title: A retrospective study of external beam radiation, neutron brachytherapy, and concurrent chemotherapy for patients with localized advanced carcinoma of the esophagus.
abstract: OBJECTIVE
  The 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 ((252)Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) and concurrent chemotherapy (CCT).
  
  
  METHODS
  From 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China. makai51888@163.com.|General Hospital of Jincheng Anthracite Mining Group Co.Ltd, Jincheng, China. makai51888@163.com.
authors.forename: Kai
authors.initials: K
authors.lastname: Ma
authors.affiliation: Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China. littlecancer@163.com.
authors.forename: Qifeng
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China. litaoxmf@126.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Changzhi Cancer Hospital, Changzhi, 046000, People's Republic of China. lindenchangzhi@hotmail.com.
authors.forename: Huiming
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Changzhi Cancer Hospital, Changzhi, 046000, People's Republic of China. 9921295@qq.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Changzhi Cancer Hospital, Changzhi, 046000, People's Republic of China. 9467834@qq.com.
authors.forename: Xitang
authors.initials: X
authors.lastname: Jia
authors.affiliation: General Hospital of Jincheng Anthracite Mining Group Co.Ltd, Jincheng, China. li1189@263.net.
authors.forename: Shufeng
authors.initials: S
authors.lastname: Li
authors.affiliation: General Hospital of Jincheng Anthracite Mining Group Co.Ltd, Jincheng, China. ljy1138@163.com.
authors.forename: Junyuan
authors.initials: J
authors.lastname: Lang
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China. mingzhi_zhang1@163.com.
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009502:Neutrons / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome