A retrospective study of californium-252 neutron brachytherapy combined with EBRT versus 3D-CRT in the treatment of esop
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RESEARCH
Open Access
A retrospective study of californium-252 neutron brachytherapy combined with EBRT versus 3D-CRT in the treatment of esophageal squamous cell cancer Qifeng Wang1, Tao Li1, Jinyi Lang1, Jie Wang1, Jian Wang1, Huiming Liu2, Xitang Jia2, Bo Liu2 and C-K Chris Wang3*
Abstract Background: 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. Methods: The 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. Results: Among 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. Conclusions: The 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. Keywords: Esophageal squamous cell carcinoma (ESCC), Neutron brachytherapy (NBT), High-LET, Relative biological effectiveness (RBE)
Background Worldwide, an estimated 482,000 new esophageal cancer cases were diagnosed and approximately 407,000 deaths occurred in 2008 [1]. The management of localized esophageal cancers has shifted from surgery or radiation single modality approaches to the trimodality. The current trimodality approach combining chemotherapy, radiation therapy, and surgery, has shown improved survival rates * Correspondence: [email protected] 3 Medical Physics Program, School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0745, USA Full list of author information is available at the end of the article
[2]. However, there are patients that either cannot tolerate or decide not to undergo surgery. For these individuals, concurrent chemoradiotherapy (CCRT) is the standard approach. In recent years, two radiotherapy modalities have become widely used in China to treat esophageal cancers: the neutron brachytherapy in combination with conventional
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