Preoperative radiotherapy has been

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BACKGROUND Preoperative radiotherapy reduces the rate of local recurrence and improves the chance of survival in patients with resectable, advanced rectal carcinoma. However, because not all tumors respond similarly to radiation, sorting out suitable patients is required to irradiate tumors rationally. The authors examined the possible role of Ku protein in determining tumor radiosensitivity and disease free survival in patients with rectal carcinoma. METHODS The authors studied 96 patients with advanced rectal carcinoma. In preradiation biopsy specimens of tumor samples, the number of cells that were stained positive for Ku protein was evaluated by immunohistochemistry. The expression pattern of Ku protein was examined for an association between tumor radiosensitivity (which was determined according to T classification downstaging, complete pathologic response, or Response Evaluation Criteria in Solid Tumors) and disease free survival. RESULTS There was a high degree of correlation between the percentage of cells that expressed the 70‐kDa Ku protein (Ku70) and the 86‐kDa Ku protein (Ku86) in the tumor sections (correlation coefficient = 0.85; P < 0.001). The expression pattern of Ku protein was correlated not only with tumor radiosensitivity but also with disease free survival. Pathologic TMN classification, histopathologic grade, and Ku70 expression were significant prognostic variables for disease free survival in a multivariate analysis (P = 0.0031, P = 0.030, and P = 0.023, respectively). CONCLUSIONS Ku70 and Ku86 raise the predictive possibility of tumor radiosensitivity. Ku may be a useful parameter for selecting patients with rectal carcinoma for preoperative radiotherapy. Cancer 2002;95:1199–205. © 2002 American Cancer Society. DOI 10.1002/cncr.10807

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Malignant melanoma is a typical cutaneous tumor, arising from melanocytes. Primary malignant melanoma of the esophagus (PMME) is uncommon, comprising from 0.1% to 0.2% of all malignant esophageal tumors. PMME is characteristically aggressive and disseminates early via the bloodstream and lymphatics. 1 Here, we report the first case of surgically treated PMME with adjuvant dendritic-cell (DC) therapy. The patient has been free from any signs of recurrence for 2.5 years after the surgery.A 56-year-old man was investigated because he had vomited blood with clots. Physical examinations revealed no pigmented lesions of the skin, rectum, eyes, or elsewhere that were suspicious for melanoma. Esophagogastroscopy showed an ulcerated tumor, sited 27-32 cm from the incisors (Fig. 1a,b). On the biopsy specimen, the lesion was identified as a malignant melanoma. Computed tomography (CT) showed no evidence of distant metastasis.On July 9, 2001, subtotal esophagectomy and lymph node dissection was performed through a retrosternal route. The patient's postoperative course was uneventful. The surgical specimen contained an ulcerative tumor, which showed a black area under the normal mucosa on the margin of tumor. Histologically, the tumor cells had invaded to the muscularis propia, and the resection margins were free of tumor. Tumor cells at the edge of the tumor contained abundant melanin granules, and there were melanophages in the matrix (Fig. 2a,b). There was no lymph node metastasis. Immunohistochemical staining was positive for antibodies against S-100 and HMB-45 (Fig. 2c,d) and negative for cytokeratin, findings that were consistent with malignant melanoma. The diagnosis of R0-resected PMME, analogous to a pT2N0M0 stage carcinoma was verified. PMME has extremely high malignant potential, with a mean survival of 14 months after radical resection, and with metastasis or recurrence often being observed even in the early stage. 2,3 Therefore, we performed DC therapy as adjuvant therapy. The DC therapy was performed as described previously. 4 Briefly, the DC therapy had been approved by the Ethics Committee of the University of Tokyo, and written informed consent was obtained from the patient before the DC therapy was started. DCs were generated from peripheral monocytes collected by leukapheresis. The monocytes were cultured with 1000 IU/ml granulocyte-macrophage (GM)-colony-stimulating factor (CSF) and 500 IU/ml interleukin (IL)-4 for 7 days, with pulsation of autologous tumor lysates. The patient received four intradermal infections, of 3 or 4 ϫ 10 7 DCs, weekly. At 2.5 years after the operation, the patient is healthy, without any sign of relapse on chest or abdominal computed tomography, or as shown by tumor markers.The main treatment of PMME is supposed to be surgical resection. However, as stated above, the mean survival after radical resection is 14 months, and the overall 5-year survival rate after radical surgical resection is reported to be 4.2%; 1 the efficacy of adjuvant therapy for PMME has never been clearly demo...