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Salemis NS, Koliarakis N, Spiliopoulos K, Kimpouri K, Marinos L. Primary cutaneous follicle center lymphoma of the breast: Management of an exceedingly rare malignancy. Intractable Rare Dis Res 2020; 9:263-265. [PMID: 33139988 PMCID: PMC7586880 DOI: 10.5582/irdr.2020.03095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary cutaneous follicle center lymphoma (PCFCL) is defined as a low-grade B-cell non- Hodgkins lymphoma, which primarily occurs and remains confined to the skin, without evidence of extracutaneous or systemic involvement at the time of diagnosis. PCFCL affecting the breast skin is an exceedingly rare entity with only two cases reported in the English literature. We present a case of PCFCL affecting the periareolar breast skin and review the relevant literature. Our patient was a 64-year-old female who presented with an erythematous plaque in the periareolar region of the left breast. The diagnosis of PCFCL was confirmed by a biopsy performed with a seven-month delay, as the tumor had been initially misdiagnosed as a benign lesion. The patient was successfully treated with local radiation therapy. PCFCL is an indolent lymphoma associated with an excellent prognosis. For localized lesions, skin-directed therapies mainly consisting of radiation therapy or complete surgical excision are curative therapeutic approaches, while systemic chemotherapy should be reserved for patients with extensive disease. This case highlights the need to consider PCFCL as an important differential diagnosis in patients presenting with non-resolving erythematous breast skin lesions. A timely biopsy should be obtained to avoid delays in the initiation of appropriate treatment.
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Affiliation(s)
- Nikolaos S. Salemis
- Breast Cancer Surgery Unit, Army General Hospital, Athens, Greece
- IASO Women's Hospital, Athens, Greece
- IASO Thessalias Hospital, Larissa, Greece
- Address correspondence to:Nikolaos S. Salemis, Breast Cancer Surgery, Army General Hospital, 19 Taxiarhon Street, 19014 Kapandriti, Athens, Greece. E-mail:
| | - Nikolaos Koliarakis
- Department of Radiation Oncology, Andreas Syggros Hospital of Dermatology and Venereology, Athens, Greece
| | - Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
| | | | - Leonidas Marinos
- Department of Haematopathology, Evaggelismos General Hospital, Athens, Greece
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Meimeti E, Kafanas A, Pavlou P, Evangelatou A, Tsouparelou P, Kanellopoulos S, Kipouros P, Koliarakis N, Leonis G, Ioannou E, Roussis V, Rallis M. Topical Treatment of Skin Injury Inflicted in Mice by X-Ray Irradiation. Skin Pharmacol Physiol 2018; 31:175-183. [PMID: 29617695 DOI: 10.1159/000487404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS There is no treatment, without side effects, efficiently preventing or curing skin burns, caused by radiotherapy. A new experimental topical treatment protocol was assessed in mice receiving orthovoltage X-rays at an equivalent dose to that applied to human breast cancer patients in conventional radiotherapy. METHODS SKH-HR2 female hairless mice were irradiated on their dorsum with a total dose of 4,300 cGy during a 1-month period (20 fractions). The treatment group received a combination of 3 topical products, an oil-in-water cream, a gel containing Pinus halepensis bark aqueous extract, and an ointment containing olive oil extract of the marine isopod Ceratothoa oestroides. The positive control group was treated with a conventionally used commercial gel, whereas the negative control group did not receive any topical treatment. Skin alterations were evaluated by macroscopic examinations, measurements of transepidermal water loss (TEWL), melanin content, erythema intensity, hydration, and histopathology assessment. RESULTS Sixty days after radiation, TEWL and hydration values were abnormal and elements of acute, chronic, and granulomatous inflammation were present in all cases. The severest damage was detected in the deeper dermis. Treatment showed a comparatively beneficial effect on chronic and granulomatous inflammation while positive control was beneficial on acute inflammation. CONCLUSION Skin anti-inflammatory treatment was the most effective but must be applied for several months. Further preclinical studies should be conducted, assimilating a human cancer radiation therapeutic schema with the aim of optimizing skin inflammation treatment.
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Affiliation(s)
- Evangelia Meimeti
- Department of Pharmaceutical Technology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagoula Pavlou
- Department of Pharmaceutical Technology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonia Evangelatou
- Department of Radiation Oncology, Andreas Syggros Hospital of Dermatology and Venereology, Athens, Greece
| | - Panagiota Tsouparelou
- Department of Radiation Oncology, Andreas Syggros Hospital of Dermatology and Venereology, Athens, Greece
| | - Stelios Kanellopoulos
- Department of Radiation Oncology, Andreas Syggros Hospital of Dermatology and Venereology, Athens, Greece
| | - Panagiotis Kipouros
- Department of Radiation Oncology, Andreas Syggros Hospital of Dermatology and Venereology, Athens, Greece
| | - Nikolaos Koliarakis
- Department of Radiation Oncology, Andreas Syggros Hospital of Dermatology and Venereology, Athens, Greece
| | - Georgios Leonis
- Department of Pharmaceutical Technology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathia Ioannou
- Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Roussis
- Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rallis
- Department of Pharmaceutical Technology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
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Kouloulias V, Mosa E, Tolia M, Kantzou I, Koliarakis N, Platoni K, Georgakopoulos I, Siatelis A, Sarris G, Beli I, Chrisofos M, Kelekis N. Evaluation of efficacy and toxicity in two different hypofractionated 3D-conformal external beam radiotherapy schedules in localised muscle invasive bladder cancer. J BUON 2013; 18:942-948. [PMID: 24344021] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the efficacy as well as acute and late toxicity of two different accelerated hypofractionated 3D-conformal radiotherapy (Hypo-3DCRT) schedules in patients with bladder cancer. METHODS Between February 2006 and June 2011, 50 elderly patients with cT1-2N0 bladder carcinoma were treated with Hypo-3DCRT. Mean age was 75 years. All patients were medically inoperable, with poor performance status, who couldn't tolerate either cystectomy or radical external beam irradiation on a daily basis. A dose of 36 Gy in 6 weekly fractions (arm A, N=39) or 39.96 Gy of 3.33 Gy twice daily, once a week, for 6 weeks (arm B, N=11) were prescribed. The primary study endpoints were the evaluation of acute/late gastrointestinal (GI) toxicity according to the EORTC/RTOG scale together with the visual analogue bladder-related pain score (VAS). RESULTS The GI acute toxicities were: grade 1: arm A 24/39 (61.5%), arm B 9/11 (81.8%); grade 2: arm A 14/39 (35.9%), arm B 1/11 (9.1%); grade 3: arm A 1/39 (9.1%) (x(2), p=0.29). Only grade 1 late GI toxicity was seen and was significantly higher in arm A: arm A 17/39 (43.6%) and arm B 1/11 (9.1%) (x(2), p=0.037). The reduction of VAS score was similar in both arms (p=0.065). The median relapse free survival (RFS) was 15 and 16 months for arm A and B, respectively (log rank, p=0.71). CONCLUSIONS Beyond the non-randomized design of the trial, the Hypo-3DCRT schedules used appear to be an acceptable alternative to the traditional longer radiotherapy (RT) schedules for elderly patients unfit for daily irradiation.
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Affiliation(s)
- V Kouloulias
- 2nd Radiology Department, Radiotherapy unit, Attikon University Hospital Athens, Greece
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Danopoulou I, Korfitis C, Koliarakis N, Trafalis DT. Rapid improvement of extensive non-melanoma skin cancers with combination of 13-cis-retinoic acid and radiotherapy: report of three cases. J BUON 2009; 14:515-517. [PMID: 19810148] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Extensive non-melanoma skin cancer (NMSC) constitutes a therapeutic challenge especially in old and debilitated patients. Applied treatments include surgical excision, MOHS micrographic surgery, cryosurgery, electrodesiccation, and radiotherapy. We present 3 elderly patients with extensive basal or squamous cell carcinomas and poor general condition who were treated with a combination of 13-cis-retinoic acid 1 mg/kg daily and radiotherapy 2.5 Gy daily. The treatment resulted in rapid improvement of the tumors with significant reduction of their size.
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Affiliation(s)
- I Danopoulou
- Department of Dermatology, "A. Sygros" Hospital, University of Athens, Athens, Greece
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Vorgias G, Profitis E, Sarris G, Strigou S, Kosmas C, Katsoulis M, Karamoussa E, Kalinoglou N, Koliarakis N, Dertimas B, Bafaloukos D, Akrivos T. Evaluation of the possible benefits of post-radiotherapy surgery after concomitant chemoradiotherapy with a new radio-sensitizing regimen (irinotecan / CPT-11, interferon A2b and amifostine) for advanced-stage cervical carcinoma. Preliminary results of a pilot phase-II study. J BUON 2009; 14:197-202. [PMID: 19650166] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE This phase II pilot study was conducted to evaluate the results of a three-modality approach (which included post-chemoradiotherapy surgery) in advanced-stage cervical carcinomas. PATIENTS AND METHODS Thirty-six patients underwent either surgery or were put on follow-up after having received radical cervical radiotherapy (RT) combined with radiosensitizing chemoimmunotherapy with irinotecan (CPT-11), interferon (IFN) A2b, and amifostine. The last selection (surgery or follow-up) was based on clinical evaluation (downstaged or not). Feasibility, morbidity, surgical outcome and survival were evaluated. RESULTS Twenty-six patients had stage IIb and 10 IIIb disease at diagnosis. Sixteen (44%) were clinically downstaged, thus becoming eligible for surgery. Twelve (33%) were operated and the others were put on follow-up. There was no significant increase in treatment-related morbidity of the group of patients receiving three-modality therapy, since only one intraoperative complication had occurred. In 58% of the operated patients, chemoradiotherapy-resistant tumor was found on pathology of the cervical specimens, while 29% of them had lymph nodes infiltrated by the tumor. After a median follow-up of 42.5 months, overall survival (OS) of operated vs. non-operated patients (88 vs. 56%, respectively) show only a trend toward significance (p=0.10). The overall recurrence/metastasis rate was 36.1% and the disease-free survival (DFS) 56% for operated vs. 76% for non-operated patients, respectively (p=0.63). CONCLUSION These results indicate that post-chemoradiotherapy surgery is justified because of the high rate of residual disease found. Morbidity can be effectively limited with proper patient selection. A considerable survival benefit is expected, although this remains to be confirmed with phase III studies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Amifostine/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Camptothecin/administration & dosage
- Camptothecin/analogs & derivatives
- Carcinoma, Adenosquamous/drug therapy
- Carcinoma, Adenosquamous/radiotherapy
- Carcinoma, Adenosquamous/surgery
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Combined Modality Therapy
- Feasibility Studies
- Female
- Humans
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Irinotecan
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Pilot Projects
- Preoperative Care
- Prognosis
- Radiotherapy Dosage
- Recombinant Proteins
- Survival Rate
- Treatment Outcome
- Uterine Cervical Neoplasms/drug therapy
- Uterine Cervical Neoplasms/radiotherapy
- Uterine Cervical Neoplasms/surgery
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Affiliation(s)
- G Vorgias
- Department of Gynaecology, Metaxa Cancer hospital, Piraeus, Greece.
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Markouizou A, Koliarakis N, Paraskevaidis M, Tsakiris G, Karageorgis A, Karageorgis P. Radiation dermatitis: implicated factors, clinical aspects, possible prevention, and medical care. J BUON 2007; 12:463-470. [PMID: 18067203] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The increasing incidence of cancer is due to many factors. Among them quite significant is considered the rising proportion of older people in the population and the modern methods of early diagnosis. Radiotherapy (RT), along with surgery and chemotherapy, is a major therapeutic modality in the management of cancer. In the context of current treatment methods and practice, approximately half of the patients with cancer will receive RT at some stage of their illness. RT can lead to cure some kinds of cancer but it can also be delivered for palliation. Unfortunately, skin damage is a complication affecting by and large all patients receiving external beam RT. In order to minimize the risk of this damage it would be helpful to know the complex underlying molecular mechanisms and evaluate the related clinical symptoms, not only for medical but also for psychological reasons related to the patient. The purpose of this article was to review the current approaches to this particular clinical condition, in order to realize an effective patient-oriented clinical practice and keep this radiation-induced complication as low as possible.
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Affiliation(s)
- A Markouizou
- 2nd Department of Radiation Oncology, Metaxa Cancer Hospital, Piraeus, Greece.
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Ziras N, Tsoutsou P, Koliarakis N, Magdalinos N, Sarris G, Potamianou A, Paraskevaides M, Synodinou M, Chrysanthou K, Karageorgis P, Athanassiou AE. Phase I study of postoperative radiotherapy with concomitant weekly irinotecan, 5- fluorouracil and folinic acid in locally advanced rectal cancer. J BUON 2004; 9:255-61. [PMID: 17415823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE 5- fluorouracil (5-FU)-based chemotherapy with concomitant pelvic radiotherapy represents the gold standard of the adjuvant treatment of high-risk rectal cancer. This study aimed to determine the maximum tolerated dose (MTD) of weekly irinotecan (CPT-11) when combined with fixed 5FU/FA doses and pelvic irradiation. PATIENTS AND METHODS Twenty- four patients with stage II or III rectal cancer were accrued. All had undergone curative surgery before entering the study. Standard pelvic radiotherapy was delivered (50.4 Gy, 1.8 Gy/ fraction in 5.5 weeks). The 5-FU/FA doses were 350/250 (mg/m(2)) in the first 6 patients and 250/100 in the remaining patients. Weekly doses of CPT-11 started at 30 mg/m(2) with escalation steps of 10 mg/m(2). CPT-11 was escalated when 3 patients had been monitored for 8 weeks, without a dose limiting toxicity (DLT). RESULTS Twenty-three out of 24 patients completed the chemoradiation course. Only 1 patient discontinued the treatment due to persistent grade 3 diarrhea. Of the 144 planned weekly chemotherapy cycles, only 7 were omitted as a result of persisting grade 2-3 gastrointestinal toxicity in 3 patients and grade 3 neutropenia in 1 patient. Grade 3 gastrointestinal DLTs were observed at doses at the level of 30/250/100 in 1 patient and 70/250/100 in 2 patients. Late DLTs were severe radiation dermatitis and colitis at 40/ 350/250 (1 patient) and 70/250/100 (2 patients), respectively. With a follow-up of 18 months 20 (83.3%) patients remain disease- free. CONCLUSION The administration of weekly CPT-11/ 5FU/FA with concomitant pelvic radiotherapy is feasible and effective. This treatment schedule is associated with mild myelosuppression and mild to moderate gastrointestinal toxicity. Caution should be paid on late radiotherapy-induced toxicities. The MTD of weekly CPT-11 is 30 mg/m(2) when combined with 5FU/FA doses (mg/m(2)) of 350sol;250 and reaches 60 mgsol;m(2) with lower doses of 5FU/FA (250/100).
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Affiliation(s)
- N Ziras
- First Department of Medical Oncology, Oncology, Metaxa Cancer Hospital, Piraeus, Greece
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