Cis-platinum is a widely used cytotoxic agent with known radiosensitising properties. It is used in the treatment of various types of lung cancer that may include radiation to the lung as part of the treatment protocol. There is little evidence and some conflict as to whether it sensitises pulmonary tissue to the effects of radiation treatment. This project investigates the effect of cis-platinum alone or in combination with radiation on mouse lung. Four end points were used to evaluate treatments. They were: the release of pulmonary surfactant, changes in breathing rate, a histology based score of damage and changes in TGF-β - a cytokine important in the development of fibrosis. Single doses of either cis-platinum or radiation, cis-platinum given immediately before a single dose of radiation, cis-platinum given immediately before the first of two fractions of radiation and cis-platinum given at various times before and after a single dose of radiation were investigated. Cis-platinum alone was observed to cause an increase in the phospholipid content of lavaged surfactant. Cis-platinum was observed to cause an early release in surfactant and a trend existed for it to induce an early increase in breathing rates as compared to that induced by radiation alone. Cis-platinum was observed to increase radiation damage as assessed using a histology based scoring system. Higher TGF-β levels in lavaged surfactant were observed in C57 /Bl mice as compared to Balb/C. No difference in TGF-β levels was seen in homogenised lung between the strains. Cis-platinum may cause changes in TGF-β in C57/Bl mice but further work is necessary to confirm this.

by Chung Lung Ying. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 149-157). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abbreviations --- p.ii / Abstracts --- p.v / List of figures --- p.ix / List of tables --- p.xii / Contents --- p.xiii / Contents / General Introduction --- p.1 / Chapter CHAPTER ONE --- CISPLATIN RESISTANCE MECHANISMS / Chapter 1.1 --- INTRODUCTION --- p.3 / Chapter 1.1.1 --- History of Cisplatin as An Anticancer Drug --- p.3 / Chapter 1.1.2 --- Active Mechanisms of Cisplatin --- p.8 / Chapter 1.1.3 --- Formation of DNA Adducts --- p.8 / Chapter 1.1.4 --- Cisplatin Resistance Mechanisms --- p.9 / Chapter 1.1.4.1 --- Intracellular Accumulation of Cisplatin --- p.11 / Chapter 1.1.4.2 --- Glutathione-S-transferase and Glutathion --- p.12 / Chapter 1.1.4.3 --- Metallothionein --- p.16 / Chapter 1.1.4.4 --- Cell Cycle Perturbation --- p.16 / Chapter 1.1.4.5 --- P-glycoprotein --- p.17 / Chapter 1.1.4.6 --- Multidrug Resistant Protein --- p.19 / Chapter 1.1.4.7 --- Topoisomerase II --- p.20 / Chapter 1.1.4.8 --- DNA Repair --- p.22 / Chapter 1.1.4.9 --- Induction of Programme Cell Death --- p.23 / Chapter 1.2 --- OBJECTIVES --- p.27 / Chapter 1.3 --- MATERIALS AND METHODS / Chapter 1.3.1 --- Materials --- p.28 / Chapter 1.3.2 --- Methods --- p.31 / Chapter 1.3.2.1 --- Cell Lines --- p.31 / Chapter 1.3.2.2 --- Drug Sensitivity Assay --- p.31 / Chapter 1.3.2.3 --- Platinum Uptake --- p.32 / Chapter 1.3.2.4 --- Cell Cycle Analysis --- p.32 / Chapter 1.3.2.5 --- Western Blot Analysis --- p.33 / Chapter 1.3.2.6 --- Glutathione Content Determination --- p.36 / Chapter 1.3.2.7 --- DNA Fragmentation --- p.36 / Chapter 1.3.2.8 --- JC-1 Staining --- p.37 / Chapter 1.3.2.9 --- HE and DCF Staining --- p.38 / Chapter 1.3.2.10 --- Quantitative RT-PCR --- p.38 / Chapter 1.4 --- RESULTS / Chapter 1.4.1 --- Cisplatin Sensitivity of A431 Cells by MTT Assay --- p.40 / Chapter 1.4.2 --- Cross-resistance to Anti-cancer Drugs --- p.40 / Chapter 1.4.3 --- Quantitation of Cisplatin Accumulation in A431 Cells by AAS --- p.44 / Chapter 1.4.4 --- Drug Detoxification Agent --- p.45 / Chapter 1.4.5 --- Detection of Cell Cycle Arrest by Flow Cytometer --- p.47 / Chapter 1.4.6 --- Expression of Drug Resistance Related Genes --- p.48 / Chapter 1.4.7 --- Detection of Apoptosis by DNA Fragmentation --- p.50 / Chapter 1.4.8 --- Role of Mitochondria and Reactive Oxygen Species by Flow Cytometer --- p.52 / Chapter 1.4.9 --- Detection of Apoptotic mRNA Level by Quantitative RT-PCR --- p.57 / Chapter 1.4.10 --- Detection of Apoptotic Protein Level by Western Blot Analysis --- p.57 / Chapter 1.5 --- DISCUSSIONS --- p.59 / Chapter CHAPTER TWO: --- THE INTERACTION BETWEEN DRUG RESISTANCE MECHANISMS AND GROWTH FACTOR SIGNALLING PATHWAY / Chapter 2.1 --- INTRODUCTION --- p.63 / Chapter 2.1.1 --- Structure of EGF and EGFR --- p.64 / Chapter 2.1.2 --- Growth Factor Signal Transduction Pathway --- p.69 / Chapter 2.1.3 --- Biological Effect of EGF --- p.69 / Chapter 2.1.3.1 --- Modification of Drug Sensitivity by EGF --- p.71 / Chapter 2.2 --- OBJECTIVES --- p.74 / Chapter 2.3 --- MATERIALS AND METHODS / Chapter 2.3.1 --- Materials --- p.75 / Chapter 2.3.2 --- Methods / Chapter 2.3.2.1 --- Cell Lines --- p.76 / Chapter 2.3.2.2 --- Drug Sensitivity Assay --- p.77 / Chapter 2.3.2.3 --- Northern Blot Analysis --- p.77 / Chapter 2.3.2.4 --- Southern Blot Analysis --- p.78 / Chapter 2.3.2.5 --- Others --- p.78 / Chapter 2.4 --- RESULTS / Chapter 2.4.1 --- Sensitivity to EGF --- p.79 / Chapter 2.4.2 --- EGFR Expression Levels --- p.80 / Chapter 2.4.3 --- EGF Induced Protein Phosphorylation Pattern --- p.84 / Chapter 2.4.4 --- Effect of EGF on A431 Cells --- p.86 / Chapter 2.4.5 --- Response of Cells to Agents Targeting on EGF Signalling Pathway --- p.91 / Chapter 2.4.6 --- Response of Cells to Other Growth Factors --- p.97 / Chapter 2.4.7 --- Sensitivity of Cells to Different Anti-cancer Drugs --- p.99 / Chapter 2.4.8 --- Drug Resistance Mechanisms --- p.103 / Chapter 2.4.9 --- 5-Fluorouracil Sensitivity in A431 Cells --- p.108 / Chapter 2.4.10 --- Cisplatin Sensitivity in A431 Cells --- p.113 / Chapter 2.5 --- DISCUSSIONS --- p.117 / Chapter CHAPTER THREE: --- IDENTIFICATION OF DIFFERENTIALLY EXPRESSED GENE IN A431 CELLS BY DIFFERENTIAL DISPLAY / Chapter 3.1 --- INTRODUCTION --- p.122 / Chapter 3.2 --- MATERIALS AND METHODS / Chapter 3.2.1 --- Materials --- p.128 / Chapter 3.2.2 --- Methods / Chapter 3.2.2.1 --- Identification of Differentially Expressed Genes by RT-PCR / Chapter 3.2.2.2 --- Cloning of a Differentially Expressed cDNAs --- p.129 / Chapter 3.2.2.3 --- Screening and Sequencing of cDNA Inserts --- p.130 / Chapter 3.2.2.4 --- Rapid Amplification of cDNA Ends (RACE) --- p.131 / Chapter 3.2.2.5 --- Amplifcation Reaction --- p.131 / Chapter 3.2.2.6 --- Cloning and Sequencing of the RACE Fragment --- p.132 / Chapter 3.3 --- RESULTS / Chapter 3.3.1 --- Identification of novel cDNA by mRNA differential display --- p.133 / Chapter 3.4 --- DISCUSSIONS --- p.145 / General Conclusion --- p.147 / References --- p.149

Platinum(II) anticancer medications essentially react with DNA forming kinks inthe double helix of DNA and causing apoptosis. It has also been noted that theseanticancer medications react with methionine and cysteine in the body. With the new discoveries of selenium containing amino acids including selenomethionine and selenocysteine, new research is ongoing to see what types of products can be formed from these amino acids. Our research reacts [Pt(Met-S,N)Cl2] 2+ with selenomethionine to determine what types of products are produced. Monochelates including [Pt(SeMet-Se,N)Cl2] 2+ have formed two isomers, as well as other products that insinuate both selenomethionine and methionine binding with the platinum to form various [Pt(SeMet- Se,N)(Met-S,N)]2+ products. When initially reacting 6 mM [Pt(Met-S,N)Cl2] 2+ with 3 mM SeMet, the monochelates of both are produced without forming any free methionine which would suggest that there is free platinum in our solution creating the SeMet monochelate. When adding additional SeMet to the solution the same products are formed that are created when reacting 6 mM [Pt(Met-S,N)Cl2] 2+ and 6 mM SeMet. The 1H NMR spectrum for these products imply a product of [Pt(SeMet-Se,N)(Met-S,N)] 2+. Also, reactions with [Pt(en)(ox)] 2+ and SeMet were conducted and produced various products at two different pH’s. A [Pt(SeMet-Se,N2] 2+ product was formed at lower pH and produced free ethylenediamine, however at a higher pH only [Pt(en)(SeMet-Se,N)]2+ was produced.

AQ4N (banoxantrone) is a prodrug that, under hypoxic conditions, is enzymatically converted to a cytotoxic DNA-binding agent, AQ4. Incorporation of AQ4N into conventional chemoradiation protocols therefore targets both oxygenated and hypoxic regions of tumors, and potentially will increase the effectiveness of therapy. This current pharmacodynamic and efficacy study was designed to quantify tumor exposure to AQ4 following treatment with AQ4N, and to relate exposure to outcome of treatment. A single dose of 60 mg/kg AQ4N enhanced the response of RT112 (bladder) and Calu-6 (lung) xenografts to treatment with cisplatin and radiation therapy. AQ4N was also given to separate cohorts of tumor-bearing mice 24 hours before tumor excision for subsequent analysis of metabolite levels. AQ4 was detected by high performance liquid chromatography/mass spectrometry in all treated samples of RT112 and Calu-6 tumors at mean concentrations of 0.23 and 1.07 microg/g, respectively. These concentrations are comparable with those shown to be cytotoxic in vitro. AQ4-related nuclear fluorescence was observed in all treated tumors by confocal microscopy, which correlated with the high performance liquid chromatography/mass spectrometry data. The presence of the hypoxic marker Glut-1 was shown by immunohistochemistry in both Calu-6 tumors and RT112 tumors, and colocalization of AQ4 fluorescence and Glut-1 staining strongly suggested that AQ4N was activated in these putatively hypoxic areas. This is the first demonstration that AQ4N will increase the efficacy of chemoradiotherapy in preclinical models; the intratumoral levels of AQ4 found in this study are comparable with tumor AQ4 levels found in a recent phase I clinical study, which suggests that these levels could be potentially therapeutic.

INTRODUÇÃO: Quimiorradioterapia (QRT) concomitante adjuvante aumenta a sobrevida livre de doença (SLD) em pacientes portadores de carcinoma epidermóide de cabeça e pescoço (CECCP) de alto risco operados com intenção curativa, porém está associada a toxicidade não desprezível e seu impacto na sobrevida global (SG) é incerto. ERCC1 (Excision Repair Cross Complementing Group 1) é uma proteína com função crítica no reparo de DNA por excisão de nucleotídeos (NER) e está envolvido na resistência à quimio- e radioterapia. Neste trabalho tivemos como objetivos determinar a expressão da proteína ERCC1, a expressão do RNA mensageiro (mRNA) de ERCC1 e a ocorrência do polimorfismo de nucleotídeo único T19007C de ERCC1 em pacientes portadores de CECCP de alto risco, operados e tratados com QRT adjuvante, bem como o valor prognóstico destes marcadores. MÉTODOS: Trata-se de um estudo retrospectivo em pacientes portadores de CEC de cavidade oral, orofaringe, hipofaringe ou laringe, operados com intenção curativa e portadores de doença de risco alto ou intermediário. Pacientes elegíveis haviam sido tratados com QRT adjuvante: 60-70 Gy e cisplatina concomitante (100 mg/m2, dias 1, 22 e 43), não apresentavam metástases a distância e nem sinais de recidiva após cirurgia. A expressão da proteína ERCC1 foi avaliada por imunohistoquímica, através de um escore H semiquantitativo, obtido pelo produto da intensidade da coloração nuclear (0-3) pelo escore proporcional atribuído à porcentagem estimada de núcleos corados (0;0,1;0,5;1). O método da transcrição reversa e reação em cadeia da polimerase (PCR) em tempo real quantitativo foi utilizado para determinação da expressão do mRNA de ERCC1 em tecido de tumor primário, normalizada em relação à expressão da fração 18S do RNA ribossomal. Genotipagem de ERCC1 (códon 118) foi realizada por PCR - polimorfismo do tamanho do fragmento de restrição a partir de DNA genômico extraído de linfonodos normais destes pacientes, após digestão com BsrDI. RESULTADOS: 69 pacientes com idade mediana de 56a, sendo 81% homens, foram estudados. Em relação à neoplasia, os sítios primários observados foram: cavidade oral (41%), laringe (32%), hipofaringe (16%) e orofaringe (12%), com estadio III 14% e estadio IV 86%, sendo pT3-pT4 78% e pN2-pN3 58%. Quarenta e três pacientes apresentaram-se com pelo menos dois linfonodos positivos, 27 com extravazamento extracapsular da metástase linfonodal e 18 com margens positivas. Achados de alto risco foram detectados em 40 pacientes (58%). No seguimento mediano de 47 meses, observou-se 11 recidivas loco-regionais, sete recidivas a distância, 10 casos com segundo tumor primário (sendo quatro com primário em pulmão e quatro em esôfago) e 30 óbitos (22 pela doença). A taxa de SG em 5 anos foi 40% e a taxa de SLD em 5 anos foi 31%. Escore H superior a 1,5 foi encontrado em 32 pacientes (54%), os quais apresentaram melhor taxa de sobrevida global em 5 anos (50% versus 18%, HR 0,43, 95%CI 0,20-0,90, p=0,026). Quinze pacientes (33%), dos 45 analisados, apresentaram elevada expressão do mRNA de ERCC1 (> 3,1) e estes pacientes tiveram melhor taxa de sobrevida global em 5 anos em comparação com aqueles com baixa expressão (86% versus 31%, HR 0,26, 95%CI 0,14-1,01, p=0,052). A distribuição dos genótipos de ERCC1 no códon 118 em 49 pacientes foi 39% C/T, 37% C/C, e 24% T/T. Não foi encontrada associação significativa entre idade, sexo, estadiamento e achados anatomopatológicos de risco, e os polimorfismos genéticos no códon 118 de ERCC1 ou a expressão do mRNA de ERCC1. Não houve diferença entre os genótipos C/C, C/T e T/T seja em termos taxa de sobrevida global em 5 anos (45%, 46%, 46%; p=0,808), seja em termos de taxa de sobrevida livre de doença em 5 anos (31%, 34%, 20%, p=0,770, respectivamente). O escore H (> 1,5 versus 1,5; HR ajustado 0,20, 95%CI 0,07-0,57, p=0,003) e a expressão normalizada do mRNA de ERCC1 (> 3,1 versus 3,1; HR ajustado 0,12, 95%CI 0,03-0,59, p=0,009), permaneceram significantes do ponto de vista estatístico, como fatores prognósticos na análise multivariada. CONCLUSÕES: Alta expressão imunohistoquímica da proteína ERCC1 e alta expressão do mRNA de ERCC1 conferem melhor prognóstico em pacientes portadores de CECCP operados de alto risco tratados com QRT adjuvante baseada em cisplatina. O polimorfismo genético T19007C de ERCC1 não apresentou valor prognóstico nestes pacientes. / BACKGROUND: Adjuvant concurrent chemoradiation (CRT) improves diseasefree survival (DFS) in patients diagnosed with head and neck squamous cell carcinoma (HNSCC) presenting with high-risk features treated with surgery with curative intent, but treatment-related toxicity is not negligible and its impact on overall survival (OS) is uncertain. ERCC1 (Excision Repair Cross Complementing Group 1) is a protein with a critical role in the nucleotide excision repair (NER) pathway, associated with resistance to chemo- and radiation therapy. We aimed here to study ERCC1 protein expression, ERCC1 messenger RNA (mRNA) expression and the single nucleotide polymorphism T19007C of ERCC1 as prognostic markers in HNSCC patients presenting with high-risk features treated with surgery and adjuvant CRT. METHODS: It is a retrospective study in patients with oral cavity, oropharynx, hypopharynx or larynx SCC submitted to radical surgery with curative intent and presenting with pathologic features of high- or intermediate-risk. Eligible patients were treated with adjuvant CRT: 60-70 Gy and concurrent cisplatin (100 mg/m2, days 1, 22 and 43), with no distant metastasis and no relapsed disease after surgery. ERCC1 protein expression was evaluated by immunohistochemistry, using a semi-quantitative H-score, calculated by multiplying the nuclear staining intensity (0-3) by the proportion score attributed to the percentage of positive tumor nuclei (0;0,1;0,5;1). Quantitative real-time reverse transcriptase polymerase chain reaction (PCR) assay was performed to determine ERCC1 mRNA expression in primary tumors tissue specimens. The ERCC1 mRNA expression was normalized using 18S fraction of ribosomal RNA expression as internal reference. ERCC1 (codon 118) genotypes were detected using PCR restriction fragment length polymorphism method carried out in genomic DNA extracted from normal lymph nodes. The PCR products were digested with BsrDI. RESULTS: 69 patients (median age 56 y, 81% male) were studied. Regarding tumor characteristics, primary sites were: oral cavity 41%, larynx 32%, hypopharynx 16%, oropharynx 12%, stage III 14%, stage IV 86%, pT3- pT4 78% and pN2-pN3 58%. Forty-three patients presented with two or more positive lymph nodes, 27 with extracapsular spread of nodal disease and 18 with positive margins. High-risk pathologic features were detected in 40 patients (58%). During the median follow-up of 47 months, we observed 11 locoregional relapses, seven distant relapses, 10 patients were diagnosed with secondary primary tumors (four in lungs and four in esophagus) and 30 deaths (22 disease-related). The 5-year overall survival rate was 40% and the 5-year disease-free survival rate was 31%. High H-score (> 1.5) was seen in 32 patients (54%), who presented better 5-year overall survival rate in comparison to those with lower H-scores (50% versus 18%, HR 0.43, 95%CI 0.20-0.90, p=0.026). Fifteen patients (out of 45, 33%) whose tumors presented normalized ERCC1 expression > 3.1 were classified as having high ERCC1 mRNA expression, and these patients presented better 5-year overall survival rate in comparison to those with lower ERCC1 mRNA expression (86% versus 30%, HR 0.26, 95%CI 0.14-1.01, p=0.052). Genotype distribution at ERCC1 codon 118 in 49 patients was 39% C/T, 37% C/C, and 24% T/T. No significant association was found between age, gender, stage, grading and pathological risk features and ERCC1 codon 118 genotypes or ERCC1 mRNA expression. No difference was detected among C/C, C/T and T/T genotypes, either in terms of 5-year overall survival rates (45%, 46%, 46%; p=0.808), or 5-year diseasefree survival rate (31%, 34%, 20%, p=0.770, respectively). H-score (> 1.5 versus 1.5; adjusted HR 0.20, 95%CI 0.07-0.57, p=0.003) and ERCC1 mRNA normalized expression (> 3.1 versus 3.1; adjusted HR 0.12, 95%CI 0.03-0.59, p=0.009), remained significant as favorable prognostic factors after adjusting for prognostic factors in a multivariate analysis. CONCLUSIONS: High immunohistochemical expression of ERCC1 protein and high ERCC1 mRNA expression, but not the T19007 single nucleotide polymorphism, were associated with better prognosis in HNSCC patients submitted to surgery and adjuvant cisplatin-based chemoradiation.

INTRODUÇÃO: Quimiorradioterapia (QRT) concomitante adjuvante aumenta a sobrevida livre de doença (SLD) em pacientes portadores de carcinoma epidermóide de cabeça e pescoço (CECCP) de alto risco operados com intenção curativa, porém está associada a toxicidade não desprezível e seu impacto na sobrevida global (SG) é incerto. ERCC1 (Excision Repair Cross Complementing Group 1) é uma proteína com função crítica no reparo de DNA por excisão de nucleotídeos (NER) e está envolvido na resistência à quimio- e radioterapia. Neste trabalho tivemos como objetivos determinar a expressão da proteína ERCC1, a expressão do RNA mensageiro (mRNA) de ERCC1 e a ocorrência do polimorfismo de nucleotídeo único T19007C de ERCC1 em pacientes portadores de CECCP de alto risco, operados e tratados com QRT adjuvante, bem como o valor prognóstico destes marcadores. MÉTODOS: Trata-se de um estudo retrospectivo em pacientes portadores de CEC de cavidade oral, orofaringe, hipofaringe ou laringe, operados com intenção curativa e portadores de doença de risco alto ou intermediário. Pacientes elegíveis haviam sido tratados com QRT adjuvante: 60-70 Gy e cisplatina concomitante (100 mg/m2, dias 1, 22 e 43), não apresentavam metástases a distância e nem sinais de recidiva após cirurgia. A expressão da proteína ERCC1 foi avaliada por imunohistoquímica, através de um escore H semiquantitativo, obtido pelo produto da intensidade da coloração nuclear (0-3) pelo escore proporcional atribuído à porcentagem estimada de núcleos corados (0;0,1;0,5;1). O método da transcrição reversa e reação em cadeia da polimerase (PCR) em tempo real quantitativo foi utilizado para determinação da expressão do mRNA de ERCC1 em tecido de tumor primário, normalizada em relação à expressão da fração 18S do RNA ribossomal. Genotipagem de ERCC1 (códon 118) foi realizada por PCR - polimorfismo do tamanho do fragmento de restrição a partir de DNA genômico extraído de linfonodos normais destes pacientes, após digestão com BsrDI. RESULTADOS: 69 pacientes com idade mediana de 56a, sendo 81% homens, foram estudados. Em relação à neoplasia, os sítios primários observados foram: cavidade oral (41%), laringe (32%), hipofaringe (16%) e orofaringe (12%), com estadio III 14% e estadio IV 86%, sendo pT3-pT4 78% e pN2-pN3 58%. Quarenta e três pacientes apresentaram-se com pelo menos dois linfonodos positivos, 27 com extravazamento extracapsular da metástase linfonodal e 18 com margens positivas. Achados de alto risco foram detectados em 40 pacientes (58%). No seguimento mediano de 47 meses, observou-se 11 recidivas loco-regionais, sete recidivas a distância, 10 casos com segundo tumor primário (sendo quatro com primário em pulmão e quatro em esôfago) e 30 óbitos (22 pela doença). A taxa de SG em 5 anos foi 40% e a taxa de SLD em 5 anos foi 31%. Escore H superior a 1,5 foi encontrado em 32 pacientes (54%), os quais apresentaram melhor taxa de sobrevida global em 5 anos (50% versus 18%, HR 0,43, 95%CI 0,20-0,90, p=0,026). Quinze pacientes (33%), dos 45 analisados, apresentaram elevada expressão do mRNA de ERCC1 (> 3,1) e estes pacientes tiveram melhor taxa de sobrevida global em 5 anos em comparação com aqueles com baixa expressão (86% versus 31%, HR 0,26, 95%CI 0,14-1,01, p=0,052). A distribuição dos genótipos de ERCC1 no códon 118 em 49 pacientes foi 39% C/T, 37% C/C, e 24% T/T. Não foi encontrada associação significativa entre idade, sexo, estadiamento e achados anatomopatológicos de risco, e os polimorfismos genéticos no códon 118 de ERCC1 ou a expressão do mRNA de ERCC1. Não houve diferença entre os genótipos C/C, C/T e T/T seja em termos taxa de sobrevida global em 5 anos (45%, 46%, 46%; p=0,808), seja em termos de taxa de sobrevida livre de doença em 5 anos (31%, 34%, 20%, p=0,770, respectivamente). O escore H (> 1,5 versus 1,5; HR ajustado 0,20, 95%CI 0,07-0,57, p=0,003) e a expressão normalizada do mRNA de ERCC1 (> 3,1 versus 3,1; HR ajustado 0,12, 95%CI 0,03-0,59, p=0,009), permaneceram significantes do ponto de vista estatístico, como fatores prognósticos na análise multivariada. CONCLUSÕES: Alta expressão imunohistoquímica da proteína ERCC1 e alta expressão do mRNA de ERCC1 conferem melhor prognóstico em pacientes portadores de CECCP operados de alto risco tratados com QRT adjuvante baseada em cisplatina. O polimorfismo genético T19007C de ERCC1 não apresentou valor prognóstico nestes pacientes. / BACKGROUND: Adjuvant concurrent chemoradiation (CRT) improves diseasefree survival (DFS) in patients diagnosed with head and neck squamous cell carcinoma (HNSCC) presenting with high-risk features treated with surgery with curative intent, but treatment-related toxicity is not negligible and its impact on overall survival (OS) is uncertain. ERCC1 (Excision Repair Cross Complementing Group 1) is a protein with a critical role in the nucleotide excision repair (NER) pathway, associated with resistance to chemo- and radiation therapy. We aimed here to study ERCC1 protein expression, ERCC1 messenger RNA (mRNA) expression and the single nucleotide polymorphism T19007C of ERCC1 as prognostic markers in HNSCC patients presenting with high-risk features treated with surgery and adjuvant CRT. METHODS: It is a retrospective study in patients with oral cavity, oropharynx, hypopharynx or larynx SCC submitted to radical surgery with curative intent and presenting with pathologic features of high- or intermediate-risk. Eligible patients were treated with adjuvant CRT: 60-70 Gy and concurrent cisplatin (100 mg/m2, days 1, 22 and 43), with no distant metastasis and no relapsed disease after surgery. ERCC1 protein expression was evaluated by immunohistochemistry, using a semi-quantitative H-score, calculated by multiplying the nuclear staining intensity (0-3) by the proportion score attributed to the percentage of positive tumor nuclei (0;0,1;0,5;1). Quantitative real-time reverse transcriptase polymerase chain reaction (PCR) assay was performed to determine ERCC1 mRNA expression in primary tumors tissue specimens. The ERCC1 mRNA expression was normalized using 18S fraction of ribosomal RNA expression as internal reference. ERCC1 (codon 118) genotypes were detected using PCR restriction fragment length polymorphism method carried out in genomic DNA extracted from normal lymph nodes. The PCR products were digested with BsrDI. RESULTS: 69 patients (median age 56 y, 81% male) were studied. Regarding tumor characteristics, primary sites were: oral cavity 41%, larynx 32%, hypopharynx 16%, oropharynx 12%, stage III 14%, stage IV 86%, pT3- pT4 78% and pN2-pN3 58%. Forty-three patients presented with two or more positive lymph nodes, 27 with extracapsular spread of nodal disease and 18 with positive margins. High-risk pathologic features were detected in 40 patients (58%). During the median follow-up of 47 months, we observed 11 locoregional relapses, seven distant relapses, 10 patients were diagnosed with secondary primary tumors (four in lungs and four in esophagus) and 30 deaths (22 disease-related). The 5-year overall survival rate was 40% and the 5-year disease-free survival rate was 31%. High H-score (> 1.5) was seen in 32 patients (54%), who presented better 5-year overall survival rate in comparison to those with lower H-scores (50% versus 18%, HR 0.43, 95%CI 0.20-0.90, p=0.026). Fifteen patients (out of 45, 33%) whose tumors presented normalized ERCC1 expression > 3.1 were classified as having high ERCC1 mRNA expression, and these patients presented better 5-year overall survival rate in comparison to those with lower ERCC1 mRNA expression (86% versus 30%, HR 0.26, 95%CI 0.14-1.01, p=0.052). Genotype distribution at ERCC1 codon 118 in 49 patients was 39% C/T, 37% C/C, and 24% T/T. No significant association was found between age, gender, stage, grading and pathological risk features and ERCC1 codon 118 genotypes or ERCC1 mRNA expression. No difference was detected among C/C, C/T and T/T genotypes, either in terms of 5-year overall survival rates (45%, 46%, 46%; p=0.808), or 5-year diseasefree survival rate (31%, 34%, 20%, p=0.770, respectively). H-score (> 1.5 versus 1.5; adjusted HR 0.20, 95%CI 0.07-0.57, p=0.003) and ERCC1 mRNA normalized expression (> 3.1 versus 3.1; adjusted HR 0.12, 95%CI 0.03-0.59, p=0.009), remained significant as favorable prognostic factors after adjusting for prognostic factors in a multivariate analysis. CONCLUSIONS: High immunohistochemical expression of ERCC1 protein and high ERCC1 mRNA expression, but not the T19007 single nucleotide polymorphism, were associated with better prognosis in HNSCC patients submitted to surgery and adjuvant cisplatin-based chemoradiation.