The safety and usefulness of neutron brachytherapy and external beam radiation in the treatment of patients with gastroesophageal junction adenocarcinoma with or without chemotherapy

Radiation Oncology

Jinyi Lang¹  Xin Wan²  Bo Liu³  Xitang Jia³  Huiming Liu³  Tao Li¹  Qifeng Wang¹ 

[1] Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu 610041, People’s Republic of China;Department of Radiation Oncology, Fouth Hospital of Hebei Medical University, Shijiazhuan 050011, People’s Republic of China;Department of Radiation Oncology, Changzhi Cancer Hospital, Changzhi 046000, People’s Republic of China

关键词: Overall survival acute/late toxicity;    External beam radiation (EBRT);    Neutron brachytherapy (NBT);    Gastroesophageal junction adenocarcinoma (GEJAC);   

Others  :  805475
DOI  :  10.1186/1748-717X-9-99

 received in 2013-08-29, accepted in 2014-04-21,  发布年份 2014

【 摘 要 】

Purpose

To assess the safety and usefulness of neutron brachytherapy (NBT) as an adjuvant in the treatment of patients with gastroesophageal junction adenocarcinoma (GEJAC) with external beam radiation (EBRT), with or without chemotherapy.

Methods and Materials

In total, 197 patients with localized, advanced GEJAC received EBRT and NBT with or without chemotherapy. Radiotherapy consisted of external irradiation to a total dose of 40–54 Gy (median 50 Gy) and brachytherapy to 8–25 Gy (median 20 Gy) in two to five fractions. In total, 88 patients received chemotherapy that consisted of two cycles of a regimen with CDDP and 5FU from days l-4. The cycles were administered on days 1 and 29. MMC was given alone in bolus injection on day 1 each week. The cycles were administered on days 1, 8, 15 and 22.

Results

The duration of follow-up ranged from six to 106 months (median 30.4 months). The median survival time for the 197 patients was 13.3 months, and the one, two, three- and five-year rates for overall survival were 57.1%, 35.1%, 23.0% and 9.2%, respectively. For acute toxicity, no incidences of fistula and massive bleeding were observed during this treatment period. In total, 159 (80.7%) patients developed Grade 2 hematologic toxicity and 146 (74.1%) patients developed Grade ≥ 2 esophagitis. The median times of incidence of fistula and bleeding were 9.5 (3–27.3) months and 12.7 (5–43.4) months, respectively. The incidence of severe, late complications was related to higher NBT dose/f (20–25 Gy/5 F) and higher total dose(≥70 Gy). In total, 75.2% of the patients resumed normal swallowing and 2.0% had some residual dysphagia (non-malignant) requiring intermittent dilatation.

Conclusion

A combination of EBRT and NBT with the balloon type applicator was feasible and well tolerated. Better local-regional control and overall survival cannot achieved by a higher dose, and in contrast, a higher dose caused more severe esophageal injury.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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