Gain Survival Benefit Research Articles

Immune-Infiltration Based Signature As a Novel Prognostic Biomarker in Gastrointestinal Stromal Tumor

Background: Accumulating evidence showed that tumor-infiltrating lymphocytes (TILs) are dominant determinants of survival outcomes in various kinds of tumors. Thus, we sought to investigate the distribution and density of TILs in gastrointestinal stromal tumors (GISTs), and develop an immune-infiltration (II) based signature to predict prognosis. Methods: The expression of 7 immune features was investigated by immunohistochemistry from 435 GIST patients in tumor center (TC) and margin (TM), respectively. Then, a 4-feature-based II-GIST signature was constructed using the LASSO Cox regression model in the training cohort and validated in another two validation cohorts. The II-GIST signature integrated CD3+ TC, CD3 + TM, CD8+ TM and CD45RO+ TM. Results: High CD3+, CD8+, CD45RO+, NKp46+ and CD20+ infiltrations, in TC or TM correlated with improved recurrence-free survival (RFS) and overall survival (OS). Kaplan-Meier analysis and the log rank test suggested that high II-GIST patients experience better RFS and OS. Multivariate analyses demonstrated that II-GIST signature is an independent prognostic factor. When stratified by tumor size, mitotic index, National Institutes of Health (NIH) risk categories and primary tumor location, II-GIST remained to be an efficient prognostic model. The receiver operator characteristic (ROC) curve demonstrated that the prognostic accuracy of II-GIST signature is superior to that of NIH risk categories. Further analysis demonstrated that moderate and high risk GIST patients with high II-GIST could gain survival benefits from adjuvant imatinib therapy. Conclusion: The novel II-GIST signature could accurately predict the survival outcomes of GIST patients. In addition, the II-GIST signature was a useful predictor for survival benefit from imatinib therapy among moderate and high risk GISTs. Funding Statement: This study was supported by National Natural Science Foundation of China, No. 81702325; Natural Science Foundation of Guangdong Province, No. 2017A030310565; 3&3 Project of the First Affiliated Hospital of Sun Yat-sen University. Declaration of Interests: The authors declare that they have no conflict of interest. Ethics Approval Statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University and the Second Affiliated Hospital of Guangzhou University of Chinese Medicine.

Gastric Mixed Adenoneuroendocrine Carcinoma with Extensive Liver Metastases Treated with Neoadjuvant Chemotherapy and Surgery

Gastric mixed adenoneuroendocrine carcinomas (G-MANEC) are rare malignancies with about 40 cases reported to date in English literature. Clinically, G-MANEC is characterized by aggressive behavior with rapid progression including a high incidence of regional and distant metastasis, leading to tumor-related death without any chance of surgical resection. Moreover, there is no uniform standard adjuvant chemotherapy for G-MANEC. Here, we report a case of G-MANEC with extensive liver metastases that gained survival benefits from neoadjuvant chemotherapy. A brief discussion of the biological behavior and treatment of G-MANEC is presented.

Matched case-control survival analysis of older chinese breast cancer patients treated with surgery or primary endocrine therapy

BackgroundPrimary endocrine therapy (PET) has been used as an alternative to primary surgery for elderly with estrogen receptor (ER) positive breast tumors. Such practices are less commonly performed in Asian countries and the response to PET in Chinese cohort is still lacking. This study aims to compare the clinical outcome of PET to primary surgery. Patients and MethodsMedical records of Chinese patients aged 70 and above with stage I to III, ER positive breast cancer treated at a University affiliated tertiary hospital from 2008 to 2017 were reviewed. Excluding those with extreme comorbidity, a one-to-one case-control survival analysis of patients treated with PET or primary operation was performed, using propensity score case-match analysis to adjust for confounding factors. Results292 patients fulfilled the inclusion criteria during the study period. 209 patients received primary operation, whereas 83 patients received PET. Excluding those with extreme comorbidity, a one-to-one matching was performed, and the dataset was stratified into survival time within 0–5 years and beyond 5 years. Both groups had similar survival within 0–5 years (p = 0.63). The survival curves diverged beyond 5 years, with a significantly better outcome in patients operated than those treated with PET (p = 0.0029). ConclusionsFor frail older patients with limited life expectancy, PET may be appropriate since equivalent survival can be achieved for PET with or without surgery. Those patients with longer life expectancy may gain survival benefits from local treatment. A comprehensive geriatric assessment is useful to predict the survival probability and guide the optimal treatment.

Fitness consequences of different migratory strategies in partially migratory populations: A multi-taxa meta-analysis.

Partial migration—wherein migratory and non‐migratory individuals exist within the same population—represents a behavioural dimorphism; for it to persist over time, both strategies should yield equal individual fitness. This balance may be maintained through trade‐offs where migrants gain survival benefits by avoiding unfavourable conditions, while residents gain breeding benefits from early access to resources.There has been little overarching quantitative analysis of the evidence for this fitness balance. As migrants—especially long‐distance migrants—may be particularly vulnerable to environmental change, it is possible that recent anthropogenic impacts could drive shifts in fitness balances within these populations.We tested these predictions using a multi‐taxa meta‐analysis. Of 2,939 reviewed studies, 23 contained suitable information for meta‐analysis, yielding 129 effect sizes.Of these, 73% (n = 94) reported higher resident fitness, 22% (n = 28) reported higher migrant fitness, and 5% (n = 7) reported equal fitness. Once weighted for precision, we found balanced fitness benefits across the entire dataset, but a consistently higher fitness of residents over migrants in birds and herpetofauna (the best‐sampled groups). Residency benefits were generally associated with survival, not breeding success, and increased with the number of years of data over which effect sizes were calculated, suggesting deviations from fitness parity are not due to sampling artefacts.A pervasive survival benefit to residency documented in recent literature could indicate that increased exposure to threats associated with anthropogenic change faced by migrating individuals may be shifting the relative fitness balance between strategies.

Intratumoral IL22-producing cells define immunoevasive subtype muscle-invasive bladder cancer with poor prognosis and superior nivolumab responses.

Our previous researches have identified immunoevasive subtype muscle-invasive bladder cancer (MIBC) characterized with immune cells infiltration patterns. Our study explored the clinical significance, immunoregulatory role and therapeutic value of intratumoral IL22-producing cells in MIBC. Two hundred and fifty-nine formalin-fixed paraffin-embedded MIBC samples and 83 freshly resected MIBC tissues and 391 TCGA MIBC samples were retrospectively evaluated. Immunohistochemistry and flow cytometry were applied to identify immune cell infiltration and functional status. In vitro intervention studies were to test the therapeutic and predictive potential of IL22+ cells. Our data revealed patients with high IL22+ cells infiltration suffered poor overall survival and recurrence-free survival in both training and validation cohorts. Only pT2 patients of combined cohort with low IL22+ cells infiltration gained survival benefits from adjuvant chemotherapy (ACT) significantly. Besides, immune contexture featured with increased pro-tumor cells and immunosuppressive cytokines was identified in patients with high IL22+ cells density. The expression pattern of exhausted and effector markers in CD8+ T cells from high IL22+ cells subgroup indicated their dysfunctional status. Importantly, nivolumab showed tumor-killing efficacy in tumors with high IL22+ cells infiltration, and immunosuppressive contexture with CD8+ T cells exhaustion was abrogated in tumors treated with anti-IL22 antibody. In summary, IL22+ cells infiltration determined immunosuppressive contexture with CD8+ T cell dysfunction. Tumor-infiltrating IL22+ cells could be used as an independent marker to predict prognosis and ACT responses. IL22+ cells infiltration possessed the potential to be a favorable predictor for nivolumab application and IL22 blockade could be a novel therapeutic strategy in MIBC.

Anatomic resection and wide resection margin play an important role in hepatectomy for hepatocellular carcinoma with peritumoural micrometastasis.

Anatomic hepatectomy and wide resection margin may improve surgical outcome of patients with hepatocellular carcinoma (HCC), but not everyone gain survival benefit. It remains unclear what kind of patients would benefit from those surgical methods. We investigated the factors affecting survival of patients with HCC, with special attention paid to the surgical methods and pathological factors. A retrospective analysis was conducted on 231 patients with hepatitis B-related HCC who underwent surgery from August 2011 to November 2013 in authors' institute. The survival analysis included the following variables: gender, age, viral load, alpha-fetoprotein, des-γ-carboxy prothrombin, tumour size, cirrhosis, blood transfusion, complications, resection method, resection margin, microvascular invasion (mVI), peritumoural satellite nodule, recurrence time and recurrent burden. The median follow-up time was 59 months. A total of 196 patients (84.9%) recurred and 151 patients (65.4%) deceased due to the disease. Multivariate analysis showed that cirrhosis, mVI and periturmoral satellite nodules were independent risk factors affecting overall survival after operation. The comparison between anatomic resection and local resection, and wide resection margin and narrow resection margin showed no significant differences for recurrence-free survival and overall survival, respectively (P = 0.089 and 0.068, 0.108 and 0.122). Stratified analysis revealed that anatomic resection and wide resection margin surgery improved survival when mVI or peritumoural satellite existed. Anatomic resection and wide resection margin are effective methods to improve the surgical outcome of HCC with periturmoral micrometastasis, although tumour characteristics affect patients' survival more than surgical techniques.

Treatment Choices and Outcomes for Patients with Multiple Myeloma after Relapse on Lenalidomide Maintenance Therapy: Results from the Connect® MM Registry

Treatment Choices and Outcomes for Patients with Multiple Myeloma after Relapse on Lenalidomide Maintenance Therapy: Results from the Connect® MM Registry

Successful Ra-223 treatment with a long interval between the second and the third cycles: a case report

Ra-223 therapy is recommended for Castration Resistant Prostate Cancer (CRPC) patients with bone metastases. The standard protocol is 5-6 cycles of therapy with 4 weeks intervals to gain survival benefit. We report a case of a chemo-naive CRPC patient who after 1.5 years of androgendeprivation therapy had widespread bone metastases, PSA of 4186 ng/ml, alkaline phosphatase (ALP) at 2982 U/l, bone marrow involvement with anaemia and thrombocytopaenia. 223RaCl2 therapy was started in August 2014. After the first two cycles of 223RaCl2 PSA dropped to 70 ng/ml, ALP to 877 U/l. The third cycle was delayed for 5.5 months due to technical reasons. Unexpectedly, during Ra-223 therapy interruption the positive changes were still ongoing. PSA-level decreased further, to 0.28 ng/l and ALP to 254 U/l. Hb level increased from 101 to 125 g/l, PLT from 105 to 180x109/l. After the interruption the patient received 4 planned cycles. Control bone scan after the 4th cycle revealed pathological uptake only in shoulder joints and sternum. In the follow-up period the patient demonstrated minimal disease signs: with normal ALP level, PSA 0.11 ng/ml. Ra-223 Therapy can give anti-tumour effect, as can be seen from the significant decrease in the PSA level. Breaks in Ra-223 Therapy are not dramatic. After interruption, it can be continued again. This fact can be taken into account while planning therapy. As shown here, clinical cases such the one we have reported, may allow a degree of flexibility to the standard recommendations on a case to case basis.

Capecitabine in Combination with Standard (Neo)Adjuvant Regimens in Early Breast Cancer: Survival Outcome from a Meta-Analysis of Randomized Controlled Trials.

Capecitabine has been investigated in early breast cancer in several studies, but it was undefined that whether it could improve survival. To investigate whether the addition of capecitabine affected survival in patients with early breast cancer, a meta-analysis was conducted and overall survival (OS), disease-free survival (DFS), and toxicity were assessed. The PubMed, Embase databases and the Cochrane Central Register of Controlled Trials were searched for studies between January 2006 and April 2016. Hazard ratios (HRs) with their 95% confidence intervals (CIs), or data for calculating HRs with 95% CI were derived. Seven trials with 9097 patients, consisted of 4 adjuvant and 3 neoadjuvant studies, were included in this meta-analysis. Adding capecitabine showed no improvement in DFS (HR = 0.93; 95% CI, 0.85–1.02; P = 0.12), whereas a significant improvement in OS was observed (HR = 0.85; 95% CI, 0.75–0.96; P = 0.008). A sub-analysis of DFS showed that benefit of capecitabine derived from patients with triple negative subtype and with extensive axillary involvement. Safety profiles were consistent with the known side-effects of capecitabine, but more patients discontinued scheduled treatment in the capecitabine group. Combining capecitabine with standard (neo)adjuvant regimens in early breast cancer demonstrated a significantly superior OS, and indicated DFS improvement in some subtypes with high risk of recurrence. Selection of subtypes was a key to identify patients who might gain survival benefit from capecitabine.

Prevention and Treatment of Cancer: Hypes and Hopes 6th International Translational Cancer Research Conference

Cancer is primarily an "old-age" disease that has an "age-old" history. The overall incidence of cancer is much higher in Western countries, but is rapidly growing in Eastern countries perhaps due to change in life-style. Almost three million studies published to date indicate that cancer is a hyperproliferative disorder that arises from dysregulation of multiple cell signaling pathways. The cancer genome landscape indicates that approximately 140 genes and 12 cell signaling pathways drive almost all cancers. "Targeted therapy," a buzz word in cancer treatment for the past two decades, has provided antibodies, as well as small-molecule inhibitors. These therapies have been successful only in few instances. However, in most cases, minor increase in overall survival has been reported at the cost of huge expense. An alternative strategy is to prevent cancer or to diagnose and treat the disease at an early stage to gain survival benefits. Such interventions are also cost-effective. To address some of these issues, the 6th International Translational Cancer Research Conference was held during February 4-7th, 2016, in Ahmedabad, Gujarat, India; the homeland of Mahatma Gandhi. This conference was focused on utilizing multidisciplinary approaches for prevention and early treatment that would likely simultaneously or sequentially target many key pathways. Several distinguished speakers were invited from around the world. This article highlights primary features of this conference.

Effectiveness of adjuvant chemotherapy for elderly patients with lymph node-positive colorectal cancer.

BackgroundSeveral guidelines state that postoperative adjuvant chemotherapy (AC) confers survival benefits to patients with lymph node-positive colorectal cancer. However, older patients are usually not administered AC due to the higher risk of side effects. The aim of this study was to evaluate the benefit of AC for elderly patients (EP) and examine its tolerability.MethodsData from 204 patients with lymph node-positive colon cancer were retrospectively analyzed. Patients were subdivided into two groups: EP, >75 years old (n = 53) and young patients (YP), <75 years old (n = 151). Clinicopathological features, type of chemotherapy, and outcomes were compared between groups.ResultsFrequency of comorbidities and performance status were significantly higher in EP (p < 0.01 each), a greater proportion of YP (76 %) than EP received AC (40 %, p < 0.01), and YP received combination therapy more frequently than EP (p < 0.01). In terms of side effects, few EP showed severe side effects. Both YP and EP gained survival benefits from AC (p = 0.07 and p < 0.01, respectively).ConclusionsAC should not be withheld from eligible EP purely because of age.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-0959-5) contains supplementary material, which is available to authorized users.

Male and female helper effects on maternal investment and adult survival in red-winged fairy-wrens

Despite its importance for the evolution of cooperative breeding, it has proven difficult to determine whether helpers improve their recipients’ fitness. Helpers affect fitness in multiple ways, both positive and negative, but their effects can also be concealed through reduced maternal investment. Furthermore, determining the direction of causation is difficult, as helper presence may indicate a productive territory, rather than high productivity indicating an effect of help. In cooperatively breeding red-winged fairy-wrens (Malurus elegans) groups reduce care when they have male helpers, but groups with female helpers do not, so nestlings receive more food. Thus our predictions vary with helper sex rather than helper number, and by studying within-group changes with regard to group composition we separate phenotypically plastic responses from among-group correlations. Females did not reduce egg size in response to an increasing number of female helpers. However, more male or female helpers allowed females to lay larger clutches and more female helpers reduced re-nesting intervals. There was mixed support for a benefit of load lightening: Helpers, but not breeders, gained survival benefits with increasing number of male helpers. However, helper survival decreased with the number of female helpers, suggesting that increased competition counterbalanced these male helper benefits. We also found consistent among-group differences, which would have erroneously been interpreted as helper effects had we not disentangled the within-group changes with regard to group composition. This study highlights the importance of assessing carers’ benefits in relation to both group composition and size, and of investigating the within-individual plastic response of helper effects.

Females gain survival benefits from immune-boosting ejaculates

Females in many animal taxa incur significant costs from mating in the form of injury or infection, which can drastically reduce survival. Therefore, immune function during reproduction can be important in determining lifetime fitness. Trade-offs between reproduction and immunity have been extensively studied, yet a growing number of studies demonstrate that mated females have a stronger immune response than virgins. Here, we use the Texas field cricket, Gryllus texensis, to test multiple hypotheses proposed to explain this postmating increase in immune function. Using host-resistance tests, we found that courtship, copulation, and accessory fluids alone do not affect female immunity; rather, only females that acquire intact ejaculates containing testes-derived components exhibit significant increases in survival after exposure to bacterial pathogens. Our data suggest that male-derived components originating from an intact ejaculate and transferred to females during sex are required for the increased immune function characteristic of mated female crickets to occur.

Identification and Construction of Combinatory Cancer Hallmark-Based Gene Signature Sets to Predict Recurrence and Chemotherapy Benefit in Stage II Colorectal Cancer.

Decisions regarding adjuvant therapy in patients with stage II colorectal cancer (CRC) have been among the most challenging and controversial in oncology over the past 20 years. To develop robust combinatory cancer hallmark-based gene signature sets (CSS sets) that more accurately predict prognosis and identify a subset of patients with stage II CRC who could gain survival benefits from adjuvant chemotherapy. Thirteen retrospective studies of patients with stage II CRC who had clinical follow-up and adjuvant chemotherapy were analyzed. Respective totals of 162 and 843 patients from 2 and 11 independent cohorts were used as the discovery and validation cohorts, respectively. A total of 1005 patients with stage II CRC were included in the 13 cohorts. Among them, 84 of 416 patients in 3 independent cohorts received fluorouracil-based adjuvant chemotherapy. Identification of CSS sets to predict relapse-free survival and identify a subset of patients with stage II CRC who could gain substantial survival benefits from fluorouracil-based adjuvant chemotherapy. Eight cancer hallmark-based gene signatures (30 genes each) were identified and used to construct CSS sets for determining prognosis. The CSS sets were validated in 11 independent cohorts of 767 patients with stage II CRC who did not receive adjuvant chemotherapy. The CSS sets accurately stratified patients into low-, intermediate-, and high-risk groups. Five-year relapse-free survival rates were 94%, 78%, and 45%, respectively, representing 60%, 28%, and 12% of patients with stage II disease. The 416 patients with CSS set-defined high-risk stage II CRC who received fluorouracil-based adjuvant chemotherapy showed a substantial gain in survival benefits from the treatment (ie, recurrence reduced by 30%-40% in 5 years). The CSS sets substantially outperformed other prognostic predictors of stage 2 CRC. They are more accurate and robust for prognostic predictions and facilitate the identification of patients with stage II disease who could gain survival benefit from fluorouracil-based adjuvant chemotherapy.

Relationship between the use of statins and patient survival in colorectal cancer: a systematic review and meta-analysis.

BackgroundStudies have indicated that statins influence the risks and mortality rates of several types of solid tumors. However, the association between statin use and survival in patients with colorectal cancer (CRC) remains unclear.MethodsWe searched the PubMed and Embase databases for relevant studies published up to September 2014 that assessed statin use and CRC prognosis. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS). The secondary outcomes were disease-free survival (DFS) and recurrence-free survival (RFS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted and pooled with Mantel–Haenszel random-effect modeling. All statistical tests were two-sided.ResultsFour studies on post-diagnosis statin therapy and five studies on pre-diagnosis statin use were included in our meta-analysis of 70,608 patients. Compared with the non-users, the patients with post-diagnosis statin use gained survival benefits for OS (HR 0.76; 95% CI: 0.68 to 0.85, P<0.001) and CSS (HR 0.70; 95% CI: 0.60 to 0.81, P<0.001). In addition, we observed that pre-diagnosis statin use prolonged the survival of patients with CRC for OS (HR 0.70; 95% CI: 0.54 to 0.91, P=0.007) and CSS (HR 0.80; 95% CI: 0.74 to 0.86, P<0.001). However, we did not observe a survival benefit for DFS (HR 1.13; 95% CI: 0.78 to 1.62, P=0.514) or RFS (HR 0.98; 95% CI: 0.36 to 2.70, P=0.975) in the CRC patients with post-diagnosis statin use.ConclusionsStatin use before or after cancer diagnosis is related to reductions in overall and cancer-specific mortality in colorectal cancer survivors.

Current Status of Molecular Targeted Therapies in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death in Korea. Curative treatment is only possible when the disease is diagnosed at the early stage. The prognosis of patients with HCC is even dismal in advanced stages. No systemic cytotoxic chemotherapy has proven to be beneficial in overall survival. Recently, the understanding of the molecular pathogenesis led to the development of new therapies. With the evidence of dysregulation of critical genes associated with cellular proliferation, growth factor signaling, cell cycling, apoptosis, and angiogenesis in HCC, a number of molecular target agents are under clinical trials. Sorafenib is the first systemic anticancer drug which has proven to gain survival benefit in the global as well as Asia-Pacific trials. However, the survival gain is still modest, and further efforts to improve outcomes in patients with HCC are necessary by developing novel drugs or combining other forms of therapies. This article will review signaling pathways in HCC and introduce molecular target agents under investigation currently.

Current concepts in transarterial chemoembolization of hepatocellular carcinoma

Transarterial chemoembolization (TACE) has the potential to improve survival in patients with intermediate stage hepatocellular carcinoma (HCC). Careful selection of patients is mandatory to gain survival benefit and safe quality of life. Basic principles of TACE in HCC include selective treatment via intrahepatic and extrahepatic arteries, proper management of side effects and continuation of treatment guided by imaging. After conventional TACE, based on delivery of cytotoxic drugs emulsified in iodized oil and embolization of various types of particles, has been used for more than 20 years, the new concept of drug-eluting microspheres has been introduced. This technology effectively combines enhanced local drug delivery and ischemic embolization effects. Clinical studies showed intensified local necroses and reduced systemic toxic side effects compared to conventional TACE. Embolization of HCC with sub-100 μm particles penetrating deeply into the tumor vascular bed is another promising new option. Very effective devascularization of HCC nodules has been shown after 40 μm bland embolizations, however, potential risks like passage of particles into hepatic veins and systemic circulation have to be considered. Today the indication for TACE in intermediate stage HCC patients is widely accepted; however, there is no clear methodical standard so far. Further studies are necessary to define how to adapt various available methods to individual HCC and patients characteristics.

Patients with bone metastases from solid tumours and poor prognostic features may gain survival benefits from zoledronic acid

Patients with bone metastases from solid tumours and poor prognostic features may gain survival benefits from zoledronic acid

Results of the German fulvestrant in practice evaluation programme to evaluate the efficacy, safety, tolerability and acceptance of fulvestrant under daily routine conditions.

Abstract Abstract #6132 Material and Methods: Fulvestrant is an estrogen receptor (ER) antagonist with a distinct mode of action used in the treatment of postmenopausal women with advanced breast cancer progressing or recurring on an antiestrogen. 848 postmenopausal women with ER+ advanced mamma carcinoma, relapsed during or after adjuvant anti-estrogene treatment, or with a disease progression under an anti-estrogene therapy, were enrolled in this Fulvestrant In Practice Evaluation Programme (IPEP). Under daily routine conditions and without intervention by the sponsor regarding selection of subjects, diagnostic procedures or therapeutic decisions relevant data of the fulvestrant therapy was documented over a period of 9 months. Results: The median patient age was 64 years, 52 % of patients had a co-morbidity, 78 % one or more prior palliative therapies. Efficacy: Clinical benefit was observed in 627/848 patients, including 62 complete and 177 partial remissions. Best response was delayed in 115 patients (not seen at 3 months but at 6 months). Estimated 9-month overall survival (OS) was 89%; 9-month event-free survival (EFS) was 71%. Safety: 244 non-serious adverse events by patient were recorded, most commonly General disorders and administration site conditions, gastrointestinal and musculo-sceletal symptoms. Excluding deaths, 7 serious adverse events were recorded (none attributed to fulvestrant); no new or unexpected safety issues arose. 20 patients died during observation. Tolerability: Tolerability was judged as good to very good by the majority of both specialists and patients with stable values at 3, 6 and 9 months. Acceptance of injection: The vast majority of both doctors and patients found the application via injection to be acceptable or very acceptable, the handling was judged by the doctors as mostly good to very good. Conclusion: Fulvestrant treatment was well tolerated and well accepted in this palliative patient collective, no new safety findings occurred. The treatment showed good efficacy with any patient, who had achieved disease stabilization or better after three months being likely to gain survival benefit from prolonged Fulvestrant therapy. Best response often occured delayed. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6132.

Can patients with head and neck cancers invading carotid artery gain survival benefit from surgery?

Conclusion. Surgical treatment of carotid invasion may give an improved 2-year survival in selected patients without significant morbidity. Objective. To evaluate survival outcomes in patients with head and neck squamous cell carcinomas invading the carotid artery. Patients and methods. At the time of carotid invasion, 23 patients underwent surgery (n=11), chemoradiotherapy (n=6), or palliation (n=6). Surgical methods included carotid resection and ligation (n=5), carotid resection and reconstruction with saphenous vein (n=4), and peeling (n=2). Survival outcomes among different treatments were compared. Results. None of the 11 surgical patients experienced perioperative mortality or major neurologic complications. Three of these patients survived, but two had recurrent disease at last follow-up; their 2-year overall survival and disease-free survival rates were 24.5% and 18.2%, respectively. In contrast, all patients treated with chemoradiation or palliation died within 15 months. Median survival time was 16.5 months in the surgery group, 11.5 months in the chemoradiation group, and 3 months in the palliation group (p=0.025).