Impact Of Glucocorticoid In Patients With Locally Advanced Esophageal Cancer Treated With Concurrent Chemoradiotherapy

Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL Background: Concerns about the effect of glucocorticoids (GC) on tumor growth and chemosensitivity have been raised recently. Our pervious study shows that GC receptor is highly expressed in esophageal squamous cell carcinoma (ESCC) tumor tissues (Histopathology 2008;52:314-324). This study sought to further characterize the GC effect on the efficacy of conventional anti-cancer therapy to ESCC. Materials and Methods:The in vitro study was performed in 2 esophagus cell lines: KYSE-70 and KYSE-410. The cell viability is determined by MTT assay and clonogenic assay. The effect of GC on cytotoxic treatment -induced apoptotic cell death was determined by flow cytometric and Western blot analysis. Further, we retrospectively analyzed impact of GC usage on the outcomes of 92 patients with locally advanced ESCC who received preoperative concurrent chemoradiotherapy in a prospective clinical trial. Among 92 locally advanced ESCC patients, 39 patients who received GC twice weekly for four to six weeks (a total of eight doses or more) and 53 patients who received GC only two doses in the first week at discretion of individual physicians. Results: In vitro study showed pretreatment of GC confer resistance to cytotoxic agents including paclitaxel, gemcitabine and 5-FU, and resistance to irradiation. The effect of increase chemo-resistance by GC may be through decrease of the apoptosis according to PI/annexin V staining flow cytometric study and Western blot study. In the retrospective clinical study, the two groups were well balanced with respect to disease stage and other prognostic factors. Multivariate analysis showed that corticosteroid usage and performance status were independently prognostic of survivals. The median overall survivals of the two-dose group the eight-dose-or-more group were 38.4 and 15.1 months, (p = 0.089), respectively. The median progression-free survivals were 27.5 and 9.4 months (p = 0.024), respectively. Conclusion: This data suggest that GC decrease chemo-sensitivity and radio-sensitivity of ESCC cells. Frequent usage of GC during concurrent chemoradiotherapy may have a detrimental effect on patients with locally advanced ESCC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 364. doi:10.1158/1538-7445.AM2011-364