Publications by authors named "I Pajares Bernad"

19 Publications

Daylight photodynamic therapy for prevention of new actinic keratosis and keratinocyte carcinomas in organ transplants. A cryotherapy-controlled randomized clinical trial.

J Eur Acad Dermatol Venereol 2020 Jul 5;34(7):1464-1470. Epub 2020 Feb 5.

Department of Dermatology, Clínica Universidad de Navarra, Pamplona, Spain.

Background: Organ transplant recipients (OTR) have a higher risk of actinic keratosis (AK) and keratinocyte carcinomas (KC). There are no clinical trials assessing the effectiveness of daylight photodynamic therapy (DPDT) to prevent new AK and KC in OTR.

Objectives: To determine whether repeated treatments of field cancerization with DPDT are effective in preventing new AK and KC in OTR.

Methods: A randomized, intra-subject controlled, evaluator-blind, split-face and/or scalp trial, from April 2016 to October 2018. Participants were OTR older than 18 years, 1-year posttransplant, with at least 5 AK on each hemi-face/hemi-scalp. One side received six field treatments with DPDT: two sessions 15 days apart at baseline, two at 3 months and two at 9 months after baseline. Control side received lesion-directed treatment with cryotherapy (double freeze-thaw) at baseline, 3 and 9 months. Total number of lesions (AK and KC) at 21 months, number of new AK and KC at 3, 9, 15 and 21 months and treatment preferences were analysed.

Results: Of 24 men included, 23 were analysed at 3 months; and 21, at 9, 15 and 21 months. Mean (SD) age was 69.8 years (9.2). The total number of lesions at 21 months was 4.7 (4.3) for DPDT and 5.8 (5.0) for control side; P = 0.09. DPDT showed significantly lower means [SD] of new lesions compared to control side at 3 months (4.2 [3.4] vs. 6.8 [4.8]; P < 0.001), 9 months (3.0 [3.3] vs. 4.3 [3.4]; P = 0.04) and 15 months (3.0 [4.6] vs. 4.8 [5.0]; P = 0.02), and non-significant at 21 months (3.7 [3.5] vs. 5.0 [4.5]; P = 0.06). Most participants preferred DPDT.

Conclusion: DPDT showed potential effectiveness in preventing new AK and KC in OTR by consecutive treatments of field cancerization. The preference for DPDT could facilitate adherence to the long-term treatment necessary in these patients.
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July 2020

Elongated Dorsal Nasal Flap to Reconstruct Large Defects of the Nose.

Dermatol Surg 2017 Aug;43(8):1036-1041

*All authors are affiliated with the Department of Dermatology, University Clinic of Navarra, Pamplona, Spain.

Background: The typical reconstructive option for closing large-sized defects of the distal half of the nose is the paramedian forehead flap. Other alternatives are a melolabial interpolation flap and bilobed or trilobed flaps. The dorsal nasal (Rieger) flap is suitable for closing small-sized defects at this location, especially when they are medially located.

Objective: The authors describe a modified dorsal nasal flap reconstruction for large nasal defects. The novelty of this study lies in lengthening the leading edge of flap rotation, which may provide tissue either from the adjacent nasal skin, the nasofacial groove, or the cheek.

Materials And Methods: The authors performed a retrospective chart review of all patients with large defects (>20 mm) of the nose who underwent modified dorsal nasal flap repair between January 2004 and March 2015 at a single academic center.

Results: Twenty-seven patients (16 male, 11 female; ages 44-88, mean age 62 years) had defects (the smallest 15 × 21 mm, and the largest 32 × 37 mm) on the lower portion of the nasal pyramid. Follow-up ranged from 12 months to 11 years with good or excellent results in all cases.

Conclusion: Elongated dorsal nasal flap is a reproducible one-stage flap for large defects of the nose, with minimal risk of aesthetic or functional complications.
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August 2017

Activity of weekly paclitaxel-cetuximab chemotherapy in unselected patients with recurrent/metastatic head and neck squamous cell carcinoma: prognostic factors.

Clin Transl Oncol 2017 Jun 24;19(6):769-776. Epub 2017 Jan 24.

Medical Oncology Department, Miguel Servet University Hospital, 1-3 Isabel la Catolica Avenue, 50009, Saragossa, Spain.

Background: Standard treatment for recurrent/metastatic head and neck squamous cell carcinoma (RM-SCCHN) is based in on platinum and cetuximab combination therapy. Unfortunately, not all patients are candidates to receive platinum-based treatment, because of different conditions as comorbidity and poor performance status. Weekly paclitaxel and cetuximab (WPC) is an active therapeutic alternative, based on a phase II study, with less toxicity. Our main objective is to confirm its activity in unselected patients, mostly unfit for aggressive therapies, analysing also some clinically relevant prognostic factors (PFs).

Methods: Retrospective data was collected for RM-SCCHN patients, treated at our institution between January 2008 and July 2014 with weekly paclitaxel (80 mg/m) and cetuximab (400/250 mg/m).

Results: 148 patients were treated. The objective response rate (OR) was as follows: 13 patients (8.78%) complete response (CR); 57 patients (38.51%) partial response (PR) and 30 patients (20.3%) stable disease (SD). Median overall survival (OS) was 10 months (95% CI 8.31-11.69) and median progression free survival (PFS) was 7 months (95% CI 5.88-8.12). Response to treatment showed independent prognosis relevance as PF in multivariate analysis for PFS and OS. Furthermore, decline in serum magnesium during the treatment was also an independent PF for OS.

Conclusions: WPC activity was confirmed as a useful therapy on real-life unselected RM-SCCHN patients, with similar benefit to that obtained in the phase II study, and comparable to platinum and cetuximab based treatment, confirming its value in unfit patients. In addition to treatment response, a change in serum magnesium values during treatment was proved as independent PF on OS.
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June 2017

Gene expression profiling and its use in adenocarcinomas of unknown primary origin: A case report.

Oncol Lett 2015 Oct 4;10(4):2657-2661. Epub 2015 Aug 4.

Department of Medical Oncology, Miguel Servet University Hospital, Zaragoza 50009, Spain.

Carcinomas of unknown primary origin account for 3-5% of all malignancies. The current literature suggests that metastatic dissemination is able to occur in the absence of primary tumor growth. In metastatic disease that is difficult to diagnose, the origin usually remains unknown even after an exhaustive evaluation of immunohistochemistry (IHC) markers. In the current study, a 49-year-old male presented with lymph nodes metastases of unknown origin. The excisional biopsy of an inguinal node revealed an adenocarcinoma growth pattern, but the IHC could not determine the primary origin. A gene profiling test was performed to complete the diagnosis and a salivary gland adenocarcinoma was diagnosed with 90% probability. Subsequently, the patient underwent appropriate chemotherapy for salivary gland adenocarcinoma, and exhibited an improved partial response. The present case study highlights the importance of an accurate diagnosis of the primary tumor and the use of all the current tools available in order to provide patients with the best treatment possible.
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October 2015

Atypical bullous pemphigoid with extensive cutaneous and mucosal erosions associated with chronic lymphocytic leukemia.

J Dermatol 2015 Nov 24;42(11):1128-9. Epub 2015 Aug 24.

Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Navarra, Spain.

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November 2015