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Abramson Cancer CenterNCI CANCERLIT® Search: Esophageal Neoplasms - October 2002
National Cancer Institute®
Last Modified: October 1, 2002
- Oesophageal cancer: a common malignancy in young people of Bomet District, Kenya.
- Expression of PTTG (pituitary tumor transforming gene) in esophageal cancer.
- Decreased peroxisome proliferator-activated receptor gamma gene expression is correlated with poor prognosis in patients with esophageal
- Positron emission tomography in the initial staging of esophageal cancer.
- Diagnosis and treatment of oesophageal cancer.
- How many lymph nodes are needed for an accurate pN classification in esophageal cancer? Evidence for a new threshold value.
- Omentoplasty versus no omentoplasty for cervical esophagogastrostomy following radical esophagectomy.
- Expression and prognostic significance of S100A2 protein in squamous cell carcinoma of the esophagus.
- Preoperative therapy for patients with resectable squamous cell carcinoma of the esophagus: are we still confused?
- The clinical efficacy of neoadjuvant chemotherapy in squamous esophageal cancer: a prospective nonrandomized study of pulse and
- The hepatocyte nuclear factor 3 alpha gene, HNF3alpha (FOXA1), on chromosome band 14q13 is amplified and overexpressed in esophageal and
- Esophageal cancer patients surviving 6 years after esophagectomy.
- Three isoforms of annexin I are preferentially expressed in normal esophageal epithelia but down-regulated in esophageal squamous cell
- Current guidelines fail young patients with oesophagogastric cancer.
- Photodynamic therapy for Barrett's esophagus and high grade dysplasia: results of a patient satisfaction survey.
- Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node
- Usefulness of positron emission tomography for assessing the response of neoadjuvant chemoradiotherapy in patients with esophageal cancer.
- [Esophageal cancer: did combined treatments improve prognosis?]
- [Comment apropos of the article "Esophageal cancer: did combined treatment improve prognosis?" by G. Ganem et al]
- [A clinical analysis of combination treatment with brachytherapy and external radiation, plus chemotherapy for the treatment of esophageal
- Identification of differentially expressed genes in esophageal squamous cell carcinoma (ESCC) by cDNA expression array: overexpression of Fra-1,
- Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials.
- Follow up of oesophageal cancer therapy at the Kenyatta National Hospital, Nairobi.
- [Attributed risk to smoking for lung cancer, laryngeal cancer and esophageal cancer]
- Esophagogram and CT vs endoscopic and surgical specimens in the diagnosis of esophageal carcinoma.
- Neoadjuvant treatment of esophageal cancer: Immunosuppression following combined radiochemotherapy.
- Quality of life in patients with Barrett's esophagus undergoing surveillance.
- MN antigen expression in normal, preneoplastic, and neoplastic esophagus: a clinicopathological study of a new cancer-associated
- How can we improve the outcome of oesophagectomy?
- Use of laser in the relief of malignant dysphagia: a district hospital experience.
- In vitro cytotoxic dose-relation of cisplatin and sodium thiosulphate in human tongue and oesophageal squamous carcinoma cell lines.
- Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or
- Potential impact of preoperative EUS on esophageal cancer management and cost.
- Results of surgical therapy of adenocarcinomas of the esophagogastric junction according to a standardized surgical resection technique.
- Influence of a human protease inhibitor on surgical stress induced immunosuppression.
- Can reflux prevention prevent esophageal adenocarcinoma?
- [Positron emission tomography for the preoperative staging of esophageal carcinoma]
- Surgical treatment for locally advanced (T4) squamous cell carcinoma of the thoracic esophagus.
- Molecular staging of lung and esophageal cancer.
- Photodynamic therapy (PDT) for oesophageal dysplasia and early carcinoma with mTHPC (m-tetrahydroxyphenyl chlorin): a preliminary study.
- Management of oesophageal carcinoma with associated lung tuberculosis.
- Photodynamic therapy (PDT) for oesophageal dysplasia and early carcinoma with mTHPC (m-Tetrahidroxyphenyl chlorin): a preliminary study.
- [New indications in the treatment of advanced esophageal cancer using self-expanding stent]
- Effects of platelet activating factor, butyrate and interleukin-6 on cyclooxygenase-2 expression in human esophageal cancer cells.
- Quality of life after esophagectomy for cancer: an assessment using the questionnaire with the face scale.
- Techniques and results of esophageal cancer surgery in Germany.
- Impact of antireflux surgery on Barrett's esophagus.
- Thoracoscopy/laparoscopy in the staging of esophageal cancer: Maryland experience.
- Surgical treatment of esophageal carcinoma complicated by fistulas.
- The risk of surgical procedures for the treatment of malignant respiratory fistulas.
- Quality of life after esophagectomy for cancer.
- Oesophageal intestinal metaplasia.
- An attempt to cure Stage III and IV oesophageal cancer with concurrent chemotherapy and irradiation in common clinical practice.
- Squamous carcinoma of the oesophagus: continuing to challenge.
- Clinicopathologic factors correlated with number of metastatic lymph nodes in oesophageal cancer.
- EsophaCoil for palliation of dysphagia in unresectable oesophageal carcinoma: short- and long-term results.
- Curative treatment for esophageal cancer: Vancouver Island Cancer Centre experience from 1993 to 1998.
- Trimodality treatment versus surgery alone for esophageal cancer. A stratified analysis with minimally invasive pretreatment staging.
- [Reflux, smoking, alcohol. Approach to prevention of esophageal carcinoma]
- [Peptic stenosis, motility disorder or carcinoma. What is ate the bottom of dysphagia?]
- [Esophageal carcinoma in an advanced stage. The value of surgery plus radiochemotherapy]
- [No grounds for Barrett hysteria. Current monitoring strategies are adequately reliable]
- Dynamism of tumour vasculature in the early phase of cancer progression: outcomes from oesophageal cancer research.
- Prognostic value of TP53 transcriptional activity on p21 and bax in patients with esophageal squamous cell carcinomas treated by definitive
Table of Contents
1
UI - 12241722
AU - White RE; Abnet CC; Mungatana CK; Dawsey SM
TI -
Oesophageal cancer: a common malignancy in young people of Bomet
District, Kenya.
SO - Lancet 2002 Aug 10;360(9331):462-3
AD - Tenwek Hospital, PO Box 39, Bomet, Kenya. rwhite@maf.or.ke
Oesophageal cancer is a common cancer with uneven geographical
distribution. We reviewed all malignancies diagnosed at Tenwek Hospital
(Bomet District, Kenya) between 1989 and 1998. Oesophageal cancer was
the most common malignancy; 274 cases accounted for 19% of 1459
malignancies diagnosed, and for a steady rise in total cancer cases
during this period. A striking feature of our study was the presence of
a subset of very young patients. 26 (11%) patients were aged 30 years or
less at diagnosis, and the youngest patient was 14 years old. This area
of West Kenya seems to be a high-risk region for oesophageal cancer.
2
UI - 12324572
AU - Shibata Y; Haruki N; Kuwabara Y; Nishiwaki T; Kato J; Shinoda N; Sato A;
TI -
Kimura M; Koyama H; Toyama T; Ishiguro H; Kudo J; Terashita Y; Konishi
S; Fujii Y
Expression of PTTG (pituitary tumor transforming gene) in esophageal
cancer.
SO - Jpn J Clin Oncol 2002 Jul;32(7):233-7
AD - Department of Surgery II, Nagoya City University Medical School, Nagoya,
Japan.
BACKGROUND: Recently, a vertebrate securin [pituitary tumor transforming
gene (PTTG) in humans] has been identified that inhibits sister
chromatid separation and is involved in malignant transformation and
tumorigenesis. Abundance of this protein would disrupt cell division,
generate chromosomal instability and thereby increase cell
susceptibility to acquisition of further mutations during subsequent
division. Esophageal cancer is a disease with poor prognosis with early
local invasion and lymph node metastasis. It is important to identify
factors that influence the aggressiveness of esophageal cancer. METHODS:
Expression of PTTG messenger ribonucleic acid (mRNA) was evaluated by
real-time reverse transcription polymerase chain reaction in 48
esophageal cancer specimens and matched normal esophageal mucosa. The
data were analyzed with reference to clinicopathological factors.
RESULTS: Tumor tissue expressed a significantly higher level of PTTG1
mRNA than the corresponding normal tissue (P < 0.0001). PTTG1 mRNA
expression was significantly higher in tumors with higher pathological
stage (IV vs 0-III, P = 0.0442) or more extensive lymph node metastasis
(pathological N factor; N4 vs N0-3, P = 0.003). The median survival for
patients with high PTTG1 expression (8.5 months) was less than that for
patients with low PTTG1 expression (14.0 months, P = 0.039). PTTG1
expression was one of the significant predictors of survival on
univariate analysis (hazard ratio 2.225; 95% confidence interval
1.007-4.915). CONCLUSIONS: Detection of high PTTG1 expression in
surgically excised esophagus tumor tissues might help to identify
patients with aggressive disease who require adjuvant therapy and
provide prognostic information.
3
UI - 12324573
AU - Terashita Y; Sasaki H; Haruki N; Nishiwaki T; Ishiguro H; Shibata Y;
TI -
Kudo J; Konishi S; Kato J; Koyama H; Kimura M; Sato A; Shinoda N;
Kuwabara Y; Fujii Y
Decreased peroxisome proliferator-activated receptor gamma gene
expression is correlated with poor prognosis in patients with esophageal
cancer.
SO - Jpn J Clin Oncol 2002 Jul;32(7):238-43
AD - Department of Surgery II, Nagoya City University Medical School, Nagoya,
Japan.
BACKGROUND: Peroxisome proliferator-activated receptor gamma (PPAR
gamma) induces apoptosis by ligand stimulation in various tumor cell
lines. In esophageal cancer cell lines, PPAR gamma activation also has
suppressed the proliferation. METHODS: In 55 primary esophageal squamous
cell carcinomas (ESCCs) we examined the correlation between the
expression of PPAR gamma mRNA with prognosis of esophageal cancer
patients. The expression of PPAR gamma mRNA was quantified by real-time
reverse transcription polymerase chain reaction using LightCycler.
Immunohistochemistry was used to study the expression of PPAR gamma
protein. RESULTS: The expression of PPAR gamma mRNA was significantly
decreased in esophageal cancer cells compared with normal esophageal
mucosa (P = 0.0084). Among the clinical factors, PPAR gamma mRNA
expression was lower in the tumors with extensive lymph node metastasis
(n4) than those with less extensive lymph node metastasis (n0-3) (P =
0.0059). Patients with low PPAR gamma mRNA expression had significantly
shorter postoperative survival time than those with high PPAR gamma mRNA
expression (P = 0.0191). In immunohistochemistry, PPAR gamma protein was
expressed in the nuclei of cells in some cases and expressed in the
nuclei and cytoplasm in others. The expression of PPAR gamma protein is
decreased in esophageal cancer tissue compared with normal esophageal
squamous epithelium. However, we could not deduce the apparent relation
for the expression between PPAR gamma mRNA and PPAR gamma proteins in
immunohistochemistry (P = 0.284). CONCLUSIONS: In esophageal cancer
tissues, the expression of PPAR gamma was decreased compared with normal
esophageal epithelium. The mRNA expression level of PPAR gamma may be a
marker of prognosis after operation in esophageal cancer patients.
4
UI - 12215149
AU - Wren SM; Stijns P; Srinivas S
TI -
Positron emission tomography in the initial staging of esophageal
cancer.
SO - Arch Surg 2002 Sep;137(9):1001-6; discussion 1006-7
AD - Department of Surgery, Palo Alto Veterans Hospital, 3801 Miranda Ave,
Palo Alto, CA 94304, USA. swren@stanford.edu
OBJECTIVE: To assess the value of positron emission tomography (PET)
compared with computed tomography (CT) in the initial staging of
esophageal cancer. DESIGN: Case series. SETTING: Tertiary care veterans
hospital. PATIENTS: Patients with newly diagnosed esophageal cancers
scanning within 4 weeks were included in the study (n = 24). Only
patients who underwent pathological or radiographic follow-up were
included. MAIN OUTCOME MEASURES: The sensitivity, specificity, and
negative and positive predictive values of CT and PET were determined
based on a criterion standard of pathological staging in 16 patients
(67%) and follow-up imaging in 8 patients (33%). RESULTS: For staging
regional lymph node involvement, CT and PET scans showed no
statistically significant difference in sensitivity (57% and 71%,
respectively) and specificity (71% and 86%, respectively). For detection
of metastatic disease, CT and PET showed no significant difference in
sensitivity (83% and 67%, respectively) and specificity (75% and 92%,
respectively). There was no significant difference in clinical decision
making when the results of both tests were discordant. CONCLUSIONS:
There was no significant difference between the 2 imaging modalities in
the initial staging of esophageal cancer. The CT scan was a sensitive
indicator of distant metastases, whereas PET was more specific. It is
unclear what additional role PET scanning should have in the initial
screening of patients.
5
UI - 12233170
AU - Wakefield C; Paterson-Brown S
TI -
Diagnosis and treatment of oesophageal cancer.
SO - Practitioner 2002 Sep;246(1638):586-8, 591-2, 594
AD - Royal Hampshire County Hospital, Winchester.
6
UI - 11941947
AU - Dutkowski P; Hommel G; Bottger T; Schlick T; Junginger T
TI -
How many lymph nodes are needed for an accurate pN classification in
esophageal cancer? Evidence for a new threshold value.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):176-80
AD - Department of Surgery, University of Mainz, Langenbeckstr. 1, 55101
Mainz, Germany.
BACKGROUND/AIMS: The UICC recommends a number of at least six lymph
nodes to be examined in the surgical therapy of esophageal cancer for a
reliable pN classification. The aim of this study was to evaluate this
threshold by means of the data from our patients. METHODOLOGY: Following
curative resection (R0) of esophageal cancer the numbers of examined
tumor-free and tumor-involved lymph nodes were compared. Different
statistical models of logistic regression were fitted to the data and
checked for plausibility (Hosmer Lemeshow test). The sensitivity of a
correct pN classification was then calculated and correlated to the
total number of examined lymph nodes. RESULTS: A maximum increase of the
sensitivity in classifying pN occurred from 0 to 6 examined lymph nodes.
Nevertheless an additional improvement of sensitivity was continuously
shown up to 100 examined nodes. An over 90% sensitivity of a correct
lymph node classification was reached when more than twelve nodes were
examined. Thus the results demonstrate in the case of esophageal cancer,
that the suggestion by the UICC to examine at least 6 nodes for defining
pN appears too low and may not represent the clinical situation. A
ninety percent confidence level of a correct lymph node classification
can be expected above 12 examined nodes similarly to the current
recommended threshold in colorectal carcinoma. CONCLUSIONS: We suggest a
new threshold for the number of examined lymph nodes of at least 12
instead of 6 nodes for accurately defining the pN category in esophageal
cancer.
7
UI - 11941948
AU - Ohwada S; Ogawa T; Kawate S; Koyama T; Yamada T; Yoshimura S; Sato Y;
TI -
Tomizawa N; Ohya T; Morishita Y
Omentoplasty versus no omentoplasty for cervical esophagogastrostomy
following radical esophagectomy.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):181-4
AD - Second Department of Surgery, Gunma University Faculty of Medicine,
3-39-15 Showa-Machi, Maebashi 371-8511, Japan. sohwada@med.gunma-u.ac.jp
BACKGROUND/AIMS: Omentoplasty--wrapping the omentum around the
alimentary tract anastomosis is thought to lower the rate of anastomotic
leakage. We evaluated the role of omentoplasty to reinforce cervical
esophagogastrostomy after radical esophagectomy. METHODOLOGY: We
compared anastomotic leakage, stricture formation, and related deaths in
63 patients who underwent radical esophagectomy and cervical
esophagogastrostomy, with (n = 48) or without (n = 15) omentoplasty,
between 1995 and 1999. RESULTS: An esophageal anastomotic leakage was
diagnosed in 1 of the 48 patients (2.1%) with omentoplasty versus 3 of
the 15 patients (20.0%) without omentoplasty (P < 0.01). Anastomotic
stricture occurred in 2 (4.2%) of the omentoplasty group and 1 (6.7%) of
the no omentoplasty group (P < 0.01). Death within 1 month was zero in
the omentoplasty group and one (6.7%) in the no-omentoplasty group,
despite no differences in lethal anastomotic leakage. CONCLUSIONS:
Omentoplasty of cervical esophagogastrostomy reduced anastomotic
leakage. Although promising, these observations require confirmation
with a randomized prospective study.
8
UI - 11956617
AU - Kyriazanos ID; Tachibana M; Dhar DK; Shibakita M; Ono T; Kohno H;
TI -
Nagasue N
Expression and prognostic significance of S100A2 protein in squamous
cell carcinoma of the esophagus.
SO - Oncol Rep 2002 May-Jun;9(3):503-10
AD - Shimane Medical University, Second Department of Surgery, Izumo, Shimane
693-8501, Japan. yannis@shimane-med.ac.jp
The purpose of this study was to evaluate the expression of S100A2
Ca2+-binding protein and its prognostic significance in the management
of squamous cell carcinoma of the esophagus. Changes in cytosolic Ca2+
concentration control a wide range of cellular responses including
cellular apoptosis. Intracellular S100 Ca2+-binding proteins are key
molecules in transducing Ca2+ signaling. Among these, S100A2 has
recently attracted major interest due to its stable expression in normal
epithelia and down-regulation in some tumors. As a candidate tumor
suppressor, expression of S100A2 has been proposed as a valuable
prognostic marker in different tumors. We examined the clinical
significance of S100A2 expression in 116 resected specimens of
esophageal squamous cell carcinomas (ESCC) using immunohistochemistry.
S100A2 was positive in 49 cases (42.2%) and its expression was
significantly higher in large (p=0.01) and well differentiated tumors
(p=0.013). Lymph node-positive tumors had a lower expression of S100A2
protein in comparison to the corresponding lymph node negative
equivalents in each of the T stages, but the difference was
statistically significant (p=0.041) only for the T1b tumors. S100A2
status became an independent predictor of patient survival (p=0.026) in
lymph node-negative cases but not in node-positive cases. Evaluation of
S100A2 protein expression may play an important role in the management
of ESCC. The node-negative ESCC patients without S100A2 expression might
be a high-risk group with poor survival and will need further attention
to design appropriate adjuvant therapy.
9
UI - 12167571
AU - Ajani JA
TI -
Preoperative therapy for patients with resectable squamous cell
carcinoma of the esophagus: are we still confused?
SO - Ann Surg Oncol 2002 Aug;9(7):605-6
10
UI - 12167574
AU - Chan AC; Lee DW; Griffith JF; Leung SF; Lam YH; Lam CC; Lau JY; Ng EK;
TI -
Chung SC
The clinical efficacy of neoadjuvant chemotherapy in squamous esophageal
cancer: a prospective nonrandomized study of pulse and
continuous-infusion regimens with Cisplatin and 5-Fluorouracil.
SO - Ann Surg Oncol 2002 Aug;9(7):617-24
AD - Department of Surgery, Prince of Wales Hospital, The Chinese University
of Hong Kong, Hong Kong, China.
BACKGROUND: We evaluated cisplatin and 5-fluorouracil as preoperative
adjuvant chemotherapy for patients with locally advanced squamous
esophageal cancer and compared two different infusion regimens. The
outcomes were also compared with those of our historical control
patients treated by surgery alone. METHODS: From 1991 to 1997, 83
consecutive esophageal cancer patients underwent surgical exploration
after completion of two cycles of cisplatin and 5-fluorouracil
chemotherapy regimens, either in pulse or in continuous infusion cycles.
Outcomes were compared with those of 76 historical control patients.
Both groups were comparable in demographic characteristics and tumor
stages. The resection rates, operative morbidity, mortality, and
survival rates were compared. RESULTS: Partial response was achieved in
50% of patients who received chemotherapy. There was no
chemotherapy-related mortality. The resection, morbidity, and mortality
rates and median survival between the surgery-alone group and the
chemotherapy group were 71.1% vs. 82%, 51% vs. 55%, and 4% vs. 10.8%,
12.0 vs. 13.5 months, respectively (P >.05). There was also no
statistically significant difference between the two regimens.
CONCLUSIONS: Preoperative adjuvant chemotherapy with cisplatin and
5-fluorouracil infusion, in pulse or continuous regimens, followed by
surgery for squamous esophageal cancer patients had no added benefit in
the overall survival.
11
UI - 12234996
AU - Lin L; Miller CT; Contreras JI; Prescott MS; Dagenais SL; Wu R; Yee J;
TI -
Orringer MB; Misek DE; Hanash SM; Glover TW; Beer DG
The hepatocyte nuclear factor 3 alpha gene, HNF3alpha (FOXA1), on
chromosome band 14q13 is amplified and overexpressed in esophageal and
lung adenocarcinomas.
SO - Cancer Res 2002 Sep 15;62(18):5273-9
AD - Section of General Thoracic Surgery, Department of Surgery, University
of Michigan Medical School, Ann Arbor, MI 48109, USA.
Genomic amplification is observed in many, if not all, types of human
malignancy and is one of the mechanisms for the activation of
dominant-acting oncogenes in tumorigenesis. In the present study, three
amplified restriction fragments were identified in an esophageal
adenocarcinoma (P16) using the restriction landmark genome scanning
two-dimensional gel technique. These fragments were cloned, sequenced,
and mapped to chromosome band 14q13. Using the sequence tagged
site-amplification mapping approach, we defined the core-amplified
domain by screening 75 normal-tumor paired esophageal samples. The
frequency of 14q13 amplification is 6.7% in esophageal tumors, and the
amplicon spans >6 Mb in 1 tumor but is contained in a region <0.3 Mb in
all of the remaining amplified tumors. Quantitative reverse
transcription-PCR (RT-PCR) of 8 genes and expressed sequence tags
located within the core-amplified domain revealed that the HNF3alpha
(FOXA1)(4) gene, a forkhead gene family member, was overexpressed in all
of the amplified esophageal tumors. HNF3alpha amplification was
confirmed by Southern blot and interphase fluorescence in situ
hybridization analyses, and the results of real-time RT-PCR were
consistent with that of the regular quantitative RT-PCR. Increased
immunohistochemical nuclear staining of the HNF3alpha protein was
detected in all of the tumors containing 14q13 amplification. Affymetrix
oligonucleotide microarrays of 86 lung adenocarcinomas demonstrated that
expression of the HNF3alpha mRNA was elevated (> or =2.5-fold of mean
expression in normal lung) in 37% (32 of 86) of the tumors analyzed.
Gene amplification of HNF3alpha was detected in 2 of the 5 overexpressed
lung tumors examined. This is the first report of HNF3alpha
amplification, and overexpression in esophageal and lung
adenocarcinomas. Amplification of HNF3alpha in esophageal and lung
tumors may suggest a potential oncogenic role for this gene in
tumorigenesis.
12
UI - 12111259
AU - Tachibana M; Dhar DK; Kinugasa S; Yoshimura H; Fujii T; Shibakita M;
TI -
Ohno S; Ueda S; Kohno H; Nagasue N
Esophageal cancer patients surviving 6 years after esophagectomy.
SO - Langenbecks Arch Surg 2002 Jun;387(2):77-83
AD - Second Department of Surgery, Shimane Medical University, Enya-cho 89-1,
Izumo 693-8501, Japan. nigeka35@shimane-med.ac.jp
BACKGROUND: Esophageal cancer is one of the most malignant tumors, with
a dismal prognosis in spite of recent advances in early diagnosis and
extended lymphadenectomy. These patients need to be stratified according
to prognostic variables for precise identification of high-risk group.
MATERIAL AND METHODS: Seventy-six patients with esophageal carcinoma
were uniformly treated with curative intent between 1980 and 1992 with
at least 6 years follow-up. Results and prognostic factors of long-term
survival were analyzed by univariate and multivariate analyses. RESULTS:
Thirty patients (39.5%) survived 6 years, and the remaining 46 patients
died within 6 years: recurrent esophageal cancer in 27 and causes
unrelated to esophageal cancer in 19. The 1-, 2-, 3-, and 6-year overall
survival rates in all 76 patients were 77.6%, 57.9%, 53.9%, and 39.5%,
respectively. The factors influencing survival rate verified by
univariate analysis were Borrmann classification (0, 1 vs. 2, 3), size
of tumor (< or =3.0 vs. >3.0 cm), depth of invasion (T1, 2 vs. T3, 4),
pN category (pN0 vs. pN1), number of lymph node metastasis (< or =4vs.
>4), metastatic lymph node ratio (< or =0.1 vs. >0.1), time of operation
(< or =480 vs. >480 min), and amount of perioperative blood transfusion
given (< or =2 vs. >2 U). Among the significant variables independent
prognostic factors for survival determined by multivariate analysis were
metastatic lymph node ratio and amount of blood transfusion.
CONCLUSIONS: A significant number of patients can thus apparently be
cured of esophageal carcinoma by extensive resection. Patients with many
metastatic lymph nodes and much blood transfusion, on the other hand,
should receive appropriate treatment against such esophageal carcinoma.
13
UI - 12242662
AU - Xia SH; Hu LP; Hu H; Ying WT; Xu X; Cai Y; Han YL; Chen BS; Wei F; Qian
TI -
XH; Cai YY; Shen Y; Wu M; Wang MR
Three isoforms of annexin I are preferentially expressed in normal
esophageal epithelia but down-regulated in esophageal squamous cell
carcinomas.
SO - Oncogene 2002 Sep 26;21(43):6641-8
AD - National Laboratory of Molecular Oncology, Cancer Institute (Hospital),
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing 100021, People's Republic of China.
The development and progression of human cancer are believed to be due
to the alterations of multiple genes or/and their protein products. For
identifying the proteins associated with esophageal cancer, we analysed
the protein profiles of 24 pairs of esophageal squamous cell
carcinomas/matched adjacent normal epithelia. Microdissection of
routinely unstained frozen sections was performed to purify cancerous
and epithelial cells. The protein expression profiles were obtained by
two-dimensional electrophoresis. Selected proteins dysregulated in
tumors were identified by MALDI-TOF-MS. Three isoforms of annexin I were
detected in normal esophageal mucosa and down-regulated in esophageal
squamous cell carcinomas. RT-PCR analysis showed annexin I mRNA levels
were significantly reduced in 17 out of 24 carcinomas.
Immunohistochemistry demonstrated that annexin I appeared strong
positive in all normal epithelia layers except basal cells. In cancer
tissues, decreased expression of annexin I was observed in 12 out of 16
well differentiated tumors, 16 out of 17 moderately differentiated
tumors, and 3 out of 3 poorly differentiated tumors as compared with the
corresponding normal esophageal epithelia. There was a significant
correlation between annexin I expression and the status of tumor
differentiation. Well differentiated tumors presented stronger
immunohistochemical reaction than moderately and poorly differentiated
tumors. These data suggested that there existed three different isoforms
of annexin I in normal esophageal epithelia, which may be the results of
post-translational modification. Down-expression of three annexin I
isoforms was a frequent event in esophageal carcinogenesis.
14
UI - 12117899
AU - Foster MA; Attwood SE
TI -
Current guidelines fail young patients with oesophagogastric cancer.
SO - Gut 2002 Aug;51(2):296-7
15
UI - 12195146
AU - Hemminger LL; Wolfsen HC
TI -
Photodynamic therapy for Barrett's esophagus and high grade dysplasia:
results of a patient satisfaction survey.
SO - Gastroenterol Nurs 2002 Jul-Aug;25(4):139-41
AD - Esophageal Disease Group, Mayo Clinic, Jacksonville, Florida 32224, USA.
There are few data available describing the experience of patients who
have undergone photodynamic therapy with porfimer sodium for Barrett's
esophagus. We describe the results of a satisfaction survey reported by
16 of 18 patients (11 men, 5 women; median age 75 years; median response
at 27 months after treatment) treated with photodynamic therapy for
Barrett's esophagus with high-grade dysplasia. Treatments were performed
on an outpatient basis although two patients required clinic visits for
intravenous fluids. Subjects reported their most significant
post-treatment problem was odynophagia or dysphagia (75%), which was
best treated with a hydrocodone bitartrate and acetaminophen elixir
(75%). Cutaneous photosensitivity persisted for a median of six weeks;
two patients had phototoxic reactions requiring clinic evaluation and
treatment. All but two patients reported swallowing problems lasting a
median of four weeks, and weight loss (median 6.8 kg). All patients
indicated they would again choose photodynamic therapy if they were
faced with a similar choice of endoscopic treatment versus surgery for
Barrett's esophagus with high-grade dysplasia. These results indicate a
generally high level of satisfaction in patients who have been treated
with porfimer sodium photodynamic therapy for Barrett's esophagus with
high-grade dysplasia.
16
UI - 12237911
AU - Eloubeidi MA; Desmond R; Arguedas MR; Reed CE; Wilcox CM
TI -
Prognostic factors for the survival of patients with esophageal
carcinoma in the U.S.: the importance of tumor length and lymph node
status.
SO - Cancer 2002 Oct 1;95(7):1434-43
AD - Department of Medicine, Division of Gastroenterology and Hepatology, The
University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
meloubeidi@uabmc.edu
BACKGROUND: The current TNM classification system does not consider
tumor length or the number of lymph nodes in the staging and
classification scheme for patients with esophageal carcinoma. Using data
from the National Cancer Institute SEER Program, the authors explored
the effect of tumor length and number of positive lymph nodes on
survival in patients with esophageal carcinoma. METHODS: Patients with
esophageal adenocarcinoma or squamous cell carcinoma were subgrouped
according to historic stage with localized, regional, or distant
disease. Demographic factors (age at diagnosis, race, and gender) and
tumor characteristics (morphology, histologic grade, tumor length,
primary site, depth of invasion, number of positive lymph nodes,
proportion of positive lymph nodes dissected, and distant metastatic
sites) were examined. RESULTS: Overall factors that were associated with
an increased mortality risk included increasing age at diagnosis, black
race versus white race, histologic grade, primary tumor site in the
lower esophagus and abdomen versus upper regions, and increasing depth
of invasion. Among patients with regional disease, the number of
positive lymph nodes (>/= 5 vs. < 5) was related to an increasing risk
(hazard ratio [HR], 1.29; 95% confidence interval [95%CI], 1.06-1.56).
The proportion of positive lymph nodes compared with the number of lymph
nodes dissected conferred an increased risk (HR, 1.63; 95%CI,
1.26-2.11). Among patients with distant disease, sites other than
distant lymph nodes implied an increased mortality risk (HR, 1.37;
95%CI, 1.37-1.65). Tumor length was an independent predictor of
mortality when controlling for depth of invasion in patients with
localized disease (HR, 1.15; 95%CI, 1.08-1.21). CONCLUSIONS: Tumor
length, the number of involved lymph nodes, and the ratio of positive
lymph nodes are important prognostic factors for survival in patients
with esophageal carcinoma. A revised TNM classification system for
patients with esophageal carcinoma might consider adding tumor length
and number of positive lymph nodes as two important prognostic factors.
Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10868
17
UI - 12354600
AU - Kato H; Kuwano H; Nakajima M; Miyazaki T; Yoshikawa M; Masuda N; Fukuchi
TI -
M; Manda R; Tsukada K; Oriuchi N; Endo K
Usefulness of positron emission tomography for assessing the response of
neoadjuvant chemoradiotherapy in patients with esophageal cancer.
SO - Am J Surg 2002 Sep;184(3):279-83
AD - Department of Surgery I, Gunma University Faculty of Medicine, 3-39-22,
Showa-machi, Maebashi 371-8511, Japan. hiroyuki@po.wind.ne.jp
BACKGROUND: In this study, we retrospectively assessed the performance
of 18-F-fluorodeoxyglucose positron emission tomography (FDG-PET)
compared with computed tomography (CT) and esophagography for assessing
the response of advanced esophageal squamous cell carcinoma (SCC) to
neoadjuvant chemoradiotherapy. METHODS: We studied 10 patients with
thoracic esophageal SCC who received neoadjuvant chemoradiotherapy
followed by surgery. Tumor response was assessed by CT, endoscopy,
esophagography and FDG-PET before and after neoadjuvant treatment.
RESULTS: Assessment of the rate of decrease in standardized uptake value
(SUV) revealed a partial response (more than 50% decrease) in 5 (50%) of
the patients, and assessment of length decrease of FDG uptake showed a
partial response in 9 (90%) of the patients. Comparison of the
histological response and the rate of decrease of various parameters
revealed significant associations between histological response and
tumor length (P <0.05), SUV after neoadjuvant therapy (P <0.05), and
reduction in the extent of FDG uptake (P <0.01). However histological
response was not significantly correlated with the rate of reduction of
SUV, for both CT and esophagography. CONCLUSIONS: FDG-PET may be of
considerable value for predicting the pathologic response of esophageal
SCC to neoadjuvant therapy. Despite assessment of SUV before neoadjuvant
therapy, low FDG uptake after therapy and reduction in the extent of FDG
uptake may provide a reliable assessment of the response to therapy.
18
UI - 1467597
AU - Ganem G; Raoul Y; Goudier MJ; Dubray B; Colin P; Extra JM; Hennequin C;
TI -
Michel-Langlet P; Vignoud J; Bardet E
[Esophageal cancer: did combined treatments improve prognosis?]
SO - Bull Cancer 1992;79(8):735-50
AD - Centre d'oncoradiotherapie et d'hematologie Victor-Hugo, Le Mans,
France.
Prognosis of esophageal cancer is very poor. Five-year survival does not
exceed 20% after radical surgery, the best available treatment.
Unfortunately, only 40% of the patients are amenable to surgery because
of poor general status and/or locoregional extension. Adjuvant treatment
did not yield survival improvement. Preoperative radiotherapy (three
randomized trials) or postoperative radiotherapy (one randomized trial)
showed only a decrease of regional relapses, perhaps only for the nodes
negative patients. Neoadjuvant chemotherapy obtains some interesting
response rate (20-60%), but there has been no evidence yet for survival
improvement. Recently, promising results were presented after
combination of radiotherapy and chemotherapy. In this paper, we review
the present status of combined treatment for esophageal cancer. Our
multicentric group (OSOF) is now completing a phase II trial, that
should soon form the basis for a phase III prospective study.
19
UI - 8173179
AU - Bosset JF; Gignoux M; Elias D; Triboulet JP; Mantion G; Rougier P
TI -
[Comment apropos of the article "Esophageal cancer: did combined
treatment improve prognosis?" by G. Ganem et al]
SO - Bull Cancer 1993 Mar;80(3):261-4
20
UI - 11235580
AU - Zhong X; Yuan D; Yang L
TI -
[A clinical analysis of combination treatment with brachytherapy and
external radiation, plus chemotherapy for the treatment of esophageal
cancer]
SO - Zhonghua Zhong Liu Za Zhi 2000 Nov;22(6):519-21
AD - Huizhou Central People's Hospital, Guangdong 516001, China.
OBJECTIVE: To analyse the value of various combinations of treatment for
esophageal cancer. METHODS: One hundred twenty cases of esophageal
cancer were randomly divided into four groups, 30 cases in each group.
Group I was treated with external radiation (RT) alone; group II, with
RT plus brachytherapy; group III with RT plus chemotherapy, and group IV
with RT plus brachytherapy and chemotherapy. RT with 60Co was given 2 Gy
daily, 5 times a week, with a total dose of 60-74 Gy. Brachytherapy was
given 6-8 Gy once weekly with a total dose of 18-24 Gy. Chemotherapy
with carboplatin was given 100 mg/day, five days a week at first and
fifth week. RESULTS: The 1, 2, 3-year survival rate in group II, III and
IV was higher than that in group I (P < 0.05). The 3-year survival rate
of group I-IV patients was 13.3%, 36.7%, 40.0%, 46.7%, respectively.
More patients died of cancer recurrence and progression in group I than
in any of the other 3 groups of patients (P < 0.05). However, the
frequency of distant metastasis was not significantly different.
CONCLUSION: The combination treatment with external radiation,
brachytherapy and chemotherapy can improve the local control of tumor
growth and the survival rate in esophageal cancer patients.
21
UI - 11489794
AU - Hu YC; Lam KY; Law S; Wong J; Srivastava G
TI -
Identification of differentially expressed genes in esophageal squamous
cell carcinoma (ESCC) by cDNA expression array: overexpression of Fra-1,
Neogenin, Id-1, and CDC25B genes in ESCC.
SO - Clin Cancer Res 2001 Aug;7(8):2213-21
AD - Department of Pathology, Faculty of Medicine, The University of Hong
Kong, Queen Mary Hospital, Pok Fu Lam Road, Hong Kong.
PURPOSE: This study aims to identify differentially expressed genes in
esophageal squamous cell carcinoma (ESCC) through the use of a
membrane-based cDNA array. EXPERIMENTAL DESIGN: Two newly established
human ESCC cell lines (HKESC-1 and HKESC-2) and one corresponding to a
morphologically normal, esophageal epithelium tissue specimen,
prospectively collected from the HKESC-2-related patient, were screened
in parallel using a cDNA expression array containing gene-specific
fragments for 588 human genes spotted onto nylon membranes. RESULTS: The
results of cDNA expression array showed that 53 genes were up-regulated
2-fold or higher and 8 genes were down-regulated 2-fold or higher in
both ESCC cell lines at the mRNA level. Semiquantitative RT-PCR analysis
of a subset of these differentially expressed genes gave results
consistent with cDNA array findings. Four of the differentially
expressed genes that belong to the categories of oncogenes/tumor
suppressor genes (Fra-1 and Neogenin) and cell cycle-related genes (Id-1
and CDC25B) were studied more extensively for their protein expression
by immunohistochemistry. The two ESCC cell lines and their corresponding
primary tissues, 61 primary ESCC resected specimens and 16 matching,
morphologically normal, esophageal epithelium tissues were analyzed. The
immunostaining results showed that Fra-1, Neogenin, Id-1, and CDC25B
were overexpressed in both ESCC cell lines and their corresponding
primary tumors at the protein level, validating the microarray findings.
The results of the clinical specimens showed that the Fra-1 gene was
overexpressed in ESCC compared with normal esophageal epithelium in 53
of 61 cases (87%), Neogenin in 57 of 61 cases (93%), Id-1 in 57 of 61
cases (93%), and CDC25B in 48 of 61 cases (79%). Furthermore, the
expression of Fra-1, Neogenin, and Id-1 in ESCC correlated with tumor
differentiation. CONCLUSIONS: Overall, this study demonstrates that
multiple genes are differentially expressed in ESCC and provides the
first evidence that oncogenes Fra-1 and Neogenin and cell cycle-related
genes Id-1 and CDC25B are overexpressed in ESCC.
22
UI - 12119515
AU - Urschel JD; Blewett CJ; Young JE; Miller JD; Bennett WF
TI -
Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction
after esophagectomy: a meta-analysis of randomized controlled trials.
SO - Dig Surg 2002;19(3):160-4
AD - Department of Surgery, McMaster University, Hamilton, Ont., Canada.
urschelj@mcmaster.ca
BACKGROUND/AIM: A gastric conduit is usually used to reconstruct the
foregut after esophagectomy for cancer. The gastric emptying may be
impaired after this operation, so some esophageal surgeons routinely add
a pyloric drainage procedure (pyloroplasty or pyloromyotomy). We
performed a meta-analysis of randomized controlled trials (RCTs) to
determine the effect of pyloric drainage on patient outcomes. METHODS:
Medline and manual searches were done (completed independently and in
duplicate) to identify all published RCTs that addressed the issue of
pyloric drainage procedures during gastric conduit reconstruction of the
esophagus. The selection process was inclusive; no trials were excluded.
Trial validity assessment was done, and a trial quality score was
assigned. Early outcomes assessed by meta-analysis included operative
mortality, esophagogastric anastomotic leaks, pulmonary morbidity,
pyloric drainage complications, fatal pulmonary aspiration, and gastric
outlet obstruction. A random-effects model was used, and the relative
risk was the principal measure of effect. Systematic semiquantitative
review was used for late outcomes such as gastric emptying, bile reflux,
nutritional status, and obstructive foregut symptoms. RESULTS: Nine
RCTs, that included a total of 553 patients, were selected, with quality
scores ranging from 1 to 4 (5-point Jadad scale). Selection and validity
agreement was strong. The relative risk (95% CI; p value), expressed as
pyloric drainage versus no drainage (treatment vs. control), was 0.92
(0.34, 2.44; p = 0.86) for operative mortality, 0.90 (0.47, 1.76; p =
0.77) for esophagogastric anastomotic leaks, 0.69 (0.42, 1.14; p = 0.15)
for pulmonary morbidity, 2.55 (0.34, 18.98; p = 0.36) for pyloric
drainage complications, 0.25 (0.04, 1.60; p = 0.14) for fatal pulmonary
aspiration, and 0.18 (0.03, 0.97; p = 0.046) for gastric outlet
obstruction. Systematic semiquantitative review showed a nonsignificant
trend favoring pyloric drainage for the late outcomes of gastric
emptying, nutritional status, and obstructive foregut symptoms. For the
late outcome of bile reflux, there was a nonsignificant trend favoring
the no-drainage group. The scintographic gastric emptying time,
expressed as a ratio (pyloric drainage/no drainage), was 0.53.
CONCLUSIONS: Data synthesized from existing RCTs show that pyloric
drainage procedures reduce the occurrence of early postoperative gastric
outlet obstruction after esophagectomy with gastric reconstruction, but
they have little effect on other early and late patient outcomes.
Copyright 2002 S. Karger AG, Basel
23
UI - 12199447
AU - Ogendo SW
TI -
Follow up of oesophageal cancer therapy at the Kenyatta National
Hospital, Nairobi.
SO - East Afr Med J 2001 Dec;78(12):650-4
AD - Department of Surgery, College of Health Sciences, University of
Nairobi.
OBJECTIVE: To determine the pattern of follow-up for oesophageal cancer
patients following hospital discharge and reviewing followup results of
the different treatment modalities with emphasis on oesophagectomies.
DESIGN: A retrospective hospital based study covering the period January
National Hospital, Nairobi. MAIN OUTCOME MEASURES: Determination and the
comparison of the one, two and three-year followup rates for the
different treatment modalities and their median follow-up period in
addition to reviewing the common variables associated with follow-up.
RESULTS: The median followup for patients managed by oesophagectomy was
9.5 months with a 43%, 22% and 10% one-, two- and three-year followup
rates respectively. This compared to a median of two months and a 7% and
3% one-, and two- year followup rate for patients managed by intubation,
and a 3-month median followup with a one- and two- year follow-up rate
of 12% and 4% respectively for radiotherapy treated patients.
Oesophagectomy patients had a better followup compared to intubations
and radiotherapy (p<.00001). Oesophagectomy for stage T4 tumours had an
apparently better follow-up compared to both stage T1-3 tumours and
patients managed with intubations (p=.002 and .02 respectively).
24
UI - 12045791
AU - Menezes AM; Horta BL; Oliveira AL; Kaufmann RA; Duquia R; Diniz A; Motta
TI -
LH; Centeno MS; Estanislau G; Gomes L
[Attributed risk to smoking for lung cancer, laryngeal cancer and
esophageal cancer]
SO - Rev Saude Publica 2002 Apr;36(2):129-34
AD - Departamento de Clinica Medica, Universidade Federal de Pelotas,
Pelotas, RS, Brasil.
OBJECTIVE: Lung, laryngeal and esophageal cancers have smoking as one of
their main risk factors. The objective of this study was to evaluate the
population attributed risk (PAR) of smoking for these forms of cancer.
METHODS: The study was based in three case-control studies conducted in
medium size cities in Brazil. Incident cases of lung cancer, laryngeal
cancer and esophageal cancer seen at a hospital setting and diagnosed
through biopsy were analyzed; controls were hospitalized patients with
another diagnoses. Smoking was the exposure factor measured at three
levels: non-smokers, former smokers and smokers, which were defined
using a questionnaire applied by trained interviewers. For effect
measure, odds ratio was used and the populational attributed risk for
smoking was then calculated for a 95% CI. RESULTS: A total of 122 lung
cancer cases and 244 controls, 50 cases of laryngeal cancer and 48 cases
of esophageal cancer, and 96 controls for both of them were studied. The
prevalence of smoking exposure was 34%, which is the overall prevalence
of smoking in this city's adult population. Odds ratios (OR) for the PAR
analysis were the adjusted OR for confounding variables from each study.
Lung cancer PAR was 63% (95% IC, 0.58-0.68) for former smokers and 71%
(95%IC, 0.65-0.77) for smokers. Larynx cancer PAR was 74% (95% IC,
0.70-0.78) and 86% (95%IC, 0.81-0.85) for former smokers and smokers,
respectively. Esophageal cancer PAR was 54% (95%IC, 0.46-0.62) for
smokers. CONCLUSION: Smoking is an avoidable risk factor and smoking
cessation could be responsible for significant reductions in the
incidence of these three forms of cancer.
25
UI - 12107384
AU - Drudi FM; Trippa F; Cascone F; Righi A; Iascone C; Ricci P; David V;
TI -
Passariello R
Esophagogram and CT vs endoscopic and surgical specimens in the
diagnosis of esophageal carcinoma.
SO - Radiol Med (Torino) 2002 Apr;103(4):344-52
AD - Istituto di Radiologia, Universita degli Studi di Roma La Sapienza,
Policlinico Umberto I, Rome, Italy. FrancescoM.Drudi@uniromal.it
PURPOSE: Aim of our study was to assess the accuracy of diagnostic
imaging in establishing site, morphology and size of the neoplasm
comparing surgical specimens or endoscopic examination with
esophagograms and CT in patients with esophageal cancer. CT accuracy in
defining TNM staging was also evaluated. MATERIAL AND METHODS: From 1993
to 2000 we examined 39 patients with esophageal cancer: 30 males (77%)
and 9 females (23%), age range 41-85 years. All patients underwent
esophagogram, digestive endoscopy, and chest and abdominal CT. In 22
patients who underwent surgery, we evaluated the correlation between
diagnostic imaging and surgical specimens. Patients were divided into 3
groups on the basis of discrepancy between pathological and radiological
measurements: =/<1 cm (considered as no discrepancy); 1 to 3 cm; > 3 cm.
RESULTS: Esophagogram identified neoplasm in 38 patients out of 39,
while CT identified neoplasm in all patients. Location and morphology of
the neoplasm established at endoscopy were confirmed in all patients.
Lesion length measured at esophagogram corresponded to length of
surgical specimens in 13 of the 22 surgically treated patients (59%). In
this group there was a dominance of polypoid and stenotic tumor forms.
In the remaining 9 cases there was a dominance of ulcerative tumor
forms. CT measurement corresponded in 7 patients (32%) with a dominance
of polypoid and stenotic tumor forms. T staging performed with CT
corresponded to surgical specimens in 12 patients (54%, T3-T4). N
staging correlated in 19 patients (86%). CT identified distant
metastases in 6 patients (27%). DISCUSSION AND CONCLUSIONS: Our study
proves a high sensitivity of esophagogram and CT in the diagnosis of
esophageal carcinoma. Esophagogram presented a higher accuracy in
establishing tumor length (59% of cases, as compared to CT 32%). Tumor
morphology influenced the accuracy of the esophagogram, and highest
accuracy was obtained in polypoid and stenotic tumors. T staging
performed with CT corresponded to surgical specimens in advanced stages
(T3-T4), while accuracy was poorer in smaller superficial lesions
(T1-T2) due to the inability of CT to differentiate the layers of the
esophageal wall. N understaging in 14% of cases did not modify surgical
management. CT presented a high sensitivity in the identification of
loco-regional lymph nodes and identified distant metastases in 6
patients. In conclusion, these techniques are accurate and non-invasive
and their role in establishing the correct management is therefore
important.
26
UI - 12324764
AU - Heidecke CD; Weighardt H; Feith M; Fink U; Zimmermann F; Stein HJ;
TI -
Siewert JR; Holzmann B
Neoadjuvant treatment of esophageal cancer: Immunosuppression following
combined radiochemotherapy.
SO - Surgery 2002 Sep;132(3):495-501
AD - Department of Surgery, Technische Universitat Munchen, Germany.
BACKGROUND: The biologic effects of neoadjuvant tumor therapies on the
immune system of cancer patients are largely unknown. Immune deviations
may be particularly detrimental if they occur in conjunction with
postoperative immunosuppression. The effects of combined
radiochemotherapy (RCTx) on T cell functions in patients with squamous
cell carcinoma of the esophagus were investigated. METHODS: T cell
proliferation was stimulated by incubation of peripheral blood
mononuclear cells with bacterial superantigens or by exposure of
enriched T cells to superantigens presented by B lymphoma cells.
Cytokine production of enriched T cells was induced by cross-linking of
CD3 and CD28 and the secretion of interleukin (IL)-2, IL-4, IL-10, and
interferon-gamma was measured by enzyme-linked immunosorbent assay. T
cell expression of human leukocyte antigen-DR (HLA-DR) molecules was
determined by flow cytometry. RESULTS: T lymphocytes from patients
having undergone RCTx exhibited a significantly reduced proliferative
response following stimulation with 3 independent superantigens.
Cytokine production of T cells and the antigen presenting capacity of
p
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