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. 2017 Aug;9(4):330-337.
doi: 10.5114/jcb.2017.69334. Epub 2017 Jul 27.

External beam radiation and high-dose-rate brachytherapy for elderly patients with gastroesophageal junction adenocarcinoma

Wei Zhang  1 , Qifeng Wang  1 , Tao Li  1 , Jiahua Lv  1 , Huiming Liu  2 , Xitang Jia  2 , Bo Liu  2 , Yu Fan  1 , Yi Wang  1 , Junchao Wang  1 , Lei Wu  1 , Jinyi Lang  1
Affiliations

External beam radiation and high-dose-rate brachytherapy for elderly patients with gastroesophageal junction adenocarcinoma

Wei Zhang et al. J Contemp Brachytherapy. 2017 Aug.

Abstract

Purpose: The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 96 elderly patients with gastroesophageal junction adenocarcinoma (GEJAC) who were treated with californium-252 (252Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) with or without chemotherapy.

Material and methods: From January 2002 to November 2012, 96 patients with GEJAC underwent treatment. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in 2 to 5 fractions, with 1 fraction per week. The total dose via EBRT was 40-54 Gy, which was delivered over a period of 4 to 5.5 weeks with normal fraction.

Results: The median survival time for the 96 patients was 15.3 months, and the 1-, 2-, 3-, and 5-year rates of overall survival (OS) were 62.5%, 33.7%, 20.1%, and 7.9%, respectively. The 1-, 2-, 3-, and 5-year rates for local-regional control (LRC) were 78.7%, 57.9%, 41.8%, and 26.4%, respectively. The patients' age was an independent factor that was significantly associated with OS (p = 0.006) and LRC (p = 0.0005), according to univariate analysis. The 3-year OS (LRC) was 31.9% (62.9%) for patients aged 70-74 years and 16.1% (19.5%) for patients aged ≥ 75 years. From the time of treatment completion to the development of local-regional recurrence or death, 5 (5.2%) patients experienced fistula and 7 (7.3%) experienced massive bleeding.

Conclusions: The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with GEJAC, and that the side effects were tolerable. The patient's age could be used to select the appropriate treatment in an elderly patient.

Keywords: californium-252; gastroesophageal junction adenocarcinoma; late complications; neutron brachytherapy.

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Conflict of interest statement

Authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Images (first-fourth NBT) showing the tumor regression conditions before each of the 4 neutron brachytherapy treatments under an X-ray treatment-planning simulator
Fig. 2
Fig. 2
Comparison of the overall survival rate (A) and the local control rate (B) between the 2 age groups
See this image and copyright information in PMC

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