Wang Qifeng, Li Tao, Liu Huiming, Jia Xitang, Liu Bo, Wan Xin, Lang Jinyi
Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu 610041, People's Republic of China.
Radiat Oncol. 2014 Apr 29;9:99. doi: 10.1186/1748-717X-9-99.
To assess the safety and usefulness of neutron brachytherapy (NBT) as an adjuvant in the treatment of patients with gastroesophageal junction adenocarcinoma (GEJAC) with external beam radiation (EBRT), with or without chemotherapy.
In total, 197 patients with localized, advanced GEJAC received EBRT and NBT with or without chemotherapy. Radiotherapy consisted of external irradiation to a total dose of 40-54 Gy (median 50 Gy) and brachytherapy to 8-25 Gy (median 20 Gy) in two to five fractions. In total, 88 patients received chemotherapy that consisted of two cycles of a regimen with CDDP and 5FU from days l-4. The cycles were administered on days 1 and 29. MMC was given alone in bolus injection on day 1 each week. The cycles were administered on days 1, 8, 15 and 22.
The duration of follow-up ranged from six to 106 months (median 30.4 months). The median survival time for the 197 patients was 13.3 months, and the one, two, three- and five-year rates for overall survival were 57.1%, 35.1%, 23.0% and 9.2%, respectively. For acute toxicity, no incidences of fistula and massive bleeding were observed during this treatment period. In total, 159 (80.7%) patients developed Grade 2 hematologic toxicity and 146 (74.1%) patients developed Grade ≥ 2 esophagitis. The median times of incidence of fistula and bleeding were 9.5 (3-27.3) months and 12.7 (5-43.4) months, respectively. The incidence of severe, late complications was related to higher NBT dose/f (20-25 Gy/5 F) and higher total dose(≥70 Gy). In total, 75.2% of the patients resumed normal swallowing and 2.0% had some residual dysphagia (non-malignant) requiring intermittent dilatation.
A combination of EBRT and NBT with the balloon type applicator was feasible and well tolerated. Better local-regional control and overall survival cannot achieved by a higher dose, and in contrast, a higher dose caused more severe esophageal injury.
评估中子近距离放射治疗（NBT）作为辅助治疗手段，联合或不联合化疗，用于食管胃交界腺癌（GEJAC）患者外照射放疗（EBRT）时的安全性和有效性。
总计197例局部晚期GEJAC患者接受了EBRT和NBT治疗，部分患者联合化疗。放疗包括外照射，总剂量为40 - 54 Gy（中位剂量50 Gy），近距离放射治疗剂量为8 - 25 Gy（中位剂量20 Gy），分2 - 5次进行。总计88例患者接受了化疗，化疗方案为第1 - 4天给予顺铂（CDDP）和5-氟尿嘧啶（5FU）两个周期，周期分别在第1天和第29天进行。丝裂霉素（MMC）在每周第1天单次静脉推注给药，周期分别在第1、8、15和22天进行。
随访时间为6至106个月（中位时间30.4个月）。197例患者的中位生存时间为13.3个月，1年、2年、3年和5年总生存率分别为57.1%、35.1%、23.0%和9.2%。急性毒性方面，治疗期间未观察到瘘管和大出血事件。总计159例（80.7%）患者出现2级血液学毒性，146例（74.1%）患者出现≥2级食管炎。瘘管和出血的中位发病时间分别为9.5（3 - 27.3）个月和12.7（5 - 43.4）个月。严重晚期并发症的发生率与较高的NBT分次剂量（20 - 25 Gy/5次）和较高的总剂量（≥70 Gy）相关。总计75.2%的患者恢复正常吞咽，2.0%的患者有一些残留吞咽困难（非恶性），需要间歇性扩张治疗。
EBRT和NBT联合球囊型施源器的治疗方案可行且耐受性良好。更高的剂量并不能实现更好的局部区域控制和总生存，相反，更高的剂量会导致更严重的食管损伤。
