Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2012 Vol.21 Issue.2 Published 2012-03-10

	Head and Neck Tumors Abdominal Tumors Review Thoracic Tumors Physics·Biology·Technique

Head and Neck Tumors

	97	Clinic results of 121 nasopharyngeal carcinoma patients treated by helical tomotherapy
		DU Lei^*, MA Lin, FENG Lin-chun, ZHOU Gui-xia, QU Bao-lin, REN Gang. XU Shou-ping, XIE Chuan-bin. ZHANG Xin-xin. LI Fang
		Objective To summarize the outcome of nasopharyngeal carcinoma (NPC) treated by helical tomotherapy in the Chinese PLA general hospital. Methods Between September 2007 and August 2010, 121 newly diagnosed NPC patients were treated by radiotherapy with Tomotherapy system, with (n=90) or without (n=31) concurrent chemotherapy or molecular target therapy. The prescription dose was 70－74 Gy/33f to primary tumor and positive lymph node planning target volume,60.0－62.7 Gy/33f to high risk planning target volume, and 52－56 Gy/33f to low risk planning target volume. Acute side-effects were evaluated with RTOG/EORTC criteria. Results The remission rate of primary lesion and positive lymph nodes was 95.0% and 99.0%, respectively. The follow-up rate was 100%.The number of patients with 1, 2 and 3 years followed-up were 99, 49, and 7. The 1-, 2-and 3-year local relapse-free survival rates were 97.3%, 97.3% and 97.3%, respectively. The 1-,2-and 3-year nodal relapse-free survival rates were 100%, 100% and 100%,respectively. The 1-,2-and 3-year distant metastasis-free survival rates were 98.4%, 96.3% and 96.3%,respectively. The 1-, 2-and 3-year overall survival rates were 96.5%, 92.6% and 86.8%, respectively. Acute toxicities of skin, oral mucosa and xerostomia with grade 0,1,2 and 3 were 5.0%, 74.4%, 15.7% and 4.9%;0.8%, 37.2%, 57.9% and 4.1%;3.3%, 53.7%,43.0% and 0%, respectively. Xerostomia restored with time, no grade 2 or more xerostomia was observed 1 year after radiation therapy. Concurrent chemotherapy significantly increased incidence of mucositis, esophagitis and tracheitis. Conclusion Helical tomotherapy is efficient, secure and effective modality for the treatment of nasopharyngeal carcinoma.
		2012 Vol. 21 (2): 97-100 [Abstract] ( 4471 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	101	Clinical analysis on primary salivary gland type nasopharyngeal carcinoma
		CAO Cai-neng,ZHANG Xi-mei, LUO Jing-wei,XU Guo-zhen,GAO Li,YI Iun-lin,HUANG Xiao-dong, XIAO Jian-ping,LI Su-yan
		Objective To analyze the clinical characteristics, therapeutic outcomes, and prognostic factors of primary salivary gland type nasopharyngeal carcinoma (SNPC). Methods The medical records of 54 patients with SNPC at single institution between 1963 and 2006 were reviewed, 2 patients received surgery alone, 30 patients received radiotherapy alone and 22 patients received combined modality therapy consisting of surgery (S) and radiotherapy (RT)(S+RT in 15 and RT+S in 7). Of them, 8 patients received chemotherapy, including post-operative adjuvant chemotherapy in 1 patient, palliative chemotherapy in 6 patients and concurrent chemotherapy in 1 patient. 36 patients had adenoid cystic carcinoma (ACC), 11 mucoepidermoid carcinoma (MEC), and 7 primary traditional adenocarcinoma (AC). The Kaplan-Meier method was used to calculate the overall survival (OS), locoregional failure-free survival (LRFFS),and distant failure-free survival (DFFS) rates. Univariate analyses were performed using the Log-rank method. Comparisons of variables between cases were performed using Pearson chi-square test. Results The follow-up was 89%.The 2-,and 5-year overall survival rates, loco-regional failure free survival rates and distant failure free survival rates were 85% and 61%, 74% and 55%, 92% and 70%, respectively. Among the 35 patients with treatment failure, 26 patients had locoregional failure (1 in primary site and cervical lymph node,23 in primary site and 2 in cervical lymph node),and 13 had distant metastasis. The lung was the most common site of metastasis (n=10), followed by liver (n=3), bone (n=2), brain (n=1), and subcutaneous tissue (n=1). Univariate analyses indicated that histological subtypes correlated with overall survival (χ²=15.29,P=0.000) and cervial lymph node metastases correlated with distant failure-free survival (χ²=9.08,P=0.003). Conclusions Primary salivary gland type nasopharyngeal carcinoma is a locally aggressive disease with a long course. The optimal treatment policy for patients with SNPC may be surgery plus radiotherapy.
		2012 Vol. 21 (2): 101-104 [Abstract] ( 4038 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	105	The value of diffusion-weighted magnetic resonance imaging in gross tumor volume definition and tumor recurrence/metastasis prediction in nasopharyngeal carcinoma
		ZHU Xiang-zhi^*, KANG Zheng, HE Xia
		Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWMRI) in gross tumor volume definition and localregional recurrence/distant metastasis prediction in nasopharyngeal carcinoma (NPC). Methods From Jun.2008 to Feb.2011, each of 36 patients with or without localregional recurrence and/or distant metastasis treated by intensity-modulated radiotherapy in our hospital was matched in this study. The difference of apparent diffusion coefficient (ADC) values between these two groups was compared by t-test method. The conventional MRI and DWMRI before treatment were centrally reviewed to evaluated whether DWMRI would benefit to the definition of gross tumor volume. Results The mean ADC value were (0.753±0.091)×10^－3 mm²/s and (0.793±0.094)×10^－3 mm²/s in treatment failure group and control group, respectively (t=－1.79,P=0.078). The extension of gross tumor volume were much more outstanding in DWMRI when compared to conventional MRI. DWMRIpredicted localregional recurrence more accuracy than conventional MRI in one patient. Conclusions DWMRI is help to definition of gross tumor volume. The ADC value before radiotherapy can not predict the localregional recurrence and/or distant metastasis for nasopharyngeal carcinoma.
		2012 Vol. 21 (2): 105-107 [Abstract] ( 4072 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	108	Stereotactic Radiotherapy for Brain metastases from 152 lung cancer patients
		LI Xiang-pan, XIAO Jian-ping, CHEN Xiu-jun, JIANG Xue-song, ZHANG Ye, XU Ying-jie, HUAN Fu-kui, FANG Hao, WAN Bao, LI Ye-xiong
		Objective To assess the clinical efficacy and prognostic factors of Stereotactic Radiotherapy (SRT) for patients with brain metastases (BM) from lung cancer. Methods From March 1995 to July 2006, 152 consecutive patients with BM from lung cancer were treated by SRT, among them, 59 patients received SRT alone, 40 patients received SRT plus whole brain radiotherapy (SRT+WBRT), and 53 patients were salvaged by SRT after WBRT (salvaged group). Log-rank method was used for univariate analyses. Cox regression model was used for multivariate analyses. Results The follow-up rate was 97.4%. The half year and 1 year local control rate for SRT alone group, SRT+WBRT group and salvage group were 96.0% and 93.4%,94.2% and 90.8%,81.7% and 77.5%(χ²=5.39,P=0.068) respectively. The 1-,2-,5 year survival rate for SRT alone group, SRT+WBRT group and salvage group were 47.4%, 23.7%, 8.5%;55.0%, 20.0%,0%;41.5%,7.5%,1.9%, respectively. The median overall survival for each group was 11,12,11 months (χ²=4.08,P=0.130). The univariate analysis showed that the interval between diagnosis of lung cancer and BM, KPS, thoracic surgery, GPA grade, RPA class, system disease stable were significant prognostic factors (χ²=11.97, 5.91, 15.48, 14.48, 15.86, 17.36, P=0.001, 0.015, 0.000, 0.000, 0.000, 0.000).The multivariate analysis showed that the RPA class, thoracic surgery were the independent prognostic factors (χ²=21.02,8.18,P=0.000,0.004). KPS score less than 70, 80,90 for all patients before SRT and 3 months later after SRT were 48.7%, 33.6%,17.8% and 27.0%,46.7%,26.3% respectively (t=7.16,P=0.000). Conclusions A definitive benefit of SRT in the treatment BM from lung cancer is observed;there is no difference of survival among SRT alone, SRT+WBRT and salvage treatment. SRT can improve the patients′ KPS score. Thoracic surgery, RPA class were the independent prognostic factors for patients with BM from lung cancer.
		2012 Vol. 21 (2): 108-111 [Abstract] ( 4497 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	112


		2012 Vol. 21 (2): 112-113 [Abstract] ( 3480 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	114	Risk factors for radiation induced lung toxicity in locally advanced non-small cell lung cancer treated with three-dimensional radiotherapy
		WANG Jing-bo, CAO Jian-zhong, JI Wei, DAI Jian-rong, Lv Ji-ma, LIANG Jun, FENG Qin-fu, CHEN Dong-fu, ZHOU Zong-mei, ZHNAG Hong-xing, XIAO Ze-fern, YIN Wei-bo, WANG L-hua
		Objective To investigate the patient and treatment related predictors for the development of radiation induced lung toxicity (RILT) in patients with locally advanced non-small cell lung cancer (NSCLC) receiving definitive three-dimensional radiotherapy. Methods Data were retrospectively collected from inoperable or unresectable 253 patients with stage Ⅲ NSCLC treated with definitive three-dimensional radiotherapy between January 2001 and April 2007. National cancer institute common toxicity criteria version 3.0 was employed to evaluate the classification of RILT and grade ≥2 toxicity served as the endpoint. The correlation between RILT and aforementioned factors was analyzed. Results The grade ≥ 2 RILT was 26.5%. Univariate analysis showed age, FEV1%, DLCO%, contralateral lung (CL) V₅-V₁₅,ipsilateral lung (IL) V₅-V₄₀, total lung (TL) V₅-V₅₀, IL and TL mean lung dose (MLD) were significantly correlated with the development of RILT (χ²=4.46－23.99,P=0.000－0.035). Mmultivariate analysis showed TL MLD>17.5 Gy and FEV1%≥72% were significantly correlated with the development of RILT (χ²=17.49,9.30,P=0.000,0.002). Patients were stratified into four groups according to MLD and FEV1%, corresponding to the RILT incidence of 9.3%, 24.7%, 38.5% and 63.6%, respectively (χ²=25.27,P=0.000). Conclusions TL MLD and baseline FEV1% are significant factors correlated with the development of RILT in NSCLC patients treated with three-dimensional radiation therapy. The combination of TL MLD and FEV1% may help classify NSCLC patients per risk of RILT and subsequently direct risk-adaptive radiation therapy. Poor baseline pulmonary function does not increase the risk of RILT and may even be associated with lower RILT probability, whichhas yet to be validated in larger patient cohorts.
		2012 Vol. 21 (2): 114-119 [Abstract] ( 4410 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	120


		2012 Vol. 21 (2): 120-121 [Abstract] ( 3381 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	122	Metastasis features of 546 patients with stage Ⅳ non-small cell lung cancer at first visit and the significance in radiotherapy
		LI Feng-hu, LU Bing, FU Fe-yi, HAN Lei, LI Qing-song, LI Hui-qin
		Objective To investigate the clinical metastasis features and the possibility of 3 dimensional radiotherapy of stage Ⅳ non-small cell lung cancer (NSCLC). Methods The clinical materials of 546 patients with stage Ⅳ NSCLC and the relationship b T and N stage and metastasis were retrospectively analyzed. Results In 546 patients with stage ⅣNSCLC, the number with bone metastasis was 294, the number with brain metastasis was 167, the number with lung metastasis was 137, the number with liver metastasis was 79,the number with adrenal gland metastasis was 66, 37 with lymph node metastasis, 35 with subcutaneous metastasis and 10 with other organ metastasis. The number with single organ metastasis was 379(69.4%),in which 37.7% with bone metastasis,19.8% with brain metastasis,16.9% with lung metastasis,7.4% with liver metastasis,7.4% with adrenal gland metastasis,4.5% with lymph node metastasis,5.5% with subcutaneous metastasis and 0.8% with other organ metastasis. The bone metastasis probability of T₃₊₄ patient was similar with T₁₊₂(69.4%,30.6%,χ²=7.65,P=0.067),but N₂₊₃ patient was more than N₀₊₁(69.7%,30.3%,χ²=7.89,P=0.044).The brain metastasis probability of T₃₊₄ patient was more than T₁₊₂(70.7%,29.3%,χ²=10.64,P=0.018),but N₂₊₃ patient was similar with N₀₊₁(54.5%,45.5%,χ²=7.14,P=0.079),and N₁₊₃₊₃ patient was more than N₀(86.8%,13.2%,χ²=10.26,P=0.024). Conclusions In 546 patients with stage ⅣNSCLC, the most common metastatic organ is bone, the second is brain, the third is lung, the forth is liver, followed by adrenal gland;single organ metastasis is more common than multiple organ metastasis. The later the T stage is, the more severe is the metastasis. Through 3 dimensional radiotherapy, not only the quality of life of some stage Ⅳ patients is improved, but also the survival time was prolonged observably.
		2012 Vol. 21 (2): 122-125 [Abstract] ( 4314 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	126	Metastatic characteristics of lymph node in cervical region and radiotherapy target volume after dissection of thoracic esophageal carcinoma
		LI Cheng-lin^*,WANG Ya-di, HAN Chun,LIU Qing, SUN Guo-gui, CHENG Yun-jie, JING Shao-wu, YANG Cong-rong
		Objective To investigate the metastatic characteristics of cervical lymph node in thoracic esophageal cancer of two-field lymph node dissection after radical surgery and to provide evidence for postoperative radiotherapy. Methods Local-regional lymph node metastasis after surgery of 126 cases with esophageal squamous cell carcinoma from 2004 to 2009 were reviewed. Boundaries of cervical lymph node were according to Som,s imaging-based nodal classification system. Enumeration data were compared by χ²test, and the risk factors of lymph node metastasis were analyzed with Logistic regressive model. Results Lymph node metastasis rate of cervical region was up to 68.3% in all the cases with local-regional lymph node metastasis (86/126), and lymph node metastasis rate in levelⅠwas higher than those in the other levels (43.7%, 55/126). There was obvious difference in lymph node metastasis rate between the right and the left cervical region (53.2% vs 30.2%,χ²=13.73,P=0.000). Moreover, the results also shown that lymph node metastasis rate was notably increased in levelⅠ, Ⅱ and Ⅲ_a of the right compared with those of the left, showing statistical significance (43.7%∶15.1%,17.5%∶7.1%,17.5%∶5.6%,χ²=24.79,6.22,8.77,P=0.000,0.013,0.003).The sum of lymph node metastasis rate was 95%(82/86) in para-recurrent nerve and medial jugular vein, and 85%(73/86) in para-recurrent nerve. In addition, multivariate analysis showed that lymph node metastasis in levelⅠwas high risk factor for lymph node metastasis of levelⅡ. Conclusions Lymph node metastasis of cervical region mainly focused on para-recurrent nerve and medial jugular vein.
		2012 Vol. 21 (2): 126-128 [Abstract] ( 4440 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	129


		2012 Vol. 21 (2): 129-130 [Abstract] ( 3146 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	131	Prognostic factor analysis of preoperative radiotherapy for esophageal squamous cell carcinoma
		WANG Qi-feng, ZHANG Wen-cheng,XIAO Ze-fen, ZHANG Hong-xing, CHEN Dong-fu,FENG Qin-fu, ZHOU Zong-mei, Lv Ji-ma, LIANG Jun, WANG Lü-hua, YIN Wei-bo
		Objective To evaluate the prognostic factors affecting preoperative radiotherapy for esophageal squamous cell carcinoma (ESCC). Methods Three hundred and eleven patients with ESCC undergone preoperative radiotherapy were retrospectively analyzed. Detailed clinical and histological materials and radiotherapy and surgery records were examined. Univariate and multivariate analyses were used to study the factors affecting prognosis. Results The follow-up rate was 96.5%, 123 and 86 patients,respectively were followed up more than 3 and 5years. The 5-year survival rates of patients without (106 patients) and with (205 patients) tumorremnants in primary locations after radiotherapy were 43.2% and 23.2%, respectively (χ²=11.53,P=0.001). The 5-year survival rates of 129 patients with primary tumor remnants but without lymph node metastasis in the T₁+T₂ phase, the T₃ phase and the T₄ phase were 42%, 30% and 16%, respectively (χ²=20.20,P=0.000). The 5-year survival rates of patients without lymph node metastasis (211 patients) and those whose lymph node metastases numbered less than 4(95 patients) was 38.3% and 13%, respectively;the 3-year survival rate of patients whose lymph node metastases numbered greater than 4 was 14%, and the 5-year survival rate was 0(χ²=42.13,P=0.000). In multivariate analysis, the local region with or without residual cancer, the depth of tumor infiltration, the status of the lymph node, the number of lymph node metastases, and gender were independent prognostic factors (χ²=32.20,36.33,18.24,4.60,6.21, P=0.000, 0.000, 0.000, 0.032, 0.013, respectively). Conclusions Histological T and N staging following preoperative radiotherapy for ESCC andnumbers oflymph node metastases were critical factors affecting prognosis and could be used for better prediction.
		2012 Vol. 21 (2): 131-135 [Abstract] ( 3979 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	136	A efficacy analysis of intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for resected thoracic esophageal squamous cell carcinoma
		ZHANG Wen-cheng, WAGN Qi-feng, XIAO Ze-fen, WANG L-hua, ZHANG Hong-xing, CHEN Dong-fu, FENG Qin-fu, ZHOU Zong-mei, LIANG Jun, HUI Zhou-guang, YIN Wei-bo
		Objective To analyze retrospectively the clinical therapeutic effect and toxicities of three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) for resected stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma (TESCC). Methods A total of 251 patients with resected TESCC underwent 3DCRT or IMRT at the Cancer Hospital (Institute), Chinese Academy of Medical Sciences between 2004.1 to 2009.7 enrolled. Postoperative radiotherapy applied via 3DCRT (20 patients) or IMRT (231 patients) with a median total dose of 60 Gy. The Kaplan-Meier method was used to calculate the survival rates, and the log-rank test was used for univariate analysis. The Cox proportional model was used for multivariate analysis. Results The follow-up rate was 98.8%. 159 and 57 patients were followed to 3 and 5 years, respectively. The 1-, 3-and 5-year overall survival (OS) rates for all the patients were 90.8%, 56.1% and 45.8%, respectively. For the stage Ⅱ_a, Ⅱ_b, and Ⅲ stage patients, the 5-year OS rates were 65.0%, 53.8% and 38.4%, respectively (χ²=7.30,P=0.026). The 5-year OS rates were 64.9% and 40.4% for the patients with negative and positive lymph node metastasis (χ²=7.04,P=0.008). Univariate analysis showed that the significant prognostic factors include UICC 2002 stage, the degree of differentiation, lymphatic metastasis and vascular carcinomatous thrombus (χ²=7.30,7.04,8.34,9.40,P=0.026,0.008,0.004,0.002). Multivariate analysis revealed that the grade of differentiation, lymphatic metastasis and vascular carcinomatous thrombus were independent prognostic factors (χ²=6.86,5.27,4.24,P=0.009,0.022,0.040). Treatment failure occurred in 58patients because of systemic metastases, 14 cervical lymph node recurrence, 17 abdominal lymph node metastases, and 31 of intrathoracic recurrence. Five patients had grade 2 or worse late treatment-related anastomotic stenosis, and 8 patients died from late treatment-related gastrointestinal bleeding. Conclusions Postoperative prophylactic 3DCRT or IMRT of TESCC can provide a favorable local control rate and acceptable toxicity. Postoperative radiotherapy should be included into the standard treatment of Stage Ⅲ TESCC or TESCC with lymph node metastasis.
		2012 Vol. 21 (2): 136-139 [Abstract] ( 4268 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	140	A correlation study on target displacement and volume variation of primary middle and distal esophageal cancer during normal respiration using four-dimensional CT
		WANG Wei^*, LI Jian-bin, ZHANG Ying-jie,XU Min, FAN Ting-yong, SHAO Qian, SHANG Dong-ping
		Objective To investigate the correlation between the motion of gross tumor volume (GTV) and the interested organs, and the correlation between the volume of GTV and the volume ofheart and lung for the mid-and distal esophageal cancer using four-dimensional CT (4DCT). Methods Seventeen patients with middle/distal esophageal carcinoma underwent respiration-synchronized 4DCT simulation during free breathing. All image sets were registered with the reference image (T₀ phase), and the GTV, the dome of diaphragm, lung and heart were delineated on CT images of the ten respiratory phases. The position of GTV, lung, heart and the dome of diaphragm were identified in all 4DCT phases, and the volume of GTV, lung and heart were also achieved. Paired sample t test were performed to compare the primary esophageal cancer displacement in the three directions. The pearson correlation test was use to study the correlation of GTV motion with the OARs, and the volume correlation of GTV with lung and heart. Results The maximum displacement of the GTV were 0.19 cm,0.17 cm,and 0.48 cm, respectively in x, y and z directions. And the displacement were significant different between z and x, y directions (t=－3.59,－4.09,P=0.002,0.001). The displacement of GTV correlated well with right lung and heart in three dimensions (r_RL-x=0.922,P_RL-x=0.000, r_RL-y=0.700, P_RL-y=0.024,r_RL-z=0.994, P_rRL-z=0.000;r_H-x=0.720,P_H-x=0.010,r_H-y=0.920, P_H-y=0.000,r_H-z=0.910,P_H-z=0.000), and only significantly associated with left lung in z direction (r=0.987,P=0.000). There was a good correlation between GTVand the dome of diaphragm in z direction (r_L=0.918, P_L=0.000;r_R=0.928,P_R=0.000). Changes in the GTV volume was correlated well with the lung volume (r_LL=－0.680, P_LL=0.031;r_rL=－0.670, Pr_L=0.034), but the correlation was not significant with the heart (r=－0.368, P=0.295) during respiratory cycle. Conclusions For middle/distal esophageal cancer, the primary tumor motion was maximal in superior-inferior direction during normal respiration, and synchronized with the dome of diaphragm. The primary tumor displacement and volume variation have different correlations with heart and lung.
		2012 Vol. 21 (2): 140-143 [Abstract] ( 4345 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	144	Comparative study of overall and stratified measurement of internal margin expansion of esophageal cancer based on four-dimensional computed tomography
		ZHANG Ying-jie, LI Jian-bin, WANG Wei, TIAN Shi-yu, MA Zhi-fang, SHANG Dong-ping
		Objective To evaluate the difference of esophageal cancer internal margin expansion measured by contouring the overall or stratified GTVs parallel to the top, bottom and center level of adjacent vertebra based on 4DCT. Methods Based on T₁ phase of 4DCT scanned for 13 patients with esophageal cancer, an radiation oncologist contoured the gross tumor volumes of 10 respiratory phases in treatment planning system, the center coordinates of target volumes were recorded. Then according to the top,bottom and center level of adjacent vertebra,target volumes on multiple CT slices of 10 respiratory phases were contoured, the center coordinates (x, y) and maximum diameters of GTVs were recorded. Internal margins of multiple esophageal cancer layers contoured according to the adjacent vertebra were calculated by the formula:IM=x(y) _T1-T10－x(y) _T1±(d _T1-T10－d _T1),then the maximum IM of the same direction were filtered. The relationship of three dimensional movement of esophageal cancer and the difference ofinternal margin expansion measured by the whole or layers of esophageal cancer were analyzed. Results The motion range of the whole esophageal cancer was 1.32 mm in left-right (x-axis) direction,1.09 mm in anterior-posterior (y-axis) direction, and 2.92 mm in cranial-caudal (z-axis) direction. It was similar in x and y directions (t=1.21,P=0.251), but different in x and z directions (t=－3.38,P=0.005), and different in y and z directions (t=－4.02,P=0.002).There were significant relationship between motion range in x and y directions (r=0.597,P=0.040), in x and z directions (r=0.662, P=0.019) and in y and z directions (r=0.723, P=0.008). The mean movement of whole esophageal cancer in left, right, anterior and posterior was －0.38,0.94,－0.62 and 0.47 mm, respectively;the mean maximum movementof esophageal cancer layers according to adjacent vertebra level was －1.83,2.21,－1.85 and 2.02 mm, respectively. There were significant differences of internal margin expansion by overall or stratified measurement of esophageal cancer in left, right, anterior and posterior dimensions (t=5.15,－4.58,3.50,－7.56,P=0.000,0.001,0.004,0.000). Conclusions There was significant relationship between motion range in thee dimensions, internal margin expansion measured by the overall esophageal cancer was less than that by stratified measurement.
		2012 Vol. 21 (2): 144-146 [Abstract] ( 4101 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	147


		2012 Vol. 21 (2): 147-148 [Abstract] ( 3024 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	149	Primary mucosa-associated lymphoid tissue lymphoma of Waldeyer′s ring:clinical characteristics and long-term outcome
		WU Run-ye, LI Ye-xiong, QI Shu-nan, LIU Qing-feng, JIN Jing, WANG Wei-Hu, SONG Yong-wen, WANG Shu-lian, LIU Yue-ping, REN Hua, FANG Hui, LU Ning-ning, ZHANG Xi-mei, CHEN Bo, LIU Xin-fan, YU Zi-hao
		Objective To investigate the clinical characteristics and long-term outcome of patients with mucosa-associated lymphoid tissue (MALT) lymphoma of Waldeyer′s ring. Methods Ten patients were retrospectively analyzed. Seven patients had stage Ⅰ_E and 3 patients had stage Ⅱ_E disease. All patients received radiation therapy with a median dose of 40 Gy, and 7 patients also received 1 to 4 cycles of CHOP-based chemotherapy before radiation. Results The ratio of male to female was 1∶9. The median age was 58 years. No patient had B symptoms. One patient had elevated LDH level. The complete response rate after treatment was 100%. With median follow-up periods of 90 months, 1 patient died from rectal cancer. One patient developed brain metastasis and was salvaged by radiotherapy. The 5-year overall survival, cancer specific survival and progression-free survival rates were 90%, 100% and 80%, respectively. Conclusions The clinical characteristics of Waldeyer′s ring MALT lymphoma were similar to that of nongastric MALT lymphoma. For patients with Waldeyer′s ring MALT lymphoma, primary radiotherapy can result in excellent long-term survival.
		2012 Vol. 21 (2): 149-151 [Abstract] ( 4114 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	152	Efficacy of postoperative three-dimensional conformal radiotherapy in transitional cell carcinoma of the renal pelvis or ureter
		LI Xiao-mei, WANG Qing-guo, ZHAO Qing, LI Hong-zhen, ZHANG Min, HOU Zhen-liang, QIN Shang-bin, GAO Xian-shu
		Objective To evaluate the role of postoperative three-dimensional conformal radiotherapy (3DCRT) in transitional cell carcinoma of the renal pelvis or ureter. Methods We retrospectively reviewed a series of 103 patients with transitional cell carcinoma of the renal pelvis or ureter. All patients received surgery without distant metastases and had T₃ or T₄ disease, or grade 3 disease if T₂. No patient received chemotherapy. Thirty-seven patients received three-dimensional conformal radiotherapy (3DCRT) following surgery. Sixty-six patients received surgery alone. The local control rates and survival rates were calculated by Kaplan-Meier method and compared by Logrank test in univariate analysis. Cox regression was used for multivariate analysis. Results The follow-up rates were 89% and 92% in surgery alone and 3DCRT groups. The number of patients who had minimal followed-up time of 5 years were 33,37 in surgery alone and 3DCRT groups. The 1-,3-, and 5-year local control rates were 89% vs. 94%, 74% vs. 90%, and 72% vs. 90% in surgery alone and 3DCRT groups, respectively (χ²=3.90,P=0.048). The 1-,3-, and 5-year bladder tumor-free survival rates were 87% vs. 94%, 60% vs. 79%, and 57% vs. 79% in surgery alone and 3DCRT groups, respectively (χ²=4.50,P=0.037). The 1-,3-, and 5-year overall survival rates were 90% vs. 84%, 71% vs. 65%, and 65% vs. 62% in surgery alone and 3DCRT groups, respectively (χ²=0.32,P=0.573). Univariate and multivariate analyses showed that T stage, lymph node metastasis, positive surgical margin were correlated with overall survival rate (χ²=7.91,64.69,40.20 and 5.08,17.23,8.22,P=0.005,0.000,0.000 and 0.024,0.000,0.004). Conclusions 3DCRT may improve local control and reduce tumor recurrence in bladder in patients with locally advanced transitional cell carcinoma of the renal pelvis or ureter. However, 3DCRT does not improve overall survival in this group of patients.
		2012 Vol. 21 (2): 152-155 [Abstract] ( 3825 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	156	The influence of endorectal balloon on normal tissue dosimetry in prostate cancer treated with intensity-modulated radiation therapy
		WANG Wen-qing,WANG Wei-hu,LI Ye-xiong,JIN Jing,LIU Yue-ping, WANG Shu-lian,SONG Yong-wen, XU Ying-jie, DAI Jian-rong
		Objective To investigate the influence of endorectal balloon on normal tissue dosimetry in prostate cancer patients treated with intensity-modulated radiation therapy (IMRT). Methods Ten patients with prostate cancer were included and each had two sets of planning CT-scans:one with and one without an air-filled endorectal balloon. Target volumes and organs at risk (rectum,bladder,femoral heads) were contoured on the 20 CT scans and IMRT plannings were performed. The prescription dose was 78 Gy to 95% of planning target volume. The percentage of volume of organs at risk (without or with endorectal balloon) receiving more than 10 Gy, 20 Gy, 30 Gy, 40 Gy, 50 Gy, 60 Gy, 70 Gy and 75 Gy (V₁₀－V₇₀, in increments of 10 Gy, and V₇₅) were analyzed. Results The V₁₀－V₆₀ of rectum with endorectal balloon were 75.5%, 52.6%, 35.3%, 26.1%, 19.6%, 14.2%,and those without endorectal balloon were 82.2%, 62.8%, 43.9%, 31.4%, 24.0%, 17.1%, respectively (χ²=9.46,P<0.01).Use of endorectal balloon significantly reduced the dose to the rectum (V₁₀－V₆₀). The V₇₀ and V₇₅ of rectum with endorectal balloon were 9.1% and 8.2%;and those without endorectal balloon were 9.9% and 6.2% respectively (χ²=1.82,P>0.05).The difference was not significant. There were nosignificant differences in the dose tobladder,left and right femoral head between patients with and without endorectal balloon. Conclusions Endorectal balloon can significantly decrease the medium and low dose volume of rectum for prostate cancer patients treated with IMRT, which may reduce the rectal toxicity.
		2012 Vol. 21 (2): 156-159 [Abstract] ( 4273 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2012 Vol. 21 (2): 166-167 [Abstract] ( 4277 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	160	The design and implementation of the radiation therapy information management system (RTIMS) based on the workflow of radiation therapy
		WU Qin-hong, LI Gao-feng, ZHONG Qiu-zi, HOU Xiu-yu, LI Ming, XU Yong-gang, HE Jing-xue
		Objective To meet the special needs of the department of radiation oncology, a radiation therapy information management system (RTIMS) has been developed as a secondary database system to supplement the Varian Varis/Aria since 2007. Methods The RTIMS server was used to run a database and web service of Apache+ PHP+MySQL. The RTIMS sever′s web service could be visited with Internet Explorer (IE) to input, search, count, and print informations from about 30 workstations and 20 personal computers. As some workstations were installed with Windows and IE in English only, some functions had English version. Results In past five years, as the RTIMS was implemented in the department, some further needs were met and more practical functions were developed. And now the RTIMS almost covered the whole workflow of radiation therapy (RT). By September 2011, recorded patients data in the RTIMS is as follows:3900 patients, 2600 outpatient RT records, 6800 progress notes, 1900 RT summaries, 6700 charge records, 83000 workload records, 3900 plan application forms, 1600 IGRT records, etc. Conclusions The RTIMS based on the workflow of RT has been successfully developed and clinically implemented. And it was demonstrated to be user-friendly and was proven to significantly improve the efficiency of the department. Since it is an in-house developed system, more functions can be added or modified to further enhance its potentials in research and clinical practice.
		2012 Vol. 21 (2): 160-162 [Abstract] ( 4496 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	163	Analysis of setup errors and its impact on dosimetric distribution for thoracic carcinoma radiotherapy with cone-beam CT-based image guidance
		CAO Xiao-hui, LIU Ming, ZHAI Fu-shan, WANG An-feng, YANG Yong-feng, LIU Bing, BAO Chao-en
		Objective To study the role of kilovolt cone beam CT (CBCT) on the geometrical accuracy of three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) and to analyze the effect of the setup error on the dosimetric distribution of targets and peripheral organs at risk for thoracic carcinoma. Methods 23 patients with thoracic carcinoma were collected. Varian-IX linear accelerator on-board imaging system was used to acquire CBCT scans in 3DCRT or IMRT before delivery. The right-left (x), superior-inferior (y), anterior-posterior (z) setup errors can be obtained from the images automatically restructured by the system. And then CMS treatment planning system was used to analyze the impact of setup errors on dosimetric distribution of targets and peripheral organs at risk if the isocenter was replaced by the actual location which obtained from the CBCT scan. Results The setup error were －0.181 mm, －0.429 mm, －2.637 mm respectively and the absolute maximum was 13 mm, 21 mm, 8 mm respectively according to 182 CBCT scans on x, y, z directions. Within 5 mm of which accounted for 93.9%, 71.4%, 81.9% respectively. Target dose reduced with respect to treatment plan, mean value were 89.7%(F=7.04,P=0.011), 97.9%, 95.5% and 98.8%(F=0.32,1.68,0.11;P=0.572,0.201,0.740) for PTV D95%, PTV D_mean, GTV D95% and GTV D_mean. Mean value of the difference in normal organ dose were 102.7%, 103.1%, 105.0%, 110.6%, 103.0%, 98.1% for the volume of lung accept 5 Gy, 10 Gy, 20 Gy, 30 Gy, the mean dose of lung, the maximum dose of 1 cm³ spinal cord. The difference of PTV D95% was significant if setup errors more than 5 mm in any direction (F=14.58,P=0.001). Conclusions Setup errors of this group mostly within 5 mm. It was more obvious in the y directions. There was significantly difference if setup errors more than 5 mm in any direction.
		2012 Vol. 21 (2): 163-165 [Abstract] ( 4544 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	168	Gantry orientation optimization of intensity-modulated radiotherapy for brain glioma
		YANG Zhen^*, ZHANG Yan-qiu, HONG Ji-dong, LIU Gui, ZHANG Zi-jian, Lv Zhi-ping
		Objective To compare the dosimetric characteristics of intensity-modulated radiotherapy (IMRT) treatment plan with gantry orientation optimization. Methods Fifteen post-operation patients with brain glioma were selected randomly. Two plans were designed for each patient with the same dose-volume constraints and number of fields (from 5 to 9 fields). A standard coplanar equi-space gantry angles were used in the first plan (plan 1), whereas the selection of gantry angle was optimized by plan geometry optimization algorithm for the same number of beams in the second plan (plan 2). Under conditions of the same prescription dose requirement, dosimetric parameters of target and organs at risk (OAR) were evaluated by dose-volume-histogram and monitor units (MU). Results The conformity index of GTV_tb in Plan 1 is better than in plan 2(0.84∶0.85,t=2.77,P=0.015).The maximum dose of left len, right len and left optical nerve in the plan 2 is lower than in the plan 1(528.91 cGy∶662.40 cGy, t=3.15, P=0.007;535.87 cGy∶631.99 cGy, t=2.72, P=0.017;2189.85 cGy∶2676.41 cGy, t=3.06, P=0.008) respectively. For the dose of normal tissue (defined as the region of the total brain subtracted by plan target volume (PTV), namely B-P), the volume V₅,V₁₀,V₁₅ and V₂₀ in plan 2 are obviously lower than in plan 1(52.17%∶55.43%,t=3.76, P=0.002;42.91%∶46.66%, t=4.44, P=0.001;36.05%∶40.01%,t=5.91, P=0.000;29.45%∶32.35%, t=4.89,P=0.000),respectively. MU in plan 2 decreased by 10.7% on average compared with plan 1(851∶760, t=3.60,P=0.003). Conclusions Gantry orientation optimization of IMRT for brain glioma can reduce the dose delivered to OAR to a certain extent, and protect the normal tissue around target better, and also reduce MU. Therefore there are some dosimetric advantages in the IMRT plan with gantry orientation optimization for brain glioma.
		2012 Vol. 21 (2): 168-171 [Abstract] ( 4399 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	172	The impact of resolution to Gamma pass rate in the verification of dose distribution
		CAO Wu-fei, HUANG Xiao-yan, SUN Wen-zhao, CHEN Li
		Objective To study the impact of the resolution of reference dose distribution and evaluated dose distribution to Gamma rate in the verification of IMRT. Methods Designed four fields, the resolution of dose distribution calculated in water phantom and exported from TPS are 1,2,3,4,5,6 mm. To calculate Gamma index by IBA′s OmniPro-I′mRT software in different sampling resolution. Results When the resolution of evaluated dose distribution was fixed, the change of reference dose distribution′s resolution has little effect on Gamma rate (5% to IMRT field);When the resolution of reference dose distribution was fixed, the Gamma rate increased as the evaluated dose distribution′s resolution (>1 mm) raise (the Gamma rate increase (15.2±6.2)%(t=11.99,P<0.01) and (14.9±5.5)%(t=13.24,P<0.01) while the resolution of evaluated dose distribution changed from 6 mm to 3 mm and from 3 mm to 1 mm respectively). Conclusions To use Gamma method for verification of IMRT, the measured data can be as a reference dose distribution without interpolation;the computed data by TPS can be as a evaluated dose distribution and it is more appropriate for the resolution of 1 mm.
		2012 Vol. 21 (2): 172-175 [Abstract] ( 4173 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	176	Quantitative analysis of image quality, stability and volume precision in kilovoltage cone beam CT
		WANG Jun-qi, XU Zhi-yong, HU Wei-gang, LI Long-gen, PENG Jia-yuan
		Objective To quantitatively evaluate the image quality, stability and volume precision in kilovoltage cone beam CT (CBCT) on Varian linear accelerator. Methods The Catphan600 phantom was repeatedly scanned in the full-fan and half-fan CBCT scanning modes. A simulation fan-beam CT (FBCT) was used as a benchmark and results related to the low contrast resolution, spatial resolution, uniformity and image noise were compared with the CBCT using the treatment planning system. The comparison of image quality and long-term stability and volume precision was analyzed. Results Spatial resolution was no differences observed between FBCT and CBCT (6 lp/cm∶6 lp/cm,T=18.00, P>0.05). Low contrast resolution was, on average, 1.65% and 1.74% for both CBCT_Full-Fan and CBCT_Half-Fan, and 1.03% for the FBCT (T=6.00, P<0.05). Uniformity was, on average, 0.005 and 0.033 for both, and 0.003 for the FBCT (T=6.00, P<0.05). In terms of image noise, the FBCT images were superior to the CBCT (T=30.00, P<0.05). In valid scan range of the CBCT, reconstructed precision was high. There was no significant time trend in the image quality. Conclusions The image quality of kilovoltage CBCT is inferior to the conventional CT. However, tumor and soft tissues are visible in the CBCT images. The image stability and reconstructed precision is satisfying.
		2012 Vol. 21 (2): 176-180 [Abstract] ( 4416 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	181	Investigation of 8 MV X-rays energy spectrum structure of medical linear accelerator
		BAI Yan-ling^*, XIAO Xue-fu, SHAO Wen-cheng
		Objective To study the spectrum structure of X-ray and simplify the description method of it. Methods By the general program of Monte Carlo Geant4 to study X-ray spectrum structure and angular distribution of X-ray energy spectrum. Results The results of percentage depth doses and profile curves at different depths of any radiation fields in water phantom calculated by Monte Carlo Geant4 were consistent with the measurements. Conclusions In radiotherapy, X-ray with same nominal energy have very similar dosimetry characteristics, this indicates they have very similar energy spectrum and angular distribution of spectrum, the differences of dosimetric details reflect the different details of the X-ray spectrum structure and angular distribution of X-ray energy spectrum. These studies have very important significances to rapidly build precise virtual source modeling for Monte Carlo calculation based on dose curves measurements in water phantom.
		2012 Vol. 21 (2): 181-184 [Abstract] ( 4080 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2012 Vol. 21 (2): 185-185 [Abstract] ( 3269 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review

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		2012 Vol. 21 (2): 186-188 [Abstract] ( 3839 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2012 Vol. 21 (2): 189-191 [Abstract] ( 4013 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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Cancer Hospital of Chinese
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