Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2013 Vol.22 Issue.6 Published 2013-10-25

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

Abdominal Tumors

	427	Status of breast conservative therapy for breast cancer in China between 1999 and 2008:an epidemiological study
		WANG Shu-lian, LI Ye-xiong, ZHANG Bao-ning, SONG Qing-kun, LI Jing, FAN Jin-hu, ZHANG Bin, YANG Hong-jian, XIE Xiao-ming, TANG Zhong-hua, LI Hui, LI Jia-yuan, HE Jian-jun, QIAO You-lin.
		Objective To investigate the status of breast conservative therapy for breast cancer in Mainland China. Methods A multi-center retrospective epidemiological study was undertaken. Patients with breast cancer treated between 1999 and 2008 were randomly selected from seven hospitals. 230 patients treated with breast conservative therapy were included for this analysis. Information on patients′ characteristics, pathology and treatment were collected and analyzed. The use of postoperative radiotherapy (RT) and radiation targets were analyzed. Wilcoxon analysis, Cochran-Armitage trend test and the chi-square test were used to compare differences. Results The median age of the patients was 43 years (range, 23—85). 198(86.1%) patients received axillary dissection, 16(7.0%) sentinel lymph node biopsy and 15(6.5%) patients didn′t have axillary operation,1(0.4%) unknown. Of 164(71.3%) patients who had frozen section analysis for intraoperative margin assessment, 17(10.4%) had positive margin and underwent 31 subsequent re-excision. One patient had positive margin on final analysis after surgery. 165(71.7%) patients received RT. From 1999 to 2008, there was no significant change in the use of RT (P=0.212). However, there were significant regional differences in the use of RT (P=0.000). 134(81.2%) patients received tumor bed boost after whole breast radiation. Of 152 patients with RT (excluding patients with ductal carcinoma in situ), 48(31.6%), 12(7.9%) and 8(5.3%) had received RT in supraclavicular fossa (SCF), axilla and internal mammary chain, respectively. The use of SCF RT was 31.5%(28/89), 54.2%(13/24) and 100%(7/7) for patients with 0, 1—3 and ≥4 positive axillary nodes (P=0.000).Conclusions The use of breast conservative surgery and sentinel node biopsy is quite low in the treatment of DOI:10.3760/cma.j.issn.1004-4221.2013.06.001 作者单位:100021 北京协和医学院中国医学科学院肿瘤医院肿瘤研究所放疗科(王淑莲、李晔雄),乳腺外科(张保宁),流行病室(宋清坤、李静、范金虎、乔友林);辽宁省肿瘤医院乳腺外科(张斌);浙江省肿瘤医院乳腺外科(杨红健);中山大学附属肿瘤医院乳腺科(谢小明);中南大学湘雅二院乳腺甲状腺外科(唐中华);四川省肿瘤医院乳腺外科(李卉);四川大学华西公共卫生学院流行病室(李佳圆);西安交通大学附属第一医院肿瘤外科(何建军) 通信作者:李晔雄,Email:yexiong@yahoo.comearly breast cancer patients in Mainland China. Radiotherapy after breast-conserving surgery ranges are relatively specification. The use of radiotherapy after breast conservative surgery needs improving.
		2013 Vol. 22 (6): 427-430 [Abstract] ( 3877 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	433	A meta-analysis of controlled clinical trials comparing postoperative adjuvant chemoradiotherapy with adjuvant chemotherapy in patients with gastric cancer
		GUO Qi,HUANG Wei-xian, CUI Xi-xi, ZHANG Li-yuan,TIAN Ye.
		Objective To compare postoperative adjuvant chemoradiotherapy with adjuvant chemotherapy in patients with gastric cancer by a meta-analysis. Methods PubMed, EMbase, Cochrane Library, Wanfang, CNKI, VIP, and CBM databases were searched to identify the controlled clinical trials of postoperative adjuvant chemoradiotherapy versus adjuvant chemotherapy for gastric cancer. The obtained data were analyzed using RevMan 5.2.5 and Stata 12.0. The difference between two groups was estimated by calculating the odds ratio (OR) with 95% confidence interval (CI). Results A total of 12 controlled clinical trials involving 1674 gastric cancer patients, which were selected according to inclusion and exclusion criteria, were included in this meta-analysis. The meta-analysis showed that the 3-and 5-year survival rates were significantly higher in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group (OR=2.96, 95%CI=1.75—5.03, P=0.000;OR=1.45, 95%CI=1.06—1.99, P=0.020);the local recurrence rate was significantly lower in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group (OR=0.50, 95%CI=0.34—0.72, P=0.000);there was no significant difference in distant metastasis rate between the two groups (OR=0.79, 95%CI=0.58—1.07, P=0.130). Conclusions The meta-analysis of existing study results shows that compared with adjuvant chemotherapy alone, adjuvant chemoradiotherapy is a relatively safe and effective postoperative treatment for gastric cancer.
		2013 Vol. 22 (6): 433-436 [Abstract] ( 3860 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	439	Prognostic effects of pathological stages in patients with locally advanced rectal cancer after neoadjuvant radiochemotherapy plus radical surgery
		PENG Hai-hua, YOU Kai-yun, WANG Cheng-tao, HUANG Rong, CHANG Hui, ZHOU Guan-qun, ZENG Zhi-fan, LIU Meng-zhong, WEN Bi-xiu, GAO Yuan-hong.
		Objective To investigate the prognostic effects of pathological stages in patients with locally advanced rectal cancer after neoadjuvant radiochemotherapy (Neo-RCT) plus radical surgery. Methods A retrospective analysis was performed on the clinical data of 210 patients with locally advanced rectal cancer who were admitted to our hospital from 2003 to 2010 and were treated with Neo-RCT followed by radical surgery. After Neo-RCT plus radical surgery, the pathological stages included ypT_0-2N (－)(91 patients, 43.3%), ypT_3－4N (－)(69 patients, 32.9%), and ypT_0-4N (+)(50 patients, 23.8%). The Kaplan-Meier method was used for calculating survival rates;the log-rank test was used for survival difference analysis and univariate analysis of prognostic factors for disease free survival (DFS);the Cox proportional hazard model was used for multivariate analysis of prognostic factors for DFS. Results The follow-up rate was 99%, and 64 patients were followed up for at least 5 years. After Neo-RCT plus radical surgery, the patients with ypT_0-2 N (－), ypT_3－4N (－), and ypT_0-4N (+) rectal cancers had 5-year overall survival rates of 88%, 75%, and 65%, respectively (P=0.018), 5-year DFS rates of 81%, 78%, and 60%, respectively (P=0.005), and 5-year distant metastasis-free survival rates of 91%, 81%, and 64%(P=0.000). The multivariate analysis showed that ypN stage was the independent prognostic factor for DFS. Conclusions Pathological stage is strongly associated with the treatment outcome in patients with locally advanced rectal cancer treated with Neo-RCT followed by radical surgery, which may be used as guidance for postoperative individualized adjuvant therapy.
		2013 Vol. 22 (6): 439-442 [Abstract] ( 4038 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	443	Electron-beam irradiation therapy for keloids:retrospective study of 578 cases
		SUN Yu-liang, LIAN Xin, LIU Nan, ZHANG Ming-jie, HE Lei, LIU Bo-fei, ZHANG Fu-quan
		Objective To analyze the outcomes of radiotherapy for keloids by high energy electron beams and the factors influencing the treatment outcome. Methods From Jan 1998 to Jun 2012, 846 lesions in 578 patients received radiotherapy. The median age is 29 years old (range 5—80 years old). There are 841 lesions with postoperative radiotherapy and 39 lesions with skin-grafting. 656 lesions treated within 1 day after operations. The max diameter of 348 keloids are>5 cm. We used 6 MeV and 7 MeV electron-beam radiation therapy. The total dose ranging from 16—18 Gy/2f (interval 1 week). Treatment fields including entire keloid scars, and any suture/puncture holes with a 1 cm-margin around the lesion were used. The skin grafting patients need radiotherapy after the flap survived (about 10—15 days after the operation). The median follow-up period was 36 months (range 8—185 months). Results There are 736(87.0%) of 846 lesions with radiotherapy effective. Other 89(10.5%) lesions relapse in 4—33 months (median 12 months). 21 lesions were of no avail. The univariate analysis shows that keloids length, keloids location, skin-grafting, interval between operations and irradiations are the influencing factors of outcomes (P=0.007,0.000,0.000,0.001). The multivariate analysis shows that keloids location and skin-grafting remained statistically significant differences (P=0.001,0.001). Most of the recurrence cases are large and bent scars. Conclusions High-energy electron-beam radiotherapy for keloids can receive good outcomes. Treatment fields flat is very important for electron-beam radiotherapy.
		2013 Vol. 22 (6): 443-445 [Abstract] ( 3851 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	431


		2013 Vol. 22 (6): 431-432 [Abstract] ( 3377 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2013 Vol. 22 (6): 437-438 [Abstract] ( 3451 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	459


		2013 Vol. 22 (6): 459-460 [Abstract] ( 3214 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	505


		2013 Vol. 22 (6): 505-508 [Abstract] ( 3795 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	509


		2013 Vol. 22 (6): 509-512 [Abstract] ( 3521 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	513


		2013 Vol. 22 (6): 513-515 [Abstract] ( 3602 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2013 Vol. 22 (6): 516-520 [Abstract] ( 3132 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	446	Concurrent chemoradiotherapy for esophageal squamous cell carcinoma:a meta-analysis
		WANG Jun, YU Jin-ming, JING Shao-wu, CHENG Yun-jie, LIU Qing, WANG Yi, CAO Feng, YANG Cong-rong.
		Objective To analyze the efficacy and toxicities of concurrent chemoradiotherapy (CCRT) in the non-surgical treatment of esophageal squamous cell carcinoma (ESCC) in China and to provide evidence for its clinical application. Methods CNKI and Wanfang Data were searched to identify the randomized controlledor case-controlled trials of CCRT for ESCC. A meta-analysis was performed to evaluate the efficacy and safety of CCRT for ESCC in China. Results A total of 39 randomized controlledor case controlledtrials involving 4161 patients were included in the meta-analysis. The meta-analysis showed that compared with those receiving radiotherapy alone, the ESCC patients receiving CCRT had significantly improved short-term outcomes (OR=2.588, P=0.000) and significantly increased 1-, 3-, and 5-year survival rates (HR=1.995, P=0.000;HR=2.047, P=0.000;HR=2.265, P=0.000), but they also had significantly increased incidence rates of radiation esophagitis (grade ≥3), radiation pneumonia (grade ≥2), and bone marrow suppression (grade ≥3)(OR=4.372, P=0.000;OR=1.962, P=0.005;OR=4.403, P=0.000). Among the ESCC patients receiving CCRT, those treated with paclitaxel-containing regimen had significantly improved short-term outcomes (OR=1.868, P=0.036) and similar 1-and 3-year survival rates (HR=1.087, P=0.781;HR=1.315, P=0.569), as compared with those treated with FP regimen. Conclusions CCRT can significantly improve the short-term outcome and long-term survival in ESCC patients, but it also increases the incidence of toxicities. Paclitaxel-containing regimen has better short-term efficacy than standard FP regimen among ESCC patients receiving CCRT.
		2013 Vol. 22 (6): 446-449 [Abstract] ( 4177 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	450	A comparative study of GTV displacements of primary thoracic esophageal carcinoma based on repeated 4DCT scans during radiotherapy
		WANG Jin-zhi, LI Jian-bin, QI Huan-peng, WANG Wei, ZHANG Ying-jie, FAN Ting-yong, SHAO Qian, XU Min
		Objective To investigate the target volume displacements of primary thoracic esophageal carcinoma (TEC) based on repeated enhanced four-dimensional computed tomography (4DCT) scans during fractionated radiotherapy. Methods Twenty-nine patients with TEC underwent enhanced 4DCT before and in the 10^th, 20^th, and 30^th fractions of radiotherapy to delineate the gross tumor volumes (GTVs) and internal gross tumor volumes (IGTVs) in all phases. The GTV displacements of upper, middle, or lower TEC in three-dimensional directions in each time of 4DCT were compared, and the GTV displacements of upper, middle, or lower TEC in the same direction in all 4DCT scans were also compared.The changes in the centroid positions and volumes of IGTV during radiotherapy were determined. ResultsFor the patients with middle TEC, significant differences were found between the GTV displacements in left-right (LR) direction, anterior-posterior (AP) direction, and superior-inferior (SI) direction when 4DCT was performed before or in the 20^th fraction of radiotherapy (P=0.000—0.016), and significant differences were found between the GTV displacements in SI direction and LR and AP directions when 4DCT was performed in the 10^th fraction of radiotherapy (P=0.000—0.006). For the patients with lower TEC, there were significant differences between the GTV displacements in SI direction and AP direction when 4DCT was performed before or in the 10^th or 20^th fraction of radiotherapy (P=0.004—0.013). There were no significant differences between the GTV displacements in the same direction in all 4DCT scans (P=0.102—0.823). There were no significant changes in the centroid positions of IGTV during radiotherapy (P=0.689—0.999), and the most significant decreases in IGTV volumes were seen in the 20^th fraction of radiotherapy (P=0.012—0.029). Conclusions Under free breathing, the GTV displacement of upper,middle, or lower TEC in the same direction shows no significant changes in different 4DCT scans during radiotherapy;the IGTV volumes decrease significantly in the 20^th fraction of radiotherapy, but there are no significant changes in the centroid positions of IGTV during radiotherapy.
		2013 Vol. 22 (6): 450-454 [Abstract] ( 3859 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	455	Study on prediction models for severe acute radiation pneumonitis in patients with non-small cell lung cancer after concurrent chemoradiotherapy
		WANG Jin,BAO Yon, ZHUANG Ting-ting, ZHANG Li, HE Zhi-chun, TAI An, MA Hong-Lian, HU Xiao, ZHOU Qi-chao, PENG Fang, XU Yu-jin, DENG Xiao-wu, CHEN Ming.
		Objective To establish the Logistic dose response model and Lyman-Kutcher-Burman (LKB)-normal tissue complication probability (NTCP) model using dose-volume histogram (DVH) parameters and to evaluate their predictive values for severe acute radiation pneumonitis (SARP) in patients with non-small cell lung cancer (NSCLC) after concurrent chemotherapy and three-dimensional conformal radiotherapy (3DCRT). Methods The clinical data of 147 NSCLC patients who were treated with concurrent chemotherapy and 3DCRT from 2006 to 2010 were collected. According to RTOG criteria, grade 3 or even severer acute radiation pneumonitis was defined as SARP. The Logistic dose response model and LKB-NTCP model were established according to DVH dosimetric information. Results The incidence of SARP was 9.5%(14/147). The best-fit parameter values for Logistic dose response model were shown as follows:constant b₀=－6.66;constant b₁=0.252;TD₅₀=26.43 Gy;γ₅₀=1.67. The fit curve was relatively flat when the maximum limit dose (MLD) was<17 Gy, and it became sharper when the MLD was 17－18 Gy, which implied that the risk of SARP increased. The best-fit parameter values for LKB-NTCP model were shown as follows:volume factor n= 0.87±0.40;slope factor m= 0.27±0.10;TD₅₀₍₁₎=(29.5±8.0) Gy. The Logistic regression analysis and receiver operating characteristic (ROC) analysis showed that the NTCP value calculated using the parameter values had a good predictive value for SARP (Logistic regression:P=0.013;area under the ROC curve:0.707,P=0.019). Conclusions The predictive value of NTCP for SARP is better than simple dose parameters. The two model curves suggest that MLD is above 17 Gy.
		2013 Vol. 22 (6): 455-458 [Abstract] ( 4020 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	504


		2013 Vol. 22 (6): 504-504 [Abstract] ( 3062 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	461	Therapeutic effect of radiotherapy and chemotherapy in 202 elderly patients with nasopharyngeal carcinoma
		LIN Jin, HAN Lu, LIN Shao-jun, LI Rui, XU Yun, PAN Jian-ji
		Objective To retrospectively analyze the outcomes, adverse events, and prognostic factors in elderly patients initially diagnosed with nasopharyngeal carcinoma (NPC) who receive radiotherapy and chemotherapy. Methods From January 2004 to April 2007, 202 patients (over 60 years of age) initially diagnosed with NPC received radical radiotherapy or chemotherapy. These patients included 165 males (81.7%) and 37 females (18.3%), with a median age of 65 years (range 60—86 years). Of all patients, 1 had stage Ⅰ NPC, 25 had stage Ⅱ NPC, 120 had stage Ⅲ NPC, and 56 had stage Ⅳ_a/Ⅳ_b NPC, according to the AJCC staging system (6^th edition). All patients received a radiation dose of ≥66 Gy, and 146 patients (72.3%) with locally advanced NPC also received chemotherapy. The Cox model was used for multivariate analysis. Results The follow-up rate was 100%. The 5-year local control rate, regional lymph node control rate, distant metastasis-free survival (DMFS) rate, disease-free survival rate, and overall survival (OS) rate were 93%, 94%, 82%, 74%, and 67%, respectively. The multivariate analysis revealed that T stage, N stage, and age were prognostic factors for OS and DMFS (P=0.006, 0.002, and 0.008;P=0.020, 0.002, and 0.022). The severe acute toxicities included grade 4 radiation dermatitis (1 patient, 0.5%), grade 4 radiation mucositis (2 patients, 1.0%), and grade 4 bone marrow suppression (5 patients, 2.5%). Conclusions The elderly NPC patients can tolerate radiotherapy and chemotherapy well. Multimodality therapy should be adopted for the patients aged 60—74 years who have advanced-stage NPC and good general conditions.
		2013 Vol. 22 (6): 461-464 [Abstract] ( 3850 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	465	Clinical analysis of risk factors for sensorineural hearing loss in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy
		MAO Yun-fei, ZHANG Hong-yan, GAO-Jin, LIU Lei,YAN Bing, SHEN Fang.
		Objective To investigate the risk factors for sensorineural hearing loss (SNHL) inpatients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). MethodsFrom January 2012 to January 2013, 29 patients with histopathologically confirmed NPC who received radiotherapy alone or concurrent chemoradiotherapy were included in this study. All patients underwent hearing tests, including pure tone audiometry and acoustic immittance measurement, before and after the IMRT. The cochlear doses for each ear were also collected for analysis. A prospective analysis was performed to investigate the relationship between cochlear dose and SNHL in patients with NPC, and the effects of other factors, including time after radiotherapy, chemotherapy, T stage, and age, were also analyzed. Results Of the 58 ears studied, 6(10%) had low-frequency SNHL, and 17(29%) had high-frequency SNHL. There were significant differences in mean cochlear doses between the patients who developed SNHL after radiotherapy and those who did not (left ears:46.1 Gy vs. 35.5 Gy, P=0.006;right ears:45.0 Gy vs. 35.8 Gy, P=0.009). When the mean cochlear dose was less than 44 Gy, only 15%(6/38) of ears had high-frequency SNHL. The invasion of skull base bone was also a significant risk factor for SNHL(P=0.047), but age, chemotherapy, and time after IMRT were not significant risk factors. Conclusions The mean cochlear dose and invasion of skull base bone are significant risk factors for SNHL in patients with NPC after radiotherapy. It is recommended that the mean cochlear dose should be limited to 44 Gy to minimize the incidence of SNHL after IMRT.
		2013 Vol. 22 (6): 465-468 [Abstract] ( 4009 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	469	Incidence of sinusitis and its influential factors in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy
		SU Yan-xia,LI Xu,HAO Jun-fang,DONG Wei,YANG Xin-hua,LIU Lan-ping,XU Jin,CAO Xiu-juan,YU Shui
		Objective To investigate the incidence of sinusitis in nasopharyngeal carcinoma (NPC) patients before and after intensity-modulated radiotherapy (IMRT) and analyze the influential factors for incidence of sinusitis after IMRT. Methods A retrospective analysis was performed on 283 NPC patients who received IMRT in our hospital from March 2009 to May 2011. CT or MRI scans were performed before and after IMRT to evaluate the incidence of sinusitis. The influential factors for incidence of sinusitis were analyzed by log-rank univariate analysis and logistic multivariate analysis. Results The incidence rates of sinusitis in patients with T₁, T₂, T₃, and T₄ NPC before radiotherapy were 22.6%, 37.5%, 46.8%, and 61.3%, respectively (P=0.002). Among the 155 NPC patients without sinusitis before radiotherapy, the incidence rates of sinusitis at the end of radiotherapy and 1, 3, 6, 9, 12, and 18 months after radiotherapy were 32.9%, 43.2%, 61.3%, 68.4%, 73.5%, 69.7%, and 61.3%, respectively (P=0.000). The univariate analysis showed that T stage, invasion into the nasal cavity, rhinopharynx flush, and radiation dose to the nasopharynx were associated with the incidence of sinusitis in NPC patients after IMRT (P=0.003, 0.006, 0.002, and 0.020). The multivariate analysis showed that T stage, invasion into the nasal cavity, and rhinopharynx flush were the influential factors for incidence of sinusitis in NPC patients after IMRT (P=0.002, 0.002, and 0.000). Conclusions There is a higher incidence of sinusitis with higher T stage among NPC patients before radiotherapy. The incidence of sinusitis grows rapidly within 3 months after IMRT, reaches the peak level at 9 months, and tends to be stable at one year. T stage, invasion into the nasal cavity, and rhinopharynx flush are the influential factors for incidence of sinusitis in NPC patients after IMRT.
		2013 Vol. 22 (6): 469-472 [Abstract] ( 4367 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	473	A muti-center plan comparison for volumetric modulated arc therapy
		LI Ming-hui, HU Cai-rong, LI Guang-jun, YUN Wei-kang, ZHANG Dan-dan, CHEN Nian-yong, LI Jian-cheng, LI Xiang-lan, LIANG Jun, SUN Ying, BAI San, BAI Yan-ling, HUANG Xiao-yan, ZHANG Xiu-chun, DAI Jian-rong.
		Objective To evaluate the quality of volumetric modulated arc therapy (VMAT) plans among the sites and establish the common template for VMAT plan. Methods One test case was provided by each of five sites accordingly, and the CT with contours was send to the TPS after approved. All participants were asked to wake the VMAT plans for these test cases with uniform dose prescription and follow the planning strategy of their choice. Each test case includes five plans designed by the participants and one plan generated with the template. The quality score was used to evaluate the plan quality, and the MU with treatment time was used for execution efficiency. Results For NPC case, no plan was able to fulfill all dose objectives strictly;three plans failed some of the objectives but were still considered to be clinically acceptable;the other three plans were not able to reach the objectives. For Esophagus case, all six plans were considered to be clinically acceptable. For lung case, four plans were considered to be clinically acceptable;two plans were not able to reach the objectives. For Prostate case, four plans were able to fulfill all dose objectives strictly;one plan was still considered to be clinically acceptable;one plan was not able to reach the objectives. For Liver case, three plans were able to fulfill all dose objectives strictly;three plans were considered to be clinically acceptable. About the execution efficiency, treatment duration was 3—7 min, amount of MU was 350—900 MU, amount of control points was 80—160. Conclusions The presented planning studies showed that quality and execution efficiency for most plan have achieved the clinical requirements;the quality of VMAT plan′s template and benchmark database also meet the expectation.
		2013 Vol. 22 (6): 473-477 [Abstract] ( 4040 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	478	Effects of dose limitation and increased protective weight on dose distribution in auditory organs during intensity-modulated radiotherapy for nasopharyngeal carcinoma
		NI Xiao-chen, WANG Sheng-zi, LI Ji, WANG Wei-fang, YANG Gang
		Objective To investigate the protective effects of reducing average radiation dose and increasing protective weight on the auditory system (tympanic cavity, the bony portion of eustachian tube, vestibule, and cochlea) during intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods The planning system (ADAC Pinnacle³ 8.0m) with direct machine parameter optimization was used to optimize the IMRT planning for 40 patients with NPC (stage Ⅰ+Ⅱ:20 patients;stage Ⅲ+IV:20 patients). Without reducing the radiation dose for target volume, the IMRT planning was optimized by limiting the average dose administered to the auditory system or increasing the protective weight for the protected organs in auditory system. The protective effects were assessed by analyzing the average dose received by the auditory system. Results After limiting the average dose administered to the auditory system without reducing the radiation dose for target volume, the average dose received by the auditory system was significantly reduced (3855.5—5391.3 Gy vs 2960.3—4559.6 Gy, P=0.000 for all);when the protective weight for the auditory system was increased, the average dose received by the auditory system was even more reduced (3855.5—5391.3 Gy vs 2725.4—4271.4 Gy, P=0.000 for all). For all three regimens, the average dose was significantly higher in stage Ⅲ+IV patients than in stage Ⅰ+Ⅱ patients (P=0.000 for all). Conclusions For the IMRT planning for NPC, limiting the average dose administered to the auditory system can greatly reduce the average dose received by the auditory system, and increasing the protective weight for the auditory system can further reduce the average dose received by the auditory system. However, the protective effect on the auditory system may be reduced as the stage of NPC increases.
		2013 Vol. 22 (6): 478-481 [Abstract] ( 4001 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	482	The influence of multileaf collimator angle on delivery efficiency for IMRT treatment
		LI Chang-hu, ZHANG Chun-li,XU Li-ming, GE Wei, LIN Xue-lian,WU Bing.
		Objective To study the influence of the angle of multileaf collimator leaves on segments (control point for sliding windows) number and monitor units in intensity-modulated radiotherapy (IMRT) plan optimization. Methods 10 cases undergone IMRT with rectangle target volume were choosed, 2 plan were designed with step and shot technique and sliding windows technique for running direction of collimator with target long axis vertical and parallel respectively, compared the plans with similar optimization parameters for different angle of the collimator. Results The number of segments and monitor units increased by 52.8% and 49.6% more than longitudinal direction of leaf collimator with static IMRT respectively, there appeared significant difference (P=0.000);and the number of segments and monitor units increased by 58.2% and 61.9% more than longitudinal direction of leaf collimator with dynamic IMRT respectively, there appeared significant difference (P=0.000). Conclusions For the optimization of IMRT based on multileaf collimator, the direction of collimator perpendicular to the target long axis, there could be obviously decrease the number of monitor units, shorten the treatment time, improve the treatment efficiency with similar dose distribution.
		2013 Vol. 22 (6): 482-484 [Abstract] ( 4269 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	485	Evaluation of the accuracy of CTVision image-guided stereotactic body radiation therapy for non-small cell lung cancer
		ZHENG Xiao-li, YE Ke, MAO Rong-hu, YANG Cheng-liang, ZHAI Chong-ya, QIU Rong-liang, GE Hong
		Objective To investigate the accuracy of CTVision image-guided stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). Methods 10 lung SBRT patients were imaged with CTVision before and after irradiation for acquiring and analyzing the three-dimensional set-up error data sets in our department from October 2010 to May 2012. Gross tumor volumes (GTVs) were contoured on pre-and post-SBRT CT sets and combined for generating internal gross tumor volumes (IGTVs). Planning target volume (PTV) margin was calculated, and IGTVs and PTVs were compared for off-line verification of accuracy of SBRT. A paired t-test statistical analysis was conducted with the datasets using SPSS 17.0. Results 80 CT image sets were totally obtained. Setup errors was significant difference before and after radiotherapy in the left-right, superior-inferior and anterior-posterior directions, that were (－0.10±1.30) mm and (－0.15±1.31) mm (P=0.720),(0.18±1.32) mm and (0.18±1.43) mm (P=1.000) and (－0.08±1.19) mm and (－0.13±1.18) mm (P=0.750), respectively. IGTVs of ten patients were smaller than corresponding PTVs (13.53 cm³ and 37.84 cm³, P=0.000). ConclusionAccuracy and safety of SBRT could be verified by imaging with CTVision before and after delivery for non-small cell lung cancer.
		2013 Vol. 22 (6): 485-488 [Abstract] ( 3605 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	489	The setup errors and reasonable target margin in radiotherapy of superior chest segment esophageal carcinoma
		ZHANG Yong-xia,ZHAI Fu-shan,LIU Ming, LI Nan, BAO Chao-en, ZHOU Qing-xiang, YAN Yun-yu
		Objective To investigate the setup errors of super chest segment of esophageal cancer patients before radiotherapy delivery by KV cone beam CT, and evaluate the margin from CTV to PTV. Methods From 2010 to 2012, 13 patients with super chest segment of esophageal cancer whose IMRT planning CT images were included in this study. Delineate target on the CT images of treatment planning and enlarge the margin of CTV to form ITV,then enlarge the margin of ITV gradually 10 times by 1 mm each time to form varied PTV,and create the plan according to the size of the PTV, simulate setup errors in the new plan to obtain the simulation of the actual exposure curve and find a suitable PTV to assure 95% ITV volumeas ever to approach the prescription dose, obtained the outside enlarge distance of CTV→PTV. ResultsThe maximum setup errors in the direction of the anterior and posterior positioning was (3.42±2.19) mm. The margin of ITV→PTV is 5 mm which was figured out by PTV enlarging method. Compared to the original plan that under the condition of draw up the radiotherapy plan that based on the method of PTV enlarging obtained the CTV→PTV and simulate the actual dose distribution according to the setup errors:total lung V₅, spinal cord D_1cm³ ,increased by about 0.87%, 4.95 Gy, heart V₄₀, PTV D₉₅, PTV V₁₀₀, ITV D₉₅, ITV V₁₀₀ were reduced about 0.62%, 4.95 Gy, 8.38%, 1.84 Gy, 1.87%, all of them have statistically difference. Conclusions Range of external expansion of the left to right, superior to inferior and anterior to posterior is 7 mm,8 mm and 7 mm respectively, according to the method of PTV enlarging obtained the margin of CTV→PTV of super chest segment of esophageal cancer patients.
		2013 Vol. 22 (6): 489-492 [Abstract] ( 4267 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	493	A 002LFC intensity-modulated radiotherapy (IMRT) phantom evalution of Sentinel^TM system for patient set-up verification in radiotherapy
		GU Wen-dong, LI Qi-lin, GAO Ming, MO Jun-cong, PEI Hong-lei
		Objective To study the accuracy of Sentinel^TM system for patient setup using rigid-body phantom. Methods A 002LFC IMRT phantom was placed on Elekta HexaPOD^TM 6-degree couch using tattoo and the laser in the treatment room. When a well-know shift (3 directions) and rotation (3 positions) was moved, CBCT and Sentinel^TM system were scanned respectively, and the measuring errors of six dimensions were recorded. The absolute differences between applied and measured errors were compared and paired t-test. Results Total 15 well-know shifts were investigated. The Sentinel^TM system was very good stability and the largest absolute difference only 0.9 mm (z direction) and 0.2°(arbitrary direction). At the same time, a good conformance between Sentinel^TM system and CBCT was displayed because the largest absolute difference between applied and measuring error was less than 0.9 mm (z direction) and 0.2°(arbitrary direction). Conclusions Sentinel^TM system is fast, simple, non-invasive and seems to be reliable in detecting patient setup errors. It maybe hold potential to ensure precise patient positioning with reduced CBCT frequency in tumor locations with fixed relation to surface structures.
		2013 Vol. 22 (6): 493-496 [Abstract] ( 3735 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	497	Effects of radiation on apoptosis rate and expression of apoptosis-related genes in well-differentiated nasopharyngeal carcinoma cells
		WU Ran, HUANG Li, XU Li, WANG Ruo-zheng
		Objective To investigate the effects of radiation on the apoptosis rate and expression of 7 apoptosis-related genes in well-differentiated human nasopharyngeal carcinoma cell line CNE-1. MethodsCNE-1 cells were cultured in vitro. The apoptosis rates of CNE-1 cells under 0-, 2-, 4-, 6-, and 8-Gy radiation were measured by flow cytometry. The mRNA expression levels of Bcl-2, Bcl-xl, Bcl-w, Bax, Bak, Bad, and Bid were measured by RT-PCR. The Pearson test was used for analyzing the correlation of mRNA expression with apoptosis rate and radiation dose and the correlation between apoptosis rate and survival fraction. Results The early apoptosis rate of CNE-1 cells increased gradually as the radiation dose ranged from 0 to 6 Gy, but decreased when the radiation dose was 8 Gy;the late apoptosis rate of CNE-1 cells increased as the radiation dose ranged from 0 to 8 Gy. The mRNA expression of Bax was upregulated as CNE-1 cells were irradiated, and it was positively correlated with the early/late apoptosis rate and radiation dose (P=0.000 for all comparisons). The mRNA expression of Bcl-xl was downregulated, and it was negatively correlated with the early/late apoptosis rate (P=0.005 and 0.039);but it showed no correlation with radiation dose (P=0.369). The mRNA expression of Bcl-2 was upregulated and reached the peak level when the radiation dose was 4 Gy, and then it fell as the radiation dose increased. The mRNA expression of Bcl-w, Bcl-2, Bad, and Bid were not correlated with the early/late apoptosis rate (P=0.058—0.894). There was no correlation between the apoptosis rate and survival fraction in CNE-1 cells (P=0.064). Conclusions Bax and Bcl-xl have some correlation with apoptosis rate in CNE-1 cells, but no correlation between the apoptosis rate and survival fraction was observed.
		2013 Vol. 22 (6): 497-500 [Abstract] ( 3650 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	501	The analysis of clinical application of home-made immobilization device in SBRT
		LIU Hui, ZHANG Jun, ZHONG Ya-hua,ZHANG Jun-hong, ZHANG Gong, DENG Di, TAN Kang
		Objective To evaluate the effect of home-made immobilization device with KV-CBCT in lung-SBRT and investigate its clinical use value. Methods Choosing 10 lung tumor patients (half centre type tumor;half peripheral type) random analysis the interfractional and intrafractional setup errors in the SBRT process by this fixed device with KV-CBCT. The concrete method is using Varian′s KV-CBCT scans the patients before and after the SBRT each time, then make the registration between the reconstructed 3 d image and the planned CT image (both based on bone landmark),we then obtain the average setup errors in LR,AP and SI directions. Simultaneously, this research make contrastive analysis of setup errors among this fixed device and other fixed devices such as vacuum pad, phantom in body IMRT. All data make one-factor analysis of variance by SSPS 17.0. Results All the setup errors data was gaussian distribution, the centre type interfraction was at (0.01±0.32) cm (LR),(－0.08±0.38) cm (AP),(0.14±0.36) cm (SI) of the cross section, peripheral type interfraction was at (0.01±0.32) cm (LR),(－0.08±0.38) cm (AP),(0.14±0.36) cm (SI) of the cross section (P=0.001). We found out that the average of lung tumor′s setup error at all three directions have no significant difference-the largest was the AP directions (P=0.003), the second was the SI direction (P=0.003) and the smallest was the LR direction (P=0.001). The central type has no significant difference at three directions. Compare to the other fixed device, the average setup errors of our device are (0.09±0.33) cm (LR),(－0.10±0.44) cm (SI),(0.17±0.35) cm (AP) better than the report at present paper. As the interfraction setup error was small enough by using this fixed device while it has beyond the system algorithm, the registration software of system shows (0.0±0.0 cm). Conclusions The range of lung tumor motion can be cut down obviously and enhance each placement accuracy, repeatability, on SBRT with home-made immobilization device.
		2013 Vol. 22 (6): 501-503 [Abstract] ( 4344 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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