TRANSFORMING GROWTH-FACTOR-ALPHA EXPRESSION AS A POTENTIAL SURVIVAL PROGNOSTICATOR IN PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA RECEIVING HIGH-DOSE RADIATION AND CHEMOTHERAPY

Purpose: Transforming growth factor alpha (TGFA) stimulates the growth and proliferation of cells, and its overexpression has been correlate d with patient survival in a variety of tumors, including squamous car cinoma of the esophagus. This study was performed to investigate the i nfluence of TGFA in patients with esophageal adenocarcinoma (EA) recei ving high-dose radiation and chemotherapy (HDRCT). Methods and Materia ls: Thirty-one patients with localized esophageal adenocarcinoma were enrolled in a Phase II study involving high dose radiation and concurr ent 5-fluorouracil (5-FU)/mitomycin-C with or without esophagectomy, T wenty-seven pretreatment (tumor not available in 4) and 11 posttreatme nt (insufficient tumor in 20) specimens were immunostained using the a vidin-biotin-peroxidase technique. Results: Fifteen of 27 (56%) pretre atment and 4 out of 11 (36%) postchemoradiation specimens had intense TGFA staining, Eight patients with intense and seven with little or no staining on pretreatment biopsy underwent esophagectomy. Median survi val for the eight patients was 28 months, and for the seven patients 1 9 months (p = 0.4), Transforming growth factor alpha staining of postt reatment specimens that contained residual tumor also did not correlat e with overall (p = 0.36) or disease-free (p = 0.17) survival. Among t he 10 patients with both pre and posttreatment TGFA specimens, decreas ing or negative TGFA expression was associated with a better median di sease-free survival (32 vs, 13 months, p = 0.04) than persistently pos itive or increasing TGFA expression. Conclusion: There is frequent ove rexpression of TGFA in EA, Although pretreatment TGFA expression was n ot associated with survival, patients with tumors that persistently ex pressed or that increased TGFA expression had a worse prognosis, Postt reatment TGFA expression may serve as a prognostic marker in patients with EA treated with HDRCT.