Daisuke Miyawaki MD, Presenter: Nothing to Disclose

Ryohei Sasaki, Abstract Co-Author: Nothing to Disclose

Yoshiaki Okamoto MD, Abstract Co-Author: Nothing to Disclose

Tsutomu Maruta MD, Abstract Co-Author: Nothing to Disclose

Toshinori Soejima MD, Abstract Co-Author: Nothing to Disclose

Kazuro Sugimura MD, Abstract Co-Author: Nothing to Disclose

Yosuke Ota MD, Abstract Co-Author: Nothing to Disclose

Yasuo Ejima MD, Abstract Co-Author: Nothing to Disclose

Daisuke Shirasaka MD, Abstract Co-Author: Nothing to Disclose

Kunihiro Nishimura MD, Abstract Co-Author: Nothing to Disclose

Although major causes of esophageal carcinoma are believed to be alcohol consumption and tobacco abuse, esophageal squamous cell carcinoma shows different characteristics from esophageal adenocarcinoma. Recent our observation illustrated that proportion of patients with hepatitis C virus infection was quite higher in patients with esophageal squamous cell carcinoma than that of normal volunteer. Hepatitis C infection causes a chronic liver dysfunction, a hepatocellular carcinoma, and treatment-related death of chemo-radiotherapy against several malignant diseases. On the contrary, a probability for carcinogenesis and an outcome of patients with HCV-infected esophageal carcinoma remain matters to be discussed. The purpose of the present study is to examine clinical manifestations and outcomes of the chemo-radiotherapy for esophageal squamous cell carcinoma with or without hepatitis C virus infection.

Between 1994 and 2005, 361 patients with Stage I-IVA esophageal squamous cell carcinoma treated with radiotherapy or chemo-radiotherapy were retrospectively analyzed. Patients were categorized into two subgroups (HCV positive and HCV negative) according to the serum HCV antibody test. Liver functions were classified by Child-Pugh Score (Grade A, B and C). The prescribed dose ranged from 50Gy to 70Gy (median, 60Gy). Chemotherapy consisted of cisplatin (70-80 mg/m2) and 5-FU (4000-5000 mg/body in 4-5 days) was administered in 218 (60%) patients (concurrent: 83%, sequential: 17%). Cycles of the chemotherapy were 1 cycle in 3%, 2 cycles in 92%, and 3 cycles in 6%, respectively. Overall survival (OS) and disease-specific survival (DSS) of each group were calculated from the first day of radiotherapy with the Kaplan-Meier method, and analyzed by logrank test.

Serum HCV antibody was positively detected in 39 patients (11%). Their liver functions were Grade A: 33 patients (86%), Grade B: 3 patients (8%), and Grade C: 3 patients (8%), respectively. Proportions of other malignancies were 12 patients (31%) with HCV-infected (head and neck: 5, gastrointestinal: 2, lung: 1, and liver: 4), compared to 64 patients (20%) without HCV-infected (head and neck: 27, gastrointestinal: 32, lung: 5, liver: 2, and others: 7) (p = 0.12). Five-year OS and DSS were 29% and 54% in patients with HCV-infected, while they were 42% and 54% in patients without HCV-infected (OS: p = 0.91, DSS: p = 0.63). Causes of death were esophageal carcinoma: 67%, other malignancies: 0%, other disease: 19% in patients with HCV-infected, while esophageal carcinoma: 75%, other malignancies: 4%, other disease: 8% in patients without HCV-infected.

Prevalence of HCV infection affected clinical manifestations of esophageal squamous cell carcinoma. However, even if liver function were determined to be Child-Pugh Grade A or B, almost similar outcome seemed to be expected by the treatment of esophageal squamous cell carcinoma.

Miyawaki, D, Sasaki, R, Okamoto, Y, Maruta, T, Soejima, T, Sugimura, K, Ota, Y, Ejima, Y, Shirasaka, D, Nishimura, K, Clinical Manifestations of Esophageal Squamous Cell Carcinoma with Hepatitis C-Virus Infection Treated with Chemo-Radiotherapy.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/8000733.html