Li Tao, Zhang Wei, Lv Jiahua, Liu Huiming, Wang Qifeng, Jia Xitang, Liu Bo, Lang Jinyi
Department of Radiation Oncology, Sichuan Cancer Hospital & Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu; Both authors contributed equally to this work.
Department of Radiation Oncology, Sichuan Cancer Hospital & Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu.
J Contemp Brachytherapy. 2017 Feb;9(1):36-43. doi: 10.5114/jcb.2017.65839. Epub 2017 Feb 8.
The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 191 elderly patients with esophageal squamous cell cancer (ESCC) who were treated with californium-252 (Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT).
From January 2002 to November 2012, 191 patients with ESCC underwent NBT in combination with EBRT. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in two to five fractions with one fraction per week. The total dose via EBRT was 50-60 Gy, which was delivered over a period of 5 to 6 weeks with normal fractionation.
The median survival time for the 191 patients was 23.6 months, and the 5-year rates for overall survival (OS) and local-regional control (LRC) were 28.7% and 54.2%, respectively. The patients' age was a factor that was significantly associated with OS ( = 0.010), according to univariate analysis. The 5-year OS (LRC) was 37.3% (58.6%) for patients aged 70-74 years and 14.5% (47.9%) for patients aged > 74 years ( = 0.010 and = 0.038). In multivariate analysis, age and clinical N stage were associated with OS and LRC ( = 0.011 [0.041] and = 0.005 [0.005]). From the time of treatment completion to the development of local-regional recurrence or death, 5 (2.6%) patients experienced fistula and 15 (7.9%) experienced massive bleeding. The incidence of severe late complications was related to older age ( = 0.027), higher NBT dose/fraction (20-25 Gy/5 fractions), and higher total dose (> 66 Gy).
The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with ESCC, and that the side effects were tolerable. Patient's age, clinical stage N status, and radiation dose could be used to select the appropriate treatment for elderly patients.
本研究旨在回顾性观察和分析191例接受锎-252（Cf）中子近距离放射治疗（NBT）联合外照射放疗（EBRT）的老年食管鳞状细胞癌（ESCC）患者的长期治疗效果。
2002年1月至2012年11月，191例ESCC患者接受了NBT联合EBRT治疗。通过NBT给予参考点的总辐射剂量为8 - 25 Gy - eq，分2至5次给予，每周1次。通过EBRT给予的总剂量为50 - 60 Gy，在5至6周内以常规分割方式给予。
191例患者的中位生存时间为23.6个月，5年总生存（OS）率和局部区域控制（LRC）率分别为28.7%和54.2%。单因素分析显示，患者年龄是与OS显著相关的因素（P = 0.010）。70 - 74岁患者的5年OS（LRC）率为37.3%（58.6%），> 74岁患者为14.5%（47.9%）（P = 0.010和P = 0.038）。多因素分析显示，年龄和临床N分期与OS和LRC相关（P = 0.011 [0.041]和P = 0.005 [0.005]）。从治疗结束至局部区域复发或死亡，5例（2.6%）患者发生瘘管，15例（7.9%）患者发生大出血。严重晚期并发症的发生率与年龄较大（P = 0.027）、较高的NBT剂量/分次（20 - 25 Gy / 5次）和较高的总剂量（> 66 Gy）有关。
临床数据表明，NBT联合EBRT对老年ESCC患者产生了良好的局部控制和长期生存率，且副作用可耐受。患者年龄、临床分期N状态和放射剂量可用于为老年患者选择合适的治疗方法。
