title: The prognostic significance of tumor epidermal growth factor receptor (EGFR) expression change after neoadjuvant chemoradiation in patients with rectal adenocarcinoma.
abstract: OBJECTIVE
  The aim of this retrospective study was to determine the prognostic impact of epidermal growth factor receptor (EGFR) expression changes during neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer.
  
  
  METHODS
  Fifty patients with locally advanced rectal cancer were evaluated. All the patients were administered the total dose of 44 Gy. Capecitabine has been concomitantly administered in the dose 825 mg/m(2) in two daily oral administrations. Surgery was indicated 4-8 weeks from the chemoradiotherapy completion. Epidermal growth factor receptor expression in the pretreatment biopsies and in the resected specimens was assessed with immunohistochemistry.
  
  
  RESULTS
  All of 50 patients received radiotherapy without interruption up to the total planned dose. In 30 patients sphincter-saving surgery was performed, 20 patients underwent amputation of the rectum. Downstaging was described in 30 patients. Four patients have had complete pathologic remission. Twenty-six patients have had partial remission, the disease was stable in 15 patients. Progression was reported in 5 patients. The median disease-free survival was 64.9 months, median overall survival was 76.4 months. Increased EGFR expression was found in 12 patients (26.1%). A statistically significantly shorter overall survival (p < 0.0001) and disease-free survival (p < 0.0001) was found in patients with increased expression of EGFR compared with patients where no increase in the expression of EGFR during neoadjuvant chemoradiotherapy was observed.
  
  
  CONCLUSIONS
  The overexpression of EGFR during neoadjuvant chemoradiotherapy for locally advanced rectal adenokarcinoma associated with significant shorter overall survival and disease free survival.
authors.affiliation: Department of Oncology, Regional Hospital Liberec, Liberec, Czech Republic.
authors.forename: Igor
authors.initials: I
authors.lastname: Richter
authors.affiliation: Department of Oncology and Radiotherapy, Charles University, Medical School and Teaching Hospital, Hradec Kralove, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Dvořák
authors.affiliation: Department of Pathology, Ceska Lipa Hospital, Ceska Lipa, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Urbanec
authors.affiliation: Department of Medical Biophysics, Charles University, Medical School and Teaching Hospital, Hradec Kralove, Czech Republic.
authors.forename: Antonin
authors.initials: A
authors.lastname: Bluml
authors.affiliation: Department of Medical Biophysics, Charles University, Medical School and Teaching Hospital, Hradec Kralove, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Čermáková
authors.affiliation: Department of Oncology, Regional Hospital Liberec, Liberec, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Bartoš
authors.affiliation: Department of Oncology and Radiotherapy, Charles University, Medical School and Teaching Hospital, Hradec Kralove, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Petera
keywords: chemotherapy; epidermal growth factor receptor; neoadjuvant treatment; radiotherapy; rectal adenocarcinoma