Present occupation and affiliation: Dermatologist-Venereologist at the Institute of Social Security. Scientific Associate at the Department of Dermatology, University of Athens, A. Sygros Hospital.
Clinical background: M.D. Degree: 1995 University of Crete Residency: Heraklion University General Hospital, Dept of Dermatology (1997-2000) PhD: 2001 University of Crete
RESEARCH EXPERIENCE • PhD at the University of Crete, Division of Medicine. Title “Photodiagnosis and Photodynamic Therapy of HPV skin and mucocutaneous infections”. Grade: Excellent. • Molecular study in melanoma in collaboration with the Department of Dermatology, University of Athens, A. Sygros Hospital and the Medical Genetics Laboratory, University of Athens, Agia Sophia Hospital for Children.
SCIENTIFIC WORK Proceedings: 1. C Antoniou, A. Stratigos, MG Kosmadaki, I. Stefanaki, M. Daboudi, G. Avgerinou, P.Stavropoulos, I. Potouridou, K. Desinioti, AD Katsambas. Our experience with efalizumab. International Proceedings From Hippocrates to Modern Dermatology. 15th Congress of the European Academy of Dermatology and Venereology, Rhodes (Greece), October 4-8, 2006: 753-5.
Chapters in books: 1. Bacterial and mycobacterial diseases. Irene Stefanaki, Andreas Katsambas. Manual of Gender Dermatology, Chapter 25, p.231-237. Editors: Lawrence Parish, Sarah Brenner, Marcia Ramos-e-Silva, Jennifer L. Parish, Copyright: Jones & Bartlett Learning, ISBN-13: 978-0-7637-6396-1, ISBN-10: 0-7637-6396-9 2. Rickettsial and viral diseases. Noah Scheinfeld, Lawrence Parish, Irene Stefanaki. Manual of Gender Dermatology, Chapter 26, p.239-245. Editors: Lawrence Parish, Sarah Brenner, Marcia Ramos-e-Silva, Jennifer L. Parish, Copyright: Jones & Bartlett Learning, ISBN-13: 978-0-7637-6396-1, ISBN-10: 0-7637-6396-9
Announcements in International Congresses: 1. S. Politaki, I. Stefanaki, J. Chatzinicolaou, G. Polychronaki, V Chologitas, C. Giannakopoulou. The effects on the newborn of alcohol, nicotine and drug abuse during pregnancy. 1st European Congress of Medical Students, Athens Greece 14-16 April 1995. 2. I. Stefanaki, N. Karpeta, M. Christodoulakis, I. Melissas. Surgical treatment of morbid obesity. 6th European Students Conference, Berlin 19-21 October 1995. 3. H. Varveris, C. Fragiadaki, M. Mazonakis, E. Christodoulakis, P. Mandolas, S. Kahris, I. Stefanaki, H. Varanakis, S. Sifakis, P. Prokopakis, D. Tsiftsis. Does postoperative radiotherapy increase morbidity and reduce survival in breast cancer carcinoma patients? Effects of local nodal irradiation on mediastinum and systemic immunity to cancer or the breast. HSBCR Second International Congress, Kos 25-28 October 1995. 4. H. Varveris, Z. Haralambakis, M. Koukourakis, M. Mazonakis, I. Stefanaki, G. Pissakas, S. Sifakis, A. Zolindaki, C. Relakis, G. Froudarakis, E. Koumantakis. A phase II trial of concurrent brachytherapy and chemotherapy with platinum compounds for the treatment of locally advanced carcinoma of the uterine cervix (Stage II, III, IVA). Radiology and Oncology ’96, Birmingham 20-22 May 1996. 5. D. Ioannidou, M. Stefanidou, I. Stefanaki, M. Alexandrakis, J. Panayotidis, K. Krasagakis. Langerhans cell histiocytosis in an elderly patient complicated with Serratia marcencens infection. Clinical Dermatology 2000, Vienna 17-20 May 2000. 6. I. Stefanaki, C. Balas, G. Themelis, E. Vazgiouraki, A. Tosca. Photodiagnosis of condylomata acuminata by using acetic acid and 5-aminolevulinic acid. Clinical Dermatology 2000, Vienna 17-20 May 2000. 7. I. Stefanaki, C. Balas, G. Themelis, E. Vazgiouraki, D. Dokianakis, D. Spandidos, A. Tosca. In vivo detection and staging of human papilloma virus-induced lesions of anogenital area by quantitative assessment of acetic acid-tissue interaction kinetics. 6th World Congress on Advances in Oncology and 4th International Symposium on Molecular Medicine, Hersonissos Crete 18-20 October 2001. 8. I. Stefanaki, G. Themelis, J.G. Panayiotidis, C. Balas, A. Tosca. Photodiagnosis of HPV infections through multispectral image spectroscopy. 15th Congress of I.S.D.Q.P., 8th Congress of E.S.A.C.P. and 6th Congress of Telepathology, Heraklion Crete 14-21 September 2002. 9. I. Stefanaki, S. Georgiou , G. Themelis, E. Vazgiouraki , A. Tosca. Photodynamic therapy efficacy after topical application of 5-aminolevulinic acid in condylomata acuminata: a pilot study. 11th Congress of the European Academy of Dermatology and Venereology, Prague 2-6 October 2002. 10. I. Stefanaki, G. Dimisianos, V. Nikolaou, O. Papadopoulos, E. Gogas, A. Katsambas, E. Kanavakis, A. Stratigos. A case/control study of the frequency of p53 codon 72 polymorphism in patients with cutaneous melanoma A case/control study of the frequency of p53 codon 72 polymorphism in patients with cutaneous melanoma. 6th World Congress on Melanoma, Vancouver 6-10 September 2005. 11. R. Dimisianos, M. Poulou, I. Stefanaki, V. Nikolaou, H. Goga, O. Papadopoulos, C. Sofokleous, A. Katsambas, E. Kanavakis, A Stratigos. Melanocortin 1 receptor (MC1R) gene polymorphisms and the risk of cutaneous melanoma in a case-control study. 35th Annual ESDR Meeting, Tübingen 22-24 September 2005. 12. D. Gerasimos, I. Stefanaki, V. Nikolaou, M. Poulou, H. Gogas, O. Papadopoulos, E. Kanavakis, A. Katsambas, A. Stratigos. Mutations of the golden gene in a melanoma case/control study. 3rd Annual International Melanoma Research Congress, Noordwijk, The Netherlands, 14-16 September 2006. 13. I. Stefanaki. Malignant melanoma in pregnancy. 15th Congress of the European Academy of Dermatology and Venereology, Rhodes, Greece, 4-8 October 2006. 14. C Antoniou, A. Stratigos, MG Kosmadaki, I. Stefanaki, M. Daboudi, G. Avgerinou, P.Stavropoulos, I. Potouridou, K. Desinioti, AD Katsambas. Our experience with efalizumab. 15th Congress of the European Academy of Dermatology and Venereology, Rhodes, Greece, 4-8 October 2006. 15. E. Nicolaidou, M. Hadjivassiliou, G. Bethimoutis, C. Stefanaki, I. Stefanaki, A.D. Katsambas. MSM comprise only a small part of new early syphilis cases in Athens, Greece. 22nd IUSTI-Europe Conference on Sexually Transmitted Infections, Versailles, France, 19-21 October 2006. 16. I. Stefanaki , K. Kypraiou , V. Nikolaou , V. Sypsa , D. Polidorou , H. Gogas , O. Papadopoulos , C. Antoniou , A. Katsambas , A. Stratigos. Investigation of the role of a functional MDM2 polymorphism (SNP309) and its interaction with codon 72 P53 polymorphism in melanoma risk. 18th Congress of the European Academy of Dermatology and Venereology, Berlin, Germany, 7-11 October 2009 17. I. Stefanaki. Treatment of condylomata. Cumulative experience from our STD Clinic. 7th EADV Spring Symposium. Cavtat,Croatia, 13-16 May 2010. 18. F. Chatzinasiou, C. Lilli, K. Kypraiou, I. Stefanaki, V. Nikolaou, G. Spyrou, E. Evangelou, J. Roehr, E. Kodela, A. Katsambas, J. Ioannidis, L. Bertram, A. Stratigos. comprehensive review and field synopsis of genetic associations in cutaneous melanoma. 6th EADO Congress, Vouliagmeni-Athens, Greece, 16-19 June 2010. 18. V. Nikolaou, M. Plaka, D. Polydorou, V. Chasapi, I. Stefanaki, I. Potouridou, E. Hatziolou, E. Kodela, O. Papadopoulos, A. Katsambas, A. Stratigos. Epidemiological and clinical characterization of patients with multiple primary melanomas in a Greek cohort. 6th EADO Congress, Vouliagmeni-Athens, Greece, 16-19 June 2010. 19. V. Nikolaou, X.G. Kang, H. Gogas, M. Plaka, J. Njauw, K. Kypraiou, I. Mirmigi, I. Stefanaki, A. Stratigos, H. Tsao. Mutational analysis of CDKN2A and CDK4 genes in a hospital-based series of Greek patients with melanoma. 6th EADO Congress, Vouliagmeni-Athens, Greece, 16-19 June 2010.
TEACHING EXPERIENCE 1. Teaching class of Dermatology at the Technical Professional School of Nurses, Venizelio General Hospital of Heraklion, during the academic year 1996-1997. 2. Invited speaker on the topic of Sexually Transmitted Diseases at the Department of Medicine, University of Crete, from 2001 to 2005. 3. Participation at the Clinical Educational Program in Dermatology, University of Athens, A. Sygros Hospital 2004-2008.
SCIENTIFIC COLLABORATIONS 1. Foundation of Research and Technology Hellas – Institute of Electronic Structure & Laser, Heraklion: training and clinical experience on systems of Photodiagnosis and Lasers. 2. Laboratory of Virology, Medical School, University of Crete and Medical Genetics Laboratory, University of Athens, Agia Sophia Hospital for Children: training in molecular biology techniques. 3. University of Athens, A. Sygros Hospital: application of molecular biology techniques in protocols of molecular epidemiology. 4. Laboratory of Microbiology, A. Sygros Hospital: clinical protocol on treatment of fungal infections of the skin.
CLINICAL PROTOCOLS 1. Study title: A multicentre, open label Phase IIIb/IV study of subcutaneous administered efalizumab in the treatment of adult patients with moderate to severe chronic plaque psoriasis who have failed to respond to, or who have a contraindication to, or are intolerant of other systemic therapies including ciclosporin, methotrexate and PUVA. Protocol number: IMP 25300. EUDRACT number: 2004-001236-23.
Abstract: BACKGROUND: Infliximab, a chimeric monoclonal antibody, has been shown to be effective for moderate to severe psoriasis. Clinical experience with long-term infliximab therapy for psoriasis is accumulating, and it is therefore important to share our experience with its use in real-life clinical practice. OBJECTIVES: To report our experience with infliximab (Remicade; Schering Plough, Kenilworth, NJ, U.S.A.) for the treatment of moderate to severe plaque psoriasis (and/or arthritis) from a single clinic in Greece. PATIENTS AND METHODS: Between August 2004 and March 2008, 62 patients presenting to our clinic with moderate to severe psoriasis were treated with infliximab. Disease phenotype, clinical course, disease severity and adverse events were assessed throughout the treatment period. RESULTS: Infliximab resulted in a reduction of median Psoriasis Area and Severity Index (PASI) of 70% at week 6 and 84.4% at week 14. Nineteen patients who have completed 1 year on infliximab treatment experienced sustained efficacy with a median PASI improvement of 92.16% and a Physician's Global Assessment (PGA) of 'clear' or 'almost clear', while nine patients have reached approximately 20 months of continuous therapy. All patients with psoriatic arthritis showed marked improvement in their clinical symptoms following the first infusion. Eight patients (12.9%) experienced adverse events that required discontinuation of treatment. There were no statistically significant differences in PASI and Dermatology Life Quality Index (DLQI) scores between patients with arthritis and those with only skin lesions, or between those who received methotrexate, either from the beginning or during infliximab therapy, and those who did not receive methotrexate at all. Selected patients of interest are discussed. CONCLUSIONS: The above data confirm previous reports that treatment with infliximab is an efficacious and safe option for patients with moderate to severe plaque psoriasis (and/or arthritis). Long-term follow-up, continued pharmacovigilance, and controlled comparative studies will be required to fully evaluate its use in the treatment of psoriasis.
Abstract: Seborrheic dermatitis is a recurrent, usually mild, skin disorder with typical clinical manifestations. As it most frequently involves exposed areas, such as the face and scalp, patients seek advice from a dermatologist in order to control their disease. This article will review the available treatments for this common dermatologic problem.
Abstract: The SLC24A5 gene, the human orthologue of the zebrafish golden gene, has been shown to play a key role in human pigmentation. In this study, we investigate the prevalence of the variant allele rs1426654 in a selected sample of Greek subjects. Allele-specific polymerase chain reaction was performed in peripheral blood samples from 158 attendants of a dermatology outpatient service. The results were correlated with pigmentary traits and MC1R genotype. The vast majority of subjects (99%) were homozygous for the Thr(111) allele. Only two subjects from the control group (1.26%) were heterozygous for the alanine and threonine allele. Both of these Thr(111)/Ala(111) heterozygotes carried a single polymorphism of MC1R (one with the V92M variant and another with the V60L variant). Following reports of the rs1426654 polymorphism reaching fixation in the European population, our study of Greek subjects showed a prevalence of the Thr(111) allele, even among subjects with darker skin pigmentation or phototype.
Abstract: Phase-sensitive nuclear Overhauser enhancement spectroscopy (NOESY) experiments, (3)J couplings and computational molecular modeling (MM2* and MMFF force fields) were employed to examine the conformational properties of verrucarin A in chloroform solutions. The MMFF force field calculations resulted in a family of 12 low-energy structures along with their populations, the latter being determined by the NMR analysis of molecular flexibility in solution(NAMFIS) deconvolution analysis. The concluded model was capable of reproducing successfully the experimental NOESY cross-peak volumes and the proton-coupling constants. Among the 12 conformers, the one which was similar to the structure of verrucarin A in the solid state was the predominant accounting for 75% of the total relative population, although other low-energy conformations contributed to a lesser degree in order to explain the experimental data.
Abstract: OBJECTIVES: Limited data exist about the risk factors of melanoma in the Greek population. We investigated the association of melanoma with phenotypic and solar indices in this darker skin population residing in an environment of high ambient ultraviolet radiation. METHODS: Our study included 200 sporadic melanoma cases and 200 age-, sex-matched control subjects. Information on history of sun exposure patterns and cutaneous reaction to sunlight was obtained and a clinical evaluation of pigmentary traits, pigmented lesions, and actinic keratoses was performed. RESULTS: In the multivariate analysis, fair skin (OR: 4.63, for fair skin versus light brown, 95% CI: 1.54-13.92), intermittent sun exposure during childhood (OR: 3.33, >2 weeks/year of sun exposure versus < or =2 weeks/year 95% CI: 1.37-8.09), and outdoor leisure activities (OR: 2.74, 95% CI: 1.28-5.89), but not skin phototype or sunburns, were positively related to the risk of melanoma. In addition to an elevated count of common melanocytic nevi (OR: 6.27, > or =10 nevi versus no nevi, 95% CI: 1.65-23.76) and the presence of clinically atypical nevi (OR: 2.84, 95% CI: 1.16-6.98), solar lentigenes were an independent risk factor of melanoma (OR: 4.33, 95% CI: 1.67-11.22). CONCLUSIONS: Intermittent sun exposure of moderate intensity during childhood/adolescence and outdoor leisural activities, in conjunction with a more resistant skin phenotype to acute sunburns and a strong association with nevi and solar lentigenes was a prominent determinant of melanoma risk in our population.
Abstract: BACKGROUND: Since the year 2000 a melanoma/skin cancer screening campaign has been organized annually in Greece in the context of the Euromelanoma Screening Day Campaign. OBJECTIVES: We aimed to analyse the characteristics of the screened population, to recognize relevant risk factors and to identify the cases of histologically confirmed malignant melanoma (MM) in individuals with suspicious skin lesions. METHODS: An analysis of the completed screening forms from the years 2000-2004 was performed with respect to relevant demographic, epidemiological and clinical data. RESULTS: A total of 9723 individuals were screened, most of whom where below the age of 50 years (71%), female (59%), and of skin phototype II and III (76%). Sunburn during childhood was reported in 47% of participants, while 5% of the screened population had a personal or family history of melanoma. On clinical examination, 14.4% had actinic keratoses, 31.2% had dysplastic nevi, while 6.4% carried a presumptive diagnosis of non-melanoma skin cancer. In the 2003-2004 screening campaign, 19 out of the 171 clinically suspicious lesions were histologically proven to be MM, the majority of which (58%) were 'thin' melanomas (Breslow's thickness of<or=1 mm) of the superficial spreading type. CONCLUSIONS: Our study suggested that, a melanoma/skin cancer screening programme in a Mediterranean country, supported by an intense publicity campaign, attracted many individuals at risk for skin cancer and detected mostly thin melanomas of the superficial spreading type.
Abstract: BACKGROUND: p53 has a common polymorphism at amino acid 72, encoding either arginine or proline. p53Arg and p53Pro exhibit differences in various biological activities, such as cell-cycle arrest and induction of apoptosis. Numerous epidemiological studies have examined the role of this polymorphism in several human malignancies, including cutaneous cancers, with contradictory results. OBJECTIVES: To investigate the germline frequency of p53 codon 72 polymorphism in malignant melanoma in a Mediterranean population, and to examine possible associations with various clinicopathological factors. METHODS: In this hospital-based case-control study we used allele-specific polymerase chain reaction for p53 codon 72 genotyping in blood specimens from 107 Greek patients with sporadic cutaneous melanoma and 145 healthy controls. RESULTS: After adjustment for age, sex and phototype the Pro/Pro genotype was associated with increased risk for cutaneous melanoma compared with the Arg/Arg genotype (adjusted odds ratio, OR 3.17, 95% confidence interval, CI 1.03-9.78). This correlation was more pronounced in subjects with phototypes III or IV (adjusted OR 9.56, 95% CI 1.56-58.46), dark skin (adjusted OR 10.96, 95% CI 1.64-73.28), dark eyes (adjusted OR 8.86, 95% CI 1.69-46.52) and dark hair (adjusted OR 3.17, 95% CI 1.01-9.95), and among noncarriers of melanocortin 1 receptor gene (MC1R) red hair polymorphisms (adjusted OR 2.99, 95% CI 1.02-8.78). CONCLUSIONS: p53 codon 72 Pro/Pro genotype could be a risk factor for the development of melanoma in the Greek population, especially in subgroups with darker skin pigmentation, as well as among noncarriers of the MC1R red hair polymorphic variants.
Abstract: BACKGROUND: Efalizumab (anti-CD11a antibody) targets T cell-mediated steps important in the immunopathogenesis of psoriasis. As efalizumab is intended to be administered on a continuous long-term basis in psoriasis, it is important to share experience concerning issues commonly occurring during its use in real daily practice. OBJECTIVE: To evaluate the efficacy and safety of efalizumab treatment in Greek patients with moderate-to-severe plaque psoriasis, and to investigate whether there are specific characteristics that predict the clinical outcome of therapy. PATIENTS: Seventy-two patients with moderate-to-severe plaque psoriasis, who had failed to respond to, or had a contraindication to, or were intolerant to other systemic therapies, received efalizumab (1 mg kg(-1) per week) for 12 weeks or more. RESULTS: After 12 weeks of efalizumab treatment, 65% of patients achieved 50% or more improvement from baseline Psoriasis Area and Severity Index (PASI) and 39% achieved at least 75% reduction in PASI score. The mean percentage PASI improvement from baseline was 62%. The most common side effects were a flu-like syndrome, a transient localized papular eruption, leucocytosis and lymphocytosis. There was no correlation between the occurrence of these side effects and the clinical response. Patients with a past history of unstable types of psoriasis were likely poor responders to efalizumab, and at an increased risk of developing generalized inflammatory flare. CONCLUSION: These results confirm previous reports suggesting that treatment with efalizumab is an efficacious and safe option for patients with moderate-to-severe plaque psoriasis. A detailed previous history of psoriasis is important in order to select possible candidates for efalizumab therapy.
Abstract: BACKGROUND: Several investigators have described a seasonal variation in the diagnosis of cutaneous melanoma. Limited data exist on the seasonality of melanoma diagnosis in Southern European countries. PATIENTS AND METHODS: The seasonal pattern of diagnosis was analyzed in 404 Greek patients diagnosed with cutaneous melanoma (CM) between 1996 and 2004. A summer-to-winter ratio was determined overall and in relation to gender, age, anatomic site, histopathologic type, and tumor thickness. RESULTS: The summer-to-winter ratio was 1.53 for all patients (95% CI [confidence interval]: 1.15-2.02) with a ratio of 1.83 for women (95% CI: 1.20-2.78) and 1.28 for men (95% CI: 0.87-1.88). A seasonal pattern of melanoma diagnosis was observed for patients younger than 50 years of age (1.70, 95% CI: 1.05-2.74) and between 50 and 69 years (1.64, 95% CI: 1.05-2.56), for melanoma located on the upper or lower extremities (2.50, 95% CI: 1.12-5.56 and 2.23, 95% CI: 1.19-4.18, respectively), for superficial spreading and nodular melanomas (1.73, 95% CI: 1.12-2.69 and 1.52 95% CI: 0.96-2.41) and for melanomas with a tumor thickness of 1-2 mm (1.69, 95% CI: 0.91-3.12) and > 4 mm (2.13, 95% CI: 1.04-4.35). CONCLUSIONS: No major differences were seen in the seasonal distribution of CM diagnosis in a Mediterranean population compared to previously reported results. A better ascertainment of the skin during the summer and an increased awareness due to the melanoma screening campaigns are the more likely reasons for the seasonality of melanoma diagnosis in Greece.
Abstract: Individuals with melanocortin 1 receptor (MC1R) gene variants have been shown to carry an increased risk for the development of melanoma. In this study, we investigated the relationship of MC1R gene variants and the risk of melanoma in 123 melanoma patients and 155 control subjects from Greece. The entire MC1R gene was sequenced for polymorphisms and the results were correlated with host factors and pigmentary characteristics. MC1R polymorphisms were present in 59.4% of melanoma patients compared to 37.5% of controls, yielding an odds ratio (OR) of 2.43 (95% confidence interval (CI) = 1.50-3.96, P < 0.001) for melanoma among MC1R carriers. The risk of melanoma was enhanced in individuals carrying multiple variant alleles (OR = 6.97; 95% CI = 1.86-26.12, P = 0.004). Only the Val60Leu, Arg142His, and Arg151Cys variants were significantly associated with melanoma risk. In stratified analysis, the risk of melanoma among MC1R carriers was not influenced by skin phototype, skin color, or hair color. No association was found between MC1R genotype and the age of onset of melanoma, the tumor location, or the tumor thickness. In conclusion, MC1R polymorphisms are a predisposing factor of melanoma in a southern European population with a relatively low incidence of the disease.
Abstract: The genetic basis of melanoma susceptibility among Greek patients is uncharacterized. From 107 consecutive cutaneous melanoma patients, we analyzed the CDKN2A and CDK4 loci among 18 early-onset (< or =40 years) and two multiplex melanoma cases. Overall, we found three CDKN2A mutations (3/20; 15%), including one novel nonsense mutation (Trp110Stop) and two Arg24Pro missense alterations. There were no mutations in ARF or CDK4. CDKN2A mutations are not uncommon among Greek melanoma patients considering that none of the mutation carriers reported a family history of melanoma.
Abstract: Two-dimensional NMR spectroscopy has been used for a complete assignment of the proton and carbon-13 spectra of the metabolite from Aspergillus ochraceus, ochratoxin A. In addition, phase-sensitive nuclear Overhauser effect spectrometry experiments and computational molecular modeling (MM2 and MMFF force field programs) have been employed to examine the conformational properties of ochratoxin A in chloroform solutions. Particular attention has been given to intramolecular hydrogen-bonding formation involving the phenolic group on dihydroisocoumarin, which may be responsible for the toxic mechanism of ochratoxin A.
Abstract: BACKGROUND: Topical application of 5-aminolaevulinic acid (ALA) to condylomata acuminata leads to accumulation of protoporphyrin IX (PpIX); therefore ALA-induced photodynamic therapy (ALA-PDT) appears to be a potential treatment. OBJECTIVES: To investigate in vivo the PpIX fluorescence time course after topical application of ALA in order to determine the optimal time for irradiation, and to assess the efficacy of subsequently performed ALA-PDT. METHODS: Fluorescence kinetics was studied in 12 male patients with condylomata acuminata. Confirmation of diagnosis was established with conventional histology and polymerase chain reaction. Lesions were treated with 20% ALA and irradiated at the optimal time with a dose of 70 J cm-2 or 100 J cm-2 light. An additional session with 100 J cm-2 was administered 1 week later to lesions that persisted. RESULTS: The in vivo study of fluorescence kinetics indicated that the optimal time for irradiation varied among patients from 6 to 11 h. The overall cure rate was 72.9%, 12 months after treatment. CONCLUSIONS: Topical ALA-PDT is a potentially effective treatment for condylomata acuminata.
Abstract: Human papilloma virus infection is increasing at an alarming rate. The ability of the virus to establish a subclinical infection and its association with malignancy of the lower genital tract make the statistics even more worrisome. Topical application of acetic acid solution provokes temporal alterations of the light-scattering properties of human papilloma virus-induced lesions of anogenital area. For the in vivo study of the phenomenon, an imaging system has been employed, which performs time-lapse imaging and enables the calculation and display of the kinetics of the provoked alterations in any point within the examined area. Confirmation of diagnosis has been established with conventional histology and polymerase chain reaction. It has been shown that the method provides early detection and staging of skin alteration or transformation due to human papilloma virus infection and enables mapping of the infected area.
Abstract: Carboplatin is one of the most common drugs used for radiochemotherapy of cancer. However, the best way to combine the drug with fractionated radiotherapy has not been established. In the present study the authors investigated which maximum tolerated daily bolus dose of carboplatin would allow safe radiopotentiation for 10 consecutive radiotherapy days, the scheme being repeated twice during the 6 weeks that a conventional radiotherapy scheme lasts. Seventy-two patients with lung or pelvis malignancies were included in a dose escalation study. Twenty-four patients comprised the first baseline cohort and were treated with radiotherapy alone. The daily dose of carboplatin was escalated starting from 38 mg/m2 daily (for 10 days) and increasing by 7 mg/m2 per day. Six patients were to be included in each cohort. All 12 patients treated at the 38 mg/m2 and 45 mg/m2 dose level completed two cycles of 10-day carboplatin treatment with no grade III-IV toxicity. Granulocyte colony-stimulating factor effectively averted the incidence of neutropenia and allowed the administration of the second carboplatin 10-day cycle in five of six patients at the 52 mg/m2 daily dose level. Platelet grade III-IV toxicity was observed in all 12 patients (six supported with granulocyte colony-stimulating factor and six with granulocyte colony-stimulating factor and recombinant human erythropoietin) treated at the 59 mg/m2 daily dose level and none of them received the second cycle of chemotherapy. Twelve patients were treated at the same dose level using amifostine 500 mg before carboplatin infusion. Two patients interrupted chemotherapy because of severe nausea and vomiting. Nine of 10 who accomplished the 10-day treatment had platelet levels more than 90,000/microl on day 28 and completed the second 10-day cycle without severe toxicity. Acute radiation toxicity did not increase in the carboplatin cohorts. In this study the authors established a high-dose fractionated carboplatin schedule that can be safely administered during radical radiotherapy.
