title: Effect of multimodality therapy on circulating vascular endothelial growth factor levels in patients with oesophageal cancer.
abstract: BACKGROUND
  Angiogenesis is critical for tumour growth and metastasis. The switch to the angiogenic phenotype depends on the net balance between positive and negative angiogenic factors released by the tumour. It was hypothesized that patients with oesophageal cancer would express raised serum levels of vascular endothelial growth factor (VEGF) which would return to normal values with neoadjuvant chemoradiotherapy.
  
  
  METHODS
  Forty-four patients with oesophageal cancer who were selected for treatment with neoadjuvant chemoradiotherapy had blood samples taken before treatment, during chemoradiotherapy, before operation, on days 1, 3 and 5 after surgery, and 3 months after resection. Serum levels of VEGF were measured. Values were correlated with response to treatment. Controls were patients who were undergoing surgery for non-malignant conditions.
  
  
  RESULTS
  Serum VEGF levels were raised in patients with oesophageal cancer compared with age-matched controls (mean 247 versus 1157 pg/ml; P < 0.01). VEGF levels were unaffected by neoadjuvant treatment but fell significantly on the first day after operation (652 versus 1057 pg/ml before operation; P < 0.05). No decrease occurred in control patients. VEGF levels had returned to preoperative levels by day 5. A similar postoperative rise in VEGF levels was seen in the control subjects (1194 pg/ml on day 5 versus 71 pg/ml before operation; P = 0.001). There was no correlation between VEGF level and response to treatment or tumour stage. VEGF levels had decreased significantly at 3 months following tumour resection (594 versus 1558 pg/ml on day 5; P = 0.03).
  
  
  CONCLUSIONS
  VEGF levels are raised in patients with oesophageal cancer and are unaltered by neoadjuvant treatment, suggesting an additional source other than tumour cells for this proangiogenic agent.
authors.affiliation: Department of Surgery, Royal College of Surgeons in Ireland, James Connolly Memorial Hospital, Dublin, Ireland.
authors.forename: C O
authors.initials: CO
authors.lastname: McDonnell
authors.forename: J H
authors.initials: JH
authors.lastname: Harmey
authors.forename: D J
authors.initials: DJ
authors.lastname: Bouchier-Hayes
authors.forename: T N
authors.initials: TN
authors.lastname: Walsh
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000098:blood supply / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000098:blood supply / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D016228:Endothelial Growth Factors / Q000097:blood*; D004938:Esophageal Neoplasms / Q000097:blood* / Q000098:blood supply / Q000628:therapy; D005260:Female; D006801:Humans; D008222:Lymphokines / Q000097:blood*; D008297:Male; D009389:Neovascularization, Pathologic; D011300:Preoperative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000379:methods; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
chemical_list: D016228:Endothelial Growth Factors; D008222:Lymphokines; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors