Establishment of the individual treatment strategy in multidiciplinary therapy for patients with advanced esophageal squamous cell carcinoma

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(1) Prediction of the response to preoperative therapy by p53 status for patients with advanced esophageal squamous cell carcinoma (SCC).The presence or absence of mutation within exon 4 to 9 of p53 gene was analyzed with endoscopic biopsy sample before treatment using SSCP technique. Chemoradiotherapy was received in 67 patients, who were divided in 48 of wild type (WT) and 19 of mutant (MT). Grade 2 or more histological response was obtained in 31 of WT group (65%), to the contrary, in only 2 of MT group (11%). In 30 patients who underwent chemotherapy, WT and MT were observed in 21 and 9 patients, respectively. Clinically good responders were shown in 16 of WT group (76%) and only I of MT group (11%).(2) Response evaluation of neoadjuvant therapy by FDG-PET prediction of histological response.According to post treatment PET analysis, patients with or without FDG accumulation were classified in PET positive or PET negative. The maximum cross-sectional square area of residual tumor ranged from 0 to 32.6mm2 (average 10.0mm2) in PET negative group and from 66.0 to 676.0mm2 (average 287.7mm2) in PET positive group. The histological good response of grade 2 to 3 was obtained in 15 of PET negative patients (88%) and in only 2 of PET positive patients (12%).(3) Positive indication of salvage surgery.The 1-and 3-year overall survival rate were 93.3% and 81.7% in PET negative group compared with 67.8% and 40.7% in PET positive group.Conclusion: In multidisciplinary treatment for advanced esophageal SCC, the analysis of p53 status is useful to predict a treatment resistance and also FDG-PET may be the extremely useful modality to predict a histological response after neoadjuvant therapy. Post-treatment PET negative patient may be a good candidate for salvage surgery.