Selection Of Patients For Therapy Research Articles

MRI Radiomic Features Are Independently Associated With Overall Survival in Soft Tissue Sarcoma

PurposeSoft tissue sarcomas (STS) represent a heterogeneous group of diseases, and selection of individualized treatments remains a challenge. The goal of this study was to determine whether radiomic features extracted from magnetic resonance (MR) images are independently associated with overall survival (OS) in STS. Methods and MaterialsThis study analyzed 2 independent cohorts of adult patients with stage II-III STS treated at center 1 (N = 165) and center 2 (N = 61). Thirty radiomic features were extracted from pretreatment T1-weighted contrast-enhanced MR images. Prognostic models for OS were derived on the center 1 cohort and validated on the center 2 cohort. Clinical-only (C), radiomics-only (R), and clinical and radiomics (C+R) penalized Cox models were constructed. Model performance was assessed using Harrell's concordance index. ResultsIn the R model, tumor volume (hazard ratio [HR], 1.5) and 4 texture features (HR, 1.1-1.5) were selected. In the C+R model, both age (HR, 1.4) and grade (HR, 1.7) were selected along with 5 radiomic features. The adjusted c-indices of the 3 models ranged from 0.68 (C) to 0.74 (C+R) in the derivation cohort and 0.68 (R) to 0.78 (C+R) in the validation cohort. The radiomic features were independently associated with OS in the validation cohort after accounting for age and grade (HR, 2.4; P = .009). ConclusionsThis study found that radiomic features extracted from MR images are independently associated with OS when accounting for age and tumor grade. The overall predictive performance of 3-year OS using a model based on clinical and radiomic features was replicated in an independent cohort. Optimal models using clinical and radiomic features could improve personalized selection of therapy in patients with STS.

Deleterious alterations in DNA-damage repair (daDDR) genes as a predictive biomarker for platinum-based chemotherapy in metastatic pancreatic ductal adenocarcinoma (mPDAC).

266 Background: Germline genetic testing and somatic genomic profiling using commercial multigene panels are now routine in mPDAC. A subset of these patients have deleterious alterations in genes involved with DDR. Herein we investigate the role of daDDR as a predictive biomarker for response to first-line platinum-based chemotherapy. Methods: Utilizing the IRB-approved pancreas cancer and genetics clinic databases at the University of Miami, we identified all patients with mPDAC who had germline and/or somatic mutation testing. We performed a retrospective chart review to extract demographic and clinical characteristics including treatments received, response and survival. Results: Between 2012 and 2018, 116 patients with mPDAC underwent germline (using Invitae, Ambry Counsyl or Myriad) and/or somatic testing (using FoundationOne CDx). Among these, 40 received first-line therapy with FOLFIRINOX (95%) or gemcitabine/cisplatin (5%). The median age was 59 years and 15 (38%) were female. The majority (70%) were Hispanic and 63% had de-novo mPDAC (treatment-naïve). Germline testing revealed daDDR in 5 patients and somatic NGS found an additional 4 patients with daDDR (total of 9 (23%), including 5 with BRCA2, one each with BRCA1, RAD51C, ATM and MUTYH). The median progression-free survival (PFS) was significantly longer in patients with daDDR than without (17.3 vs 7.8 months, log-rank p = 0.01). The median overall survival (OS) was not statistically different between the two groups. Three patients with daDDR had complete or near-complete radiological and tumor marker responses to FOLFIRINOX and were treated with olaparib (a PARP inhibitor) as maintenance and remain progression-free after 7, 12.4 and 13.6 months respectively. Conclusions: daDDR appears to define a subset of patients with mPDAC who may be more sensitive to platinum agents. There are currently no biomarkers for selection of first-line therapy in patients with mPDAC and we demonstrate that this composite biomarker which is easily done via commercially available assays may be able to inform treatment selection.

Abstract 16771: Patient Selection for Therapies to Prevent Major Adverse Limb Events

Introduction: Recently medical therapies have shown benefit in reducing major adverse limb events (MALE) including acute limb ischemia (ALI), urgent revascularization for ischemia, and ischemic amputation in patients with atherosclerotic vascular disease. Defining predictors of MALE may facilitate patient selection for application of novel therapies. Hypothesis: Clinical characteristics can be used to develop a risk score that will predict MALE Methods: Clinical characteristics independently predictive of ALI were identified among 3,985 patients with PAD randomized to placebo in TRA 2°P-TIMI 50 and were used to develop a risk score (c-statistic 0.82). This score was prospectively validated in 7,053 and 13,723 placebo patients from the PEGASUS-TIMI 54 and FOURIER trials respectively. Risk in each trial was evaluated stratified by the investigational treatment (vorapaxar, ticagrelor, or evolocumab). Results: In the broad PAD placebo population of TRA 2°P-TIMI 50, seven independent predictors of ALI with relative risks ranging from 1.69 to ~10 fold were identified including claudication, prior peripheral revascularization or amputation, ankle brachial index ≤ 0.5, heart failure, low body weight, elevated CRP and ASA monotherapy and assigned a point score.There was a gradient of MALE risk in placebo treated patients from 0.1% to 19.7% with increasing score (p<0.0001; Figure, Top). When validated in PEGASUS-TIMI 54 and FOURIER, discrimination remained high (c-statistic of 0.81 in both datasets). A risk of 4 generally correlated to an annualized risk of MALE of ~ 1% (1.1% TRA2P-TIMI 50, 0.93% PEGASUS-TIMI 54, 1.2% FOURIER). A score <4 identified patients at low risk of MALE, whereas those with a score ≥ 4 had greater baseline risk and benefit of randomized therapy (Figure, Bottom). Conclusions: A simple risk score can identify patients at greater risk of MALE who derive greater absolute reductions with effective therapies.

Epidemiology and Management of Hepatocellular Carcinoma

The major risk factors for hepatocellular carcinoma (HCC) in contemporary clinical practice are becoming increasingly related to sustained virological response after hepatitis C, suppressed hepatitis B virus during treatment, and alcoholic and nonalcoholic fatty liver disease. We review the emerging data on the risk and determinants of HCC in these conditions and the implications of HCC surveillance. However, from a public health perspective, active hepatitis C and B continue to drive most of the global burden of HCC. In United States, the age-adjusted incidence rates of HCC in Hispanics have surpassed those of HCC in Asians. Prognosis in HCC is complex because of the competing risk imposed by underlying cirrhosis and presence of malignancy. In addition to tumor burden, liver function and performance status; additional parameters including tumor biopsy, serum markers, and subclassification of current staging systems; and taking into account patterns of tumor progression may improve patient selection for therapy. Advancements in the treatment of HCC have included identification of patients who are most likely to derive a clinically significant benefit from the available therapeutic options. Additionally, the combination strategies of locoregional therapies and/or systemic therapy are being investigated.

Comprehensive Molecular Profiling of Intrahepatic and Extrahepatic Cholangiocarcinomas: Potential Targets for Intervention.

Purpose: Various genetic driver aberrations have been identified among distinct anatomic and clinical subtypes of intrahepatic and extrahepatic cholangiocarcinoma, and these molecular alterations may be prognostic biomarkers and/or predictive of drug response.Experimental Design: Tumor samples from patients with cholangiocarcinoma who consented prospectively were analyzed using the MSK-IMPACT platform, a targeted next-generation sequencing assay that analyzes all exons and selected introns of 410 cancer-associated genes. Fisher exact tests were performed to identify associations between clinical characteristics and genetic alterations.Results: A total of 195 patients were studied: 78% intrahepatic and 22% extrahepatic cholangiocarcinoma. The most commonly altered genes in intrahepatic cholangiocarcinoma were IDH1 (30%), ARID1A (23%), BAP1 (20%), TP53 (20%), and FGFR2 gene fusions (14%). A tendency toward mutual exclusivity was seen between multiple genes in intrahepatic cholangiocarcinoma including TP53:IDH1, IDH1:KRAS, TP53:BAP1, and IDH1:FGFR2 Alterations in CDKN2A/B and ERBB2 were associated with reduced survival and time to progression on chemotherapy in patients with locally advanced or metastatic disease. Genetic alterations with potential therapeutic implications were identified in 47% of patients, leading to biomarker-directed therapy or clinical trial enrollment in 16% of patients.Conclusions: Cholangiocarcinoma is a genetically diverse cancer. Alterations in CDKN2A/B and ERBB2 are associated with negative prognostic implications in patients with advanced disease. Somatic alterations with therapeutic implications were identified in almost half of patients. These prospective data provide a contemporary benchmark for guiding the development of targeted therapies in molecularly profiled cholangiocarcinoma, and support to the use of molecular profiling to guide therapy selection in patients with advanced biliary cancers. Clin Cancer Res; 24(17); 4154-61. ©2018 AACR.

Oral Microbiome and Response to Immunotherapy: Is It Time To Pay Attention?

Microbiome studies have shown associations between the presence of certain bacteria in the gut and response to checkpoint inhibition (CPI) therapies in cancer patients. Studies looking at any such potential associations between oral microbiome and response to CPI therapies are lacking. Oral cavity is an important microbial habitat. Microbes present in the oral cavity influence not only the local and systemic immune homeostasis; but also the gastrointestinal microbial diversity. If associations exist between specific gut microbes and response to CPI therapies, it is reasonable to assume that such relationships exist between oral microbes and therapy response in cancer patients. Since the findings from such studies will have resounding implications on patient selection for therapies and prophylactic or therapeutic modulation of microbes for prevention or treatment of malignancies; it is crucial that dental and oral research community pays attention and joins this research effort to identify associations and elucidate mechanisms of oral microbial determinants of CPI therapy responses in cancer patients.

Baseline Amnestic Severity Predicts Progression From Amnestic Mild Cognitive Impairment to Alzheimer Disease Dementia at 3 Years.

Given the long preclinical disease course of Alzheimer disease (AD) pathology, novel treatments may be more efficacious if administered before the emergence of dementia. Thus, accurate prediction of who will develop AD dementia is of key importance in selecting individuals for trials of treatment and may become crucial for future selection of patients for therapy. As part of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing, 901 individuals who did not have dementia were recruited. We assigned individuals according to Petersen criteria and Winblad criteria for Mild Cognitive Impairment (MCI) at baseline. We then stratified individuals with amnestic MCI into 2 groups according to the severity of their memory impairment on baseline neuropsychological assessment. Incident diagnosis of AD dementia was established by consensus of an expert panel at 36 months. At 36 months, 725 (80.5%) participants were followed up, 54 (7.4%) of whom developed AD dementia. Subjects with amnestic MCI according to Petersen criteria were more likely to develop AD dementia [positive predictive value; PPV, 24.1%; 95% confidence interval (CI), 18.4-30.6] than healthy controls (PPV, 1.0%; 95% CI, 0.3-2.3). Winblad criteria were also effective, with multiple domain amnestic MCI being most accurate at predicting AD dementia (PPV, 47.3%; 95% CI, 33.7-61.2). Finally, more severe amnestic impairment below the median was useful for predicting the development of AD dementia in single domain amnestic MCI (PPV, 28.1%; 95% CI, 17.0-41.5) and in multiple domain amnestic MCI (PPV, 65.7%; 95% CI, 47.8-80.9). Memory impairment per se, impairment in multiple cognitive domains and severity of memory impairment were all associated with greater risk of developing AD dementia in this sample. Characterizing the severity of memory impairment may provide prognostic stratification within Petersen or Winblad taxonomies of amnestic MCI.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Guide for Drug Selection During Pregnancy and Lactation: What Pharmacists Need to Know for Current Practice.

To provide guidance for clinicians on risk assessment of medication use during pregnancy and lactation. Authors completed PubMed searches to identify articles focused on the use of medications in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. Articles were reviewed to provide overall guidance to medication selection during pregnancy. The following information was reviewed: medication use in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. This article will provide an overview of medication safety considerations during pregnancy and lactation. Information was interpreted to help clinicians predict the potential risk and benefit in each patient to make an evidence-based decision. The article concludes with guidance on risk assessment and how pharmacists may support fellow health care providers and their patients when considering medication use. Information about the effects of medication use during reproductive periods is limited. With the removal of the Food and Drug Administration pregnancy categories, clinicians will be relying on pharmacists to aid in the appropriate selection of therapies for patients. It is critical that pharmacists keep abreast of resources available and be able to assess data to help prescribers and their patients.

Current approaches to selection of the 1st line therapy in patients with metastatic hormone-sensitive prostate cancer

Hormone therapy of metastatic prostate cancer (mPC) has been the “golden standard” of treatment since 1941. However, survival rates in patients with this pathology have remained low. Based on the results of newer studies, early start of docetaxel chemotherapy or antiandrogen abiraterone therapy in combination with standard hormone therapy allows to significantly increase survival of patients with mPC. In this review, data from these studies and advisability of docetaxel and abiraterone at the 1st line therapy of mPC are discussed.

Dynamic changes in 18F-borono-L-phenylalanine uptake in unresectable, advanced, or recurrent squamous cell carcinoma of the head and neck and malignant melanoma during boron neutron capture therapy patient selection

BackgroundWe evaluated dynamic changes in 18F–borono-L-phenylalanine (18F–BPA) uptake in unresectable, advanced, or recurrent squamous cell carcinoma of the head and neck (SCC) and malignant melanoma (MM) during boron neutron capture therapy (BNCT) patient selection.MethodsDynamic changes in the maximum standardized uptake value (SUVmax), tumor-to-normal tissue ratio (TNR), and tumor-to-blood pool ratio (TBR) for 18F–BPA were evaluated in 20 patients with SCC and 8 patients with MM.ResultsSUVmax in SCC tumors decreased significantly from 30 to 120 min. There was a non-statistically significant decrease in SUVmax for SCC tumors from 30 to 60 min and from 60 to 120 min. Patients with MM had nonsignificant SUVmax changes in 18F–BPA uptake on delayed imaging. Nonsignificant 18F–BPA TNR and TBR changes were seen in patients with SCC and MM.ConclusionsDynamic changes in SUVmax for 18F–BPA uptake had a washout pattern in SCC and a persistent pattern in MM. Dynamic 18F–BPA -PET studies should be performed to investigate the pharmacokinetics of 18F–BPA in humans and select appropriate candidates who may benefit from BNCT.

Особенности подбора терапии у пациентов с глаукомой и синдромом «сухого глаза»

Особенности подбора терапии у пациентов с глаукомой и синдромом «сухого глаза»

Still restricted usability of imaging criteria in therapeutic decisions for acute ischemic stroke treatment

A 90-year-old woman developed a severe stroke (National Institutes of Health Stroke Scale Score (NIHSS) 24) due to an occlusion of the left carotid T. Computed tomography 60 min after symptom onset showed a large area of tissue at risk with a relatively large area of reduced cerebral blood volume indicating a relative large infarct core. After successful reperfusion, she recovered very well with only residual facial asymmetry (NIHSS 1). Up to now, therapeutic decisions for intravenous thrombolysis and endovascular treatment were mainly based on these time windows, although it was well known that the individual time window may vary widely due to a large variability of the quality of collateral circulation. The recently presented results of the DAWN trial have demonstrated that patients can be successfully treated in a time window up to 24 h when selected by imaging and clinical criteria. The described case impressively demonstrates that this positive selection of patients beyond established treatment time windows does not implicate in reverse that patient selection for therapy within the established time windows can be based on the same imaging criteria. In conclusion, patient selection beyond the established time windows may be based on the available techniques, but imaging-based decisions against therapy in patients within the established time windows should be made only with extreme caution.

Principles of selecting therapy for patients with mild asthma. RAACI and RRO agreed recommendations

The recommendations represent the rating scheme of the assessment and selection of therapy for patients with mild asthma. The variety of therapeutic options for the treatment of easy asthma can provide the achievement of the disease control, or if it is impossible to create a good continuity with the next steps of therapy. Fixed IGX/ KDBA and IGX/DBA combinations increase the compliance and effectiveness of therapy. The creation of therapy algorithms of mild asthma will be an important step to optimize medical care and to attract the attention of doctors to the problem of easy asthma. The goal of recommendations. To provide clinicians with based on the results of controlled clinical trials algorithms for mild asthma treatment.

Preliminary study of tumor heterogeneity in imaging predicts two year survival in pancreatic cancer patients.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers in the United States with a five-year survival rate of 7.2% for all stages. Although surgical resection is the only curative treatment, currently we are unable to differentiate between resectable patients with occult metastatic disease from those with potentially curable disease. Identification of patients with poor prognosis via early classification would help in initial management including the use of neoadjuvant chemotherapy or radiation, or in the choice of postoperative adjuvant therapy. PDAC ranges in appearance from homogeneously isoattenuating masses to heterogeneously hypovascular tumors on CT images; hence, we hypothesize that heterogeneity reflects underlying differences at the histologic or genetic level and will therefore correlate with patient outcome. We quantify heterogeneity of PDAC with texture analysis to predict 2-year survival. Using fuzzy minimum-redundancy maximum-relevance feature selection and a naive Bayes classifier, the proposed features achieve an area under receiver operating characteristic curve (AUC) of 0.90 and accuracy (Ac) of 82.86% with the leave-one-image-out technique and an AUC of 0.80 and Ac of 75.0% with three-fold cross-validation. We conclude that texture analysis can be used to quantify heterogeneity in CT images to accurately predict 2-year survival in patients with pancreatic cancer. From these data, we infer differences in the biological evolution of pancreatic cancer subtypes measurable in imaging and identify opportunities for optimized patient selection for therapy.

Circulating Tumor DNA Reveals Clinically Actionable Somatic Genome of Metastatic Bladder Cancer

Purpose: Targeted agents and immunotherapies promise to transform the treatment of metastatic bladder cancer, but therapy selection will depend on practical tumor molecular stratification. Circulating tumor DNA (ctDNA) is established in several solid malignancies as a minimally invasive tool to profile the tumor genome in real-time, but is critically underexplored in bladder cancer.Experimental Design: We applied a combination of whole-exome sequencing and targeted sequencing across 50 bladder cancer driver genes to plasma cell-free DNA (cfDNA) from 51 patients with aggressive bladder cancer, including 37 with metastatic disease.Results: The majority of patients with metastasis, but only 14% of patients with localized disease, had ctDNA proportions above 2% of total cfDNA (median 16.5%, range 3.9%-72.6%). Twelve percent of estimable samples had evidence of genome hypermutation. We reveal an aggressive mutational landscape in metastatic bladder cancer with 95% of patients harboring deleterious alterations to TP53, RB1, or MDM2, and 70% harboring a mutation or disrupting rearrangement affecting chromatin modifiers such as ARID1A Targetable alterations in MAPK/ERK or PI3K/AKT/mTOR pathways were robustly detected, including amplification of ERBB2 (20% of patients) and activating hotspot mutations in PIK3CA (20%), with the latter mutually exclusive to truncating mutations in TSC1 A novel FGFR3 gene fusion was identified in consecutive samples from one patient.Conclusions: Our study demonstrates that ctDNA provides a practical and cost-effective snapshot of driver gene status in metastatic bladder cancer. The identification of a wide spectrum of clinically informative somatic alterations nominates ctDNA as a tool to dissect disease pathogenesis and guide therapy selection in patients with metastatic bladder cancer. Clin Cancer Res; 23(21); 6487-97. ©2017 AACR.

Biomarkers to Diagnose, Assess and Treat Chronic Spontaneous Urticaria: Not There Yet

Purpose of Review Biomarkers to identify patients with chronic spontaneous urticaria (CSU), to grade clinical severity of CSU, and to guide therapy selection in patients with CSU have not yet been validated in any large CSU patient population. As such, there is insufficient evidence to recommend routine use of any particular biomarker. This review will summarize ongoing research in the field of biomarker development and how it could 1 day benefit diagnosis, severity grading, and treatment decisions in CSU. Recent Findings Second-generation antihistamines are the accepted first-line therapy in the treatment of CSU. The United States Food and Drug Administration (FDA) has approved omalizumab for use in CSU that is refractory to antihistamines. Multiple alternative pharmacologic therapies have been utilized with varying levels of success, although no others are FDA approved. Of the alternative therapies, cyclosporine is the best-studied. Hydroxychloroquine, sulfasalazine, dapsone, and colchicine are others that are frequently prescribed. While oral corticosteroids can provide symptomatic relief for most patients, using corticosteroids for more than a couple of weeks is not advised due to significant side effects. Regardless of which therapy is chosen, a significant fraction of patients do not respond. With the emerging market of biologic products targeting specific immunologic molecules, additional therapies for CSU are likely to become available in the next 10 years. Identifying biomarkers to assess disease response to therapy and to determine which patients are most likely to benefit from which therapy would greatly benefit the field. Summary The ideal tissue source for biomarker identification in CSU has not been determined. Basophil trafficking has been demonstrated to be abnormal in CSU and would benefit from further exploration. Autoreactive T cells have been recently identified in some CSU patients and combined with autologous serum skin test may be useful as a diagnostic tool. Finally, relative to the search for blood biomarkers, the skin has been a poorly charted territory as a possible source for biomarkers and would likely benefit from additional investigation.

The impact of treatment accuracy on proton therapy patient selection for oropharyngeal cancer patients

Background and purposeThe impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients. Materials and methodsData of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 GyRBE/54.25 GyRBE in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively. ResultsThe degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%). ConclusionsTreatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy.

Musculoskeletal manifestations of systemic lupus erythmatosus.

Imaging studies suggest potential changes to the classification and assessment of inflammatory musculoskeletal lupus. This is important because of the burden of disease but the potential for new targeted therapies. Using our current classification and treatment, musculoskeletal symptoms continue to impact significantly on quality of life and work disability. Ultrasound and MRI studies suggested that new approaches to the diagnosis, classification, and evaluation of these symptoms are needed. Many patients with pain but no synovitis have ultrasound-proven joint and tendon inflammation but would not qualify for clinical trials or score highly on disease activity instruments. MRI studies show that erosions are more common than previously thought and may have a different pathogenesis than RA. Immunology studies suggest differences from other autoimmune synovitis, with a complex role for type I interferons. A wide range of biologic therapies appear more consistently effective for arthritis than some other manifestations. Changes to the selection of patients for therapy and stratification using musculoskeletal imaging may offer new approaches to clinical trials and the routine care of systemic lupus erythematosus patients with inflammatory musculoskeletal symptoms. Outcomes may thereby be improved using existing therapies. There are significant knowledge gaps that must be addressed to achieve these potential improved outcomes.

Age and Outcome in Gastrointestinal Cancers: A Population-Based Evaluation of Oesophageal, Gastric and Colorectal Cancer

Background: With demographic changes and partial representativeness of randomized studies the question arises which results are achieved in the treatment of the elderly. The objective was to analyse population-based data on gastrointestinal cancers in terms of age. Methods: Analyses included data of the Munich Cancer Registry, i.e. 4,014, 10,127 and 42,809 invasive oesophageal, gastric and colorectal cancer patients, respectively, which were diagnosed between 1998 and 2014. Tumour characteristics and outcome were analysed by age groups and therapy. Overall survival was analysed using the Kaplan-Meier method, and relative survival was computed as estimation for cancer-specific survival. Additionally, conditional survival of patients surviving at least 6 or 12 months was analysed by age. Results: 21, 44 and 38% of oesophageal, gastric and colorectal cancer patients, respectively, were aged >75 years. Of these, 15, 46 and 73% were surgically treated with curative intent, respectively, which is significantly less than in younger patients. The total 5-year relative survival was 24, 33 and 66%, respectively. The differences in median survival by age group were diminished by selecting those surviving at least 6 or 12 months and those with curatively intended treatment. Conclusion: An adequate patient selection for therapies of these gastrointestinal cancers was demonstrated at large. If the patients' general conditions allowed curatively intended treatment, it was applied and led to similar outcomes irrespective of age.