Surgery associated with better survival for patients with advanced laryngeal cancer

Patients with advanced laryngeal cancer appear to have better survival if they are treated with surgery than nonsurgical chemoradiation.

Approximately 11,000 to 13,000 cases of laryngeal cancer are diagnosed each year and squamous cell carcinoma accounts for the vast majority of these tumors. Prior to 1991, total surgical removal of the larynx with postoperative radiation was the standard of care for advanced cancer. Since then, chemoradiation has become increasingly popular treatment because it can preserve the larynx.

The authors evaluated survival outcomes for surgical vs. nonsurgical treatment for advanced laryngeal cancer. The authors used data from the Surveillance, Epidemiology and End Results (SEER) database for their study of 5,394 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma between 1992 and 2009.

Patients who had surgery had better 2-year and 5-year disease-specific survival (70 percent vs. 64 percent and 55 percent vs. 51 percent, respectively) and 2-year and 5-year overall survival (64 percent vs. 57 percent and 44 percent vs. 39 percent, respectively) than patients who did not under surgery. The use of nonsurgical treatment increased over time: 32 percent in the 1992 to 1997 patient group, 45 percent in the 1998 to 2003 group and 62 percent in the 2004 to 2009 group. The gap in survival between the two groups consistently narrowed over subsequent years. Patients who were diagnosed between 2004 and 2009 had better survival than those diagnosed earlier and this may be due to improvements in radiation and chemotherapy strategies.

The authors state that patients need to be made aware of the modest but significant survival disadvantage associated with nonsurgical therapy as part of the shared decision-making process during treatment selection.

Megwalu UC and Sikora AG (2014). Survival Outcomes in Advanced Laryngeal Cancer. JAMA Otolaryngol. Head Neck Surg., EPub Ahead of Print [Abstract]

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Scientists map risk of premature menopause after cancer treatment

Women treated for the cancer Hodgkin lymphoma will be able to better understand their risks of future infertility after researchers estimated their risk of premature menopause with different treatments.

The findings, set out in the Journal of the National Cancer Institute, are based on the experience of more than 2,000 young women in England and Wales treated for the cancer over a period of more than 40 years.

Previous research has suggested that women with Hodgkin lymphoma who receive certain types of chemotherapy or radiotherapy are at increased risk of going through the menopause early – but there was insufficient information to provide patients with detailed advice.

But the new study, led by scientists at The Institute of Cancer Research, London, provides precise estimates of risk for women depending on which treatment types and doses they received and at what age – allowing doctors to give them detailed advice about their risks of future infertility.

The research was largely funded by Breakthrough Breast Cancer and involved researchers from across the UK at more than 50 universities and hospitals. The research team followed-up 2,127 women who had been treated for Hodgkin lymphoma in England and Wales between 1960 and 2004, and who had been aged under 36 at the time. All had received treatment with chest radiotherapy, sometimes alongside other treatments.

Some 605 of the women in the study underwent non-surgical menopause before the age of 40. This was a large enough number for the researchers to estimate accurate risks of menopause at different ages, depending on the mixture and doses of treatments they received and the age they received them.

The researchers produced a risk table which could help improve the advice that clinicians are able to give to women who have undergone treatment for the disease. Several of the treatments caused a sharp increase in premature menopause risk.

For example, a woman who had received six or more cycles of a standard chemotherapy regimen in her late 20s, but without receiving radiotherapy to the pelvic area, had a chance of around 18 per cent of undergoing menopause by the age of 30, or 58 per cent by age 40.

Overall, risk of premature menopause was more than 20-fold raised after ovarian radiotherapy, and also after some specific chemotherapy regimens. Risk of menopause by age 40 was 81 per cent after receiving ovarian radiotherapy at an overall dose of 5 or more Grays, and up to 75 per cent after chemotherapy, depending on the type, although only one per cent after receiving a chemotherapy regimen called ABVD.

Study leader Professor Anthony Swerdlow, Professor of Epidemiology at The Institute of Cancer Research, London, said, “Hodgkin lymphoma often affects younger women, and although fortunately most survive the disease, treatments including certain types of chemotherapy and pelvic radiotherapy can lead to premature menopause.”

We hope our study will help women to understand better, in consultation with their doctors, their risks of future infertility following treatment for this malignancy. By looking in a much larger group of women than previous studies of this type, we were able to produce age and treatment specific risk estimates that we hope will be of practical use to individual women. I’m extremely grateful to the patients and doctors who made it possible for us to produce this information.

Swerdlow et al., (2014). Risk of Premature Menopause After Treatment for Hodgkin’s Lymphoma. JNCI J. Natl. Cancer Inst., 106 (9): dju207, doi: 10.1093/jnci/dju207 [Abstract]

14 Inspiring Breast Cancer Quotes

Being diagnosed with breast cancer is a life-changing experience. It can be hard to handle the news at first, and even harder to know how to proceed, no matter your prognosis.

While everyone’s journey is unique, knowing that others before you have been through something similar can give you the strength and inspiration you need to keep everything in perspective.

Click through slideshow for the type of wisdom gained from great personal struggle, and know that you’re not alone.

Written by Rachael Maier

– See more at:

http://www.healthline.com/health/breast-cancer/quotes#sthash.BUA5itc4.dpuf

Aspirin may slow recurrence in breast cancer patients

New findings published today in the journal Cancer Research reveal that some postmenopausal overweight breast cancer patients who use common anti-inflammatory drugs like aspirin or ibuprofen have significantly lower breast cancer recurrence rates.

Researchers from the Cancer Therapy & Research Center at The University of Texas Health Science Center at San Antonio and the University of Texas at Austin began by examining blood serum from CTRC breast cancer patients, said CTRC oncologist Andrew Brenner, M.D., Ph.D.

They placed the serum in a culture of fat cells that make estrogen, and then placed the serum on breast cancer cells. The serum from overweight and obese patients caused the cancer cells to grow much more aggressively than the serum from patients who were not overweight.

It looks like the mechanism is prostaglandins, which have a role in inflammation, and there’s more of it in the obese patient serum,” Dr. Brenner said.

Based on those findings, the researchers did a retrospective study on patients from the CTRC and the START Center for Cancer Care. They were segregated into those taking COX2 inhibitors (aspirin or ibuprofen) and those who did not.

Patients who were on COX2 inhibitors tended to have a lower recurrence rate,” Dr. Brenner said.

Anti-inflammatory use reduced the recurrence rate of ERα positive breast cancer by 50 percent and extended patients’ disease-free period by more than two years. ER positive breast cancers, cancers that grow in response to exposure to the hormone estrogen, are among the most common form of the disease, accounting for approximately 75 percent of diagnoses.

Cancer researcher Linda deGraffenried, Ph.D., from The University of Texas at Austin, designed the study, working closely with Dr. Brenner and Murali Beeram, M.D., a cancer specialist from the START Center.

The investigators caution that these results are preliminary.

Overweight or obese women diagnosed with breast cancer are facing a worse prognosis than normal-weight women,” said Dr. deGraffenried, who is also adjunct assistant professor in the Department of Cellular and Structural Biology at the Health Science Center.

We believe that obese women are facing a different disease. There are changes at the molecular level. We want to reduce the disease-promoting effects of obesity.” Based on those results, the CTRC has launched a pilot anti-inflammatory trial in a joint venture with UT Austin, and the research partners are seeking funding for a larger study.

We would like to identify which women are most likely to benefit from interventions like adding NSAIDs to treatment regimens,” Dr. deGraffenried said.

Bowers et al., (2014). NSAID Use Reduces Breast Cancer Recurrence in Overweight and Obese Women: Role of Prostaglandin–Aromatase Interactions. Cancer Res., 74:4446-4457, doi:10.1158/0008-5472.CAN-13-3603 [Abstract]

Injected bacteria shrink tumors in rats, dogs and humans

A modified version of the Clostridium novyi (C. noyvi-NT) bacterium can produce a strong and precisely targeted anti-tumor response in rats, dogs and now humans, according to a new report from Johns Hopkins Kimmel Cancer Center researchers.

In its natural form, C. novyi is found in the soil and, in certain cases, can cause tissue-damaging infection in cattle, sheep and humans. The microbe thrives only in oxygen-poor environments, which makes it a targeted means of destroying oxygen-starved cells in tumors that are difficult to treat with chemotherapy and radiation. The Johns Hopkins team removed one of the bacteria’s toxin-producing genes to make it safer for therapeutic use.

This is a gram stain of C. novyi-NT germination in a dog tumor. The darker rod-shaped bacteria are visible throughout the image. Credit: David L. Huso and Baktiar Karim of the Johns Hopkins Department of Pathology.

For the study, the researchers tested direct-tumor injection of the C. noyvi-NT spores in 16 pet dogs that were being treated for naturally occurring tumors. Six of the dogs had an anti-tumor response 21 days after their first treatment. Three of the six showed complete eradication of their tumors, and the length of the longest diameter of the tumor shrunk by at least 30 percent in the three other dogs.

Most of the dogs experienced side effects typical of a bacterial infection, such as fever and tumor abscesses and inflammation, according to a report on the work published online Aug. 13 in Science Translational Medicine.

In a Phase I clinical trial of C. noyvi-NT spores conducted at MD Anderson Cancer Center, a patient with an advanced soft tissue tumor in the abdomen received the spore injection directly into a metastatic tumor in her arm. The treatment significantly reduced the tumor in and around the bone. “She had a very vigorous inflammatory response and abscess formation,” according to Nicholas Roberts, Vet.M.B., Ph.D. “But at the moment, we haven’t treated enough people to be sure if the spectrum of responses that we see in dogs will truly recapitulate what we see in people.”

One advantage of using bacteria to treat cancer is that you can modify these bacteria relatively easily, to equip them with other therapeutic agents, or make them less toxic as we have done here, ” said Shibin Zhou, M.D., Ph.D., associate professor of oncology at the Cancer Center. Zhou is also the director of experimental therapeutics at the Kimmel Cancer Center’s Ludwig Center for Cancer Genetics and Therapeutics. He and colleagues at Johns Hopkins began exploring C. novyi‘s cancer-fighting potential more than a decade ago after studying hundred-year old accounts of an early immunotherapy called Coley toxins, which grew out of the observation that some cancer patients who contracted serious bacterial infections showed cancer remission.

Picture

This is a hematoxylin and eosin stain of a C. novyi-NT treated dog tumor. Lighter pink areas areas denote tumor necrosis next to areas with viable tumor cells. Black patches are calcified areas of tissue. Credit: Credit: David L. Huso and Baktiar Karim of the Johns Hopkins Department of Pathology.

The researchers focused on soft tissue tumors because “these tumors are often locally advanced, and they have spread into normal tissue,” said Roberts, a Ludwig Center and Department of Pathology researcher. The bacteria cannot germinate in normal tissues and will only attack the oxygen-starved or hypoxic cells in the tumor and spare healthy tissue around the cancer.

Verena Staedtke, M.D., Ph.D., a Johns Hopkins neuro-oncology fellow, first tested the spore injection in rats with implanted brain tumors called gliomas. Microscopic evaluation of the tumors showed that the treatment killed tumor cells but spared healthy cells just a few micrometers away. The treatment also prolonged the rats’ survival, with treated rats surviving an average of 33 days after the tumor was implanted, compared with an average of 18 days in rats that did not receive the C. noyvi-NT spore injection.

The researchers then extended their tests of the injection to dogs. “One of the reasons that we treated dogs with C. noyvi-NT before people is because dogs can be a good guide to what may happen in people,” Roberts said. The dog tumors share many genetic similarities with human tumors, he explained, and their tumors appeared spontaneously as they would in humans. Dogs are also treated with many of the same cancer drugs as humans and respond similarly.

The dogs showed a variety of anti-tumor responses and inflammatory side effects.

Zhou said that study of the C. noyvi-NT spore injection in humans is ongoing, but the final results of their treatment are not yet available. “We expect that some patients will have a stronger response than others, but that’s true of other therapies as well. Now, we want to know how well the patients can tolerate this kind of therapy.”

It may be possible to combine traditional treatments like chemotherapy with the C. noyvi-NT therapy, said Zhou, who added that the researchers have already studied these combinations in mice.

Some of these traditional therapies are able to increase the hypoxic region in a tumor and would make the bacterial infection more potent and increase its anti-tumor efficiency,” Staedtke suggested. “C. noyvi-NT is an agent that could be combined with a multitude of chemotherapy agents or radiation.”

Another good thing about using bacteria as a therapeutic agent is that once they’re infecting the tumor, they can induce a strong immune response against tumor cells themselves,” Zhou said.

Previous studies in mice, he noted, suggest that C. noyvi-NT may help create a lingering immune response that fights metastatic tumors long after the initial bacterial treatment, but this effect remains to be seen in the dog and human studies.

Roberts et al., (2014). Intratumoral injection of Clostridium novyi-NT spores induces antitumor responses.Sci. Transl. Med., 6: 249ra111 doi: 10.1126/scitranslmed.3008982 [Abstract]

Pancreatic survival rates at standstill for 4 decades

Long-term survival from pancreatic cancer has failed to improve in 40 years – with the outlook remaining the lowest of the 21 most common cancers, according to new figures published by Cancer Research UK. Today just over three per cent of pancreatic cancer patients survive for at least five years, only a fraction more than the two per cent who survived that long in the early 1970s.

Across all cancers, half of patients now survive at least twice that long. But most cases of pancreatic cancer go undetected until it is too late for surgery. And with the lack of effective tests and treatments for the disease, the majority of patients still die within a year.

But Cancer Research UK is planning to more than double its £6 million annual research spend on pancreas cancer within five years, making inroads into an area of research that until now has been globally neglected. The disease is now under the spotlight across the charity’s five institutes nationwide.

Professor Andrew Biankin is among the three quarters of scientists at Cancer Research UK’s Beatson Institute at the University of Glasgow who are contributing to pancreatic cancer research.

He said: “Pancreatic cancer has very few symptoms at first and I see far too many patients who, out of the blue, are told they may have just months or even weeks to live. We’ve been waiting too long for new drugs to treat the disease and there are very few options available for people with advanced forms of the disease. It’s a situation that simply has to change and we can only do that by funding more high quality research and trials, to get treatments out of the lab and into patients as soon as possible.”

Working with Professor Sean Grimmond, Professor Biankin is leading a team of researchers studying the unique pattern of faults in tumour samples from 400 pancreatic cancer patients and comparing this to their treatment and outcomes to create a map that will help guide the treatment of future patients.

They’re also trying to identify molecules that could be used as early warning signs for the disease, to help diagnose patients before their cancer becomes too advanced.

Yasmin, 41, from London, lost her father Shaukat to pancreatic cancer in 2008. She said: “I lost my dad just 18 months after he was diagnosed with pancreatic cancer. I don’t want other families to go through what we did. The more research we do, the more chances we have to find cures. Progress is being made but it’s hard to cope with the fact that it couldn’t help dad. By the time pancreatic cancer is diagnosed, it’s often too late for treatment to work. I miss my dad every day. Life changes around you, things go on, but I’m always aware there’s somebody missing.”

Pancreatic cancer is the tenth most common cancer in the UK. Every year, around 8,800 people are diagnosed with the disease and around 8,300 die from it.

Harpal Kumar, Cancer Research UK’s chief executive, said: “It’s shocking that so many patients are still losing their lives to pancreatic cancer, which is why we’ve made it a priority to ignite a new wave of research that will see the disease detected earlier and much needed treatments getting to patients sooner.

Overall, more than half of all cancer patients now survive at least a decade, which is testament to the power of research to transform people’s lives. But disappointingly, we are nowhere near that level with pancreas cancer, and we won’t stop until we can bring those kinds of results to all patients, regardless of their cancer type.”

Expressive writing may help breast cancer survivors

Chinese-speaking breast cancer survivors are the focus of this study

Writing down fears, emotions and the benefits of a cancer diagnosis may improve health outcomes for Asian-American breast cancer survivors, according to a study conducted by a researcher at the University of Houston (UH).

The key to developing an expressive writing intervention is the writing instruction. Otherwise, writing is just like a journal recording facts and events. Writing a journal can be therapeutic, but often we don’t get the empirical evidence to determine whether it’s effective or not,” said Qian Lu, assistant professor and director of the Culture and Health Research Center at UH.

In my research study, I found long-term physical and psychological health benefits when research participants wrote about their deepest fears and the benefits of a breast cancer diagnosis,” she said.

Lu and colleagues published a study titled, “A Pilot Study of Expressive Writing Intervention Among Chinese-Speaking Breast Cancer Survivors,” in Health Psychology. The goal of her research is to reduce the psychological burden among minority patients particularly among breast cancer survivors.

Cancer patients, like war veterans in Iraq, can experience post-traumatic stress symptoms. Many times when cancer patients get diagnosed, they face lots of emotional trauma. There’s a sense of loss, depression, anxiety about going into treatment and how they are going to face the future,” said Lu. “They have a lot of emotional events going on in their life.”

In her research, Lu, found little attention paid to Asian-American breast cancer survivor’s psychological needs. Previous studies largely focused on non-Hispanic white samples, and she found a need to research this understudied population. Some of the challenges she noted with this population were feeling stigmatized, shame associated with cancer, cultural beliefs of bearing the burden alone to avoid disrupting harmony, suppressing emotions, and a lack of trained mental health professionals with cultural and linguistic competency.

We thought of a very interesting way to help this problem. It’s actually fairly basic. It’s to express emotions using writing,” she said. “What’s so interesting is that it has been proven as a scientific paradigm.”

According to Lu, previous research found that writing about emotionally difficult events for just 20 to 30 minutes at a time over three or four days increased the immune function. The release offered by writing had a direct impact on the body’s capacity to withstand stress and fight off infection and disease.

I based my study for Chinese-speaking breast cancer survivors on Pennebaker’s research paradigm, and we have conducted a series of studies to modify the paradigm for Asian-Americans” said Lu.

Rather than going to a hospital, Lu worked with a community-based partner to recruit participants. Lu’s research team asked participants to complete a standardized health assessment and then they were asked to write 20 minutes each week for three weeks. Three sealed envelopes were mailed simultaneously to the participants with each envelope containing different writing instructions for the corresponding week. Questionnaires assessing health outcomes were mailed to participants at three and six months after the completion of the writing assignments. Semi-structured phone interviews were conducted after the 6-month follow-up.

The findings from the study suggest participants perceived the writing task to be easy, revealed their emotions, and disclosed their experiences in writing that they had not previously told others. Participants reported that they wrote down whatever they thought and felt and perceived the intervention to be appropriate and valuable,” said Lu.

Lu added that health outcomes associated with the expressive writing intervention include a decrease of fatigue, intrusive thoughts, and reducing posttraumatic stress after three months. She also noted a decrease of fatigue, posttraumatic stress, and the increase of qualify of life and positive affect after six months.

Lu notes this research study contributes to the growing literature of expressive writing by illustrating the feasibility and potential benefits among Chinese-speaking breast cancer survivors using a community-based participatory research approach and a mixed method design. The results of the intervention demonstrate that writing was associated with health benefits at long-term follow-ups and how to adapt and utilize expressive writing intervention for minorities.

Lu et al., (2014). A Pilot Study of Expressive Writing Intervention among Chinese Speaking Breast Cancer Survivors. Health Psychol., 31: 548–551. doi: 10.1037/a0026834 [Article]