Abstract
Background. The biologic effects of neoadjuvant tumor therapies on the immune system of cancer
patients are largely unknown. Immune deviations may be particularly detrimental if
they occur in conjunction with postoperative immunosuppression. The effects of combined
radiochemotherapy (RCTx) on T cell functions in patients with squamous cell carcinoma
of the esophagus were investigated. Methods. T cell proliferation was stimulated by incubation of peripheral blood mononuclear
cells with bacterial superantigens or by exposure of enriched T cells to superantigens
presented by B lymphoma cells. Cytokine production of enriched T cells was induced
by cross-linking of CD3 and CD28 and the secretion of interleukin (IL)-2, IL-4, IL-10,
and interferon-γ was measured by enzyme-linked immunosorbent assay. T cell expression
of human leukocyte antigen-DR (HLA-DR) molecules was determined by flow cytometry.
Results. T lymphocytes from patients having undergone RCTx exhibited a significantly reduced
proliferative response following stimulation with 3 independent superantigens. Cytokine
production of T cells and the antigen presenting capacity of patient's peripheral
blood mononuclear cells was not diminished following RCTx. T cell expression of HLA-DR
was increased following RCTx. Conclusions. RCTx of patients with squamous cell carcinoma of the esophagus results in the suppression
of T lymphocyte functions. The proliferative defects of T cells after RCTx may be
linked to an impaired immune surveillance of cancer and to a higher risk of surgical
complications associated with esophagectomy. (Surgery 2002;132:495-501.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Who benefits from combined modality treatment of esophageal carcinoma?.Dis Esoph. 1994; 7: 156-161
- Multidisciplinary approach to esophageal and gastric cancer.Surg Clin North Am. 2000; 80: 659-682
- Varied effects of thoracic irradiation on peripheral lymphocyte subsets in lung cancer patients.Intern Med. 1995; 34: 959-965
- Cellular immune defect caused by postsurgical radiation therapy in patients with head and neck cancer.Otolaryngol Head Neck Surg. 1998; 119: 412-417
- Radio- and chemotherapy variably affect the general immunocompetence of lung cancer patients.Panminerva Med. 1999; 41: 129-133
- Effects of concurrent cisplatinum administration during radiotherapy versus radiotherapy alone on the immune function of patients with cancer of the uterine cervix.Int J Radiat Oncol Biol Phys. 2000; 48: 997-1006
- Distinct mechanisms of immunosuppression as a consequence of major surgery.Infect Immun. 1997; 65: 2283-2291
- Inadequate interleukin-2 synthesis and interleukin-2 messenger expression following thermal and mechanical trauma in humans is caused by defective transmembrane signaling.J Trauma. 1993; 34: 846-853
- Altered gene transcription after burn injury results in depressed T lymphocyte activation.Ann Surg. 1994; 220: 342-351
- Selective defects of T lymphocyte function in patients with lethal intra-abdominal infection.Am J Surg. 1999; 178: 288-292
- Multimodal treatment for squamous cell esophageal cancer.World J Surg. 1995; 19: 198-204
- Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of the esophagus.N Engl J Med. 1997; 337: 161-167
- The Stockholm I trial of preoperative short-term radiotherapy in operable rectal carcinoma: a prospective randomized trial.Cancer. 1995; 75: 2269-2275
- Analysis of postoperative complications after esophagectomy for esophageal cancer in patients receiving neoadjuvant therapy.Jpn J Thorac Cardiovasc Surg. 1999; 47: 552-558
- Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial.J Thorac Cardiovasc Surg. 1997; 114: 210-217
- Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer.N Engl J Med. 1998; 339: 1979-1984
- Two-stage operation for poor-risk patients with carcinoma of the esophagus.J Surg Oncol. 1987; 36: 105-109
- Extensive lymphadenectomy for thoracic esophageal carcinoma: a 2-stage operation for high-risk patients.Surg Today. 1994; 24: 610-615
- Esophagectomy and staged reconstruction.Eur J Cardiothorac Surg. 2000; 17: 702-709
- Esophageal carcinoma: two-stage operation for preventing mediastinitis in high risk patients.Chirung. 2001; 72: 831-836
Article info
Publication history
Accepted:
May 20,
2002
Footnotes
*Supported by DFG Grants Si 208/5-1 and Si 208/5-4 to the Clinical Research Group “Immunosuppression und Postoperative Sepsis.”
**Reprint requests: Prof Bernhard Holzmann, MD, Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
