Wang Qifeng, Liu Huiming, Jia Xitang, Liu Bo, Wan Xin
Tumori. 2014 Jul-Aug;100(4):470-5. doi: 10.1700/1636.17916.
To assess the safety and feasibility of neutron brachytherapy (NBT) combined with external beam radiation (EBRT) in the treatment of patients with inoperable gastroesophageal junction adenocarcinoma (GEJAC).
From January 2001 until November 2011, 67 patients with inoperable GEJAC received EBRT combined with NBT. Radiotherapy consisted of EBRT up to a total dose of 40 to 54 Gy in 20 to 27 fractions and NBT up to 12 to 25 Gy in 3 to 5 fractions. The patients were divided into 2 total-dose groups: a low-dose group (28 patients, 52 to 57 Gy) and a high-dose group (39 patients, 58 to 69 Gy).
The duration of follow-up ranged from 16 to 106 months. The median survival time for the 67 patients was 15.7 months, and the 1-, 2-, 3- and 5-year rates for overall survival (OS) were 56.7%, 37.2%, 30.8% and 12.7%, respectively. The corresponding local-regional control (LRC) rates were 72.4%, 59.1%, 51.2% and 42.0%, respectively. In univariate analysis, the 5-year OS rates were 7.1% and 16.5% for patients of the low-dose and high-dose groups, respectively (P = 0.024). The incidence of acute esophagitis (grade ≥2) was significantly higher in the high-dose group (56.4%) than the low-dose group (32.1%) (P = 0.049). No fistulas or massive bleeding were observed during treatment. Six of the 67 patients (9.0%) experienced late toxicity: fistulas developed in 3 patients and massive bleeding occurred in 3 patients. Of these 6 patients, 4 had persistent or locally recurrent tumors, and 2 displayed no evidence of tumors. Three patients each were in the low-dose and high-dose groups.
The combination of EBRT and NBT was safe and effective in patients with GEJAC. The high-dose group achieved better LRC and OS but had a higher rate of acute esophagitis.
评估中子近距离放射治疗（NBT）联合外照射放疗（EBRT）治疗无法手术切除的胃食管交界腺癌（GEJAC）患者的安全性和可行性。
2001年1月至2011年11月，67例无法手术切除的GEJAC患者接受了EBRT联合NBT治疗。放疗包括EBRT，总剂量达40至54 Gy，分20至27次照射，以及NBT，剂量达12至25 Gy，分3至5次照射。患者被分为两个总剂量组：低剂量组（28例患者，52至57 Gy）和高剂量组（39例患者，58至69 Gy）。
随访时间为16至106个月。67例患者的中位生存时间为15.7个月，1年、2年、3年和5年总生存率（OS）分别为56.7%、37.2%、30.8%和12.7%。相应的局部区域控制（LRC）率分别为72.4%、59.1%、51.2%和42.0%。单因素分析显示，低剂量组和高剂量组患者的5年OS率分别为7.1%和16.5%（P = 0.024）。高剂量组急性食管炎（≥2级）的发生率（56.4%）显著高于低剂量组（32.1%）（P = 0.049）。治疗期间未观察到瘘管或大出血。67例患者中有6例（9.0%）出现晚期毒性反应：3例发生瘘管，3例出现大出血。这6例患者中，4例有持续性或局部复发性肿瘤，2例未发现肿瘤证据。低剂量组和高剂量组各有3例患者。
EBRT与NBT联合应用于GEJAC患者是安全有效的。高剂量组获得了更好的LRC和OS，但急性食管炎发生率更高。
