A phase II study of sequential neoadjuvant gemcitabine and paclitaxel, radiation therapy with cisplatin and 5-fluorouracil and surgery in locally advanced esophageal carcinoma

Oesophageal cancer: Which treatment is the easiest to swallow? A review of combined modality treatments for resectable carcinomas

Oesophageal cancer is a relatively uncommon malignancy, but with poor prognosis. Despite several treatment options that are available, the 5-year survival rates rarely exceed 40%. This review discusses the main challenges of oesophageal cancer, the available treatment options, and the most effective treatment in terms of overall survival. The outcomes of clinical trials show that neo-adjuvant chemo-radiotherapy using cisplatin and 5-fluorouracil followed by oesophagectomy results in the greatest survival. However, the optimal chemotherapy and radiotherapy schedule remains unclear. There is no satisfactory treatment to date, particularly for patients with co-morbidities or advanced tumours.

Identification of differentially expressed proteins of normal and cancerous human colorectal tissues by liquid chromatograph-mass spectrometer based on iTRAQ approach

Liquid chromatograph-mass spectrometer (LC/MS) based labeled with isobaric mass tags for relative and absolute quantitation (iTRAQ) analyses were performed to identify differentially expressed proteins from normal and cancerous human colorectal tissues. Around 802 proteins were identified, 68 proteins of which were defined as differentially expressed proteins. Bioinformatics analysis indicated that these differentially expressed proteins correlated with several specific cellular processes and pathways which have relationships with pathological changes of colorectal cancer (CRC). EHD2 were selected to verify its expression patterns and localization using western blotting and immunohistochemistry respectively. LC/MS-based iTRAQ proteomic approach would provide new information about the character of CRC.

Clinicopathological significance of deoxycytidine kinase expression in esophageal squamous cell carcinoma

Deoxycytidine kinase (dCK) mediates the rate-limiting catabolic step in the activation of gemcitabine. Gemcitabine is a key drug for pancreatic and biliary tract cancer. However, gemcitabine is not widely used for esophageal squamous cell carcinoma (ESCC). In this study, we analyzed the expression of dCK in ESCC and evaluated the possibility of gemcitabine treatment for ESCC. In total, 76 ESCC patients who underwent esophagectomy between 1990 and 2008 were analyzed. dCK expression was analyzed immunohistochemically using tissue microarray and compared to the clinocopathological characteristics of the patients. Results identified 41 patients positive for dCK and 35 patients negative for dCK. A significant association was observed between dCK expression and gender (P=0.01), whereas the remaining factors were not associated with dCK expression. Prognosis of the patients with a high dCK expression was significantly worse than that of the patients with a low dCK expression (P=0.022). Furthermore, dCK expression was an independent prognostic factor regarding cause-specific prognosis (risk ratio, 2.2; P=0.031). In conclustion, the results of the present study suggested that dCK expression is a prognostic factor of the ESCC patients.

Detection of differentially expressed low molecular weight serum proteins for diagnosis and staging of esophageal cancer

AIM: To find biomarkers for early diagnosis of esophageal cancer (EC) by detecting differentially expressed low molecular weight serum proteins using mass spectrometry.

METHODS: The serum proteomic patterns of EC patients and healthy controls were detected using the surface-enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS). Differential protein peaks between EC patients and controls were analyzed using the Biomarker Pattern Software, and a model for early diagnosis of EC was developed and validated using an artificial neural network (ANN). Differential protein peaks between early and advanced EC patients were analyzed to establish a model for staging of EC.

RESULTS: Five differential serum proteins were identified between EC patients and controls, and three differential serum proteins were found between early and advanced EC. The diagnostic model established based on the five differential serum proteins between EC patients and controls had a sensitivity of 87.88%, a specificity of 91.43%, and an accuracy of 89.71%. The blind test generated a sensitivity of 95.83%, a specificity of 89.13%, and an accuracy of 91.43%. The staging model established based on the three differential serum proteins between early and advanced EC had a sensitivity of 75.76%, a specificity of 79.17%, and an accuracy of 77.19%.

CONCLUSION: SELDI-TOF-MS in combination with ANN is simple and feasible for the diagnosis and staging of EC.

Histologic tumor type and the rate of complete response after neoadjuvant therapy for esophageal cancer

A review of the literature demonstrated that clinical evaluation cannot be used to determine ‘complete response’. The different classification systems of the histopathologic response grading after neoadjuvant radiochemotherapy of esophageal carcinoma are summarized in this report. A systematic review of studies analyzing preoperative chemoradiation of squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the esophagus demonstrated no significant difference in pathologic complete response (pCR) rates between the AC and SCC studies. Analyzing only the applied dose of radiation demonstrated that patients with AC required a higher dose than patients with SCC to achieve complete response. Incorporating chemotherapy administration does not markedly change the difference in required radiation dose. However, when the tumor does respond, the rate of pCR with increasing dosage of chemoradiotherapy increases more rapidly in AC patients than in SCC patients.