Sotiria General Hospital

Athens, Greece

Sotiria General Hospital

Athens, Greece
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Pantazopoulos I.,Sotiria General Hospital | Boura P.,National and Kapodistrian University of Athens | Xanthos T.,National and Kapodistrian University of Athens | Syrigos K.,National and Kapodistrian University of Athens
European Respiratory Journal | Year: 2013

Malignantmesothelioma (MM) is an aggressive tumour with poor prognosis whose early diagnosis is difficult. Mesothelin, megakaryocyte potentiating factor (MPF) and osteopontin have attracted attention as biomarkers. The aim of the present review is to provide an overview regarding these candidate biomarkers for MM, and discuss their potential role in today's clinical practice. Mesothelin and MPF have good specificity but sub-optimal sensitivity for detection of MM, being negative both in the sarcomatoid histological sub-type and in almost half of epithelioid mesothelioma, especially in the early stages. Osteopontin is a marker of the duration of asbestos exposure, but lacks specificity for mesothelioma. Several patient characteristics influence the diagnostic accuracy of biomarkers and make the establishment of the 'optimal' diagnostic threshold difficult. Mesothelin and MPF have proved useful in assessing response to treatment. Combining different markers together may lead to an improvement in diagnostic accuracy, but there is still need for research in this area. Extensive validation and further research is required to improve the use of serum markers in mesothelioma management. In the near future, their application in clinical practice is probably in monitoring response to therapy, rather than in guiding diagnostic decisions and risk assessment of asbestos-exposed populations.

Papaetis G.S.,Sotiria General Hospital | Papaetis G.S.,National and Kapodistrian University of Athens | Syrigos K.N.,Sotiria General Hospital | Syrigos K.N.,National and Kapodistrian University of Athens
Cancer and Metastasis Reviews | Year: 2010

Gastrointestinal stromal tumors (GISTs) present 80% of gastrointestinal tract mesenchymal tumors, with systemic chemotherapy and radiotherapy being unable to improve survival of patients with advanced disease. The identification of activating mutations in either KIT cell surface growth factor receptor or platelet-derived growth factor receptor alpha, which lead to ligand-independent signal transduction, paved the way for the development of novel agents that selectively inhibit key molecular events in disease pathogenesis. The development of imatinib mesylate in the treatment of metastatic GIST represents a therapeutic breakthrough in molecularly targeted strategies, which crucially improved patients' prognosis while its usefulness in adjuvant and neoadjuvant setting is under study. Sunitinib malate is available in the second-line setting, with ongoing studies evaluating its role in an earlier disease stage, while other targets are under intense investigation in order to enrich the therapeutical armamentarium for this disease. GIST phenotype seems to be an essential indicator of treatment response; thus, obtaining genotype information of each patient may be critical in order to tailor individualized treatment strategies and achieve maximal therapeutic results. © 2010 Springer Science+Business Media, LLC.

Sarris E.G.,Sotiria General Hospital | Harrington K.J.,The Institute of Cancer Research | Saif M.W.,Tufts University | Syrigos K.N.,Sotiria General Hospital
Cancer Treatment Reviews | Year: 2014

The population in developed countries is growing older and the number of elderly people annually diagnosed with head and neck cancers is expected to rapidly increase within the following decades, since these types of tumors are age-dependent. The vast majority of older head and neck cancer patients present with locally advanced disease and multimodality treatment, including surgery, radiation and/or chemotherapy, is considered the best therapeutic option for these patients. However, several factors, including comorbidities, disabilities, frailty, and impaired functional status are considered to be more relevant criteria than chronological age per se for treatment planning. Therapeutic decisions are often complicated and demand the participation of many specialists. Advances in surgical and radiation techniques, along with the use of conventional chemotherapy and molecularly targeted agents, have improved treatment outcomes. The best-tailored individualized therapeutic option should be selected for these patients in order to avoid high toxicity and major functional deterioration. Still, more older-specific studies are needed in order to produce more definitive and applicable results. The aim of this review article is to investigate the multimodal treatment approaches for elderly patients with head and neck cancer. © 2013 Elsevier Ltd.

Stavridi F.,Royal Marsden Hospital | Karapanagiotou E.M.,Sotiria General Hospital | Syrigos K.N.,Sotiria General Hospital
Cancer Treatment Reviews | Year: 2010

Prostate cancer is one of the leading causes of cancer related death in men, and remains incurable in the metastatic setting. Despite the initial response to androgen deprivation, the disease gradually progresses to a hormone-refractory state due to cumulative genetic alterations in tumour cells or the microenvironment. Docetaxel represents the first chemotherapeutic agent with a small survival benefit for metastatic hormone-refractory prostate cancer (HRPC). In an attempt to improve survival benefit, several novel drugs targeting specific pathways involved in cell signaling, proliferation, angiogenesis, apoptosis and immune modulation are currently under investigation either as single agents or in combination with cytotoxic drugs. Clinical trials evaluate the inhibition of prostate cancer cells growth by targeting the nuclear receptor of vitamin D alongside cytotoxic therapy. Angiogenesis inhibitors as well as epidermal growth factor receptor blockage are also under clinical investigation in several combinations. Immunomodulatory agents and autologous dendritic cells or allogenic whole cell vaccines have progressed up to phase III trials. New drugs targeting bone microenvironment or apoptotic and proliferation pathways may enhance antitumour activity of chemotherapy in HRCP. Given the complexity of mechanisms underlying prostate cancer progression, future therapeutic strategies should rely on multidisciplinary approaches, thus exploiting newer molecular targets in concert with immunotherapy and cytotoxic chemotherapy. Here, we review the latest clinical evidence regarding the use of novel agents in HRPC. © 2009 Elsevier Ltd.

Paplos K.,Sotiria General Hospital
Psychiatrikē = Psychiatriki | Year: 2012

Over the last decade several studies have discussed the association between serum cholesterol, depressive disorders and suicide. A specific psychological variable related to affect is alexithymia. Alexithymia has been linked to depression and suicidal behaviour. Concerning lipid levels there are several studies that suggest changes in serum lipid composition maybe related to depression and suicidal behaviour. In this study we examined the possible relationship between alexithymia, depression and serum lipids in suicide attempters. We studied 50 non-violent suicide attempters (drug overdosers) with a mean age of 35.0 (±12.2) years. Alexithymia was measured using the Shalling-Sifneos Personality Scale Revised (SSPS-R) and depression using the Montgomery-Asberg Depression Rating Scale (MADRS). Serum lipids concentrations were determined by enzymatic method within 24h of hospital admission. For the statistical evaluation Spearman's rank correlation coefficients were used. The mean serum lipid levels were: total serum cholesterol (TC) 175.2 (±29.6) mg/dL, highdensity lipoprotein cholesterol (H-DLC) 47.08 (±13.1) mg/dL, low density lipoprotein cholesterol (L-DLC) 109.5 (±23.5) mg/dL and the mean serum triglycerides (TR) level was 89.4 (±39.1) mg/dL. The mean scores on the questionnaires were: SSPS-R 10.3 (±3.7), MADRS 33.5 (±5.9). There were significant correlations between: (a) SSPS-R score and MADRS score (r=0.439, p<0.001), (b) SSPS-R score and TR level (r=0.323, p<0.05). There were no significant correlations between MADRS score and any of the lipid fractions measured. To our knowledge, only few studies have examined the association between alexithymia and clinical-psychopathological parameters in suicide attempters. There are no previous studies comparing serum lipid profile with alexithymia in suicide attempters. This is the first study to compare at the same time serum lipids, alexithymia and depression in suicide attempters. The results suggest that although there was a strong relationship between alexithymia and depression in suicide attempters only alexithymia was correlated to Serum triglyceride levels.

Tselebis A.,Sotiria General Hospital
Psychiatrikē = Psychiatriki | Year: 2013

Chronic Obstructive Pulmonary Disease (COPD) is mainly related to smoking habit and is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Worldwide and in Greece, COPD constitutes a major epidemiological issue. Incidence of depression and anxiety is high in the COPD population. Most studies on depression and anxiety in COPD deal with factors that are positively correlated with both of these comorbidities. The aim of our study was to assess whether two variables, sense of coherence (SOC) and perception of family support (FS), are negatively correlated with depressive and anxiety symptoms in outpatients with COPD. According to Aaron Antonovsky, sense of coherence refers to the ability of individuals to make sense of and manage events. Studies in other diseases suggest that sense of family support has a significant impact on the course and outcome of the disease, yet a limited number of reports across literature addresses the role of family support in COPD patients. In our present study one hundred twenty two (98 men and 24 women) outpatients with pure COPD were included. Age and years of education were recorded. Severity of COPD was assessed with spirometry before and after bronchodilation. All patients replied to self- administered questionnaires on depression (Beck Depression Inventory, BDI), anxiety (Spielberger State-Trait Anxiety Scale, STAI), family support (Family Support Scale, FSS-13) and sense of coherence (Sense of Coherence Scale, SOC). According to our results the mean BDI depression score was 11.65 (SD 7.35), mean trait anxiety score was 40.69 (SD 11.19), mean SOC score was 54.62 (SD 7.40) and mean FS score was 64.58 (SD 11.63). Women patients had higher anxiety scores and lower sense of family support compared to men. Significant negative correlations were evidenced between depression and sense of coherence as well as between anxiety and family support. Step-wise multiple linear regression analysis verified the results and quantified the aforementioned correlations. Notably, raising scores in sense of family support by one point reduces anxiety scores by 0.14 points, and increasing sense of coherence scores by one point reduces depression scores by 0.21 points. In sum, our study confirms the presence of high levels of anxiety and depressive symptoms in COPD patients, with females being in a more disadvantaged position as they tend to have higher levels of both. Sense of coherence and family support are both protective psychological factors against the risk of developing anxiety and depressive symptoms in these patients.

Pallis A.G.,University of Crete | Syrigos K.,Sotiria General Hospital
Cancer Treatment Reviews | Year: 2012

Maintenance treatment has been intensively investigated in the field of advanced/metastatic non-small lung cancer in order to improve outcomes in this devastating disease. Two different approaches have been evaluated; the so-called continuation maintenance when the maintenance agent was part of initial therapy and is continued in the absence of disease progression ("maintained") or switch maintenance when a third agent is initiated after a defined number of cycles chemotherapy in the absence of disease progression. Several phase III trials with both chemotherapeutic and targeted agents have demonstrated either PFS prolongation (continuation maintenance) or both PFS and OS benefit (switch maintenance). Currently, erlotinib and pemetrexed are registered as maintenance treatment in patients with NSCLC not progressing after four cycles of standard platinum-based doublet chemotherapy. However, the development of maintenance treatment has raised a series of questions such as the role of treatment-free intervals, the timing of second-line treatment, selection of patients for maintenance treatment and selection of the most proper agent, and trial design issues such as optimal end-points. The purpose of this paper is to present and discuss the current trials investigating the main treatment paradigms and argue on the above mentioned questions. © 2012.

Perlikos F.,Sotiria General Hospital | Harrington K.J.,Institute of Cancer Research | Harrington K.J.,Royal Marsden Hospital | Syrigos K.N.,Sotiria General Hospital
Critical Reviews in Oncology/Hematology | Year: 2013

Lung cancer remains one of the most common and malignant cancers worldwide. It is most often diagnosed at late stages, when it has already presented local invasion and distal metastases. The basic stages of invasion and metastasis involve the detachment of tumor cells from the extracellular matrix, invasion of surrounding tissues and basal lamina, intravasation into the blood stream, survival and transport through the blood stream, migration, arrest and extravasation at a distal site and formation of a metastatic lesion. These steps require fundamental mechanisms such as angiogenesis, degradation of matrix barriers, disruption of cell-cell and cell-matrix adhesion and inducement of cellular motility. Genes that regulate functions like unlimited growth potential, survival, genomic instability, angiogenesis, epithelial to mesenchymal transition and apoptosis evasion, are involved in giving lung cancer tumors invasive and metastatic competence. Improving of understanding of the underlying molecular and cellular mechanisms remains an urgent and essential issue, in order to develop new more effective strategies in preventing and treating lung cancer. © 2013 Elsevier Ireland Ltd.

Pallis A.G.,University of Crete | Syrigos K.N.,Sotiria General Hospital
Critical Reviews in Oncology/Hematology | Year: 2013

Recent insight into the molecular biology of cancer and mechanisms of tumorigenesis, has allowed for the identification of several potential molecular targets and the development of novel " targeted therapies". One of the most active research fields in NSCLC is the discovery of therapies that target angiogenesis. The vascular endothelial growth factor (VEGF) pathway represents a crucial component of the tumor angiogenesis process. Two different strategies have been developed in clinical practice in order to restrict tumor vasculature development; either the use of monoclonal antibodies against VEGF or small molecule tyrosine kinase inhibitors to target the tyrosine kinase domain of VEGF receptor. Among these agents that have been tested bevacizumab, a monoclonal antibody against VEGF, has been approved for the treatment of metastatic NSCLC in combination with chemotherapy, while several other agents are under phase III investigation. Moreover, several issues such as predictive biomarkers of response to antiangiogenic therapy and mechanisms of resistance to these agents remain to be elucidated. The purpose of this paper is to present the current status of antiangiogenic therapies in the treatment of NSCLC and to discuss these issues. © 2012 Elsevier Ireland Ltd.

Alevizakos M.,Sotiria General Hospital | Kaltsas S.,Sotiria General Hospital | Syrigos K.N.,Sotiria General Hospital | Syrigos K.N.,Yale University
Cancer Chemotherapy and Pharmacology | Year: 2013

Introduction: Lung cancer is a disease whose prognosis has remained poor in the last decades. Recent advances in the understanding of the molecular pathways behind this disease have revealed several mediators of important tumor functions. One of these functions is angiogenesis, which is considered essential for tumor growth and propagation, and a key mediator promoting this process is the vascular endothelial growth factor (VEGF). In lung cancer, VEGF plays a significant role in establishing a vascular supply within the tumor. Thus, a new class of drugs has emerged, targeting its pathway, which has offered substantial, albeit small, improvements in patient prognosis. Areas covered: The VEGF pathway and its role in a multitude of different human cancers are presented at first. We then proceed by analyzing its importance in lung cancer and exploring the therapeutic benefits achieved by its targeting, which set new goals for the future. Expert opinion: Today, the VEGF pathway remains an attractive target for anticancer treatment, and the way forward requires detection of predictive markers and efforts for a more complete angiogenic blockade. © 2013 Springer-Verlag Berlin Heidelberg.

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