***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The survival rate associated with esophageal cancer is very poor due to diagnosis at advanced stages of disease and insensitivity to chemotherapy . This study investigated the efficacy of gefitinib combination with radiation in 20 elderly patients with esophageal squamous cell carcinoma ( ESCC ) who were not eligible for platinum-based chemotherapy .  Immunohistochemistry was performed to analyze epidermal growth factor receptor ( EGFR ) expression , and the amplified refractory mutation system was used to detect EGFR mutations . Treatment response was assessed by endoscopy and computed tomography . Treatment toxicity  was evaluated using the National Cancer Institute 's Common Toxicity Criteria . The data showed that among these 20 patients , 5 experienced a complete response ( CR ) , 13 a partial response ( PR ) , and 2 had stable disease . The overall response rate ( CR + PR ) was 90 % , the median overall survival ( OS ) was 14.0 months ( 95 % confidence interval [ CI ] : 10.0–17.9 months ) , and the median progression-free survival was 7.0 months ( 95 % CI : 0–17.2 months ) . Patients with good Eastern Cooperative Oncology Group performance status , never smoking , and EGFR mutated tumors had the best OS ( 14.0 , 14.0 , and 17.0 months , respectively ) . Treatment-related grade 3/4 toxicity occurred in five patients . No case of grade 3/4 impaired liver function or hematological toxicity was observed . Concurrent radiotherapy with gefitinib is effective and tolerable in elderly ESCC patients Cisplatin-based concurrent chemoradiotherapy for patients with unresectable , locally advanced esophageal squamous cell carcinoma ( ESCC ) is associated with significant toxicities that are often intolerable . Prognosis for this subgroup of patients remains poor , and new therapeutic approaches are urgently needed . We investigated the efficacy and safety  of paclitaxel combined with erlotinib and concurrent radiotherapy in patients with inoperable ESCC .  Erlotinib ( 150 mg ) was administered daily for 60 days beginning at the start of radiotherapy , and paclitaxel ( 45 mg/m² ) was administered weekly along with intensity modulated conformal radiotherapy ( 60 Gy in 30 fractions ) . The median follow-up time was 21 months . The associations between EGFR and VEGF expression and treatment outcome were evaluated . Among the 21 patients treated , the overall response rate ( CR + PR ) was 85.6 % . The median LPFS , PFS and OS were : 17.5 , 14.3 , and 22.9 months , respectively . Treatment-related grade 3 toxicities included esophagitis ( two patients ) and hypoleukemia ( one patient ) . Grade 4 pulmonary toxicity was observed in one patient . Patients expressing EGFR had longer PFS , while those expressing VEGF or with a history of smoking had worse outcomes . Weekly paclitaxel combined with erlotinib and concurrent radiotherapy shows promise as an effective , tolerated regimen for patients with inoperable ESCC The utilisation of antitumour T cells induced by cancer vaccination with HER-2 peptides or antibodies ( Herceptin ) against HER-2 , as immunotherapy for oesophageal cancer , is a novel and attractive approach . It is important to clarify the frequencies of HER-2 expression and gene amplification in patients with oesophageal squamous cell carcinoma ( SCC ) and to evaluate the relationship between HER-2 status and HLA haplotype , since the c and i date s for HER-2 peptide-based vaccination are restricted to a certain HLA haplotype . We determined the frequency of HER-2 expression using the HercepTest ™ for immunohistochemistry and HER-2 gene amplification by fluorescence in situ hybridisation ( FISH ) assay in oesophageal SCC ( n=66 ) . HER-2-positive tumours ( 1+/2+/3 + ) analysed by a HercepTest were observed in 30.3 % of all the patients and HER-2 gene amplification evaluated by FISH was observed in 11.0 % of all the patients , in which all HercepTest ( 3 + ) tumours were found to have gene amplification and three of six moderately positive ( 2 + ) tumours showed gene amplification . Furthermore , HER-2-positive cells were present more diffusely and were larger within each tumour in the patients who were HercepTest 3 + than those who were HercepTest 1 + . Moreover , the survival rate in HER-2-positive group was significantly worse than that in HER-2-negative group . Also , the survival rate in the patients with HER-2 gene amplification was significantly worse than that without HER-2 gene amplification . In addition , oesophageal SCC patients with both HLA-A24-positive and HER-2-positive tumours ( 1+/2+/3 + ) accounted for 26 % of these cases , and both HLA-A2- and HER-2-positive tumours accounted for 18 % of them BACKGROUND Our previous study indicated the survival rate for esophageal squamous cell cancer ( ESCC ) patients in stage III and positive lymph node groups with  postoperative radiation therapy was significantly increased compared with surgery alone . But a predictive biomarker was needed to identify the patients who would benefit from postoperative radiotherapy . This study aims to evaluate epidermal growth factor receptor ( EGFR ) as an indicator to predict the prognosis of ESCC and to identify the patients who would benefit from  postoperative radiotherapy . METHODS Tissue sample s were collected from our previous r and omized study : 243 in the surgery alone group and 198 in the surgery plus radiotherapy group .  Expression of EGFR was analyzed by immunohistochemical staining . RESULTS The expression of EGFR is correlated with depth of tumor invasion ( p=0.005 ) , lymph node metastasis ( p<0.001 ) , and pathologic stage ( p<0.001 ) . The survival rate of patients with high  EGFR expression is significantly lower than that of patients with low EGFR expression ( p=0.000 ) . Notably , in stage IIA cases , the 5-year survival rate is 57.6 % in the low EGFR expression group and 36.6 % in the high expression group ( p=0.020 ) . EGFR is one of the independent variants that influence the prognosis . Moreover , for high EGFR expression patients the survival rate of the surgery plus radiotherapy group is higher than that of the surgery alone group ( p=0.034 ) . CONCLUSIONS Expression of EGFR can be a prognostic predictor for ESCC . Patients with high expression of EGFR may benefit from postoperative radiation therapy PURPOSE We have previously shown that loss of BAX expression is a negative prognostic factor in metastatic colorectal cancer . In the present study , we addressed the prognostic relevance of BAX and its upstream regulator p53 in squamous cell carcinoma ( SCC ) of the esophagus . Analysis of p16(ink4a/CDKN2 ) was included because p16(ink4a/CDKN2 ) and p53 were shown previously to cooperate during induction of cell cycle arrest and apoptosis . PATIENTS AND METHODS Retrospective analysis of 53 patients with curative intended R0 resection of esophageal SCC was done .  Protein expression of BAX , p53 , and p16(ink4a/CDKN2 )  was investigated by immunohistochemistry . In addition , tumor DNA was screened for BAX frameshift mutations by fragment length analysis and for p53 mutations by single-str and conformation polymorphism-polymerase chain reaction . RESULTS Overall median survival was 13.7 months . Patients with high BAX protein expression had a median survival of 19.5 months versus 8.0 months with low BAX expression ( P < .005 ) . High p16(ink4a/CDKN2 ) protein expression was associated with a median survival of 23.8 months versus 9.7 months with low p16(ink4a/CDKN2 ) ( P = .011 ) . The best survival ( median , 45.8 months ) was seen in a subgroup of 12 patients whose tumors bore the combination of both favorite phenotypes ( ie , high BAX and high p16(ink4a/CDKN2 ) protein expression ) . CONCLUSION In this retrospective investigation , the combined analysis of BAX and p16(ink4a/CDKN2 ) shows subgroups in SCC of the esophagus with favorable ( p16(ink4a/CDKN2)/BAX high expressing ) or poor prognosis ( loss of p16(ink4a/CDKN2)/loss of BAX ) . We suggest that such a multimarker analysis of apoptosis pathways could be useful for individualization of therapeutic strategies in the future , and suggest prospect i ve studies to confirm these results This study investigated cetuximab added to definitive concurrent chemoradiation for esophageal squamous cell carcinoma ( ESCC ) . Previously untreated patients with stage II – IVa ESCC received cetuximab ( 400 mg/m2 per week in week 1 , then 250 mg/m2 per week during weeks 2–8 ) , paclitaxel ( 45 mg/m2 per week ) and cisplatin ( 20 mg/m2 per week ) in weeks 2–8 with 59.4 Gy radiotherapy . Epidermal growth factor receptor ( EGFR ) status in tumor specimens was assessed . Thirty‐one patients were enrolled and evaluated  for toxicity . Of the 29 patients assessable for a response , 20 ( 69.0 % ) had a clinical complete response ( CR ) . Over a median follow up of 23.6 months , disease progression was observed in seven patients . The 1‐ and 2‐year progression‐free survival ( PFS ) rates were 85.5 % and 75.1 % , respectively . The PFS was shorter for patients with lymphatic metastatic disease than for those with locally confined tumor ; the 1‐year PFS rates were 78.7 % and 92.3 % , respectively ( P = 0.038 ) . Sixteen ( 55.2 % ) patients were immunohistochemically positive for EGFR . The patients with EGFR‐expressing tumor had a CR rate of 75.0 % compared with 61.5 % in those with negative EGFR expression ( P = 0.024 ) . The PFS for patients with EGFR‐expressing tumor was longer compared with the PFS of patients with negative EGFR ( P = 0.133 ) . The patients with prominent cetuximab‐induced rash ( ≥ grade 2 ) had a better CR rate and PFS than those with no or grade 1 rash ( P < 0.05 ) . The rates of grade s 3/4 esophagitis , hematological and dermatological toxicities were 9.7 % , 29.0 % and 16.1 % , respectively . The regimen of definitive chemoradiation plus cetuximab achieved good clinical response and has an acceptable safety profile in Chinese ESCC patients Esophageal carcinoma is one of the most prevalent malignancies in China . Surgical treatment remains to be important in the treatment for esophageal carcinoma . However , controversies exist in the surgical treatment for esophageal carcinoma including selection of appropriate surgical approach , extent of lymph node dissection , and optimization of minimally invasive esophagectomy processes and make it comparable to the open esophagectomy . All above disputed issues will be resolved through multi-center r and omized controlled studies using clinical research network platform in the future . The clinical evidence s produced by these studies will be used for revision of guidelines for esophageal carcinoma Introduction The esophageal squamous cell carcinoma ( ESCC ) is the predominant pathological type and accounts for more than 80 % of esophageal cancer in China . The successful use of anti-epidermal growth factor receptor ( EGFR ) treatment in head and neck squamous cell carcinoma provides the rationale for introducing anti-EGFR targeting treatment in ESCC . One of our prospect i ve phase II clinical trials analyzed the efficacy of nimotuzumab , an anti-EGFR agent , combined with chemotherapy ( paclitaxel and cisplatin ) to treat unresectable ESCC . Material s and methods We analyzed the correlation of the clinical response with EGFR expression by immunohistochemical staining ( IHC ) . Results Totally 55 tumor sample s were analyzed . 18/55 ( 32.7 % ) cases were with high EGFR expression while the other 37/55 ( 67.3 % ) cases were with low to moderate EGFR expression . The expression of EGFR was not related to gender , age , tumor location , tumor differentiation and clinical stage of disease . The objective response rate ( ORR ) in high EGFR expression group was 55.6 % ( 10/18 ) while that in low to moderate EGFR expression group was 54.1 % ( 20/37 ) ( P = 0.57 ) . Both the progression-free survival ( PFS ) and overall survival ( OS ) in high EGFR expression group were much shorter than those in low to moderate EGFR expression group ( PFS : 5.8 ± 0.5 vs. 11.0 ± 2.8 months , P = 0.007 ; OS : 9.7 ± 0.5 vs. 21.5 ± 1.5 months , P = 0.03 ) . Con 
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ConclusionS trong evidence supports that these 11 emerging IHC markers or their combinations may be useful in predicting prognosis and aiding personalized therapy decision-making for ESCC patients