Vassilis Kouloulias | National & Kapodistrian University of Athens (original) (raw)

Papers by Vassilis Kouloulias

The Scientific World Journal, 2013

Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensio... more Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT). Methods. Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50-52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed. Results. All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months. Conclusion. 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies.

Acta neurologica Taiwanica, 2017

PURPOSE Caregivers play a substantial role on support at stroke survivors after acute hospitaliza... more PURPOSE Caregivers play a substantial role on support at stroke survivors after acute hospitalization. The aims of the current study were: to determine the quality of life of caregivers of patients with stroke, and to evaluate the predictors of quality of life in caregivers. METHODS It is a cross-sectional study including 150 caregivers of patients with haemorrhagic or ischemic stroke. Participants completed the Greek version of the 12-item Short Form Health Survey assessing caregivers' quality of life. Caregiver burden was measured with the Revised Greek Bakas Caregiving Outcomes Scale, and psychological distress was screened with Greek Hospital Anxiety and Depression Scales. RESULTS A highly negative correlation was found between anxiety (r=0.56) and depression (r=0.59) with physical and mental health (r=0.44, 0.66, r=respectively) from quality of life subscales Physical Component Summary and Mental Component Summary scales. Physical health was influenced by caregivers' he...

Breast cancer (Tokyo, Japan), Jan 19, 2016

Evaluation of local control and acute and late toxicity regarding a hypofractionated RT schedule ... more Evaluation of local control and acute and late toxicity regarding a hypofractionated RT schedule for breast cancer patients. Between October 2007 and October 2009, 80 women with early breast cancer were treated by 42.75 Gy in 15 fractions over 5 weeks. This treatment involved three fractions per week (Monday-Wednesday-Friday). All patients received an additional boost dose to the tumor bed of 8.55 Gy in 3 fractions using 6 MV photons. The primary endpoint included any local recurrence in the treated breast. Secondary endpoint included acute and late radiation skin toxicity. The median follow-up time was 63 months (range 60-72). Radiation toxicity was graded according the RTOG/EORTC criteria. Neither local nor distant recurrence was noted in any patient during this 3-year follow-up. Grade 0, 1, 2 acute skin toxicity was observed in 56/80 (70.0 %), in 19/80 (23.8 %) and in 5/80 (6.3 %), respectively. Three months post-RT, toxicity grades 0, 1, 2 skin toxicity were 64/80 (80 %), 14/80 ...

Reviews on Recent Clinical Trials, 2009

Lumpectomy followed by breast irradiation is an alternative to mastectomy for patients with early... more Lumpectomy followed by breast irradiation is an alternative to mastectomy for patients with early-stage breast cancer. The purpose of radiation treatment following lumpectomy is to minimize the risk of recurrent cancer in the treated breast with as little toxicity as possible so that good cosmesis and function are maintained. Conventional fractionation schedules for postlumpectomy radiotherapy give 50 Gy in 2 Gy daily fractions, often with an additional boost to the tumor bed, resulting in treatment being given over 5-7 weeks. Delivering postoperative radiotherapy in a shorter period of time, provided it is as effective as longer treatment regiments, could result in greater convenience for patients. Moreover, given the high incidence of breast cancer, the use of a shorter fractionation schedule would decrease waiting lists in busy radiotherapy departments. We searched the medline (pubmed) and we reviewed all the relevant publications. We concluded that the accelerated hypofractionated schedules are safe in terms of cosmesis and effective in terms of local control.

Physica Medica, 2014

correlation between RTOG acute rectal toxicity and dosimetric parameters such as D 50 (P<0.001) a... more correlation between RTOG acute rectal toxicity and dosimetric parameters such as D 50 (P<0.001) and V 60 (P¼0.001) was found, for a/b¼10Gy. Moreover, as far as concern the breast radiotherapy, RTOG acute skin toxicity and dosimetric parameter V 60 were significantly correlated, calculated for a/b¼10Gy (P<0.001). Conclusions: Our results suggest that the transformation of physical DVHs to radiobiologically equivalent ones can constitute a useful tool for the clinicians, in terms of important dosimetric and clinical parameters. The tool seems also to be effective and reliable, as far as concern the significant correlation of dosimetric values with radiation induced acute toxicity. However, more patients are needed to extract safer conclusions and to further evaluate the reliability of the suggested tool.

Physica Medica, 2014

Background: We present a study carried out at our department in order to investigate the accuracy... more Background: We present a study carried out at our department in order to investigate the accuracy of dose distribution at the junction region for 3Dconformal radiotherapy treatments that were accomplished following our adopted clinical protocol for breast and head and neck cases. Materials and methods: "In vivo" dosimetry has been performed using thermoluminescence dosimeters (TLD) in 10 head and neck cancer patients and 10 breast cancer patients) irradiated with a 6 MV photon beam. Entrance dose measurements were performed in the field junction regions. A comparison between the measured (in-vivo) and expected (TPS) values was carried out and possible sources of discrepancy were studied and analysed. Results: The mean deviation between measured and expected dose in the region of junction was significantly higher in breast compared to head and neck irradiation (-2.8 ± 15.4 % and 0.2 ± 8.2 % respectively, Mann-Whitney test: 푃 ¼ 0.002). Discussion: The results indicate the superiority of mono-isocentric technique compared to the rotating couch technique in terms of dose delivery accuracy for treatments with field junctioning planning techniques. "In vivo" dosimetry remains a reliable method in order to check the actual dose that is finally delivered to a patient and can provide vital insight into the irradiation conditions in the treatment room, which can help in the optimization of the treatment delivery technique(s).

Reviews on Recent Clinical Trials, 2012

Journal of Cancer Research and Therapeutics, 2013

Any papillary growth of the breast presents both a diagnostic and a therapeutic challenge: For ea... more Any papillary growth of the breast presents both a diagnostic and a therapeutic challenge: For each one of them a diagnosis of whether they are malignant or benign in nature is required as well as appropriate staging and suitable treatment. In the international literature, we find a considerable amount of different terms being used for papillary breast growths. As a result, pathological and clinical evaluation is somewhat problematic. Encapsulated papillary carcinoma (EPC) is an interesting subgroup of breast papillary tumours. Because of its rarity, there have been only a limited number of large clinical studies that safely assess its appropriate treatment and expected outcome. However, more safe data exist in terms of prognosis - which seems to be excellent, as almost all published studies regarding these tumours have confirmed so far. We present a systematic overview of breast EPC and of the most important studies published on this topic in order to make diagnosis and treatment more straightforward for cancer clinicians. The information for this review was compiled by searching the Pubmed, Medline, Scopus, Embase, and ISI Web of Science databases for articles published from 1980 through December 2012. Electronic early-release publications were also included.

Human Brain Mapping, 2012

Background: White matter (WM) microstructure may vary significantly in pediatric-onset (PO) and a... more Background: White matter (WM) microstructure may vary significantly in pediatric-onset (PO) and adult-onset (AO) patients with multiple sclerosis (MS), a difference that could be explained by the effects of an inherent plasticity in the affected pediatric brains early in the disease, and a phenomenon that does not occur later in life. This hypothesis would support the observation that disease progression is much slower in POMS compared to AOMS patients. Objectives: To examine WM microstructure in the brain of adults with POMS and AOMS, using tract based spatial statistics (TBSS) analysis of diffusion-tensor imaging (DTI). Methods: Adults with relapsing-remitting (RR) POMS, who were diagnosed before age of 18 years (n ¼ 16), were compared with age-matched (AOA, n ¼ 23) and disease duration-matched (AOD, n ¼ 22) RR patients who developed MS after the age of 18 years. Scans were analyzed using the FSL software package (Oxford, UK) and statistics were performed using TBSS to evaluate WM microstructure between groups based on the mean fractional anisotropy (FA) values obtained from the DTI. Results: Widespread cortical and deep WM area differences characterized by increased FA values were seen in the AOAMS compared with POMS group (P < 0.05, TFCE corrected). Significantly increased FA values of posterior WM areas were detected in the AODMS compared with POMS group (P < 0.05, TFCE corrected). Conclusion: Increased FA values in WM areas of the AOMS compared with the POMS patients suggest that diffuse WM microstructure changes are more attributable to age of onset than a simple function of disease duration and age.

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB), 2011

Total skin electron beam therapy has been in medical service since the middle of the last century... more Total skin electron beam therapy has been in medical service since the middle of the last century in order to confront rare skin malignancies. Since then various techniques have been developed, all aiming at better clinical results in conjunction with less post-irradiation complications. In this article every available technique is presented in addition to physical parameters of technique establishment and common dose fractionation. This study also revealed the preference of the majority of institutes the last 20 years in "six dual field technique" at a high dose rate, which is a safe and effective treatment.

Aim The aim of this study was to investigate the treatment efficacy, acute and late toxicity usin... more Aim The aim of this study was to investigate the treatment efficacy, acute and late toxicity using a hypofractionated irradiation schedule combined with oral administration of glutamine (GLN) in elderly patients with advanced squamous cell carcinoma of head and neck (SCCHN). Methods In a retrospective manner, we studied 31 patients with advanced SCCHN treated with hypofractionated radiotherapy and administration of GLN. The irradiation schedules consisted of three hypofractionated schedules. The first schedule consisted of 21 irradiation fractions (56.7 Gy) within 29 days by using intensive modulated radiation therapy technique or 3D conformal radiotherapy. The second and the third schedules were performed with 3D conformal techniques by 49.5 Gy in 18 daily fractions and 59.8 Gy in 26 daily fractions. All patients received 30 g powdered GLN daily as soon as oral mucositis was presented. The median follow-up was 18 months (range: 9-24). The severity of skin toxicity and oral mucositis was graded according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results Overall complete response was seen in 12 patients (38.7%), while 5 patients (16.1%) had partial response, 7 patients (22.6%) had stable disease and 7 patients (22.6%) had progressive disease. The median relapse-free survival was 14 months. Three patients (9.7%) experienced grade III acute skin toxicity. Twenty-one (67.7%) and seven (22.6%) patients experienced grade II and grade I acute skin toxicity, respectively. A significant decrease was noted in the incidence of toxicity after the administration of GLN (P < 0.01, chi-square test). The mean score of dysphagia-related pain and oral mucositis regressed significantly (P < 0.01, Wilcoxon test) in the last week of irradiation after GLN administration. Conclusion In elderly patients suffering from SCCHN with co-morbitities and unsuitable for daily irradiation and chemotherapy, an alternative schedule of hypofractionation is possible when combined with GLN administration.

Proceedings of the 4th International Conference on Wireless Mobile Communication and Healthcare - "Transforming healthcare through innovations in mobile and wireless technologies", 2014

As the use of prophylactic cranial irradiation (PCI) increases life expectancy in certain types o... more As the use of prophylactic cranial irradiation (PCI) increases life expectancy in certain types of cancer, there is evidence that this technique may contribute to neurocognitive deficits. The aim of this research is to investigate functional connectivity in patients before and after being administered brain radiotherapy as well as their neurocognitive functionality, depending on the course of disease and the phase of treatment and time of clinical examination. In the current study we attempt to identify potential alterations in brain function during resting state and task-related functional magnetic resonance imaging (fMRI) in small cell lung cancer patients (SCLC) patients before PCI compared to healthy subjects. The brain regions that were activated for both groups during a sequential tapping task are consistent with previous studies. However, the patient group showed a lower level of activation in the primary somatosensory cortex bilaterally. During rest, the Default Mode Network (DMN) was identified in both groups. The results presented are subject to further investigation with larger patient and control group.

Cancers

Background: During RT cycles, the tumor response pattern could affect tumor coverage and may lead... more Background: During RT cycles, the tumor response pattern could affect tumor coverage and may lead to organs at risk of overdose. As such, early prediction of significant volumetric changes could therefore reduce potential radiation-related adverse effects. Nevertheless, effective machine learning approaches based on the radiomic features of the clinically used CBCT images to determine the tumor volume variations due to RT not having been implemented so far. Methods: CBCT images from 40 HN cancer patients were collected weekly during RT treatment. From the obtained images, the Clinical Target Volume (CTV) and Parotid Glands (PG) regions of interest were utilized to calculate 104 delta-radiomics features. These features were fed on a feature selection and classification procedure for the early prediction of significant volumetric alterations. Results: The proposed framework was able to achieve 0.90 classification performance accuracy while detecting a small subset of discriminative ch...

Background: The aim of this study was to investigate whether electrochemotherapy is a clinically ... more Background: The aim of this study was to investigate whether electrochemotherapy is a clinically and costeffective treatment option against skin tumors. Materials and Methods: We performed an analysis of the current literature based on database searches in PubMed/MEDLINE and we included articles till July 2012. Terms used for the search were 'electrochemotherapy', 'skin cancer', 'recurrence', and 'cutaneous and subcutaneous tumors'. Only papers published in English were included. In addition, we performed an analysis of the cost effectiveness of the method. Results: The combination of physics and chemistry is the foundation for electrochemotherapy and its efficacy, independent of the tumor histology. Clinical data showed that ECT is well tolerated and can be used in difficult cases without other available treatment options. The analysis also showed that the treatment is feasible and cost-effective. Conclusions: Electrochemotherapy is a clinically efficient safe and cost-effective treatment and clinicians should not hesitate to use it as alternative therapeutic modality or as palliative treatment.

Cells, 2022

The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 mill... more The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 million people infected and more than 5 million deaths, numbers that are escalating on a daily basis. Frontline health workers and scientists diligently fight to alleviate life-threatening symptoms and control the spread of the disease. There is an urgent need for better triage of patients, especially in third world countries, in order to decrease the pressure induced on healthcare facilities. In the struggle to treat life-threatening COVID-19 pneumonia, scientists have debated the clinical use of ionizing radiation (IR). The historical literature dating back to the 1940s contains many reports of successful treatment of pneumonia with IR. In this work, we critically review the literature for the use of IR for both diagnostic and treatment purposes. We identify details including the computed tomography (CT) scanning considerations, the radiobiological basis of IR anti-inflammatory effects, th...

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2017

Breast cancer is often treated with radiotherapy (RT), with two opposing tangential fields. When ... more Breast cancer is often treated with radiotherapy (RT), with two opposing tangential fields. When indicated, supraclavicular lymph nodes have to be irradiated, and a third anterior field is applied. The junction region has the potential to be over or underdosed. To overcome this problem, many techniques have been proposed. A literature review of 3 Dimensional Conformal RT (3D CRT) and older 3-field techniques was carried out. Intensity Modulated RT (IMRT) techniques are also briefly discussed. Techniques are categorized, few characteristic examples are presented and a comparison is attempted. Three-field techniques can be divided in monoisocentric and two-isocentric. Two-isocentric techniques can be further divided in full field and half field techniques. Monoisocentric techniques show certain great advantages over two-isocentric techniques. However, they are not always applicable and they require extra caution as they are characterized by high dose gradient in the junction region. I...

Primitive neuroectodermal tumour (PNET) is very rare, especially in adults. We report a 60-year-o... more Primitive neuroectodermal tumour (PNET) is very rare, especially in adults. We report a 60-year-old man presented with a PNET. The symptoms at the time of diagnosis were intense headache, Broca's aphasia and right hemiparesis. Only an open biopsy was performed. Irradiation of the primary tumour was the main treatment (total tumour dose 59.8 Gy) because of serious haematological side effects due to chemotherapy. The patient tolerated radiation therapy extremely well and his neurological symptoms were improved. 1 month after completion of radiotherapy, MRI showed no regression of the tumour. Clinical deterioration was observed 10 months after the initial diagnosis and the patient died 2 months later. In cases of PNET, initial therapy is surgical bulk reduction whenever possible. Irradiation of the cerebrospinal axis is justified as a routine treatment but, owing to the radioresistance of the tumour, the addition of multiregimen chemotherapy appears to improve survival, according t...

The Scientific World Journal, 2013

Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensio... more Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT). Methods. Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50-52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed. Results. All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months. Conclusion. 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies.

Acta neurologica Taiwanica, 2017

PURPOSE Caregivers play a substantial role on support at stroke survivors after acute hospitaliza... more PURPOSE Caregivers play a substantial role on support at stroke survivors after acute hospitalization. The aims of the current study were: to determine the quality of life of caregivers of patients with stroke, and to evaluate the predictors of quality of life in caregivers. METHODS It is a cross-sectional study including 150 caregivers of patients with haemorrhagic or ischemic stroke. Participants completed the Greek version of the 12-item Short Form Health Survey assessing caregivers' quality of life. Caregiver burden was measured with the Revised Greek Bakas Caregiving Outcomes Scale, and psychological distress was screened with Greek Hospital Anxiety and Depression Scales. RESULTS A highly negative correlation was found between anxiety (r=0.56) and depression (r=0.59) with physical and mental health (r=0.44, 0.66, r=respectively) from quality of life subscales Physical Component Summary and Mental Component Summary scales. Physical health was influenced by caregivers' he...

Breast cancer (Tokyo, Japan), Jan 19, 2016

Evaluation of local control and acute and late toxicity regarding a hypofractionated RT schedule ... more Evaluation of local control and acute and late toxicity regarding a hypofractionated RT schedule for breast cancer patients. Between October 2007 and October 2009, 80 women with early breast cancer were treated by 42.75 Gy in 15 fractions over 5 weeks. This treatment involved three fractions per week (Monday-Wednesday-Friday). All patients received an additional boost dose to the tumor bed of 8.55 Gy in 3 fractions using 6 MV photons. The primary endpoint included any local recurrence in the treated breast. Secondary endpoint included acute and late radiation skin toxicity. The median follow-up time was 63 months (range 60-72). Radiation toxicity was graded according the RTOG/EORTC criteria. Neither local nor distant recurrence was noted in any patient during this 3-year follow-up. Grade 0, 1, 2 acute skin toxicity was observed in 56/80 (70.0 %), in 19/80 (23.8 %) and in 5/80 (6.3 %), respectively. Three months post-RT, toxicity grades 0, 1, 2 skin toxicity were 64/80 (80 %), 14/80 ...

Reviews on Recent Clinical Trials, 2009

Lumpectomy followed by breast irradiation is an alternative to mastectomy for patients with early... more Lumpectomy followed by breast irradiation is an alternative to mastectomy for patients with early-stage breast cancer. The purpose of radiation treatment following lumpectomy is to minimize the risk of recurrent cancer in the treated breast with as little toxicity as possible so that good cosmesis and function are maintained. Conventional fractionation schedules for postlumpectomy radiotherapy give 50 Gy in 2 Gy daily fractions, often with an additional boost to the tumor bed, resulting in treatment being given over 5-7 weeks. Delivering postoperative radiotherapy in a shorter period of time, provided it is as effective as longer treatment regiments, could result in greater convenience for patients. Moreover, given the high incidence of breast cancer, the use of a shorter fractionation schedule would decrease waiting lists in busy radiotherapy departments. We searched the medline (pubmed) and we reviewed all the relevant publications. We concluded that the accelerated hypofractionated schedules are safe in terms of cosmesis and effective in terms of local control.

Physica Medica, 2014

correlation between RTOG acute rectal toxicity and dosimetric parameters such as D 50 (P<0.001) a... more correlation between RTOG acute rectal toxicity and dosimetric parameters such as D 50 (P<0.001) and V 60 (P¼0.001) was found, for a/b¼10Gy. Moreover, as far as concern the breast radiotherapy, RTOG acute skin toxicity and dosimetric parameter V 60 were significantly correlated, calculated for a/b¼10Gy (P<0.001). Conclusions: Our results suggest that the transformation of physical DVHs to radiobiologically equivalent ones can constitute a useful tool for the clinicians, in terms of important dosimetric and clinical parameters. The tool seems also to be effective and reliable, as far as concern the significant correlation of dosimetric values with radiation induced acute toxicity. However, more patients are needed to extract safer conclusions and to further evaluate the reliability of the suggested tool.

Physica Medica, 2014

Background: We present a study carried out at our department in order to investigate the accuracy... more Background: We present a study carried out at our department in order to investigate the accuracy of dose distribution at the junction region for 3Dconformal radiotherapy treatments that were accomplished following our adopted clinical protocol for breast and head and neck cases. Materials and methods: "In vivo" dosimetry has been performed using thermoluminescence dosimeters (TLD) in 10 head and neck cancer patients and 10 breast cancer patients) irradiated with a 6 MV photon beam. Entrance dose measurements were performed in the field junction regions. A comparison between the measured (in-vivo) and expected (TPS) values was carried out and possible sources of discrepancy were studied and analysed. Results: The mean deviation between measured and expected dose in the region of junction was significantly higher in breast compared to head and neck irradiation (-2.8 ± 15.4 % and 0.2 ± 8.2 % respectively, Mann-Whitney test: 푃 ¼ 0.002). Discussion: The results indicate the superiority of mono-isocentric technique compared to the rotating couch technique in terms of dose delivery accuracy for treatments with field junctioning planning techniques. "In vivo" dosimetry remains a reliable method in order to check the actual dose that is finally delivered to a patient and can provide vital insight into the irradiation conditions in the treatment room, which can help in the optimization of the treatment delivery technique(s).

Reviews on Recent Clinical Trials, 2012

Journal of Cancer Research and Therapeutics, 2013

Any papillary growth of the breast presents both a diagnostic and a therapeutic challenge: For ea... more Any papillary growth of the breast presents both a diagnostic and a therapeutic challenge: For each one of them a diagnosis of whether they are malignant or benign in nature is required as well as appropriate staging and suitable treatment. In the international literature, we find a considerable amount of different terms being used for papillary breast growths. As a result, pathological and clinical evaluation is somewhat problematic. Encapsulated papillary carcinoma (EPC) is an interesting subgroup of breast papillary tumours. Because of its rarity, there have been only a limited number of large clinical studies that safely assess its appropriate treatment and expected outcome. However, more safe data exist in terms of prognosis - which seems to be excellent, as almost all published studies regarding these tumours have confirmed so far. We present a systematic overview of breast EPC and of the most important studies published on this topic in order to make diagnosis and treatment more straightforward for cancer clinicians. The information for this review was compiled by searching the Pubmed, Medline, Scopus, Embase, and ISI Web of Science databases for articles published from 1980 through December 2012. Electronic early-release publications were also included.

Human Brain Mapping, 2012

Background: White matter (WM) microstructure may vary significantly in pediatric-onset (PO) and a... more Background: White matter (WM) microstructure may vary significantly in pediatric-onset (PO) and adult-onset (AO) patients with multiple sclerosis (MS), a difference that could be explained by the effects of an inherent plasticity in the affected pediatric brains early in the disease, and a phenomenon that does not occur later in life. This hypothesis would support the observation that disease progression is much slower in POMS compared to AOMS patients. Objectives: To examine WM microstructure in the brain of adults with POMS and AOMS, using tract based spatial statistics (TBSS) analysis of diffusion-tensor imaging (DTI). Methods: Adults with relapsing-remitting (RR) POMS, who were diagnosed before age of 18 years (n ¼ 16), were compared with age-matched (AOA, n ¼ 23) and disease duration-matched (AOD, n ¼ 22) RR patients who developed MS after the age of 18 years. Scans were analyzed using the FSL software package (Oxford, UK) and statistics were performed using TBSS to evaluate WM microstructure between groups based on the mean fractional anisotropy (FA) values obtained from the DTI. Results: Widespread cortical and deep WM area differences characterized by increased FA values were seen in the AOAMS compared with POMS group (P < 0.05, TFCE corrected). Significantly increased FA values of posterior WM areas were detected in the AODMS compared with POMS group (P < 0.05, TFCE corrected). Conclusion: Increased FA values in WM areas of the AOMS compared with the POMS patients suggest that diffuse WM microstructure changes are more attributable to age of onset than a simple function of disease duration and age.

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB), 2011

Total skin electron beam therapy has been in medical service since the middle of the last century... more Total skin electron beam therapy has been in medical service since the middle of the last century in order to confront rare skin malignancies. Since then various techniques have been developed, all aiming at better clinical results in conjunction with less post-irradiation complications. In this article every available technique is presented in addition to physical parameters of technique establishment and common dose fractionation. This study also revealed the preference of the majority of institutes the last 20 years in "six dual field technique" at a high dose rate, which is a safe and effective treatment.

Aim The aim of this study was to investigate the treatment efficacy, acute and late toxicity usin... more Aim The aim of this study was to investigate the treatment efficacy, acute and late toxicity using a hypofractionated irradiation schedule combined with oral administration of glutamine (GLN) in elderly patients with advanced squamous cell carcinoma of head and neck (SCCHN). Methods In a retrospective manner, we studied 31 patients with advanced SCCHN treated with hypofractionated radiotherapy and administration of GLN. The irradiation schedules consisted of three hypofractionated schedules. The first schedule consisted of 21 irradiation fractions (56.7 Gy) within 29 days by using intensive modulated radiation therapy technique or 3D conformal radiotherapy. The second and the third schedules were performed with 3D conformal techniques by 49.5 Gy in 18 daily fractions and 59.8 Gy in 26 daily fractions. All patients received 30 g powdered GLN daily as soon as oral mucositis was presented. The median follow-up was 18 months (range: 9-24). The severity of skin toxicity and oral mucositis was graded according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results Overall complete response was seen in 12 patients (38.7%), while 5 patients (16.1%) had partial response, 7 patients (22.6%) had stable disease and 7 patients (22.6%) had progressive disease. The median relapse-free survival was 14 months. Three patients (9.7%) experienced grade III acute skin toxicity. Twenty-one (67.7%) and seven (22.6%) patients experienced grade II and grade I acute skin toxicity, respectively. A significant decrease was noted in the incidence of toxicity after the administration of GLN (P < 0.01, chi-square test). The mean score of dysphagia-related pain and oral mucositis regressed significantly (P < 0.01, Wilcoxon test) in the last week of irradiation after GLN administration. Conclusion In elderly patients suffering from SCCHN with co-morbitities and unsuitable for daily irradiation and chemotherapy, an alternative schedule of hypofractionation is possible when combined with GLN administration.

Proceedings of the 4th International Conference on Wireless Mobile Communication and Healthcare - "Transforming healthcare through innovations in mobile and wireless technologies", 2014

As the use of prophylactic cranial irradiation (PCI) increases life expectancy in certain types o... more As the use of prophylactic cranial irradiation (PCI) increases life expectancy in certain types of cancer, there is evidence that this technique may contribute to neurocognitive deficits. The aim of this research is to investigate functional connectivity in patients before and after being administered brain radiotherapy as well as their neurocognitive functionality, depending on the course of disease and the phase of treatment and time of clinical examination. In the current study we attempt to identify potential alterations in brain function during resting state and task-related functional magnetic resonance imaging (fMRI) in small cell lung cancer patients (SCLC) patients before PCI compared to healthy subjects. The brain regions that were activated for both groups during a sequential tapping task are consistent with previous studies. However, the patient group showed a lower level of activation in the primary somatosensory cortex bilaterally. During rest, the Default Mode Network (DMN) was identified in both groups. The results presented are subject to further investigation with larger patient and control group.

Cancers

Background: During RT cycles, the tumor response pattern could affect tumor coverage and may lead... more Background: During RT cycles, the tumor response pattern could affect tumor coverage and may lead to organs at risk of overdose. As such, early prediction of significant volumetric changes could therefore reduce potential radiation-related adverse effects. Nevertheless, effective machine learning approaches based on the radiomic features of the clinically used CBCT images to determine the tumor volume variations due to RT not having been implemented so far. Methods: CBCT images from 40 HN cancer patients were collected weekly during RT treatment. From the obtained images, the Clinical Target Volume (CTV) and Parotid Glands (PG) regions of interest were utilized to calculate 104 delta-radiomics features. These features were fed on a feature selection and classification procedure for the early prediction of significant volumetric alterations. Results: The proposed framework was able to achieve 0.90 classification performance accuracy while detecting a small subset of discriminative ch...

Background: The aim of this study was to investigate whether electrochemotherapy is a clinically ... more Background: The aim of this study was to investigate whether electrochemotherapy is a clinically and costeffective treatment option against skin tumors. Materials and Methods: We performed an analysis of the current literature based on database searches in PubMed/MEDLINE and we included articles till July 2012. Terms used for the search were 'electrochemotherapy', 'skin cancer', 'recurrence', and 'cutaneous and subcutaneous tumors'. Only papers published in English were included. In addition, we performed an analysis of the cost effectiveness of the method. Results: The combination of physics and chemistry is the foundation for electrochemotherapy and its efficacy, independent of the tumor histology. Clinical data showed that ECT is well tolerated and can be used in difficult cases without other available treatment options. The analysis also showed that the treatment is feasible and cost-effective. Conclusions: Electrochemotherapy is a clinically efficient safe and cost-effective treatment and clinicians should not hesitate to use it as alternative therapeutic modality or as palliative treatment.

Cells, 2022

The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 mill... more The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 million people infected and more than 5 million deaths, numbers that are escalating on a daily basis. Frontline health workers and scientists diligently fight to alleviate life-threatening symptoms and control the spread of the disease. There is an urgent need for better triage of patients, especially in third world countries, in order to decrease the pressure induced on healthcare facilities. In the struggle to treat life-threatening COVID-19 pneumonia, scientists have debated the clinical use of ionizing radiation (IR). The historical literature dating back to the 1940s contains many reports of successful treatment of pneumonia with IR. In this work, we critically review the literature for the use of IR for both diagnostic and treatment purposes. We identify details including the computed tomography (CT) scanning considerations, the radiobiological basis of IR anti-inflammatory effects, th...

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2017

Breast cancer is often treated with radiotherapy (RT), with two opposing tangential fields. When ... more Breast cancer is often treated with radiotherapy (RT), with two opposing tangential fields. When indicated, supraclavicular lymph nodes have to be irradiated, and a third anterior field is applied. The junction region has the potential to be over or underdosed. To overcome this problem, many techniques have been proposed. A literature review of 3 Dimensional Conformal RT (3D CRT) and older 3-field techniques was carried out. Intensity Modulated RT (IMRT) techniques are also briefly discussed. Techniques are categorized, few characteristic examples are presented and a comparison is attempted. Three-field techniques can be divided in monoisocentric and two-isocentric. Two-isocentric techniques can be further divided in full field and half field techniques. Monoisocentric techniques show certain great advantages over two-isocentric techniques. However, they are not always applicable and they require extra caution as they are characterized by high dose gradient in the junction region. I...

Primitive neuroectodermal tumour (PNET) is very rare, especially in adults. We report a 60-year-o... more Primitive neuroectodermal tumour (PNET) is very rare, especially in adults. We report a 60-year-old man presented with a PNET. The symptoms at the time of diagnosis were intense headache, Broca's aphasia and right hemiparesis. Only an open biopsy was performed. Irradiation of the primary tumour was the main treatment (total tumour dose 59.8 Gy) because of serious haematological side effects due to chemotherapy. The patient tolerated radiation therapy extremely well and his neurological symptoms were improved. 1 month after completion of radiotherapy, MRI showed no regression of the tumour. Clinical deterioration was observed 10 months after the initial diagnosis and the patient died 2 months later. In cases of PNET, initial therapy is surgical bulk reduction whenever possible. Irradiation of the cerebrospinal axis is justified as a routine treatment but, owing to the radioresistance of the tumour, the addition of multiregimen chemotherapy appears to improve survival, according t...