Effect of multimodality therapy on circulating vascular endothelial growthfactor levels in patients with oesophageal cancer

Background: Angiogenesis is critical for tumour growth and metastasis. The switch to the angiogenic phenotype depends on the net balance between posit ive and negative angiogenic factors released by the tumour. It was hypothes ized that patients with oesophageal cancer would express raised serum level s of vascular endothelial growth factor (VEGF) which would return to normal values with neoadjuvant chemoradiotherapy. Methods: Forty-four patients with oesophageal cancer who were selected for treatment with neoadjuvant chemoradiotherapy had blood samples taken before treatment, during chemoradiotherapy, before operation, on days 1, 3 and 5 after surgery, and 3 months after resection. Serum levels of VEGF were meas ured. Values were correlated with response to treatment. Controls were pati ents who were undergoing surgery for non-malignant conditions. Results: Serum VEGF levels were raised in patients with oesophageal cancer compared with age-matched controls (mean 247 versus 1157 pg/ml; P < 0.01). VEGF levels were unaffected by neoadjuvant treatment but fell significantly on the first day after operation (652 versus 1057 pg/ml before operation; P < 0.05). No decrease occurred in control patients. VEGF levels had return ed to preoperative levels by day 5. A similar postoperative rise in VEGF le vels was seen in the control subjects (1194 pg/ml on day 5 versus 71 pg/ml before operation; P = 0.001). There was no correlation between VEGF level a nd response to treatment or tumour stage. VEGF levels had decreased signifi cantly at 3 months following tumour resection (594 versus 1558 pg/ml on day 5; P = 0.03). Conclusion: VEGF levels are raised in patients with oesophageal cancer and are unaltered by neoadjuvant treatment, suggesting an additional source oth er than tumour cells for this proangiogenic agent.