A retrospective study of californium-252 neutron brachytherapy combined with EBRT versus 3D-CRT in the treatment of esophageal squamous cell cancer.

Qifeng Wang,Xitang Jia,C-K Chris Wang,Bo Liu,Tao Li,Jie Wang,Jian Wang,Huiming Liu,Jinyi Lang

doi:10.1186/s13014-015-0520-7

Abstract

BackgroundWe conducted a retrospective analysis on 884 patients who were diagnosed with esophageal squamous cell carcinoma (ESCC) and treated with either the neutron brachytherapy in combination with external beam radiotherapy (NBT + EBRT) or 3-dimensional conformal radiation therapy (3D-CRT) to determine the differences in efficacy and morbidity between the two treatment groups.MethodsThe 884 ESCC patients treated with either NBT + EBRT or 3D-CRT between 2002 and 2012 were retrospectively reviewed and analyzed. Multivariable Cox regression was used to compare oncologic outcomes of the two groups of patients in the context of other clinically relevant variables. The acute and chronic toxicities associated with the two groups were compared using Fisher exact and log-rank tests, respectively.ResultsAmong the 884 patients, 545 received NBT + EBRT and 339 received 3D-CRT (i.e. EBRT-only). The age range is 39–95 years (median 66). The follow-up time range is 3–145 months (median 32). The analysis shows that the NBT + EBRT group has higher overall survival rate and local control rate than that of the 3D-CRT group. The acute toxicity effects were acceptable for both groups of patients with the NBT + EBRT group showing higher rates of leukopenia and thrombocytopenia and the 3D-CRT group showing higher rates on fistula and massive bleeding.ConclusionsThe patients treated with NBT + EBRT showed better oncologic outcomes than those treated with 3D-CRT. The toxicity effects were acceptable for both groups with the NBT + EBRT group showing higher rates on the acute effects and the 3D-CRT group showing higher rates on the late effects.

Highlights

We conducted a retrospective analysis on 884 patients who were diagnosed with esophageal squamous cell carcinoma (ESCC) and treated with either the neutron brachytherapy in combination with external beam radiotherapy (NBT + EBRT) or 3-dimensional conformal radiation therapy (3D-CRT) to determine the differences in efficacy and morbidity between the two treatment groups
Two radiotherapy modalities have become widely used in China to treat esophageal cancers: the neutron brachytherapy in combination with conventional external beam radiotherapy (NBT + EBRT) and the 3dimensional conformal radiotherapy (3D-CRT)
While esophageal cancer radiotherapy technology has progressed from 2-D CRT to 3-D CRT, and to intensitymodulated radiotherapy (IMRT), the local recurrence rates remain unchanged at about 50 % [5, 7]

Summary

Introduction

We conducted a retrospective analysis on 884 patients who were diagnosed with esophageal squamous cell carcinoma (ESCC) and treated with either the neutron brachytherapy in combination with external beam radiotherapy (NBT + EBRT) or 3-dimensional conformal radiation therapy (3D-CRT) to determine the differences in efficacy and morbidity between the two treatment groups. The management of localized esophageal cancers has shifted from surgery or radiation single modality approaches to the trimodality. There are patients that either cannot tolerate or decide not to undergo surgery For these individuals, concurrent chemoradiotherapy (CCRT) is the standard approach. Two radiotherapy modalities have become widely used in China to treat esophageal cancers: the neutron brachytherapy in combination with conventional external beam radiotherapy (NBT + EBRT) and the 3dimensional conformal radiotherapy (3D-CRT).

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Discussion

Conclusion