Xiong Yanli, Shao Li, Liu Jia, Zhou Qian, Li Chongyi, Liao Maojun, Zhang Lei, Dai Xiaoyan, Li Mengxia, Lei Xin
Cancer Center, Daping Hospital, Army Medical University, Chongqing, China.
Zhong Ke Pu Rui (ZKPR) Neutron Brachytherapy Center, Daping Hospital, Army Medical University, Chongqing, China.
Front Oncol. 2021 Nov 18;11:758698. doi: 10.3389/fonc.2021.758698. eCollection 2021.
To retrospectively and comparatively evaluate the improvement of the efficacy and safety on the addition of Cf neutron intracavitary brachytherapy (ICBT), individualized or individualized with intrarectal peritumoral injection of amifostine (IPIA) to external-beam radiotherapy (EBRT) or concurrent chemo-EBRT in 314 patients with T2N0-1 or T3N0-1 low-lying rectal adenocarcinoma.
Phase I: from 2009 to 2011, 157 patients were treated with additional Cf neutron ICBT for four fixed fractions with a total dose of 40-45 Gy-eq during the EBRT. Phase II: from 2011 to 2013, 75 patients were treated with individualized neutron ICBT delivered for two to five fractions with a total dose of 26-45 Gy-eq according to the response of tumor after concurrent chemo-EBRT. Phase III: from 2013 to 2014, 82 patients were treated with individualized ICBT protected by pretreatment IPIA.
The 4-year local control rates for the entire T2 and T3 patients were 69.4, 72.0, and 79.3%, while the 4-year overall survival rates were 63.1, 54.7, and 72.0% (P=0.08), and the 4-year disease-free survival rates were 55.4, 52.0, and 69.5% (P=0.053) in Phases I, II, and III, respectively. The late complication (LAC, ≥G2) rates were 33.8, 26.7, and 15.9%, respectively (P=0.012), and the serious LAC (≥G3) rates were 4.5, 4.2, and 0%, respectively, in Phases I, II, and III.
Concurrent chemo-EBRT combined with individualized Cf neutron ICBT protected by IPIA shows promising efficacy and safety in treating low-lying T2 and T3 rectal adenocarcinoma patients without surgery opportunity or willing.
回顾性比较评估314例T2N0-1或T3N0-1低位直肠腺癌患者在接受外照射放疗（EBRT）或同步放化疗时，加用锎（Cf）中子腔内近距离放疗（ICBT）、个体化或联合直肠周围瘤内注射氨磷汀（IPIA）的Cf中子ICBT对疗效和安全性的改善情况。
第一阶段：2009年至2011年，157例患者在EBRT期间接受额外的Cf中子ICBT，分4个固定剂量分割，总剂量为40 - 45 Gy - eq。第二阶段：2011年至2013年，75例患者在同步放化疗后根据肿瘤反应接受个体化中子ICBT，分2至5个剂量分割，总剂量为26 - 45 Gy - eq。第三阶段：2013年至2014年，82例患者接受经预处理IPIA保护的个体化ICBT。
I、II、III期T2和T3患者的4年局部控制率分别为69.4%、72.0%和79.3%，4年总生存率分别为63.1%、54.7%和72.0%（P = 0. "08），4年无病生存率分别为55.4%、52.0%和69.5%（P = 0.053）。I、II、III期的晚期并发症（LAC，≥G2）发生率分别为33.8%、26.7%和15.9%（P = 0.012），严重LAC（≥G3）发生率分别为4.5%、4.2%和0%。
同步放化疗联合经IPIA保护的个体化Cf中子ICBT在治疗无手术机会或不愿手术的低位T2和T3直肠腺癌患者中显示出有前景的疗效和安全性。
