Outcome Of Esophageal Cancer Patients Research Articles

IL-6 expression predicts treatment response and outcome in squamous cell carcinoma of the esophagus

BackgroundThe identification of potential tumor markers can improve therapeutic planning and patient management. The aim of this study was to highlight the significance of IL-6 in esophageal squamous cell carcinoma (SCC).MethodsWe retrospectively analyzed the clinical outcomes of 173 patients with esophageal SCC, and examined the correlation between IL-6 levels and clinical outcomes in esophageal cancer patients. Furthermore, the human esophageal SCC cell line CE81T was selected for cellular and animal experiments to investigate changes in tumor behavior and treatment response after manipulation of IL-6 expression.ResultsIn clinical outcome analysis, positive IL-6 staining and poor treatment response was significantly associated with shorter survival. Furthermore, the frequency of IL-6 immunoreactivity was significantly higher in esophageal cancer specimens than in non-malignant epithelium, and this staining was positively linked to the development of distant metastasis (p = 0.0003) and lower treatment response rates (p = 0.0001).By ELISA analysis, IL-6 serum levels were significantly elevated in patients developing disease failure.When IL-6 expression was inhibited, aggressive tumor behavior and radiation resistance could be overcome in vitro and in vivo. The underlying changes included increased cell death, less epithelial-mesenchymal transition and attenuated STAT3 activation. IL-6 inhibition was also associated with attenuated angiogenesis in tumor-bearing mice.ConclusionsIL-6 was significantly associated with poor prognosis in patients with esophageal cancer. Targeting this cytokine could be a promising strategy for treatment of esophageal cancer, as evidenced by inhibition of aggressive tumor behavior and treatment resistance.

The Survival Impact of XPA and XPC Genetic Polymorphisms on Patients with Esophageal Squamous Cell Carcinoma

The purpose of this study was to investigate the association between survival outcome of esophageal cancer patients and the genetic variants in xeroderma pigmentosum groups A (XPA) and C (XPC), 2 important molecules in the nucleotide excision pathway for DNA repair. A total of 501 patients with a diagnosis of esophageal squamous cell carcinoma (ESCC) were enrolled in the study. The genetic variants of XPA in 5'UTR and those of XPC at exon 15 K939Q were analyzed with the TaqMan assay from the genomic DNA of peripheral leukocytes and correlated to the posttreatment survival outcome. Patients with XPA 5'UTR A/G and XPC K939Q C/C genotypes were found to be imposed with a higher risk of mortality after treatment compared with patients with wild-type homozygous genotypes [adjusted HR (95 % CI) of death being 1.36 (1.06-1.74) and 1.34 (0.97-1.83), respectively]. Cox's multivariate analysis detected a statistically significant increased trend in risk of mortality with the accumulation of any of these 2 unfavorable genotypes compared with patients with other genotypes [adjusted HR (95 % CI) = 1.29 (1.08-1.53), P = .005]. The effect was more pronounced in the population treated with esophagectomy (P = .023) and undergoing concurrent neoadjuvant chemoradiotherapy (CCRT) (P = .002). The hereditary genetic variants in XPA and XPC can serve as independent predictors of the clinical outcome of patients with ESCC, especially in those who are treated with esophagectomy and undergo chemoradiation.

Response-based outcomes in patients with esophageal cancer treated with primarily non-cisplatin and 5-fluorouracil–based trimodality therapy.

e14620 Background: Response based outcomes in esophageal cancer patients treated with primarily non cisplatin and 5-fluorouracil based trimodality therapy Methods: Beginning in 2002 at Roswell Park Cancer Institute, alternative neoadjuvant concurrent chemoradiotherapy regimens using combinations of cisplatin, oxaliplatin, irinotecan, or capecitabine were used in the treatment of esophageal cancer patients receiving trimodality therapy. Patients who completed neoadjuvant treatment followed by surgical resection between October 2002 and April 2010 were analyzed. Survival was compared between patients with pathologic complete response (pCR) and those with pathologic non-complete response (pNCR). Follow up was calculated from the date of diagnosis to the date of death or last follow up. Unknown disease status was categorized as a recurrence. Unpaired t-tests were used for statistical comparisons. Results: A total of 115 patients were analyzed, of whom 93% of patients received non cis-5FU based neoadjuvant chemotherapy (40% with cisplatin-irinotecan based therapy, 32% oxaliplatin-capecitabine based regimens, and 15% oxaliplatin-5 FU based chemotherapy). pCR was noted in 19.1% of patients. There was no difference in gender, histology, proportion of patients receiving non cis-5FU based chemotherapy, mean radiotherapy dose delivered, chemoradiotherapy completion time, or total follow up time between patients with pCR and pNCR. With an overall median follow-up time of 28 months, survival analysis demonstrated that pCR patients had decreased disease recurrence (23% vs. 49%, p=0.0232), improved disease specific mortality (9% vs. 46%, p=0.001), and increased overall survival (77% vs. 44%, p=0.0048). Conclusions: In esophageal carcinoma patients treated with primarily non cis-5FU based neoadjuvant concurrent chemoradiotherapy followed by surgical resection, pathologic complete response appears to predict a significantly decreased risk of disease recurrence and improved survival.

The effect of smoking history on response and survival outcomes patients with in esophageal cancer treated with neoadjuvant concurrent chemoradiotherapy followed by surgery.

e14601 Background: There is limited information on the impact of current or former smoking status on survival outcomes in esophageal cancer patients treated with trimodality therapy. Methods: Patie...

Gender differences in clinicopathologic features and outcomes of esophageal cancer patients treated surgically

Background We investigated the clinicopathologic features and long-term outcomes after surgery of Japanese women with esophageal cancer in comparison to those of men.

Radiotherapy for Esophageal Cancer: Does Dose Affect Outcomes?

The INT 0123 trial demonstrated no benefit to dose escalation above 50.4 Gy for definitive chemoradiotherapy (CRT). Two randomized trials comparing CRT to trimodality therapy (TMT) use doses of 40-46 Gy for TMT and 65-66 Gy for CRT. Patients in these trials were predominately of squamous histology which does not reflect the U.S. population. We thus examined the effects of dose on outcomes for esophageal cancer patients taking into consideration histology and treatment modality.

High-dose chemoradiotherapy followed by surgery versus surgery alone in esophageal cancer: a retrospective cohort study

BackgroundWe aimed to assess whether high-dose preoperative chemoradiotherapy (CRT) improves outcome in esophageal cancer patients compared to surgery alone and to define possible prognostic factors for overall survival.MethodsHundred-and-seven patients with disease stage IIA - III were treated with either surgery alone (n = 45) or high-dose preoperative CRT (n = 62). The data were collected retrospectively. Sixty-seven patients had adenocarcinomas, 39 squamous cell carcinomas and one undifferentiated carcinoma. CRT was given as three intensive chemotherapy courses by cisplatin 100 mg/m2 on day 1 and 5-fluorouracil 1000 mg/m2/day, from day 1 through day 5 as continuous infusion. One course was given every 21 days. The last two courses were given concurrent with high-dose radiotherapy, 2 Gy/fraction and a median dose of 66 Gy. Kaplan-Meier survival analysis with log rank test was used to obtain survival data and Cox Regression multivariate analysis was used to define prognostic factors for overall survival.ResultsToxicity grade 3 of CRT occurred in 30 (48.4%) patients and grade 4 in 24 (38.7%) patients of 62 patients. One patient died of neutropenic infection (grade 5). Fifty percent (31 patients) in the CRT group did undergo the planned surgery. Postoperative mortality rate was 9% and 10% in the surgery alone and CRT+ surgery groups, respectively (p = 1.0). Median overall survival was 11.1 and 31.4 months in the surgery alone and CRT+ surgery groups, respectively (log rank test, p = 0.042). In the surgery alone group one, 3 and 5 year survival rates were 44%, 24% and 16%, respectively and in the CRT+ surgery group they were 68%, 44% and 29%, respectively. By multivariate analysis we found that age of patient, performance status, alcoholism and > = 4 pathological positive lymph nodes in resected specimen were significantly associated with overall survival, whereas high-dose preoperative CRT was not.ConclusionWe found no significant survival advantage in esophageal cancer stage IIA-III following preoperative high-dose CRT compared to surgery alone. Patient's age, performance status, alcohol abuse and number of positive lymph nodes were prognostic factors for overall survival.

Use of serum VEGF (SVEGF) levels to predict outcome of esophageal cancer (EC) patients undergoing preoperative chemoradiation (CRT).

4140 Background: Increased sVEGF concentrations have been correlated with outcome in many solid tumors, including EC. 72 pts with untreated locally advanced EC undergoing CRT were evaluated to elucidate the association of sVEGF levels with clinico-pathologic parameters andoutcome. Methods: Blood samples were obtained from pts before and after CRT. Fifty age- and sex-matched healthy blood donors were used for determination of normal sVEGF levels. sVEGF levels were determined using an ELISA kit. Results: Pretreatment sVEGF levels were significantly higher in pts than in the control group (455.2 ± 108 vs. 85.1 ± 21 pg/mL; p < 0.001). sVEGF levels were significantly higher in EUS stage III than EUS stage II disease (655.7 ± 87.3 vs. 381.2 ± 48.7 pg/mL; p = 0.0025). Preoperative sVEGF levels were not correlated with age, gender, PS, histology, grading, tumor location and platelets. All pts were evaluable for CRT response: basal sVEGF levels in responding group (pCR + pPR: 49 pts) were significantly lower than those of non-responding group (SD + PD:23 pts): 315.3 ± 95.3 vs. 689.58 ± 132.1 pg/mL; p = 0.0010). The mean follow up time was 31.2 ± 15.3 months. The 3-years OS for all pts was 37%: pts with VEGF levels higher than 455.2 pg/mL had a lower 3-year OS rate than pts with lower VEGF levels (61% vs. 17%; p < 0.001). The 3-years DFS rate for all pts was 32%: pts with VEGF levels higher than 455.2 pg/mL had a lower 3-year DFS rate than pts with lower VEGF levels (70% vs. 19%; p < 0.0014). Conclusions: Our results suggest that sVEGF levels correlate with tumor burden and are useful in predicting the outcome of EC patients undergoing preoperative CRT. No significant financial relationships to disclose.

Outcomes of Esophageal Cancer Patients Staged with 18-F-FDG-PET: Can Post-chemo-radiotherapy PET Predict the Utility of Resection?

Outcomes of Esophageal Cancer Patients Staged with 18-F-FDG-PET: Can Post-chemo-radiotherapy PET Predict the Utility of Resection?

MicroRNA Expression in Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus: Associations with Survival

The dismal outcome of esophageal cancer patients highlights the need for novel prognostic biomarkers, such as microRNAs (miRNA). Although recent studies have established the role of miRNAs in esophageal carcinoma, a comprehensive multicenter study investigating different histologic types, including squamous cell carcinoma (SCC) and adenocarcinoma with or without Barrett's, is still lacking. miRNA expression was measured in cancerous and adjacent noncancerous tissue pairs collected from 100 adenocarcinoma and 70 SCC patients enrolled at four clinical centers from the United States, Canada, and Japan. Microarray-based expression was measured in a subset of samples in two cohorts and was validated in all available samples. In adenocarcinoma patients, miR-21, miR-223, miR-192, and miR-194 expression was elevated, whereas miR-203 expression was reduced in cancerous compared with noncancerous tissue. In SCC patients, we found elevated miR-21 and reduced miR-375 expression levels in cancerous compared with noncancerous tissue. When comparing cancerous tissue expression between adenocarcinoma and SCC patients, miR-194 and miR-375 were elevated in adenocarcinoma patients. Significantly, elevated miR-21 expression in noncancerous tissue of SCC patients and reduced levels of miR-375 in cancerous tissue of adenocarcinoma patients with Barrett's were strongly associated with worse prognosis. Associations with prognosis were independent of tumor stage or nodal status, cohort type, and chemoradiation therapy. Our multicenter-based results highlight miRNAs involved in major histologic types of esophageal carcinoma and uncover significant associations with prognosis. Elucidating miRNAs relevant to esophageal carcinogenesis is potentially clinically useful for developing prognostic biomarkers and identifying novel drug targets and therapies.

Surgical Treatment and Prognosis of Esophageal Cancer After Distal Gastrectomy

BackgroundThe purpose of the present study was to explore the clinicopathological characteristics and operative therapeutic efficacy of thoracic esophageal cancer after gastrectomy and compare with those without gastrectomy. MethodsFrom January 2000 to June 2007, 28 esophageal cancer patients with a history of distal gastrectomy underwent subtotal esophagectomy. Vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Six hundred seventeen patients without a history of gastrectomy treated in the same period form the control group. After the operation, pathological characteristic, tumor staging, and survival statistics were analyzed. ResultsOf those patients with esophageal cancer associated with gastric remnant, the majority were male. There was an average of 16.5 years for diagnosing esophageal cancer from the initial partial gastrectomy, 75% (21/28) of them were patients with Billroth I anastomosis. The proportion of lower-third tumors in patients after gastrectomy (12 of 28 patients, 43%) was significantly higher compared with that of the patients with intact stomachs (124 of 617 patients, 20%; P = 0.004). After surgical treatment, the overall 1-, 3-, and 5-year survival rates of gastrectomized and nongastrectomized patients were 100%, 35.00%, and 23.33% versus 98.93%, 59.42%, and 30.85% in stages I–II and 80.00%, 30.00%, and 0% versus 98.59%, 62.03%, and 21.03% in stages III–IV. The log rank test of equality of survival distribution for the gastrectomized vs nongastrectomized patients was not significant in stages I–II (P = 0.5692) but was significant in stages III–IV (P = 0.0166). ConclusionsThe patients with partial gastrectomy for more than 5 years, having upper gastrointestinal symptoms, should be considered having the risk of esophageal cancer associated with gastric remnant. For patients with a history of distal gastrectomy, a vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Surgical efficacy was similar with the no-gastrectomy group in early stages I–II of esophageal cancer associated with gastric remnant but was lower compared with the no-gastrectomy group in stages III–IV. So, early diagnosis and an aggressive surgical approach may be crucial to achieve better outcomes for esophageal cancer patients with gastrectomy.

Research Highlights

Research Highlights

Stemness signature of BMI1 and clinical outcome in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy

4572 Background: The polycomb group (PcG) family BMI1, acting downstream of the hedgehog (Hh) pathway, plays an essential role in the self-renewal of hematopoietic, neural, and intestinal stem cells, and is dysregulated in many types of cancer. Our recent report has demonstrated that Gli-1 nuclear expression indicative of Hh signalling activation can predict very poorer prognosis of esophageal squamous cell carcinomas (ESCCs)(Br J Cancer 2008). As data were not available on the clinical role of BMI1 expression, we analyzed whether it could be also used to predict disease progression and prognosis in ESCC patients undergoing neoadjuvant chemoradiotherapy (CRT). Methods: BMI1, Gli-1, and p16INK4A expressions were evaluated in 78 ESCC patients by immunohistochemical staining. All patients underwent preoperative chemoradiotherapy; 40 Gy irradiation plus FP (5- FU and CDDP) regimen. Results: In total, 24 out of 78 patients (30.8%) showed BMI1 positive expression. All Gli- 1 nuclear positive cancers expressed BMI1. There was no significant correlation between p16INK4A expression and BMI1 expression. Overall survival (OS) was significantly correlated with the absence of BMI1 expression. The patients with BMI1-positive cancers showed significantly poorer prognoses than those without (mean disease-free survival (DFS) time 16.8 vs 71.2 months, P&lt;0.005; mean OS time 21.8 vs 76.6 months, P&lt;0.001). Conclusions: We demonstrated that BMI1 expression indicative of PcG protein chromatin silencing pathway activation was significantly correlated with esophageal cancer recurrence and poor prognosis after CRT, and that it was not inversely correlated with the presence of the downstream target p16INK4A. These findings suggest that the stemness signature including components of Hh and PcG pathways might be involved in promoting cancer regrowth and progression after CRT, and is thus a potential prognostic biomarker and rational therapeutic target for attacking the “more aggressive” cancer cells causing recurrence. No significant financial relationships to disclose.

Neoadjuvant Radiochemotherapy Increases Matrix Metalloproteinase Activity in Healthy Tissue in Esophageal Cancer Patients

Neoadjuvant radiochemotherapy (RCT) is thought to result in a favorable oncological outcome in esophageal cancer patients. Unfortunately, it also implies that adjacent healthy tissue is preoperatively exposed to the potential damaging influence of RCT. Here, the impact of preoperative RCT on matrix metalloproteinase (MMP) expression in healthy esophageal tissue aligned with the tumor at the time of surgery is examined. 23 patients participating in a clinical trial were randomized to either the control (n = 12) or the neoadjuvant RCT group (n = 11). In the latter group, surgery was performed 5 weeks after the last course of RCT. Full-thickness biopsies were taken from healthy esophageal tissue at the proximal border of the resection specimen and more distally next to the tumor. MMP-2 and MMP-9 activity in the samples was assessed by quantitative gelatin zymography and immunohistochemistry. In the proximal segment, the activities of the MMP-9-dimer (135 kDa) and proMMP-9 (92 kDa) were significantly increased in the RCT group as compared with the control group: 28.5 versus 3.0 (p = 0.025) and 87.7 versus 13.0 (p = 0.015) arbitrary units for 135 kDa and 92 kDa, respectively. In the distal part, RCT resulted in a significant increase of proMMP-2 (72 kDa: 35.8 versus 17.8, p = 0.005) and proMMP-9 (81.2 versus 23.3, p = 0.03). In esophageal cancer patients, neoadjuvant RCT results in increased MMP expression in healthy esophageal tissue as measured at the time of surgery. Since increased levels of MMPs are associated with severe postoperative complications including anastomotic leakage this finding necessitates further clinical research.

Genetic variations in the PI3K/PTEN/AKT/mTOR pathway are associated with clinical outcomes in esophageal cancer patients treated with chemoradiotherapy.

The phosphoinositide-3-kinase (PI3K), phosphatase and tensin homolog (PTEN), v-akt murine thymoma viral oncogene homolog (AKT), and mammalian target of rapamycin (mTOR) signaling pathway has been implicated in resistance to several chemotherapeutic agents. In this retrospective study, we determined whether common genetic variations in this pathway are associated with clinical outcomes in esophageal cancer patients with adenocarcinoma or squamous cell carcinoma who have undergone chemoradiotherapy and surgery. Sixteen tagging single nucleotide polymorphisms (SNPs) in PIK3CA, PTEN, AKT1, AKT2, and FRAP1 (encoding mTOR) were genotyped in these patients and analyzed for associations with response to therapy, survival, and recurrence. We observed an increased recurrence risk with genetic variations in AKT1 and AKT2 (hazard ratio [HR], 2.21; 95% CI, 1.06 to 4.60; and HR, 3.30; 95% CI, 1.64 to 6.66, respectively). This effect was magnified with an increasing number of AKT adverse genotypes. In contrast, a predictable protective effect by PTEN genetic variants on recurrence was evident. Survival tree analysis identified higher-order interactions that resulted in variation in recurrence-free survival from 12 to 42 months, depending on the combination of SNPs. Genetic variations in AKT1, AKT2, and FRAP1 were associated with survival. Patients homozygous for either of the FRAP1 SNPs assayed had a more than three-fold increased risk of death. Two genes--AKT2 and FRAP1--were associated with a poor treatment response, while a better response was associated with heterozygosity for AKT1:rs3803304 (odds ratio, 0.50; 95% CI, 0.25 to 0.99). These results suggest that common genetic variations in this pathway modulate clinical outcomes in patients who undergo chemoradiotherapy. With further validation, these results may be used to build a model of individualized therapy for the selection of the optimal chemotherapeutic regimen.

Inoperable esophageal cancer and outcome of palliative care

To determine the outcome of esophageal cancer patients referred for palliative care, in Gorgan and Gonbad gastrointestinal clinics, northeast of Iran. This cross-sectional study was done on inoperable esophageal cancer cases referred to gastrointestinal clinics in Gorgan and Gonbad city (2005-2006). Demographic data were collected during the procedure and cases were followed up every one month. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness. We recruited 39 cases into the study. Squamous cell carcinoma was the most prevalent (92.3%). The middle third of the esophagus was involved predominantly (51.3%). Dilation was the most preferred method (89.7%) and stenting was done in 4 cases. Decreasing dysphagia score was not related to palliation method or pathology type of carcinoma. Age of the patients was significantly related to the improvement of dysphagia score. Mean survival time was 137.6 d and median was 103 d. Results of this study showed a low survival rate after palliative care in esophageal cancer cases despite dysphagia scores' improvement after dilating or stenting.

The Impact of Tumor Expression of Erythropoietin Receptors and Erythropoietin on Clinical Outcome of Esophageal Cancer Patients Treated With Chemoradiation

To investigate the impact of tumor erythropoietin receptors (Epo-R) and erythropoietin (Epo) expression in 64 patients with Stage III esophageal cancer receiving or not receiving erythropoietin during chemoradiation. The impact of tumor Epo-R expression, Epo expression, and 10 additional factors (age, Karnofsky-Performance-Score [KPS], tumor length, T and N stage, histology and grading, hemoglobin during radiotherapy, erythropoietin administration, surgery) on overall survival (OS) and locoregional control (LC) was evaluated. Improved OS was associated with low (< or =20%) Epo expression (p = 0.049), KPS >80 (p = 0.008), T3 stage (p = 0.010), hemoglobin > or =12 g/dL (p < 0.001), and surgery (p = 0.010). Erythropoietin receptor expression showed a trend (p = 0.09). Locoregional control was associated with T stage (p = 0.005) and hemoglobin (p < 0.001), almost with erythropoietin administration (p = 0.06). On multivariate analyses, OS was associated with KPS (p = 0.045) and hemoglobin (p = 0.032), LC with hemoglobin (p < 0.001). Patients having low expression of both Epo-R and Epo had better OS (p = 0.003) and LC (p = 0.043) than others. Two-year OS was nonsignificantly better (p = 0.25) in patients with low Epo-R expression receiving erythropoietin (50%) than in those with higher Epo-R expression receiving erythropoietin (21%), low Epo-R expression/no erythropoietin administration (29%), or higher Epo-R expression/no erythropoietin administration (18%). Two-year LC rates were, respectively, 65%, 31%, 26%, and 29% (p = 0.20). Results for Epo expression were similar. Higher Epo-R expression or Epo expression seemed to be associated with poorer outcomes. Patients with low expression levels receiving erythropoietin seemed to do better than patients with higher expression levels or not receiving erythropoietin. The data need to be confirmed in a larger series of patients.

Surgical Outcomes in Esophageal Cancer Patients with Tumor Recurrence After Curative Esophagectomy

This study aimed to identify predictive factors and to evaluate appropriate treatments for recurrence of esophageal cancer after curative esophagectomy. About 166 consecutive patients, who underwent curative esophagectomy, were enrolled between April 1994 and March 2003. Recurrence was classified as loco-regional or distant. Logistic regression analysis was used to identify predictive factors for recurrence. Prognostic factors were evaluated by Log-rank test and Cox proportional hazard regression analysis. The disease-specific 5-year survival was 56.8%. Recurrence was observed in 72 patients (43.4%), with 64 of these occurring within 3 years. The number of metastatic lymph nodes and lymphatic invasion independently predicted recurrence. There were significant differences in time to recurrence and survival time between loco-regional, distant recurrence, and combined recurrence. The 5-year survival time in patients with recurrence was 11.9%, and median survival time was 24 months. There was also a significant difference in survival after recurrence between treatment methods (no treatment vs chemo-radiotherapy, p =0.0063; chemotherapy, p =0.0247; and radiotherapy, p < 0.0001). Meticulous, long-term follow-up is particularly necessary in patients with four or more metastatic lymph nodes to achieve early detection of recurrence. Randomized controlled trials should be used to develop effective modalities for each recurrence pattern to improve therapeutic outcomes.

Influence of apoptosis (BCL2, FAS), Cell cycle (CCND1) and growth factor (EGF, EGFR) genetic polymorphisms on survival outcome: An exploratory study in squamous cell esophageal cancer

The study aimed at investigating whether genetic polymorphisms in BCL2, FAS, CCND1, EGF and EGFR genes influence the outcome of patients of esophageal squamous cell cancer treated with radiotherapy, with or without chemotherapy. Sixty nine histologically confirmed, previously untreated, patients with a squamous cell esophageal cancer were inducted into this study. Genotyping of BCL2 (ala43thr), FAS (A-670G), CCND1 (G870A), EGF (+61A/G) and EGFR (G497A) polymorphisms were determined using the polymerase chain reaction followed by restriction fragment length polymorphism methodology. Genotyped data was analyzed using univariate and multivariate logistic regression statistical tests for predicting the survival outcome. Genotypes of BCL2, FAS, CCND1 and EGFR polymorphisms independently did not influence outcome significantly. However, patients with EGF +61AG genotype had median survival of 25.5 months [95% CI = 5.2–45.5], whereas those with EGF +61GG genotype had survival of only 3.7 months [95% CI = 0.0–9.8, P=0.006]. In univariate cox-regression analysis, interaction of genotypes EGF+61GG*radiotherapy tumor dose (≤50 Gy) and EGF+61GG*upper third tumor location showed high hazard of death, 6.6 [95%CI = 2.0-21.5, P=0.002] and 26.8 [95%CI=3.7-194.2, P=0.001] while EGF+61AG*middle third tumor location had reduced hazard 0.20 [95%CI=0.06-0.60, P=0.004]. The pilot study suggests that EGF +61AG and +61GG genotypes may predict clinical outcome in esophageal cancer patients treated with radiotherapy with or without chemotherapy. EGF +61AG genotype was associated with improved survival, however +61GG genotype adversely affected the outcome in patients particularly with upper third location of tumor and lower dose (≤50) of radiotherapy.

2129: Analysis of Radiation Therapy Equipments and Treatment Planning Processes Which Affect on the Outcome of Esophageal Cancer Patients; Results of the Patterns of Care Study

To examine whether the radiation therapy (RT) equipments and the processes of treatment planning would affect on the outcome of esophageal cancer patients or not, according to the results of the Patterns of Care Study (PCS) in Japan.