Ll. Shears et al., APOPTOSIS IN ESOPHAGEAL CANCER FOLLOWING INDUCTION CHEMORADIOTHERAPY, The Journal of surgical research (Print), 79(1), 1998, pp. 20-24
Background, The poor survival of patients with esophageal cancer follo
wing esophagectomy has led to intense investigation into combined moda
lity therapy. Based on results from clinical trials examining chemorad
iotherapy alone without surgery, resection has come under increased sc
rutiny and its necessity as a component of a multimodal approach has b
een questioned. In this study, we examined whether residual tumor cell
s in esophagectomy specimens following induction chemoradiotherapy are
viable and, therefore, provide putative evidence for the appropriaten
ess of esophagectomy. Materials and methods. Between August 1991 and J
anuary 1995, 46 patients were entered into an induction chemoradiother
apy trial consisting of B-fluorouracil, cisplatin, alpha-interferon, a
nd concurrent external beam radiotherapy followed by esophagectomy. Re
sponse was determined histologically and apoptosis assessed with a ter
minal deoxytransferase assay system. p53 status was determined by immu
nohistochemistry and mutational analysis. Results. Thirty-eight patien
ts underwent esophagectomy, 33 of whom had either a complete (n = 10)
or partial (n = 23) response; None of the 28 patients with residual tu
mor in the resected specimen had 100% apoptotic cells and the vast maj
ority of specimens had less than a 10% apoptotic rate. The percentage
of apoptotic cells did correlate with tumor differentiation but not wi
th histologic type nor presence of p53 mutations. Conclusions. These d
ata suggest that resection following upfront chemoradiotherapy is a ne
cessary component of a multimodality approach to esophageal cancer and
will ultimately provide superior local-regional control to a nonsurgi
cal approach. (C) 1998 Academic Press.