Response to chemoradiatiotherapy in squamous cell carcinoma of the esophagus: evaluation of some prognostic factors

Abstract

Dag Stockeld1, Ursula Falkmer2, Sture Falkmer3, Lars Backman1, Lars Granström1, Jan Fagerberg41Department of Surgery, Danderyd Hospital, Stockholm, Sweden; 2Department of Oncology; 3Department of Pathology, University Hospital, Trondheim, Norway; 4Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, SwedenObjective: To evaluate the predictive values of the expression of factor VIII, CD-34, p53, bcl-2, and DNA ploidy regarding the response to chemoradiation of squamous cell carcinoma of the esophagus.Design: Retrospective analysis of pretreatment biopsies with immunohistochemistry and flow cytometry. The results were correlated to tumor response (complete vs. noncomplete) following chemoradiation with three cycles of 5-FU and cisplatin combined with 40–64 Gy of radiation.Subjects: 44 consecutive patients with squamous cell carcinoma of the esophagus treated with chemoradiation with a curative intent from 1992–2000.Main outcome measures: Treatment response.Results: No correlations were found between the expressions of p53, bcl-2, or DNA ploidy and tumor response to chemoradiation. A positive correlation was found between factor VIII expression and a complete tumor response (p = 0.0357). However the other marker for angiogenesis, CD-34, showed a negative correlation (p = 0.0493). Both markers indicate blood vessel density meaning that, in this study, many vessels indicated a favorable response if measured with factor VIII, but a poor response if measured with CD-34. Conclusion: It is not possible to predict tumor response to our chemoradiation protocol through the analysis of pretreatment expression of p53, bcl-2 or DNA ploidy in biopsy specimens. In spite of significant correlations between complete tumor responses and the expressions of the markers for angiogenesis this significance may be questionable since one of the two markers, factor VIII had a positive and the other, CD-34, a negative correlation to tumor response.Keywords: chemoradiation, response, prognostic factor, apoptosis, p-53, angiogenesis, DNA ploidy