Californium-252 neutron brachytherapy combined with external beam radiotherapy for esophageal cancer: Long-term treatment results

Abstract Purpose The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes for a total of 952 esophageal cancer patients who were treated with 252 Cf neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT). Methods and Materials From November 2001 to March 2012, 952 patients with esophageal cancer underwent NBT in combination with EBRT. The patient numbers distributed over various cancer Stages I, IIA, IIB, III, and IVA were 9, 290, 51, 579, and 23, respectively. The total radiation dose to the reference point via NBT was 8–25 Gy-eq in three to five fractions with one fraction/week. The total dose via EBRT was 40–60 Gy delivered over a period of 5–6 weeks with normal fractionation. Results The overall median survival time was 20.3 months. The 1-, 3-, and 5-year survival rates were 67.1%, 36.3%, and 26.6%, respectively. These results compare favorably with the results obtained from conventional high-dose rate in combination with EBRT. Although a majority of the patients (860 or 90.3%) developed Grades 1 and 2 esophagitis during treatment, the symptoms were effectively relieved after the application of antacid and surface anesthesia. Conclusions The clinical data show that NBT in combination with EBRT produced favorable local control and long-term survival rates for patients with esophageal cancer and that the side effects are tolerable. As such, we conclude that this dual-modality method is an effective and safe way for treating esophageal cancer.