Zhang Wei, Wang Qifeng, Li Tao, Lv Jiahua, Liu Huiming, Jia Xitang, Liu Bo, Fan Yu, Wang Yi, Wang Junchao, Wu Lei, 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.
Department of Radiation Oncology, Changzhi Cancer Hospital, Changzhi, China.
J Contemp Brachytherapy. 2017 Aug;9(4):330-337. doi: 10.5114/jcb.2017.69334. Epub 2017 Jul 27.
The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 96 elderly patients with gastroesophageal junction adenocarcinoma (GEJAC) who were treated with californium-252 (Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) with or without chemotherapy.
From January 2002 to November 2012, 96 patients with GEJAC underwent treatment. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in 2 to 5 fractions, with 1 fraction per week. The total dose via EBRT was 40-54 Gy, which was delivered over a period of 4 to 5.5 weeks with normal fraction.
The median survival time for the 96 patients was 15.3 months, and the 1-, 2-, 3-, and 5-year rates of overall survival (OS) were 62.5%, 33.7%, 20.1%, and 7.9%, respectively. The 1-, 2-, 3-, and 5-year rates for local-regional control (LRC) were 78.7%, 57.9%, 41.8%, and 26.4%, respectively. The patients' age was an independent factor that was significantly associated with OS ( = 0.006) and LRC ( = 0.0005), according to univariate analysis. The 3-year OS (LRC) was 31.9% (62.9%) for patients aged 70-74 years and 16.1% (19.5%) for patients aged ≥ 75 years. From the time of treatment completion to the development of local-regional recurrence or death, 5 (5.2%) patients experienced fistula and 7 (7.3%) experienced massive bleeding.
The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with GEJAC, and that the side effects were tolerable. The patient's age could be used to select the appropriate treatment in an elderly patient.
本研究旨在回顾性观察和分析96例接受了²⁵²锎（Cf）中子近距离放射治疗（NBT）联合或不联合化疗的外照射放疗（EBRT）的老年胃食管交界腺癌（GEJAC）患者的长期治疗结果。
2002年1月至2012年11月，96例GEJAC患者接受了治疗。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40 - 54 Gy，在4至5.5周内以常规分割方式给予。
96例患者的中位生存时间为15.3个月，1年、2年、3年和5年的总生存率（OS）分别为62.5%、33.7%、20.1%和7.9%。1年、2年、3年和5年的局部区域控制率（LRC）分别为78.7%、57.9%、41.8%和26.4%。单因素分析显示，患者年龄是与OS（P = 0.006）和LRC（P = 0.0005）显著相关的独立因素。70 - 74岁患者的3年OS（LRC）为31.9%（62.9%），≥75岁患者为16.1%（19.5%）。从治疗结束到局部区域复发或死亡，5例（5.2%）患者出现瘘管，7例（7.3%）患者出现大出血。
临床数据表明，NBT联合EBRT对老年GEJAC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。患者年龄可用于老年患者选择合适的治疗方案。
