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.3 Published 2012-05-10

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

In memory

	195


		2012 Vol. 21 (3): 195-195 [Abstract] ( 3239 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	196	Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy:long-term results of 416 patients
		YI Jun-lin, GAO Li, HUANG Xiao-dong, LUO Jing-wei, Xiao Jian-ping, LI Su-yan, WANG Kai, ZHANG Shi-ping, QU Yuan, XU Guo-zhen
		Objective To summarize the long term outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy. Methods From Nov 2001 to Dec 2009, totally 416 newly diagnosed NPC patients was treated in our hospital. The prescribed dose was 70－78 Gy to the gross tumor volume and 70 Gy to the positive neck nodes, 60 Gy to the clinical target volume, and 50－56 Gy to the clinically negative neck. Among 333 stage Ⅲ/Ⅳ patients according to the 2010 UICC staging system, 187 received concurrent chemoradiotherapy with a regimen of weekly cisplatin 30 mg/m².Local control rate (LC), overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method. Results The follow up rate is 98.0%.158 patients was followed up more than 5 years. The 5 years LC, OS, DFS and DMFS of whole group were 87.7%,82.1%,71.8% and 84.5%. Sex, Age, T stage and N stage were independent prognostic factors for OS (χ²=4.59,11.20,19.40,18.00, P=0.03,0.00,0.00,0.00), T and N stage were independent prognostic factors for DFS (χ²=33.50,21.20,P=0.00,0.00) and DMFS (χ²=11.90,14.60,P=0.01,0.01). The 5 years LC, OS, DFS and DMFS for local-regional advanced disease with or without concurrent chemotherapy was 82.2% and 90.7%(χ²=1.72,P=0.19),70.2% and 83.4%(χ²=1.42, P=0.23), 62.8% and 73.2%(χ²=2.83, P=0.09),78.0% and 83.2%(χ²=0.37,P=0.55) respectively. Conclusions The long term outcomes of nasopharyngeal carcinoma treated by intensity-modulated radiotherapy was encouraged. The role of concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiotherapy needs further investigated.
		2012 Vol. 21 (3): 196-200 [Abstract] ( 4485 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	201	Multicenter safety study on cetuximab combined with intensity modulated radiotherapy and concurrent chemotherapy of cisplatin in locoregionally advanced nasopharyngeal carcinoma
		CHEN Chun-yan^*, ZHAO Chong, GAO Li, LANG Jin-yi, PAN Jian-ji, HU Chao-su, JIN Feng, WANG Ren-sheng, XIE Cong-hua, LIN Tong-yu, LU Tai-xiang
		Objective To evaluate the safety of cetuximab combined with intensity-modulated radiotherapy (IMRT) plus concurrent cisplatin chemotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC) in a Chinese multicenter clinical study. Methods From July 2008 to April 2009, 100 Patients with primary stage Ⅲ－Ⅳ_b non-keratinizing NPC were enrolled. The planned dose of IMRT to gross tumor volume and positive cervical lymph nodes was 66.0－75.9 Gy and 60－70 Gy in 30－33 fractions. Cisplatin (80 mg/m², q3 week (w)) and cetuximab (400 mg/m² one w before radiation, and then 250 mg/m² per w) were given concurrently. The adverse events (AEs) were graded according to common terminology criteria for adverse events v3.0. Results The compliance of the entire group of patient was satisfactory. Actual median dose to gross tumor volume was 69.96 Gy, and the median dose to positive cervical lymph nodes was 68 Gy. Median dose of cisplatin was 133 mg, median first-dose of cetuximab was 690 mg, and median weekly dose was 410 mg. AEs were well tolerated and manageable, mainly consisting of acneiform skin eruptions, dermatitis and mucositis. Grade 4 mucositis was observed in 2% of the patients and no other grade 4 AEs were observed. Conclusions The combined treatment modality of IMRT+concurrent chemotherapy+cetuximab in loco-regionally advanced NPC is well tolerated.
		2012 Vol. 21 (3): 201-204 [Abstract] ( 4872 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	205	Significance of primary tumor volume on prognosis in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy
		CHEN Chuan-ben^*, PAN Jian-ji, CHEN Li-sha, BAI Peng-gang, LIN Shao-jun, ZHANG Yu, ZHANG Xiu-chun, FEI Zhao-dong
		Objective To analyze the correlation between primary tumor volume (PTV) and prognosis of nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT). Methods 330 NPC patients treated by IMRT were included. Pretreatment computerized tomography image were input into tree-dimensional treatment-planning system, in which the primary tumor volume were calculated automatically. The receiver operating characteristic curve was used to determine the best cut-off point of PTV. Within the framework of UICC 2002 T stage,The PTV　was divided into four groups:V₁<10 cm³, V₂ 10－25 cm³, V₃>25－50 cm³ and V₄>50 cm³. Kaplan-Meier and Logrank test was used to analyze the survival, Cox proportion risk regression model were used to analysis the correlation between PTV and prognosis. Results The mean PTV for all NPC patients was (34.2±27.1) cm³ with the range of 0.4－153.7 cm³. The 3-year overall survival for V₁, V₂, V₃ and V₄ stage were 88.6%,90.0%,91.2% and 74.2%, respectively (χ²=12.83,P=0.005). There was no significant difference among V₁, V₂ and V₃ in terms of overall survival (χ²=1.96,P=0.376). The 3-year distant metastasis-free survival and diseases-free survival or overall survival were decrease in PTV>50 cm³ and PTV≤50 cm³(77.4%∶89.9%, χ²=7.24, P=0.007and 64.5%∶85.1%, χ²=13.95,P=0.000 or 74.2%∶90.3%, χ²=11.76,P=0.001). Multivariate analysis revealed that PTV was a adverse prognostic factors for overall survival (χ²=0.00,P=2.580). Conclusion Our data showed that the primary tumor volume had significantly impacted on the prognosis of NPC patients treated by intensity modulated radiotherapy.
		2012 Vol. 21 (3): 205-208 [Abstract] ( 4019 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	209	The role of pretreatment FDG standard uptake value in predicting for clinical outcome in locally-advanced nasopharyngeal carcinoma
		XU An-an, HAN Fei, LU Li-xia, HU Xiu-quan, LIN Xiao-ping, FAN Wei, SHEN Guan-zhu, CAO Yan-qing, ZHAO Chong
		Objective To explore the prognostic value of pretreated maximum standardized uptake value (SUV_max) using 18-fluorodeoxyglucose positron emission tomography with computed tomography (¹⁸FDG PET/CT) in locally-advanced nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT). Methods One hundred and forty previously untreated stage Ⅲ－Ⅳ_b(UICC/AJCC 6^th) patients with biopsy-proven nasopharyngeal carcinoma were examined. All of the enrolled patients accepted whole body/head-neck ¹⁸FDG PET/CT before radical IMRT. ¹⁸FDG uptakes were recorded as SUV_max of primary tumor (SUV_max-P) and SUV_max of cervical lymph nodes (SUV_max-N). The relationships between SUV_max and long-term clinical outcomes were analyzed. Results The median SUV_max-P was 10.4, and the median SUV_max-N was 6.2. The SUV_max-P was weakly correlated with T-stage (R=0.279, P=0.001). The SUV_max-N was weakly correlated with N stage (R=0.334, P=0.000). There were no difference of the median SUV_max-P (9.2 vs.10.4,U=560.50,P=0.805) and the median SUV_max-N (4.0 vs.5.0,U=576.00,P=0.908) between patients with and without local recurrence. The median SUV_max-P of patients with distant metastasis was significantly higher than those without metastasis (11.9 vs. 9.8, U=987.50,P=0.014). The SUV of 10.2 was taken as a cut-off for high and low uptake tumors. For patients with SUV_max-P>10.2, the 5-year distant metastasis-free survival (DMFS) and 5-year overall survival (OS) were significantly higher than those with SUV_max-P≤10.2(69.1% vs. 95.5%,χ²=15.88, P=0.000;68.4% vs. 94.0%,χ²=15.56,P=0.000, respectively). Multivariate analysis showed that SUV_max-P was the only independent risk factor of 5-year DMFS and OS (HR=7.87,P=0.001 and HR=5.14,P=0.003).Conclusion SUV_max-P is a useful biomarker predicting long-term clinical outcomes in newly diagnosed locally-advanced NPC patients.
		2012 Vol. 21 (3): 209-213 [Abstract] ( 4742 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	214	Results and prognostic factors of CyberKnife for lung metastasis
		QU Chen-hui, LIU Ning-bo, ZHUANG Hong-qing, SONG Yong-chun, DONG Yang, GONG Lin-lin, YUAN Zhi-yong
		Objective To investigate the effectiveness and toxicity of CyberKnife in the treatment of lung metastases. Methods Treatment details and outcomes were reviewed for 93 targets of 48 histologically verified patients treated by CyberKnife at the CyberKnife Center of Tianjin between September 2006 and June 2010. The median tumor volume was 6.0(0.2－135.2) cm³, the median biological equivalent dose was 140.8(53－180) cGy (α/β=10),the median fraction was 3(1－7) times and the median isodose line was 81%(71%－91%). Results The rate of follow-up is 96%. 33 cases were followed up for more than 2 years. The effective rate was 90.3%.Two targets of 2 patients locally progressed. The 1-and 2-year local control rates, overall survival (OS) rates and progression-free survival (PFS) rates were 98% and 98%, 83% and 63%,and 64% and 37%, respectively. Univariate analyses showed that age older than 60 versus ≤60 years tended to be predictor for PFS (χ²=3.45,P=0.063);The PFS of patients who had single lesion was better than patients with multiple lesions (χ²=4.49,P=0.034);patients with disease-free interval longer than 18 months had better OS (χ²=6.50,P=0.011).Five patients were reported to experience treatment-related grade 1 radiation pulmonary injury, and one each for subcutaneous fibrosis with pigmentation, grade 2 and grade 3 adverse event. Conclusions For patients with lung metastatic lesion, CyberKnife is an effective option with high local control rate and little acute reaction. The long-term outcome and toxicity need further study.
		2012 Vol. 21 (3): 214-216 [Abstract] ( 4389 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	217	Analysis of survival prediction value using modification 7^th UICC esophageal cancer staging system for esophageal squamous cell carcinoma with preoperative radiotherapy
		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 Lv-hua, YIN Wei-bo
		Objective To evaluate the value of the international union against cancer (UICC) stage, pathologic complete response (pCR), and the estimated treatment response as various means for prognostic stratifying patients after surgery in patients with squamous cell carcinoma of the esophagus who received preoperative radiotherapy (RT). Methods A retrospective review was performed on 311 patients with esophageal squamous cell carcinoma who received RT before the esophagectomy. Data collected included the demographics, the RT details, the pathologic findings, and the survival. Prognostic survival was analyzed by Kaplan-Meier method and Logrank test. Results The follow-up rate was 96.5%, 89 and 43 patients, respectively were followed up more than 5 and 10 years. In univariate analysis, residual disease and the number of positive lymph node were predictors of the overall survival (T-pCR,χ²=11.53,P=0.001;0,1－3,≥4,χ²=42.13,P=0.000,respectively). Further study found the 7^th stage system of UICC cannot (can or cannot) entirely predict the prognosis of this group of patients. If categorizing the stages of their lymph nodes into three groups:N₀(0), N₁(1－3) and N₂(≥4)), and the modified UICC system can accurately distinguish ypStage Ⅰ with ypStage Ⅱ(T_0-3N₁M₀+T₃N₀M₀)(χ²=11.15,P=0.001) and ypStage Ⅱ with ypStage Ⅲ(T₄N_0－1M₀ and T_0-3N₂M₀)(χ²=23.39,P=0.000). Conclusions The pathologic post-radiotherapy T stage and the number of positive lymph node are predictors for esophageal squamous cell carcinoma receiving preoperative radiotherapy. The modified UICC stage system can be a better survival predictor than the 7^th UICC stage system.
		2012 Vol. 21 (3): 217-220 [Abstract] ( 4113 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	223	Application of diffusion-weighted magnetic resonance imaging in precise radiotherapy for esophageal carcinoma
		TIAN Hua^*,WANG Lan, HAN Chun, SHI Gao-feng, GAO Chao, LI Xiao-ning, ZHANG Jing, KONG Jie
		Objective To explore the application of diffusion-weighted magnetic resonance imaging (DWMRI) in precise radiotherapy of esophageal carcinoma. Methods Thirty-seven patients with biopsy-proven esophageal cancer from March 2010 to January 2011 were included. To delineate the gross tumor volume (GTV) using CT and DWMRI images, each patient was examined by DWMRI and CT scan using the same position before radiotherapy. To compare the maximum diameters and volumes of tumor between CT and DWMRI. The tumor lengths measured by esophagogram, esophagoscope, CT and DWMRI were compared. Results Tumor lengths under esophagogram, esophagoscope, CT and DWMRI were 5.70 cm,6.06 cm,7.97 cm and 5.79 cm respectively. The lengths between CT and esophagogram, CT and esophagoscope, CT and DWMRI had statistical significance respectively (F=4.88,P=0.003). The maximum diameters of tumor shown on CT and DWMRI were 3.79 cm and 3.81 cm respectively (t=－0.32,P=0.751).The GTV were 45.75 cm³ and 38.05 cm³ in CT and DWMRI respectively (t=5.30,P=0.001). 53 lymph nodes were assessed positive on both CT and DWMRI. DWMRI excluded 25 positive lymph nodes assessed by CT;also confirmed 15 negative lymph nodes excluded by CT, 6 of which were paraesophageal lymph nodes. The addition of DWMRI information altered the clinical stage in 6 patients. Conclusions Tumor lengths measured on DWMRI and esophagogram had the optimal approximation. It was easy to find paraesophageal lymph nodes via DWMRI. With the addition of DWMRI information, the target range and clinical stage were alerted in some patients.
		2012 Vol. 21 (3): 223-226 [Abstract] ( 5370 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	227	The analysis of correlation between changes of myocardial enzymes level in serum before and after radiation and dose-volume histogram parameters of the heart
		DING Xiu-ping^*, LI Hong-jun, LI Bao-sheng, WANG Dong-qing
		Objective To analyze the correlation between the changes of myocardial enzyme level inserum before and after radiotherapy and dose-volume histogram (DVH) parameters of the heart. Methods A total of 102 patients with 68 cases of lung cancer and 34 cases of esophageal cancer were recruited. All patients received three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), with the radiation beams passing through the heart. Aspertate aminotransferase (AST), creatine kinase (CK), creatine kinase isozyme (CK-MB), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH) were determined in the serum before and after radiotherapy. All the enzyme levels before and after radiotherapy were compared through paired t-test. Independent sample t-test was conducted between sub-groups. And the dose-volume histogram (DVH) parameters of the heart were calculated (the volume percentage of heart receiving dose equal to or exceeding x Gy (Vx). The correlation between myocardial enzyme level and DVH parameters was analyzed through Pearson method. Results Serum AST, CK-MB, LDH, α-HBDH levels increased significantly after radiotherapy (19.42∶27.89,14.72∶19.57,178.80∶217.57,140.32∶176.25,t=－3.39－－6.92,all P=0.000). In Group IMRT, significant correlations between the increase of myocardial enzyme concentration and DVH parameters of the heart are found, AST with V₂₀, V₂₅, V₃₀ of heart (r=0.302－0.431,P=0.039－0.003), CK with V₃₀ of heart (r=0.345,P=0.013),and CK-MB, LDH, α-HBDH with V₂₅, V₃₀(r=0.465－0.376,P=0.001－0.005). In Group CRT, there are significant correlations between changes of CK-MB, LDH level and V₃₀of heart (r=0.330,0.274,P=0.014,0.033), α-HBDH and V₂₅, V₃₀, and V₃₅ of heart (r=0.270－0.331,P=0.046－0.014). When the irradiation dose was more than 50 Gy, significant correlations were found between the concentration changes of AST, LDH, α-HBDH and V₂₅, V₃₀ of heart (r=0.256－0.359,P=0.019－0.006), CK-MB and V₃₀(r=0.233,P=0.037). When the irradiation dose was 50 Gy or less, only the concentration change of serum CK has significant correlation with V₅ and V₄₅ of heart (r=0.581,0.536,P=0.023,0.043). Conclusions There exists certain correlations between changes of myocardial enzymes level before and after radiation and DVH parameters of the heart, which indicates that the DVH parameters of heart are helpful to evaluate the radiation-induced myocardial damage.
		2012 Vol. 21 (3): 227-230 [Abstract] ( 4305 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	221


		2012 Vol. 21 (3): 221-222 [Abstract] ( 3152 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	235


		2012 Vol. 21 (3): 235-236 [Abstract] ( 3222 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	246


		2012 Vol. 21 (3): 246-247 [Abstract] ( 3299 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	263	Study of inter-fractional variations and adaptive radiotherapy in pancreatic cancer
		YANG Cheng-liang^*, X. Allen Li, WANG Jian-hua, LI Ding-jie, MAO Rong-hu
		Objective To quantitatively characterize the inter-fractional anatomy variations and advantages of dosimetry for the adaptive radiotherapy in pancreatic cancer. Methods A total of 226 daily CT images acquired from 10 patients with pancreatic cancer treated with image-guided radiotherapy were analyzed retrospectively. Targets and organs at risk (OARs) were delineated by the atlas-based automatic segmentation and modified by the skilled physician. Various parameters, including the center of mass (COM) distance, the maximal overlap ratio (MOR) and the Dice coefficient (DC), were used to quantify the inter-fractional organ displacement and deformation. The adaptive radiation therapy (ART) was applied to handle the daily CT images. The dose distributions parameters from the ART plan were compared with those from the repositioning plan. Results The inter-fractional anatomy variations of pancreas head were obvious in the pancreatic cancer irradiation. The mean COM distance, MOR and DC of pancreas head after the bony or soft tissue alignment and registration was (7.8±1.3) mm,(87.2±8.4)% and (77.2±7.9)% respectively. Compared with the repositioning plan, the ART plan had better target coverage and OARs sparing. For example, the mean V₁₀₀ of PTV was improved from (93.32±2.89)% for repositioning plan to (96.03±1.42)% for ART plan with t=2.79,P=0.008 and the mean V_50.4 for duodenum was reduced from (43.4±12.71)% for the repositioning plan to (15.6±6.25)% for the ART plan with t=3.52,P=0.000. Conclusions The ART can effectively account for the obvious inter-fractional anatomy variations in pancreatic cancer irradiation and be used to escalate the radiotherapy dose for the pancreatic cancer, which will lead to a promising higher local control rate.
		2012 Vol. 21 (3): 263-266 [Abstract] ( 3683 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	267	Comparison of KVCBCT based on deformable image registration of adaptive planning and static 3DCRT planning for patients with lung cancer
		HOU Yong, YIN Yong, WANG Peng-cheng, MA Chang-sheng
		Objective To comparison of kilo-voltage cone-beam CT (KVCBCT) deformable image registration of adaptive planning and static planning for patients with lung cancer, and evaluate their characters. Methods Five patients with lung cancer were in the study. Two sets image were acquired every three days and were concatenated to one set. Ten sets CBCT image and planning CT image were transferred a commercial deformable image registration software. The planning CT was deformed to each set CBCT and the contours delineated, the new contour were labeled CBCT_f1-CBCT_f10.Transfer of each deformed planning CT and CBCT_f1-CBCT_f10 back into the treatment planning system enable re-calculation of actual dose distribution, then we obtain CT planning and fractional CBCT contour planning, the CBCT planning were labeled CBCT_p1-CBCT_p10.Ten times CBCT planning of every patient were added to acquire a total dose accumulation planning (DA plan),comparison of dose distribution and dose-volume histogram in CT plan and DA plan for fractionation dose and accumulation dose of left, right, total lung, PTV and spinal-cord. The difference of two plan was analyzed by Wilcoxson′s sign rank test. Results The max and min dose of PTV, the left, right, total lung V₅,V₁₀,V₂₀,V₃₀,V₅₀,spinal-cord max dose, and the left, right and total lung mean dose in DA plan were smaller than in CT plan (z=－2.02－－2.03,P<0.05).The mean dose of PTV and D₉₅ in DA plan was as well as in CT plan (z=－1.48,－1.21,P=0.138,0.225). Conclusions KVCBCT based deformable image registration of adaptive planning reduce the dose of lung and spinal-cord, and enhance the dose of PTV. This provides a tool for exploring adaptive radiotherapy strategies.
		2012 Vol. 21 (3): 267-270 [Abstract] ( 4114 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	271	A clinical test and application research of IMRT dose verification system based on patient′s anatomical structure and on-line dosimetry
		LIN Hai-lei, HUANG Shao-min, DENG Xiao-wu, JIN Guang-hua, SUN Wen-zhao, YAO Xing-hong, ZHANG Dan-dan, CHEN Li-xin
		Objective To test a three-dimensional dose verification system, which reconstructing dose to anatomy based on modeling and online measurements (RDBMOM), and to evaluate the accuracy and feasibility of its application in clinical intensity-modulated radiotherapy (IMRT) quality assurance. Methods Phantom plans of regular and irregular fields were selected for the testing. All test plans were implemented and the dose distributions were measured using the thimble ion-chamber and two-dimensional ion-chamber array, the accuracy of RDBMOM were then evaluated by comparing the corresponding results. Two practical treated nasopharyngeal carcinoma IMRT plans were verified with RDBMOM and the clinic significancy were valued. Results Compared with measurements of the thimble ion-chamber, deviations of RDBMOM were within 1% in all tested cases except small field of 3 cm×3 cm. The largest deviation of reconstructed dose in IMRT cases was 2.12%. The dose profile reconstructed by RDBMOM coincided with the measurement using two-dimensional ion-chamber array. The γ rates (3%/3 mm) were 94.56%－100%. The RDBMOM verification of IMRT cases shown that the γ rate>99% in total and>98% in planning target volume, deviation in D₉₅<0.4%, but the largest deviations in mean dose of the parotids and lens were 2.97% and 59.58% respectively. Conclusions Accuracy of the tested system satisfies the demand of IMRT dose verification. RDBMOM is able to provide information of volumetric dosimetry and anatomical location of dose error, which is benefit for evaluating the clinical value of verification results.
		2012 Vol. 21 (3): 271-274 [Abstract] ( 4418 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	278	Clinical applied study for cerrobase compensator intensity-modulated radiotherapy technique
		LI Jie, QI Guo-hai, LI Jian, YI Gang, WAN Bin, WANG Pei, LANG Jin-yi
		Objective To study the using of cerrobase as the compensation material in the intensity-modulated radiation therapy (IMRT) implementation and impact factors. Methods With therapy planning system (TPS) exported the radiation field intensity file (Dicom RT), through measuring the attenuation coefficient of cerrobase, to calculate the processing depth of AUTIMO 3D CNC corresponding for Dicom RT files at each pixel, then using the processed foam casting of Cerrobase, produced the required IMRT compensator. Through the MATRIXX testing the IMRT compensator in clinical implementation. At the same time we compared the MU of using multi-leaf collimator (MLC) and Cerrobase IMRT compensator for 10 patients. Results With cerrobase compensation IMRT can get similar dose or dose distribution to dose produced by TPS for point or plane dose, error is within 5%.To comparison with MLC, using cerrobase compensator has fewer treatment times ((4.44±0.39) min∶(5.71±0.57) min (t=10.82,P=0.000)) and fewer MU (462.5±65.8) MU∶(524.5±99.6) MU (t=3.14,P=0.012)). Conclusions Comparison with MLC IMRT, the cerrobase compensation technique has an important application value with its unique advantages. This research provides an implemented method of IMRT radiotherapy for the primary hospital.
		2012 Vol. 21 (3): 278-280 [Abstract] ( 4112 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	281	Impact factor of relationships between CT value and relative electron density for treatment planning system
		FENG Guo-sheng^*,LIANG Yuan,WU Dan-ling,HAO Yan-rong,LU He-ming,CHEN Jia-xin,LIAO Chao-long,MO Ying,HUANG Yi-hang
		Objective To study the CT values of certain phantoms scanned by various CT scanners with dissimilar parameters. Methods The CT values of tissue equivalent inserts was measured in the TM164 and CIRS-062 phantom scanned by TOSHIBA AQUILION^TM, SIEMENS SOMATOM^TMSENSATION^TM 64 and SIEMENS SOMATOM^TMSENSATION^TM OPEN with different voltages, currents and slice thicknesses and then the corresponding CT-to-density curves was compared. Results There are no significant differences of CT values with various currents and slice thicknesses and also for low atom number materials scanned by different scanners with various tube voltages. The CT values of high atom number materials have obvious differences scanned with tube voltage, the maximum is about 400 HU. There are also significant differences between CT-density curves of two phantoms in the range from soft tissues to dense bone, the maximum is up to 500 HU. Conclusions CT-density curves were highly affected by materials of phantoms, scanners and tube voltages. It is necessary to measure the curve with a comfortable phantom and certain scanner to assure the accuracy for dose calculation for treatment planning system.
		2012 Vol. 21 (3): 281-284 [Abstract] ( 5573 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	285	Analysis the effects of film dosimetry during processing and scanning
		HAN Jun, LI Qin, LIANG Zhi-wen, CHEN Mi
		Objective To explore the effects of different flushing and scanning processing on optical density (A) responding and set up the clinic quality assurance protocol based on silver halide emulsions radiographic films. Methods Setting different flushing temperature and choosing different batch′s film and developer and fixer or fixer in the same batch with different analyzing dose were performed to analyze the effect on A value;The effect of light uniform, the stabilize work time and the noise of different scanning resolution were discussed. Results The A value at the same dose level would enhance as the temperature increased;the responding curve of dose and A value with different batches of films varied a lot;the responding curve of dose and A value with different batches of films and developer and fixer solution had marked variations;the responding of dose and A with the same batches would show some low. The heterogeneity of the scanner would achieve 0.03;the A value of the same dose would gradually steady while the time of scanning was more than 10 minutes;the affect of noise would increase as the dose and resolution ratio increased. Conclusions The best processing temperature is 29－31℃. Different batches of film couldn′t be confounded. A new calibration must be obtained when the film dosimetry to evaluate dose distribution is used. A 5－10 min warm up for stabilize work and the best setting resolution/depth lever are 72 dpi/16 bit for scanning films are determined.
		2012 Vol. 21 (3): 285-288 [Abstract] ( 4366 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	289	Preventive effect of Chinese traditional medicine-Qing-Xue granula on radiation induced lung injury in mice
		WANG Xiao-zhen, JI Wei, JIANG Heng, ZHAO Lu-jun, YANG Wei-zhi, YANG Yu-fei, WANG Lv-hua
		Objective To evaluate whether oral administration of Chinese tradiational medicine, Qing-Xue granula, can prevent mouse lung injury caused by thoracic radiation. Methods 128 BalB/C mice were divided into 4 groups:control (C) group;radiation (R) group;radiation plus high dose Qing-Xue granula (H) group and radiation plus median dose Qing-Xue granula (M) group. The H and M groups were fed 0.64 g and 0.32 g of Qing-Xue granula dissolved in 0.5 ml saline once daily for two months, which were 4 and 2 times of human dosage, respectively. Whole thorax radiation of 12 Gy was delivered with a single ventral-dorsal field with 6 MV X-ray. Group C and group R received 21 days of 0.5 ml saline feeding. Mice were sacrificed at 1, 2, 4 or 6 months after radiation. Macrophage cell count of lung lavage fluid and hydroxyproline content of left lung were assayed, and the lung fibrosis was scorred according to the Ashcroft′s criteria. The plasma interleukin-6(IL-6) and vascular endothelial growth factor (VEGF) concentration were assayed with ELISA method. The One-way ANOVA was used to test the significance of any differences between groups at each time point. Results The macrophage cell number of lung lavage fluid was significantly lower in the 1^st month in group M than in group R (2∶4,q=3.92,P<0.05), but had no significant difference between group M and C (1∶4,q=2.13, P>0.05). The hydroxyproline content of group H was significantlylower than group R in the 1^st and 6^th months (q=3.62,3.54,all P<0.05), butstill higher than group C (q=4.09,3.72,all P<0.05). The fibrosis score of group H was significantlylower than group R in the 2^nd, 4^th and 6^th months (q=3.38－4.16, all P<0.05). The IL-6 concentration of group H was significantly lower than group R in the 1^st month (q=3.53, P<0.05), but not significantly higher than group C (q=1.41,P>0.05). The VEGF concentration was significantlyhigherin group R than group C since the 2^nd month (q=3.12－3.78,P<0.05). The VEGF concentration was significantlyhigherin group H and M than group R in the 2^nd and 6^th months (q=3.08－3.92,all P<0.05). Conclusions Oral Chinese traditional medicine, Qing-Xue granula, could prevent radiation induced lung fibrosis in mice, especially at high dosage. The degree of elevation of VEGF in plasma was not parallel with that of lung fibrosis.
		2012 Vol. 21 (3): 289-292 [Abstract] ( 4455 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	231	Comparison of clinical characteristics and prognoses between primary Waldeyer′s ring diffuse large B-cell lymphoma and extranodal nasal-type NK/T-cell lymphoma
		WU Run-ye^*, LI Ye-xiong, WANG Wei-Hu, JIN Jing, WANG Shu-lian, LIU Yue-ping, SONG Yong-wen, REN Hua, FANG Hui, LIU Qing-feng, WANG Zhao-yang, QI Shu-nan, LU Ning-ning, CHEN Bo, ZHANG Xi-mei, ZHOU Li-qiang, LIU Xin-fan, YU Zi-hao
		Objective This study aimed to compare the clinical characteristics and prognoses of primary Waldeyer′s ring diffuse large B-cell lymphoma (DLBCL) and extranodal nasal-type NK/T-cell lymphoma (ENKTCL). Methods From 2000 to 2008, 122 patients with primary Waldeyer′s ring DLBCL and 44 patients with primary Waldeyer′s ring ENKTCL consecutively diagnosed were retrospectively compared. Patients with DLBCL usually received 4－6 cycles of CHOP-based chemotherapy followed by involved-field radiotherapy. Patients with early stage ENKTCL usually received extended-field radiotherapy with or without subsequent chemotherapy, or short courses (1－3 cycles) of chemotherapy followed by radiotherapy. Kaplan-Meier method was used for survival analysis. Logrank method was used for univariate analysis. Results The follow-up rate was 82%. The number of patients followed 5 years were 32 and 15 in DLBCL and ENKTCL. DLBCL mainly presented with stage Ⅱ tonsillar disease with regional lymph nodeinvolvement. ENKTCL occurred predominately in young males, as nasopharyngeal stageⅠ disease with B symptoms and involving adjacent structures. The 5-year overall survival (OS) and progression-free survival(PFS) rates were 74% and 67% in DLBCL, and 68% and 59% in ENKTCL (χ²=0.53,1.06,P=0.468,0.303), respectively. In stage Ⅰ and Ⅱ diseases, the 5-year OS and PFS rates were 79% and 76% forDLBCL compared to 72% and 62% for ENKTCL (χ²=1.20,2.46,P=0.273,0.117). On univariate analysis, age>60 years, elevated lactate dehydrogenase, eastern cooperative oncology group performance status>1, international prognosis index (IPI) score ≥1, stage Ⅲ/IV diseases and bulky disease were associated with unfavorable survival for DLBCL (χ²=9.40,12.72,6.15,10.36,12.48,5.53,P=0.002,0.000,0.013,0.001,0.000,0.019), and only age>60 years and IPI score ≥1 were associated with poor survival for ENKTCL (χ²=3.98,8.41,P=0.046,0.004). Conclusions These results indicate that remarkable clinical disparities exist between DLBCL and ENKTCL in Waldeyer′s ring. Different treatment strategies for each can result in similarly favorable prognoses.
		2012 Vol. 21 (3): 231-234 [Abstract] ( 4252 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	237	Prospective phase Ⅱ trial of hypofractionated intensity-modulated radiotherapy for localized prostate cancer
		LIU Yue-ping, LI Ye-xiong, WANG Wei-hu, FANG Hui, JIN Jing, WANG Shu-lian, SONG Yong-wen, REN Hua, LIU Xin-fan, YU Zi-hao, DAI Jian-rong
		Objective To prospectively evaluate the efficacy and toxicity of hypofractionated intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods Fifty-two consecutive patients with localized prostate cancer were enrolled in this study between Feb. 2009 and Mar. 2011. All patients received hypofractionated IMRT (2.7 Gy/fx,25 fractions, total 67.5 Gy) to the prostate and seminal vesicles. 32 high risk patients also received prophylactic irradiation to the pelvic lymph nodes concurrently (2 Gy/fx,25 fractions). Imaging-guided radiotherapy was employed in 35 patients. Androgen deprivation therapy was adopted in 48 of 52 patients. Results After a median follow-up of 13 months, the mean prostate specific antigen (PSA) was reduced from (40.3±36.6) ng/ml before treatment to (0.5±1.7) ng/ml at the last follow-up. By the time of last follow-up, 2 patients (4%) failed. One had PSA failure and the other had both PSA failure and pelvic lymph node relapse. 25% of the patients experienced grade 2 acute gastrointestinal (GI) toxicity and 4% experienced grade 3 GI toxicity. Acute grade 2 and grade 3 genitourinary (GU) toxicity occurred in 15% and 2%, respectively. The incidence of late grade 2 and grade 3 GI toxicity was 17% and 0%, respectively. Late grade 2 and 3 GU toxicity was 8% and 2%. The potencywas unable to evaluate because most of the patients received androgen deprivation therapy. Conclusions The short-term PSA-free survival after 2.7 Gy/fx,25 fractions′ hypofractionated IMRT for localized prostate cancer is favorable, and the acute and late GI and GU toxicity are acceptable. A longer time follow-up is warranted to ascertain the long term efficacy and safety of this regimen.
		2012 Vol. 21 (3): 237-240 [Abstract] ( 4262 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	241	Survey on use of radiotherapy for breast cancer following breast-conserving surgery in mainland China
		ZHANG Ye, HUI Zhou-guang, ZHANG Jiang-hu, YU Zi-hao, LIU Xin-fan, JIN Jing, WANG Wei-hu, WANG Shu-lian, SONG Yong-wen, LIU Yue-ping, REN Hua, FANG Hui,LI Ye-xiong
		Objective To evaluate the current practice of breast-conserving radiotherapy (BCR) in mainland China. Methods A questionnaire on the details of treatment pattern of BCR for early breast cancer was mailed twice to all radiotherapy centers in mainland China in 2009. The responding data were collected and analyzed. Results Of the 952 surveyed centers, 396 responded (41.6%) and 328 performed BCR. The median interval between surgery and radiotherapy was 9 weeks. Of the 328 centers with BCR, whole breast was the most common irradiation target (319 centers, 97.3%), followed by supraclavicular region (273 centers, 83.2%), axilla (138 centers, 43.3%), and internal mammary chain (85 centers, 26.8%). In 97.5% of centers (310/319), whole breast was irradiated in all candidates. Supraclavicular region and axilla irradiation was performed for lymph-node positive patients in 41.8%(114/273) and 26.8%(37/138) centers, and for ≥4 positive lymph-nodes in 31.5%(86/273) and 29.0%(/138) centers, respectively. Internal mammary chain was irradiated for tumors located in the center or inner quadrant in 72.9%(56/85) centers. Conformal radiotherapy for the whole breast was used in 51.8% centers. The median total dose was 50 Gy, all using conventional fractionations. Conclusions A consensus has been reached that radiotherapy is needed for patients receiving breast-conserving surgery and that irradiation to whole breast is necessary. However, establishment and widespread use of guidelines for BCR should be strengthened.
		2012 Vol. 21 (3): 241-245 [Abstract] ( 4120 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	248	Comparison of displacement of the geometry constituted by silver clips in cavity in the different state of respiration assisted by active breathing control system in external-beam partial breast irradiation
		LI Jian-bin, ZHANG Qiu-shi, XU Min, ZHANG Ying-jie, FAN Ting-yong, LU Jie, ZUO Wen-shu, WANG Yong-sheng
		Objective To investigate the effect of the displacement of the selected silver clip in the different respiratory state achieved by active breathing control (ABC) system on the displacement of the geometry constituted by all of the silver clips at the border of the cavity in external-beam partial breast irradiation (EB-PBI). Methods Two sets of CT images in state of moderate deep inspiratory breathing hold (mDIBH), deep expiratory breathing hold (DEBH), and free breath (FB) were acquired in the same CT simulation assisted by ABC system for each of the 27 patients after breast conservative surgery. All silver clips in the cavity were delineated based on each set of CT images. Thereafter, the irregular geometry based on the silver clips as the vertices was automatically formed. Four selected clips located at the top, bottom, lateral border and medial border of the cavity were correspondingly manually registered based on automatic registration of the CT images acquired in the same or different state of respiration including mDIBH, FB, and DEBH. The displacement of center of the geometry in the direction of right-left (RL), anterior-posterior (AP), and superior-inferior (SI) separately based on automatic registration and manual registration was evaluated. The difference of the displacement was analyzed by Kruskal-Wallis H-test and Kolmogorov-Smirnov Z-test. Results When registered between mDIBH and mDIBH, FB and FB, DEBH and DEBH, the differences of the displacement of the center of geometry were not statistically significant (H=0.00－1.76,P=0.184－0.954). When registered between mDIBH and DEBH, the differences were statistically significant (Z=11.31－23.00,P=0.000－0.001).There were statistically significant differences in the displacement of geometry center based on the selected silver clip between differentregistration forms in AP and SI directions (Z=4.76－25.54,P=0.000－0.029). Conclusions The differenceof intrafractiondisplacement of the geometry constituted by the clips between the samerespiratorystates in the three dimensional direction is not statistically significant, but the difference is statistically significant between the different respiratory states in AP and SI directions.
		2012 Vol. 21 (3): 248-251 [Abstract] ( 3923 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	252	Clinical randomzied study of postoperative radiochemotherapy compared with chemotherapy alone in the treatment of locally advanced gastric cancer
		YANG Zhi-hua, ZHE Hong, YAN Gang, ZHAN Wen-hua, ZHANG Zi-xin, DING Zhe
		Objective To investigate the efficacy and toxicity of postoperative radiochemotherapy compared with chemotherapy alone in the treatment of locally advanced gastric cancer. Methods A total of 83 patients with resected adenocarcinoma of the stomach were randomly assigned to postoperative radiochemotherapy group (RCT)(n=43) or chemotherapy alone group (CT)(n=40). Patients in RCT group received radiotherapy concurrent with capecitabine chemotherapy then followed by 4－6 cycles of FOLFOX4 chemotherapy. The total dose of radiation was 45 Gy. The dose of capecitabine was 1600 mg/m² per day. In the CT group, patients received 6－8 cycles FOLFOX4 chemotherapy. Survival was analyzed using Kaplan-Meier method and Logrank test. Results The follow-up rate was 96%. The number of patients who had a minimum of 2-,3-year follow-up time were 37,12 in the RCT group and 31,10 in the CT group. The 1-,2-,3-year local control rates for RCT and CT groups were 100%,97%,94% and 95%,87%,73%(χ²=4.54,P=0.033), respectively. The 1-,2-,3-year survival rates were 98%,86%,81% in the RCT group, with 93%,80%,64% in the CT group (χ²=3.96,P=0.047). The incidence of grade 3 hematological toxicity in the RCT and CT group was 23% vs 15%(χ²=0.93,P=0.630), and grade 3 gastrointestinal toxicity was 16% vs 10%(χ²=0.95,P=0.624). Conclusions Compared with chemotherapy alone, postoperative radiochemotherapy can improve survival of locally advanced gastric cancer patients with acceptable toxicities.
		2012 Vol. 21 (3): 252-254 [Abstract] ( 3910 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	255	Gross tumor volume delineation with combination of non-contrast/contrast CT and FDG PET in pancreatic cancer
		GONG Lin-lin^*, LIU Ning-bo, ZHU Lei, YANG Cheng-wen, ZHAO Lu-jun, LI Rui-jian, WANG Ping
		Objective To investigate the application of non-contrast and contrast-enhanced ¹⁸FDG PET/CT in the delineation of gross tumor volume (GTV) of pancreatic cancer. Methods Between Jan.2008 and Dec.2009, twenty-one patients with unresectable locally advanced pancreatic cancer or recurrent pancreatic cancer after surgery in our hospital had both non-contrast CT and PET images acquired at the same body position. Among the whole group, eleven patients also had contrast CT images. The image data sets were transferred to the treatment planning workstation for registration. Then gross tumor volumes (GTV) were delineated independently using the information of PET images, contrast/non-contrast CT scan and contrast/non-contrast PET-CT fusion images. The differences of mean volume in these different sets of GTV were analyzed. Results For the whole group, the mean volume of non-contrast GTV_CT, GTV_PET, non-contrast GTV_PET-CT were 76.9 cm³, 47.0 cm³ and 44.5 cm³, respectively. The mean volume of non-contrast GTV_PET-CT was significantly smaller than non-contrast GTV_CT(z=－3.91, P=0.000). For the eleven patients with contrast CT, the mean volume of contrast GTV_CT, GTV_PET, contrast GTV_PET-CT were 64.1 cm³, 45.1 cm³ and 49.3 cm³,respectively. The mean volume of contrast GTV_PET-CT was significantly smaller than contrast GTV_CT(z=－2.13, P=0.033). No significant differences were found between contrast PET-CT and non-contrast PET-CT (z=－0.80,P=0.424). Conclusions Co-registration of PET and contrast/non-contrast CT information in pancreatic cancer may improve the accuracy of GTV delineation, and possibly reduce the adverse effect of irradiation.
		2012 Vol. 21 (3): 255-257 [Abstract] ( 4650 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	258	Changes of rectal volume and location and their influence on rectal dose during the course of intensity-modulated radiotherapy of cervical cancer
		PANG Hao-wen, QIU Jie, SUN Shuai, YANG Bo, GUAN Qiu, ZHANG Fu-quan
		Objective To investigate the anatomical changes and dose variation of rectum during radiotherapy in patients with cervical cancer. Methods Ten patients with cervical cancer underwent intensity-modulated radiotherapy using online cone beam computed tomography (CBCT) before each fraction. Rectum was contoured on each CBCT and projected onto the planning CT to analyze the changes of the rectal volume and position. The rectal volume receiving ≥ 45 Gy (V₄₅) was evaluated accordingly. Results 227 CBCT images in 10 patients were collected. The rectal volume changed from (35.0±7.3) cm³ to (97.7±14.7) cm³. The shift of rectal center was (0.14±0.06) cm in left and right direction,(0.24±0.10) cm in anterior and posterior direction, and (0.55±0.28) cm in superior and inferior direction. The V₄₅ of rectum varied from (9.19±2.46)% to (60.54±11.67)%. In 7 of the 10 patients, rectal volume and V₄₅ of the rectum had significant positive correlation (r=0.582－0.743,all P<0.01).Among the 227 images, the V₄₅ of rectum was ≤50% in 68 images (30.0%). Conclusions Significant changes in rectal volume and position occurred during fractionated radiotherapy in patients with cervical cancer, which results in variations in the dose rectum received. For most patients, rectal volume and the V₄₅ of rectum had significant positive correlation.
		2012 Vol. 21 (3): 258-260 [Abstract] ( 4406 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2012 Vol. 21 (3): 261-262 [Abstract] ( 3143 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review

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		2012 Vol. 21 (3): 275-277 [Abstract] ( 3590 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2012 Vol. 21 (3): 293--1 [Abstract] ( 3385 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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