Metastatic sites and survival in lung cancer

Objectives

Population-based data on metastatic sites and survival in site-specific metastases are lacking for lung cancer and for any cancer because most cancer registries do not record metastases. This study uses a novel population-based approach to identify metastases from both death certificates and national inpatient data to describe metastatic pathways in lung cancer patients.

Materials and methods

17,431 deceased lung cancer patients diagnosed 2002–2010 were identified from the nationwide Swedish Cancer Registry, which is based on compulsory reports. The influence of age at diagnosis, sex, and histological subtype on metastatic spread was investigated. Survival in metastatic lung cancer was assessed by histology and metastatic site.

Results

The most frequent metastatic sites were the nervous system, bone, liver, respiratory system, and adrenal gland. Liver (35%) and nervous system (47%) metastases were common in patients with metastases from small cell lung cancer, and bone (39%) and respiratory system (22%) metastases in adenocarcinoma. Women (43% vs. 35%) and younger patients had more metastases to the nervous system. Median survival after diagnosis was 13 months for non-metastatic and five months for metastatic lung cancer. In this novel data, liver metastases conferred the worst prognosis (three months), especially for large cell histology. Bone metastases also featured poor survival, whereas survival in respiratory and nervous system metastases was better.

Conclusion

Metastatic sites and survival in metastatic lung cancer is influenced by sex, histological subtype, and age at diagnosis. Liver and bone metastases signal poor survival, compared with nervous system metastases.     

The role of surgery in the management of solitary pulmonary nodule in breast cancer patients.

AIMS: To assess the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in patients who had received previous surgery for breast cancer. METHODS: A series of 79 consecutive patients who underwent surgery for an SPN between 1990 and 2003 after a curative resection for breast cancer were reviewed. RESULTS: Surgical diagnosis was obtained by open procedure before 1996 (37 cases), and by video-assisted thoracoscopic surgery (VATS) after 1996 (33 out of 42 cases, 9 open procedures) and intraoperative evaluation. Histology of SPN was primary lung cancer in 38 patients, pulmonary metastasis of breast cancer in 27, and benign condition in 14. VATS was converted to open procedure for anatomical resection in primary lung cancer and for the palpation of the lung in metastatic disease. Average disease-free interval from the initial mastectomy was significantly longer in primary lung cancer than in metastatic patients (179+/-107 vs 51+/-27 moths). Manual palpation identified multiple pulmonary nodules in 3 out of 27 metastatic patients. Five-year survival rate after pulmonary metastasectomy was 38% and was significantly influenced by disease-free interval; 5-year survival rate after resection of primary lung cancer was 43% and was significantly influenced by the pathological stage. CONCLUSIONS: VATS is a good procedure for diagnostic management of peripheral SPN. As SPN in breast cancer patients is primary lung cancer in half cases, it deserves confirmation of pathological diagnosis and appropriate surgical treatment. When breast cancer metastasis is demonstrated, open procedure must be performed to palpate the entire lung to exclude previously unknown nodules.     

Evaluation of undiagnosed solitary lung nodules according to the probability of malignancy in the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines

Background

This study retrospectively investigated the clinical significance of undiagnosed solitary lung nodules removed by surgical resection.

Patients and methods

We retrospectively collected data on the age, smoking, cancer history, nodule size, location and spiculation of 241 patients who had nodules measuring 7 mm to 30 mm and a final diagnosis established by histopathology. We compared the final diagnosis of each patient with the probability of malignancy (POM) which was proposed by the American College of Chest Physicians (ACCP) guidelines.

Results

Of the 241 patients, 203 patients were diagnosed to have a malignant lung tumor, while 38 patients were diagnosed with benign disease. There were significant differences in the patients with malignant and benign disease in terms of their age, smoking history, nodule size and spiculation. The mean value and the standard deviation of the POM in patients with malignant tumors were 51.7 + 26.1%, and that of patients with benign lesions was 34.6 + 26.7%. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.67. The best cut-off value provided from the ROC curve was 22.6. When the cut-off value was set at 22.6, the sensitivity was 83%, specificity 52%, positive predictive value 90%, negative predictive value 36% and accuracy 77%, respectively.

Conclusions

The clinical prediction model proposed in the ACCP guidelines showed unsatisfactory results in terms of the differential diagnosis between malignant disease and benign disease of solitary lung nodules in our study, because the specificity, negative predictive value and AUC were relatively low.     

Radiofrequency ablation for liver metastasis from gastric cancer

Aims

Several studies have reported the benefit of hepatic resection for metastatic tumor from gastric cancer. However, the value of treatment with radiofrequency ablation (RFA) has not been clearly defined.

Methods

Between Jan 2002 and Dec 2007, 21 patients with primary gastric cancer were diagnosed with synchronous or metachronous liver metastases. All patients were treated with RFA, and the complication, survival, and recurrence rates were assessed.

Results

The postoperative complication rate was 5% (1/21), with no mortality. The median actuarial survival time was 14 months. The 1-yr, 2-yr, 3-yr, and 5-yr survival rates after RFA were 70%, 11%, 5%, and 3%, respectively. With a median follow-up time of 19 months, local recurrence at the RFA site was 19% (4/21). Solitary metastasis had significantly longer survival than multiple lesions after RFA (22 vs 10 months, P = 0.004).

Conclusions

RFA provides a minimally invasive and safe modality of treatment patients with liver metastasis from gastric cancer. Patients with solitary liver lesion were considered appropriate candidates for RFA.     

肺内10 mm以内孤立结节的临床分析

背景与目的：肺癌是目前发病率和死亡率较高的恶性肿瘤,其预后很大程度上取决于早期诊断和治疗,而放射影像学如X线平片和CT是发现和诊断肺癌最重要的手段之一．但是对于30mm以内肺周围孤立结节（solitary puhnonary nodules．SPN）的诊断较难．尤其对10mm以内SPN的影像诊断更难。本研究拟对CT影像学10mm以内SPN进行分析总结。方法：对CT影像学上直径〈10mm且最终通过各种方法获得病理学证据的102例SPN进行分析。比较良恶性病变的差异,总结小结节肺癌的影像学特征。结果：肺内〈10mm的SPN中,以良性病变为主,占64．7％。分别是炎性假瘤、良性肿瘤、结核等;原发性肺癌占24．5％,其中分期较晚肺癌（ⅡA期及以上）占5．9％,影像学上可藉边缘不齐、有毛刺衙、气管和血管受累、强化值羞异等特点与良性病变鉴别;肺转移癌占10.8％,其影像学表现与原发性肺癌相似,结论：肺内〈10mm的SPN中。以良性肿瘤为主。其次为肺癌。     

乳腺癌合并肺孤立性结节外科治疗的临床分析

为了探讨外科治疗在乳腺癌合并肺孤立性结节诊断及治疗中的作用,对13例乳腺癌根治术同期行肺孤立性结节手术切除的临床资料进行回顾性分析。结果:手术治疗的13例患者中,肺孤立性病灶的病理结果6例为原发性肺癌,5例为乳腺癌肺转移,2例为良性病变;手术方式:1998年以前患者采用小切口开胸手术(4例),之后的患者采用胸腔镜辅助小切口手术(9例)。术后并发症为皮下气肿和支气管胸膜瘘,无手术死亡。初步研究结果提示,乳腺癌合并的肺孤立性结节并不都是肺转移瘤,乳腺癌合并肺孤立性结节应该尽可能取得病理诊断,得到正确的治疗。     

Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: A systematic review

Background

Axillary metastatic lymphadenopathy with no primary tumour identified in the breast on physical examination, mammography or ultrasound is referred to as occult breast cancer. The goal of this systematic review is to give an overview of the value and additional considerations of using breast MRI in occult breast cancer.

Methods

The databases of Pubmed, Embase, CINAHL and the Cochrane library were searched for studies addressing the use of breast MRI in occult breast cancer. Cross-referencing was used to find additional articles.

Results

8 retrospective studies were included. Breast MRI can detect an otherwise occult breast cancer in more than two thirds of patients with a high sensitivity but lower specificity. In 80% of patients MRI detected lesions could be localized again by using ultrasound. Furthermore the size and localization of the lesions found on MRI most often correlated closely with findings at pathology. Breast MRI also provided the possibility of breast conserving surgery in one thirds of patients.

Conclusion

Breast MRI can result in additional detection of otherwise occult lesions in occult breast cancer. Because of low specificity of malignant lesion detection by breast MRI, lesions should be histologically confirmed. This can be achieved either by MRI or ultrasound guided biopsy, as long as all MRI detected lesions are histologically checked. Routine application of breast MRI in occult breast cancer may also alter locoregional treatment by offering the possibility of breast conserving surgery in one thirds of patients.     

Hepatic resection for synchronous hepatic metastasis from gastric cancer

Background

The role of surgical resection for synchronous hepatic metastases arising from gastric adenocarcinoma has not been established. This study was designed to explore the clinicopathologic features and surgical results of these patients.

Methods

Twenty-five (4.8%) of 526 patients diagnosed with synchronous hepatic metastatic gastric cancer received hepatectomy and gastrectomy at the same time; 2 cases underwent repeat hepatectomy after intrahepatic recurrence. Clinicopathologic parameters of the hepatic metastases and the surgical results for all 25 patients were analysed.

Results

The 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates after resection were 96.0%, 70.4%, and 29.4%, respectively, and 56.0%, 22.3%, and 11.1%, respectively. Five patients survived for more than 5 years after surgery, and no mortality has occurred within 30 days after resection. Univariate analysis revealed that patients with multiple hepatic metastases suffered poorer OS (P = 0.026) and RFS (P = 0.035) than those with solitary hepatic metastasis. Postoperative adjuvant chemotherapy was a significant indicator of a favourable OS (P = 0.022). Number of metastatic lesions remained significant in the multivariate analysis of OS and RFS (P = 0.039, P = 0.049, respectively). None of variables of the primary lesion was a significant prognostic factor for those patients.

Conclusions

Gastric cancer patients with a solitary synchronous liver metastasis may be good candidates for hepatic resection. Postoperative adjuvant chemotherapy may provide a benefit by aiding in OS.     

Successful empirical erlotinib treatment of a mechanically ventilated patient newly diagnosed with metastatic lung adenocarcinoma

Background

Lung cancer is the most common solid tumor in critically ill cancer patients who are admitted to intensive care units (ICUs). An ICU trial consists of unlimited ICU support for a limited time period.

Case report

We present the case of a 60-year-old woman with newly diagnosed metastatic lung adenocarcinoma who required mechanical ventilation due to respiratory failure. Empirical erlotinib treatment was administered through a nasogastric feeding tube as part of an ICU trial, which led to a dramatic and durable response.

Conclusion

Empirical erlotinib should be considered when epidermal growth factor receptor (EGFR) mutations are suspected in ICU newly diagnosed patients with lung adenocarcinoma.     

CT引导Hookwire定位下电视胸腔镜手术对孤立性肺小结节的诊疗价值

背景与目的：临床检查发现,孤立性肺小结节(solitary pulmonary nodule,SPN)包含了相当一部分的早期肺癌。本研究探讨CT引导Hookwire定位下胸腔镜手术对于SPN的诊疗价值。方法：从2011年7月至2013年6月,复旦大学附属肿瘤医院胸外科收治的SPN患者310例,CT引导下留置Hookwire定位针,行胸腔镜(video assisted thoracic surgery,VATS)肺楔形切除,根据术中冰冻病理结果决定进一步治疗方式。统计定位准确率、并发症发生率、VATS 肺楔形切除手术成功率、中转开胸率以及SPN病理分型等。结果：Hookwire定位成功率为100%,咯血2例需要处理,术中Hookwire脱落12例(3.87%),VATS肺楔形切除手术成功率为99.0%,中转开胸3例。SPN术后组织学病理结果: 原发性肺癌237例,良性病变73例。结论：采用CT引导Hookwire定位下VATS手术的方法治疗微小SPN,诊断准确率高、疗效可靠,并发症少,具有很好的临床推广价值。     

Local treatment of oligometastatic recurrence in patients with resected non-small cell lung cancer

Objectives

We previously reported a retrospective study indicating the prognostic impact of the local treatment of oligometastatic recurrence after a complete resection for non-small cell lung cancer (NSCLC). In the present study, we prospectively observed postoperative oligometastatic patients and investigated the effects of local treatment on progression-free survival (PFS).

Methods

Using a prospectively maintained database of patients with completely resected NSCLC treated between October 2007 and December 2011, we identified 52 consecutive patients with postoperative recurrence, excluding second primary lung cancer. Of these patients, 31 suffering from distant metastases alone without primary site recurrence were included in this study. According to the definition of ‘oligometastases’ as a limited number of distant metastases ranging from one to three, 17 patients had oligometastatic disease. Of those 17 patients, four patients with only brain metastasis were excluded from the analysis.

Results

The oligometastatic sites included the lungs in five patients, bone in four patients, the lungs and brain in two patients, the adrenal glands in one patient and soft tissue in one patient. Eleven of the 13 patients first received local treatment. Three patients (lung, adrenal gland, soft tissue) underwent surgical resection, and the remaining eight patients received radiotherapy. The median PFS was 20 months in the oligometastatic patients who received local treatment. There were five patients with a PFS of longer than two years. The metastatic sites in these patients varied, and one patient had three lesions. On the other hand, the two remaining patients first received a systemic chemotherapy of their own selection. The PFS of these two patients was five and 15 months, respectively.

Conclusion

Local therapy is a choice for first-line treatment in patients with postoperative oligometastatic recurrence.     

An assessment of diagnostic performance of a filter-based antibody-independent peripheral blood circulating tumour cell capture paired with cytomorphologic criteria for the diagnosis of cancer

Objectives

Circulating tumour cells (CTCs) are reported to be predictive for prognosis and response to treatment in advanced lung cancer. However, the clinical utility of the CTCs detection remains unknown for early stage lung cancer as the number of CTCs is reported as low, providing challenges in identification. We have evaluated diagnostic performance of filtration-based technology using cytomorphologic criteria in patients undergoing surgery for lung cancer.

Material and methods

We processed blood from 76 patients undergoing surgery for known or suspected lung cancer using ScreenCell^® Cyto filter devices. Captured cells were stained using haematoxylin and eosin and independently assessed by two pathologists for the presence of atypical cells suspicious for cancer. Diagnostic performance was evaluated against pathologist reported diagnoses of cancer from surgically obtained specimens.

Results

Cancer was diagnosed in 57 patients (77.0%), including 32 with primary lung cancer (56.1%). The proportion of patients with early stage primary lung cancer in which CTCs were identified was 18 and 21 (56.3% and 65.6%, respectively) as reported by two pathologists. The agreement between the pathologists was 77.0% corresponding to a kappa-statistic of 53.7% indicating moderate agreement. No significant differences were found for the percentage of CTCs for primary and metastatic cancer as well as for cancer stages. On sensitivity weighted analysis, a sensitivity and specificity were 71.9% (95% CI 60.5–83.0) and 52.9% (95% CI 31.1–77.0), respectively. On specificity weighted analysis, a sensitivity and specificity were 50.9% (95% CI 39.3–64.4) and 82.4% (60.4–96.2), respectively.

Conclusion

The performance of the tested filter-based antibody-independent technology to capture CTCs using standard cytomorphologic criteria provides the potential of a diagnostic blood test for lung cancer.     

血清血管内皮生长因子在孤立性肺结节鉴别诊断中的价值

目的　检测血清血管内皮生长因子 (S VEGF)水平 ,探讨肺部孤立性结节良恶性的鉴别诊断价值。方法　采用酶联免疫吸附法 (ELISA)对 6 8例孤立性肺结节患者和 2 0例健康人的S VEGF进行测定 ,观察恶性结节 (肺癌组 )、良性结节和健康人之间S VEGF水平的差异。 6 8名患者均于术后获得病理诊断。结果　健康人S VEGF水平的中位数为 4 2 .5 (10～ 170 )pg/ml,良性结节为 4 4 .0 (18～36 0 )pg/ml,肺癌为 75 .0 (18～ 890 )pg/ml。肺癌组与健康对照组的S VEGF水平差异有显著性 (P <0 .0 1) ;与良性结节组的差异亦有显著性 (P <0 .0 5 ) ;而良性结节组与健康对照组的S VEGF水平差异无显著性 (P >0 .0 5 )。腺癌和鳞癌患者的S VEGF水平差异无显著性 (P >0 .0 5 )。结论　在孤立性肺结节患者中 ,肺癌患者的S VEGF水平明显高于良性结节患者和健康人 ,高水平 (>10 0pg/ml)的S VEGF提示病灶为肺癌的可能性大 ,可考虑手术治疗。     

The characteristics and failure pattern of gefitinib responders with postoperative recurrence of pulmonary adenocarcinoma

Aims

Gefitinib shows prominent anti-tumor activity against advanced or recurrent non-small cell lung cancer (NSCLC). However, most gefitinib-responsive patients ultimately relapse. We reviewed postoperatively recurrent NSCLC patients who received gefitinib treatment, and analyzed both the clinical features and manifestations of treatment failure in patients who initially responded to gefitinib.

Methods

From 2002 to 2006, gefitinib was administered to in 34 postoperative recurrent lung adenocarcinoma patients. There were 13 men and 21 women with a mean age of 65 years. Twenty patients had never smoked while 14 were former smokers. Epidermal growth factor receptor (EGFR) gene mutation was measured using surgical specimens of the primary tumor.

Results

The study group showed 1 complete response, 16 partial responses, 7 stable diseases and 8 progressive diseases. Mutations of EGFR gene were detected in 20 of 34 patients. Only the presence of EGFR gene mutations was significantly associated with the clinical response of gefitinib in our limited study (p = 0.036). In 9 of 12 responders, gefitinib treatment failed due to the appearance of new lesions.

Conclusions

Gefitinib was significantly effective for patients with mutations of the EGFR gene and most responders failed due to the appearance of new lesions without progression of the pre-existent target lesions.     

Solid pseudopapillary tumor of the pancreas with liver metastasis: Clinical features and management

Objective

To summarize the diagnosis and management of metastatic pancreatic solid pseudopapillary tumors (SPTs).

Methods

We retrospectively analyzed the clinical data of patients with metastatic pancreatic SPTs who were admitted to Peking Union Medical College Hospital from November 2001 to September 2013.

Results

A total of 187 patients with pancreatic SPTs were admitted. Four patients had liver metastasis, and all four were female patients aged 20–72 years old. Each patient with metastases underwent surgical resection with good postoperative recovery. The mean follow-up period was 30 months (range, 1–64 months). None of the patients had obvious recurrence or distant metastasis.

Conclusions

Pancreatic SPT with liver metastasis is very rare, and surgical resection is an effective treatment option. The principle of surgical treatment is to resect the primary and metastatic lesions as completely as possible. The affected patients require long-term postoperative follow-up.     

Thromboembolism in lung cancer – An area of urgent unmet need

Introduction

Thromboembolism is common in lung cancer. Current thromboprophylaxis guidelines lack specific recommendations for appropriate strategies in this high thrombotic risk patient cohort. We profiled lung cancer patients receiving anti-cancer therapy. Thromboembolism incidence and thromboembolism-related mortality rates are reported and we explored patient, disease, and treatment-related risk factors associated with higher thrombotic rates.

Methods

Retrospective review of lung cancer patients referred to a Comprehensive Cancer Centre between 01/07/2011 and 30/06/2012 for anti-cancer therapy. Data were collected from medical, pharmacy, pathology and diagnostic imaging electronic records.

Results

After a median follow up of 10 months (range: 0.03–32 months), 24/222 patients (10.8%) had developed radiologically confirmed thromboembolism; 131 events per 1000 person-years (95%CI 87–195). Thromboembolism occurred equally in patients with non-small cell and small cell lung cancer (10.8% and 10.5% respectively), and more frequently among patients with adenocarcinoma compared to squamous cell carcinoma (14.7% and 5.3% respectively). Chemotherapy-treated patients experienced thromboembolism more often than patients who did not receive chemotherapy (HR 5.7 95%CI 2.2–14.8). Radiotherapy was also associated with more frequent thromboembolism (HR 5.2 95%CI 2.0–13.2). New lung cancer diagnosis, presence of metastatic disease, second primary malignancy and Charlson Index ≥5 were also associated with higher rates of thromboembolism. Importantly, pharmacological thromboprophylaxis (P-TP) was not routinely or systematically prescribed for ambulant lung cancer patients during any treatment phase, at this institution. The majority (83%) of thromboembolic events occurred in the ambulatory care setting.

Conclusion

Morbidity and mortality from thromboembolism occurs frequently in lung cancer. Thromboprophylaxis guidelines should be developed for the ambulatory care setting.     

The accuracy of sentinel node biopsy in breast cancer patients with the history of previous surgical biopsy of the primary lesion: systematic review and meta-analysis of the literature

Background

One of the subjects under debate in sentinel node mapping is the eligibility of patients with the history of previous surgical biopsy of the primary lesion for sentinel node biopsy. In the current systematic review, we evaluated the false negative and detection rates of sentinel node biopsy in breast cancer patients with and without previous surgical manipulation of the primary breast lesions.

Methods

Pubmed, SCOPUS, and Google scholar were searched for any relevant study with head to head comparison of patients with and without history of previous surgical manipulation of the primary breast lesions. The outcomes of interest were detection and false negative rates in each group, and odds ratio as well as risk difference of having sentinel node detection failure or getting false negative results in the surgical biopsy compared to the non-surgical biopsy group.

Results

18 studies for false negative rate and 68 studies for detection rate evaluation were included in this review. Pooled detection rates for patients with and without previous surgical biopsy were 91.3% and 92.8%. Odds ratio and risk difference of having detection failure during surgery were 1.16 and 0.002 respectively. Pooled false negative rates for patients with and without previous surgical biopsy were 12.3% and 9.9%. Odds ratio and risk difference of having false negative results were 1.4 and 0.02 respectively.

Conclusion

Surgical biopsy of the primary breast malignant lesions does not affect the detection rate of sentinel lymph node biopsy procedure. However, false negative rate seems to be slightly higher. We believe that the advantages of sentinel node biopsy outweigh this small difference.     

Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases

Aims

Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy.

Methods

Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data.

Results

Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2–10) days for the pulmonary and 7 (1–23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8–87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%.

Conclusion

We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.     

Identification of EGFR mutations in esophageal cancer

Background

It is well known that the prognosis for esophageal cancer is worse than for other digestive cancers in spite of multimodality treatment, and there is an urgent need to improve this situation. The epidermal growth factor receptor (EGFR) inhibitor, gefitinib, was approved in Japan to treat advanced non-small cell lung cancer patients and several papers have since reported that the successfully treated patients had genetic mutations in EGFR.

Purpose

The aim of this study was to investigate the existence of EGFR mutations in esophageal cancer cell lines and primary lesions, and also to explore the possibility of treating esophageal cancer using gefitinib.

Materials and Methods

Nineteen esophageal cancer cell lines were cultured and DNA was extracted using an ultracentrifugation method. Fifty cases of primary cancer and corresponding normal tissue samples were obtained and DNA was extracted using the same protocol. Nested PCR and DNA sequencing targeting exons 18, 19, 20 and 21 of EGFR were performed to investigate the presence of mutations in esophageal cancer cell lines and primary tumors.

Results

Three of the 19 cell lines had the same silent mutation at nucleotide 2607, a G-to-A substitution in exon 20. One of the 50 patients had an EGFR mutation in codon 719, resulting in an amino acid substitution from glycine to aspartic acid.

Conclusion

EGFR mutations in esophageal carcinoma are rare but do exist, and thus gefitinib could be included in esophageal cancer treatment regimens by selecting those patients who possess such mutations.