapy is the standard if systemic therapy is to be used. Nevertheless, unfitness for cystectomy is frequently associated with unfitness-for-cisplatin. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin-based chemotherapy. Methods: Selection criteria: non-metastatic MIBC, no cystectomy, no cisplatin-based chemotherapy. Chemotherapy and/or radiotherapy should have been used apart from TURBT. Unfitness for Cisplatin was determined by: creatinine clearance < 50 ml/min, PS > 2, hearing loss, co-morbidities precluding adequate hydration. Carboplatin/gemcitabine was used in patients receiving chemotherapy. Tumor extent was evaluated by TURBT and CT. Patients consented to the use of their data. Results: 49 patients (median age 79), managed between 2/2003-2/2012 were included in this analysis (Table 1). 40 patients (82%) had T2 tumors. No factor for unfitness-for-cisplatin was present in 4 cases. During a median fup of 68 months 29 patients died (5 not due to disease). Treatment after TURBT and outcome are shown in the Table. Conclusions: Most patients with non-metastatic MIBC, not undergoing cystectomy, are also unfit-for-cisplatin, although comorbidities used as unfitness criteria do not always adhere to current guidelines. The outcome of these patients is poorer than that expected with cystectomy. Combining chemotherapy with radiotherapy produced numerically better outcomes and should be prospectively evaluated. [Table: see text]
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Affiliation(s)
- Aristotelis Bamias
- Department of Clinical Therapeutics, Athens University, Medical School, Athens, Greece
| | | | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Francesca Caparrotti
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Michael Liontos
- Deptartment of Clinical Therapeutics, University of Athens, Athens, Greece
| | - Arnaud Roth
- University Hospital Geneva, Geneva, Switzerland
| | - Maria Lykka
- Deptartment of Clinical Therapeutics, University of Athens, Athens, Greece
| | | | | | | | - Eleni Efstathiou
- Department of Clinical Therapeutics, University of Athens & Department of Genitourinary Medical Onology, The University of Texas MD Anderson Cancer Center, Athens, Greece
| | - Gregory J Wirth
- Urology Department, Geneva University Hospital, Geneva, Switzerland
| | | | | | | | | | - Raymond Miralbell
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Geneva University Hospital, Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva, Switzerland
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
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Koutsoukos K, Liontos M, Lykka M, Rigakos G, Andreadou A, Efstathiou E, Koutras A, Papatsoris A, Chrisofos M, Stravodimos K, Adamakis I, Alamanis C, Karavasilis V, Makatsoris T, Galani EP, Klouvas G, Kosmidis PA, Fountzilas G, Dimopoulos MA, Bamias A. Two cycles of carboplatin as adjuvant therapy in stage I seminoma: 8-year experience by the Hellenic Co-operative Oncology Group (HECOG). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4558 Background: Adjuvant chemotherapy is used in stage I testicular seminoma. We have reported a risk-adapted strategy of 2 cycles of cisplatin/etoposide (EP) in 64 patients with age < 34 and/or tumor diameter > 4cm) (Bamias et al, Urology 2007), resulting in no relapses over a median follow up of 5 years. Following the establishment of adjuvant carboplatin as a standard, we adopted this treatment for all patients with stage I seminoma. We report our 8-year experience and compare these results with our previous EP strategy. Methods: Patients with stage I seminoma, treated with 2 cycles of carboplatin AUC 6 and a minimum follow up of 1 year after chemotherapy were selected. All patients consented for the use of their medical information and the analysis was approved by the centers involved. Survival functions were presented using Kaplan-Meier curves. The log-rank test was used to test for survival differences across different categories. Results: 137 patients (Median age: 34; Age<34: 49%, tumor diameter>4cm: 42%; rete testis invasion: 24%), treated between 11/2003-12/2011 were selected. During a median follow up of 4 years, there were 5 relapses (5-y relapse rate [RR]: 97% [SE: 2%]): retroperitoneal lymph nodes (n=4) and isolated brain (n=1). All patients with relapse had tumor diameter > 4cm and/or age < 34. No relapse was associated with rete testis invasion. Patients with at least 1 of the above risk factors (n=94) had a significantly higher relapse rate compared with a similar population (n=64) treated with 2 cycles of adjuvant EP: 5-y RR was 95% (SE: 2%) vs.100% (SE 0%), (p=0.033). All relapsed patients were treated with BEP chemotherapy and are currently alive with no evidence of relapse. Neutropenia and nausea/vomiting were less frequent with carboplatin than with EP (11% vs. 36% and 15% vs. 65%). Conclusions: Our analysis confirms the association of age and tumor diameter with relapse in stage I seminoma treated with adjuvant carboplatin. Although adjuvant carboplatin in patients with age<34 and/or tumor diameter> 4 cm is associated with higher RR than EP, the prognosis of these patients is excellent with salvage chemotherapy and, therefore, the use of less toxic treatment is justified.
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Affiliation(s)
| | - Michael Liontos
- Deptartment of Clinical Therapeutics, University of Athens, Athens, Greece
| | - Maria Lykka
- Deptartment of Clinical Therapeutics, University of Athens, Athens, Greece
| | - Georgios Rigakos
- Deptartment of Clinical Therapeutics, University of Athens, Athens, Greece
| | | | - Eleni Efstathiou
- Department of Clinical Therapeutics, University of Athens & Department of Genitourinary Medical Onology, The University of Texas MD Anderson Cancer Center, Athens, Greece
| | | | | | | | | | | | | | | | - Thomas Makatsoris
- Clinical Oncology Laboratory, University Hospital of Patras, Patras, Greece
| | | | | | | | | | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Athens University, Medical School, Athens, Greece
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Bamias A, Dafni U, Karadimou A, Timotheadou E, Aravantinos G, Psyrri A, Xanthakis I, Tsiatas M, Koutoulidis V, Constantinidis C, Hatzimouratidis C, Samantas E, Visvikis A, Chrisophos M, Stravodimos K, Deliveliotis C, Eleftheraki A, Pectasides D, Fountzilas G, Dimopoulos MA. Prospective, open-label, randomized, phase III study of two dose-dense regimens MVAC versus gemcitabine/cisplatin in patients with inoperable, metastatic or relapsed urothelial cancer: a Hellenic Cooperative Oncology Group study (HE 16/03). Ann Oncol 2012; 24:1011-7. [PMID: 23136231 DOI: 10.1093/annonc/mds583] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The combinations of methotrexate, vinblastine, Adriamycin, cisplatin (Pharmanell, Athens, Greece) (MVAC) or gemcitabine, cisplatin (GC) represent the standard treatment of advanced urothelial cancer (UC). Dose-dense (DD)-MVAC has achieved longer progression-free survival (PFS) than the conventional MVAC. However, the role of GC intensification has not been studied. We conducted a randomized, phase III study comparing a DD-GC regimen with DD-MVAC in advanced UC. PATIENTS AND METHODS One hundred and thirty patients were randomly assigned between DD-MVAC: 66 (M 30 mg/m(2), V 3 mg/m(2), A 30 mg/m(2), C 70 mg/m(2) q 2 weeks) and DD-GC 64 (G 2500 mg/m(2), C 70 mg/m(2) q 2 weeks). The median follow-up was 52.1 months (89 events). RESULTS The median overall survival (OS) and PFS were 19 and 8.5 months for DD-MVAC and 18 and 7.8 months for DD-GC (P = 0.98 and 0.36, respectively). Neutropenic infections were less frequent for DD-GC than for DD-MVAC (0% versus 8%). More patients on DD-GC received at least six cycles of treatment (85% versus 63%, P = 0.011) and the discontinuation rate was lower for DD-GC (3% versus 13%). CONCLUSIONS Although DD-GC was not superior to DD-MVAC, it was better tolerated. DD-GC could be considered as a reasonable therapeutic option for further study in this patient population. Clinical Trial Number ACTRN12610000845033, www.anzctr.org.au.
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Affiliation(s)
- A Bamias
- Department of Clinical Therapeutics, Alexandra Hospital, Athens University Medical School, Athens, Greece.
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Alevizopoulos A, Mygdalis V, Tyritzis S, Stravodimos K, Constantinides CA. Low-grade fibromyxoid sarcoma of the renal pelvis: first report. Case Rep Nephrol Urol 2012. [PMID: 23197962 PMCID: PMC3482067 DOI: 10.1159/000341191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sarcomas of the genitourinary tract are quite rare, accounting for 2.1% of all soft tissue sarcomas and have a poor prognosis. Kidney sarcomas are quite rare, representing 1-3% of malignant renal cases. Low-grade fibromyxoid sarcoma (LGFS) of the kidney is an exceedingly uncommon, indolent but metastasizing soft tissue sarcoma with deceptively benign-appearing histological features. The estimated 5-year overall survival seems to be over 90%, but very late local relapses and distant metastasis may occur, which underlines the need for a long-term follow-up. We present a case of a 48-year-old male patient with a LGFS located on the renal pelvis. This is probably the first report of LGFS arising from the renal pelvis.
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Affiliation(s)
- Aristeidis Alevizopoulos
- 1st Academic Urology Department of Athens, Athens University Medical School - LAIKO Hospital, Athens, Greece
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11
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Karavasilis V, Tzanis K, Bamia C, Elaidi RT, Kostouros E, Visvikis A, Skarlos DV, Linardou H, Razis E, Chrisofos M, Stravodimos K, Lazaridis G, Timotheadou E, Hatzimouratidis C, Oudard S, Fountzilas G, Dimopoulos MA, Bamias A. Development and validation of prognostic models in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib: A Greek-French collaboration. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15040 Background: The use of tyrosine kinase inhibitors (TKIs) in mRCC has improved prognosis but the individual outcome remains largely unpredictable. The MSKCC model, used to identify risk groups, was developed in cytokine-treated patients and has not been externally validated in the TKI era. It contains 3 laboratory factors (total 5), making its application to retrospective series somewhat problematic. Subsequently, a more complicated model, using 4 laboratory factors (total 6) has been described. The Hellenic Cooperative Oncology Group recently described a simpler model with only 3 clinical factors. We are describing the application and external validation of this model. Methods: 128 Greek patients with mRCC treated with 1st line sunitinib were included. All had had nephrectomy. Previous interferon was allowed. Cox regression was used to develop a predictive model for overall survival (OS). Our model was compared to that of MSKCC and Heng’s using ROC curves and Harrell’s Concordance Index. Risk groups were defined by the calculated prognostic index and by clinical factors. External validation was done using a sample of 226 French patients. The Royston and Sauerbrei D statistic was used as a measure of discrimination of the survival model. Results: Time from diagnosis of RCC to start of sunitinib (<12), PS (>1) and number of metastatic sites (>1) were independent adverse prognostic factors in the Greek dataset. The co-efficients for each factor were: 0.51, 0.97, 0.61, respectively. The 3 risk groups were defined by the 25th and 75th percentiles of the prognostic index values (Table 1). The model was of equal prognostic value to the MSKCC (p=.272) and Heng’s (p=.075). French had better survival than Greek patients especially in the high risk group (for all models). Validation of our model in the French data showed that it was applicable (R2 D: 0.14, SE: 0.09), especially for the low/medium risk groups. Conclusions: Our model is the only one externally validated in TKI-treated patients. It may be considered as a simpler alternative to those currently applied. [Table: see text]
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Affiliation(s)
| | | | | | - Reza-Thierry Elaidi
- Medical Oncology Department, Georges Pompidou European Hospital, Paris, France
| | | | | | | | - Helena Linardou
- Hellenic Cooperative Oncology Group Data Office, Athens, Greece
| | - Evangelia Razis
- Hellenic Cooperative Oncology Group Data Office, Athens, Greece
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Griniatsos J, Dimitriou N, Tyritzis S, Pappas P, Sougioultzis S, Stravodimos K. Toxic megacolon due to fulminant Clostridium Difficile colitis. Acta Gastroenterol Belg 2011; 74:359-360. [PMID: 21861326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Bamias A, Karadimou A, Lampaki S, Lainakis G, Malettou L, Timotheadou E, Papazisis K, Andreadis C, Kontovinis L, Anastasiou I, Stravodimos K, Xanthakis I, Skolarikos A, Christodoulou C, Syrigos K, Papandreou C, Razi E, Dafni U, Fountzilas G, Dimopoulos MA. Prognostic stratification of patients with advanced renal cell carcinoma treated with sunitinib: comparison with the Memorial Sloan-Kettering prognostic factors model. BMC Cancer 2010; 10:45. [PMID: 20163744 PMCID: PMC2837011 DOI: 10.1186/1471-2407-10-45] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 02/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment paradigm in advanced renal cell carcinoma (RCC) has changed in the recent years. Sunitinib has been established as a new standard for first-line therapy. We studied the prognostic significance of baseline characteristics and we compared the risk stratification with the established Memorial Sloan Kettering Cancer Center (MSKCC) model. METHODS This is a retrospective analysis of patients treated in six Greek Oncology Units of HECOG. Inclusion criteria were: advanced renal cell carcinoma not amenable to surgery and treatment with Sunitinib. Previous cytokine therapy but no targeted agents were allowed. Overall survival (OS) was the major end point. Significance of prognostic factors was evaluated with multivariate cox regression analysis. A model was developed to stratify patients according to risk. RESULTS One hundred and nine patients were included. Median follow up has been 15.8 months and median OS 17.1 months (95% CI: 13.7-20.6). Time from diagnosis to the start of Sunitinib (12 months, p = 0.001), number of metastatic sites (1 vs. >1, p = 0.003) and performance status (PS) (1, p = 0.001) were independently associated with OS. Stratification in two risk groups ("low" risk: 0 or 1 risk factors; "high" risk: 2 or 3 risk factors) resulted in distinctly different OS (median not reached [NR] vs. 10.8 [95% confidence interval (CI): 8.3-13.3], p < 0.001). The application of the MSKCC risk criteria resulted in stratification into 3 groups (low and intermediate and poor risk) with distinctly different prognosis underlying its validity. Nevertheless, MSKCC model did not show an improved prognostic performance over the model developed by this analysis. CONCLUSIONS Studies on risk stratification of patients with advanced RCC treated with targeted therapies are warranted. Our results suggest that a simpler than the MSKCC model can be developed. Such models should be further validated.
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Affiliation(s)
- Aristotelis Bamias
- Dept of Clinical Therapeutics, Athens University, Medical School, Athens, Greece
| | - Alexandra Karadimou
- Dept of Clinical Therapeutics, Athens University, Medical School, Athens, Greece
| | - Sofia Lampaki
- Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - George Lainakis
- Dept of Clinical Therapeutics, Athens University, Medical School, Athens, Greece
| | - Lia Malettou
- Data Office, Hellenic Cooperative Oncology Group, Athens, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Kostas Papazisis
- 3rd Dept of Medical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | | | - Loukas Kontovinis
- 3rd Dept of Medical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | | | | | - Ioannis Xanthakis
- Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | | | | | - Kostas Syrigos
- 3rd Dept of Internal Medicine, University of Athens, Medical School, Athens, Greece
| | | | - Evangelia Razi
- 1st Dept of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Urania Dafni
- Data Office, Hellenic Cooperative Oncology Group, Athens, Greece
| | - George Fountzilas
- Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Zavos G, Pappas P, Karatzas T, Karidis NP, Bokos J, Stravodimos K, Theodoropoulou E, Boletis J, Kostakis A. Urological complications: analysis and management of 1525 consecutive renal transplantations. Transplant Proc 2008; 40:1386-90. [PMID: 18589113 DOI: 10.1016/j.transproceed.2008.03.103] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 03/11/2008] [Indexed: 02/07/2023]
Abstract
Urological complications after renal transplantation increase morbidity, delay graft function, and occasionally lead to graft and/or patient loss. The aim of this study was to analyze the causes of and therapeutic approaches to urological complications in renal transplantation as they related to patient outcomes. A series of 1525 consecutive renal transplantations were performed over a 24-year period. Renal grafts were obtained in 814 cases from living-related and in 711 from cadaveric donors. A Lich-Gregoire ureterovesical reimplantation technique with minimal bladder wall dissection was employed in all cases. Ureteral stents were routinely used in cadaveric transplants and exceptionally among living-related grafts. Urological complications were classified according to the mechanism and site of urinary tract involvement: graft ureteropelvic junction obstruction/stenosis (A), ureteral obstruction/stenosis (B), ureterovesical anastomosis obstruction/stenosis (C), urinary leakage (D), and other (E). Overall, we encountered 96 urological complications (6.3%). Group C complications occurred in 29 cases (30.2%), followed by 27 cases (28.1%) for group B patients, 25 cases (26.0%) for group D, 12 cases (12.5%) for group A, and 3 cases (3.1%) for group E patients. Surgical intervention was required in 49 (51.0%) of all urological complications. The others (n = 47, 49.0%) were treated either conservatively or by minimally invasive procedures. A rapid diagnosis of urological complications, assisted by early posttransplant DTPA scans, routine ultrasonography, and especially prompt treatment, resulted in compensation of renal graft dysfunction in the vast majority (n = 90, 93.8%) of cases. Surgical techniques of graft retrieval and reimplantation are of utmost importance to minimize the incidence of urological complications.
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Affiliation(s)
- G Zavos
- Transplantation Unit, Laiko General Hospital, Athens, Greece
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15
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Santucci R, Serafetinides E, Mitsogiannis I, Stravodimos K, Anastasiou I, Giannopoulou M, Giannopoulos A. MP-22.02: Evaluation and management of blunt renal trauma in adults with solitary kidney or impaired renal function. Urology 2007. [DOI: 10.1016/j.urology.2007.06.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Koritsiadis G, Stravodimos K, Mitropoylos D, Constantinides C, Fokitis I, Doymanis G, Koritsiadis S. POD-11.05: The effect of endogenous testosterone on urodynamic parameters in men with bladder outlet obstruction. Urology 2007. [DOI: 10.1016/j.urology.2007.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Stravodimos K, Koritsiadis G, Mitropoylos D, Koytalellis G, Adamakis I, Lazaris A, Zervas A. POS-02.76: The effect of a1-blocker in hypoxia in human obstructed detrusor. Urology 2007. [DOI: 10.1016/j.urology.2007.06.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Stravodimos K, Koritsiadis G, Michalakis A, Migdalis V, Panagis N, Loumos B, Gavalaki, Tsoukala A, Karafoylidoy A, Zervas A. POS-03.21: Ca19-9 tumor marker in benign hydronephrosis and the correlation with lewis status blood group. Urology 2007. [DOI: 10.1016/j.urology.2007.06.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diamantopoulou K, Lazaris A, Mylona E, Zervas A, Stravodimos K, Nikolaou I, Athanassiadou S, Nakopoulou L. Cyclooxygenase-2 protein expression in relation to apoptotic potential and its prognostic significance in bladder urothelial carcinoma. Anticancer Res 2005; 25:4543-9. [PMID: 16334139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Cyclooxygenase-2 (COX-2), a critical enzyme in the conversion of arachidonic acid to prostaglandin E2, influences the biological behavior of human tumors, being involved in carcinogenesis, tumor progression, reduced apoptosis and differentiation. The aim of the present study was to investigate the role of COX-2 protein expression in urothelial carcinoma (UC) of the urinary bladder in relation to clinicopathological data and indices of apoptotic potential. MATERIALS AND METHODS Immunohistochemistry was applied to 134 paraffin-embedded specimens of UC for the detection of COX-2, p53, bcl-2, caspase-3, bax protein, MLH1 and hTERT. RESULTS Ninety-four UCs (70.1%) had an enhanced expression of COX-2. The COX-2 semi-quantitative expression was unrelated to tumor grade and local invasion, but it was positively linked with caspase-3 (CPP32) and bax protein semi-quantitative immunoreactivity (p = 0.007 and p = 0.026), as well as with the quantitative expression of MLH1 (p = 0.019). COX-2 was also found to be inversely correlated with the nuclear localization of the catalyst component of the telomerase complex, hTERT (p = 0.009). Multivariate statistical analysis showed that COX-2 immunopositivity was independently associated with worse prognosis of patients with non muscle-invasive UCs (p = 0.002). CONCLUSION COX-2 overexpression, being possibly a subsequence of apoptosis activation, is associated with an unfavorable overall survival of patients with pTa-T1 UCs.
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Affiliation(s)
- K Diamantopoulou
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias St., Goudi, GR-11527 Athens, Greece
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Tsavaris N, Kosmas C, Skopelitis H, Dimitrakopoulos A, Kopterides P, Kopteridis P, Bougas D, Stravodimos K, Mitropoulos D, Alamanis C, Giannopoulos A. Methotrexate-paclitaxel-epirubicin-carboplatin (M-TEC) combination chemotherapy in patients with advanced bladder cancer: an open label phase II study. J Chemother 2005; 17:441-8. [PMID: 16167525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The present phase II study aimed to define the application of a novel regimen incorporating methotrexate, paclitaxel, epirubicin, and carboplatin (M-TEC) in advanced bladder cancer, essentially as an M-VAC-like regimen, by substitution of cisplatin by carboplatin, doxorubicin by epirubicin and vinblastine by paclitaxel. Forty patients with advanced bladder cancer entered the study; 34 males/6 females, median age: 68 (range, 59-76), median PS (Karnovsky): 80, without receiving prior chemotherapy. Disease extention was as follows; 11/40 had local recurrence, 6/40 liver metastases, 14/40 lung metastases, bone and lymph node 8/40, bones-lymph node-lung metastases 4, lymph node and liver 4/40, lymph node-liver and lung metastases 2/40. Drug schedule and doses were as follows: paclitaxel 180 mg/m2, carboplatin AUC = 5 (according to creatinine clearance, based on Calvert's formula), and epirubicin 40 mg/m2 were administered during day 1, whereas methotrexate 30 mg/m2 and epirubicin 40 mg/m2 were administered on day 14. All patients were evaluable for response with 24/40 responding [response rate (RR) 60%]; 10/40 (25%) CR, 14/40 (35%) PR, 9/40 (22.5%) SD, and 7/40 (17.5%) PD. Symptomatic improvement was observed in 50% of patients. The median duration of response was 22 (14-32) weeks, median time-to-progression (TTP) 33 (12-44) weeks, and median survival was 56 (20-84) weeks. Toxicity was well accepted and was mainly neutropenia > grade 3: 17%, anemia >grade 3: 16%, thrombocytopenia > grade 2: 6%, nausea & vomiting mainly > grade 2: 31%, according to the administered chemotherapy cycles, whereas fatigue grade 2-3: 19%, neurotoxicity grade 1-2 13% of patients, and alopecia grade 2 was observed in all patients. The present pilot study indicates the feasibility of the M-TEC combination for bladder cancer with acceptable toxicity.
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Affiliation(s)
- N Tsavaris
- Department of Pathophysiology, Oncology Unit, Athens University School of Medicine, Laikon General Hospital, 115 27 Athens, Greece
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Stravodimos K, Constantinides C, Manousakas T, Pavlaki C, Pantazopoulos D, Giannopoulos A, Dimopoulos C. Immunohistochemical expression of transforming growth factor beta 1 and nm-23 H1 antioncogene in prostate cancer: divergent correlation with clinicopathological parameters. Anticancer Res 2000; 20:3823-8. [PMID: 11268461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Prostate cancer is one of the main causes of morbidity and mortality among men. Several oncogenes and growth factors have been studied in an attempt to explain the molecular basis of carcinogenesis and progress of this carcinoma. In this study we correlated the immunohistochemical expression of antioncogene nm-23 H1 and transforming growth factor beta 1 (TGF-beta 1) with the clinical stage, PSA values, Gleason score and survival in prostate cancer. MATERIALS AND METHODS Fifty nine patients with prostate cancer were evaluated. PSA measurement, Gleason score determination and clinical staging were recorded for all the patients by the time of initial diagnosis and prior to any treatment. Follow-up ranged from 12 to 40 months. Tissue sections from representative areas of the tumors were immunohistochemically stained for nm-23 H1 and TGF-beta 1. The expression of these markers was correlated with stage, PSA values, Gleason score and survival. RESULTS There was a negative correlation between nm-23 H1 staining and tumor stage and grade. High grade (Gleason score 8-10) and stage D tumors showed weaker staining than low stage and grade tumors. There was a positive correlation between TGF-beta 1 staining, tumor stage and serum PSA levels. Additionally, TGF-beta 1 proved to be a negative predicting factor for patient survival. In tumors expressing both markers, TGF-beta 1 was the one to determine the aggressiveness of the carcinoma. CONCLUSIONS nm-23 H1 appears to be a tumor suppressor gene in prostate cancer, while TGF-beta 1 may act as a stimulating agent provoking aggressive behavior and metastasis. Their immunohistochemical staining may constitute complementary information in the evaluation of prostate cancer patients.
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Affiliation(s)
- K Stravodimos
- Department of Urology, Athens University, Medical School, Athens, Greece
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