Abstract
PurposeThe aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of a total of 140 esophageal cancer patients who were treated with californium-252 (252Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) and concurrent chemotherapy (CCT).Methods and materialsFrom January 2002 to November 2012, 140 patients with esophageal cancer underwent NBT in combination with EBRT and CCT. The distribution of the patient numbers over the various cancer stages of IIA, IIB, and III were 43, 7, and 90, respectively. 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 five to six weeks with normal fractionation. Fifty-four and 86 patients received tegafur suppositories (TS) and continuous infusion of fluorouracil (5-Fu) with cisplatin (CDDP), respectively.ResultsThe median follow-up time was 42 months. The minimum follow-up was three months, and the maximum was 106 months. The overall median survival including death from all causes was 29.5 months. The five-year overall survival rate (OS) and local control (LC) were 33.4% and 55.9%, respectively. The chemotherapy regimen was a factor that was significantly associated with OS (p = 0.025) according to univariate analysis. The five-year OSs were 27.4% and 44.3% for the PF and TS chemotherapy regimens, respectively. Regarding acute toxicity, no incidences of fistula or massive bleeding were observed during this treatment period. The incidence of severe, late complications was related to the PF chemotherapy regimen (p = 0.080).ConclusionsThe clinical data indicated that NBT in combination with EBRT and CRT produced favorable local control and long-term survival rates for patients with esophageal cancer and that the side effects were tolerable. A reasonable CRT regimen can decrease the rate of severe, late complications.
Highlights
In 2013, an estimated 17,990 cases of esophageal cancer were diagnosed in the United States, and approximately 15,210 people died from this disease [1]
The incidence of severe, late complications was related to the PF chemotherapy regimen (p = 0.080)
The clinical data indicated that neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) and CRT produced favorable local control and long-term survival rates for patients with esophageal cancer and that the side effects were tolerable
Summary
In 2013, an estimated 17,990 cases of esophageal cancer were diagnosed in the United States, and approximately 15,210 people died from this disease [1]. An estimated 482,000 new esophageal cancer cases were diagnosed, and approximately 407,000 deaths occurred in 2008 [2]. Surgery continues to be the standard approach for the majority of localized esophageal cancers, the cure rates following surgery alone are poor with three- to five-year survival rates that range from 6% to 35% [3,4,5]. The management of loco-regional or locally advanced esophageal cancer has shifted from single modality surgery or radiation approaches to trimodal approaches involving the addition of chemotherapy. The current trimodal approach, which combines chemotherapy, radiation therapy, and surgery, has significantly improved prognoses, and several studies have shown improved survival rates [6]. Many patients cannot tolerate or decline surgery; for such individuals, definitive concurrent chemoradiotherapy (CCRT) is the standard approach
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