Prediction of chemoradiosensitivity of esophageal cancer

食管癌是最令人沮丧的疾病之一，预后差，虽然食管癌的标准治疗是手术排斥，但近年来诊断和治疗程序的进步导致了除手术外的多种治疗选择，如化疗，放疗，放化疗以及各种治疗方式的联合。近年来的研究表明，放化疗（CRT）在保留器官的情况下，显示出与手术几乎相同的疗效。因此，CRT的适应症已扩大到可手术的食管癌。然而，在一般情况下，病理完全缓解保持在20 - 30%左右，CRT的晚期不良反应严重。此外，根治性CRT超过50 Gy后的挽救手术往往导致严重的发病率和死亡率。因此，有必要建立食管癌CRT敏感性的预测指标，以指导食管癌治疗策略的制定。在这项研究中，我们评估了基因表达，3DCT，FDG-PET对食管癌化疗敏感性的研究：1）p21蛋白阳性表达可预测CRT后食管癌的组织学CR。2）FDG-PET可预测CRT对原发灶的有效性，但不能预测淋巴结转移。3）4）CRT前后PET SUV max值的变化不足以评价放化疗的敏感性; 5）从MIB-1指数来看，放疗剂量大于50 Gy比小于40 Gy更有效，放疗剂量大于50 Gy时，MIB-1指数更高，放疗剂量小于40 Gy时，MIB-1指数更低。3DCT是评价CRT治疗食管癌敏感性的有效手段，目前，几种生物标志物或影像学检查尚不足以作为评价CRT治疗食管癌的预测工具。需要进一步研究。

Esophageal cancer is one of the most dismal diseases with poor prognosis.Although the standard treatment of esophageal cancer is surgical rejection, a recent advancement of diagnostic and therapeutic procedure leads to a variety of treatment choices other than surgery, such as chemotherapy, radiation, chemoradiotherapy, and the combination of all treatment modalities. Recent reports have indicated that the chemoradiotherapy(CRT) shows almost equal therapeutic effect to surgery, with organ preservation. Thus, the indication of CRT has been widening for an operable esophageal cancer. However, in general, pathological complete response remains around 20〜30% and late adverse effects of CRT are severe. Moreover, salvage surgery after radical CRT with more than 50Gy often results in severe morbidity and mortality. Thus, it is necessary to establish the predictive tcol for a sensitivity of CRT which can guide decision making of treatment strategy for esophageal cancer. In this study, we evaluated the predictive value of gene expression, 3DCT, FDG-PET for chemosensitivity of esophageal cancer.We clarified the following results from the current study.1) Positive expression of p21 protein can predict histological CR of esophageal cancer after CRT.2) FDG-PET can predict the effectiveness of CRT for a primary lesion but for lymph node metastasis.3) Effectiveness against lymph node is different between intra-and extra-radiation field.4) The change of SUV max value of PET before and after CRT is not enough to evaluate the sensitivity of chemoradiation.5) The radiaticn more than 50Gy is more effective than less than 40Gy with regard to MIB-1 index, Tunnel index, and histopai ; hological effect.6) 3DCT is a valuable means to assess the sensitivity of CRT against esophageal cancer.At present, several biomarkers or imaging modalities are not enough to be a predictive tool to assess of CRT against esophageal cancer. Further studies are necessary.