Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2014 Vol.23 Issue.3 Published 2014-04-24

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

Abdominal Tumors

	177	Clinicopathological features and treatment outcomes for patients with metastatic triple-negative breast cancer
		Wu Tao, Wang Shulian, Jin Jing, Liu Yueping, Wang Weihu, Song Yongwen, Yu Zihao, Liu Xinfan, Zhang Jianghu, Li yexiong
		Objective To analyze the clinicopathological features and survival of patients with metastatic triple-negative breast cancer (TNBC) and the value of locoregional treatment for metastatic TNBC. Methods A retrospective analysis was performed on the clinical features and treatment outcomes of 220 patients with metastatic TNBC admitted from 1998 to 2013. Of them, 206 patients with stage Ⅰ—Ⅲ disease developed metastasis disease after treatment (186 patients undergoing modified radical mastectomy, 14 patients undergoing breast-conserving surgery plus radiotherapy, 5 patients undergoing breast-conserving surgery alone, and one patient not undergoing surgery;196 patients receiving chemotherapy, and 88 patients receiving locoregional radiotherapy after modified radical mastectomy), and 14 patients presented stage Ⅳ disease (8 patients undergoing modified radical mastectomy, one patient undergoing segmental mastectomy, and 5 patients not undergoing surgery). Overall survival (OS) and progression-free survival were calculated by the Kaplan-Meier method;the log-rank test and univariate prognostic analysis were used to assess treatment outcomes. Results The most common metastatic sites were the lung followed by bones. Of all patients, 182(82.7%) developed visceral organs metastasis. Sixty-three (28.6%) developed metastasis to a single organ, whereas 182 (69.5%) withmultiple metastatic disease and 4 patients were unclear.Most patients developed distant metastasis within 3 years after the initial diagnosis of TNBC, and only 6.4% of all patients developed distant metastasis over 5 years later. With a median follow-up of 22 months, the 5-year OS was 25.0%, and the median survival time was 21 months.The 5-year OS of patients with single metastasis was 38.2%, compared with 17.5% for those with multiple metastases (P=0.005). The 5-year OS of patients with visceral organ metastasis was 20.3%,compared with 56.2%for those with metastasis inbones (P=0.049). For 63 patients with singlemetastasis, those receiving locoregional treatment with radiotherapy or surgery had a significantly increasedOS compared with those receiving no locoregional treatment (48% vs 29%, P=0.006). Conclusions Patients with metastatic TNBC usually present with visceral metastasis. Patients with single metastasis have a better outcomes than those with multiple metastases. Patients with metastasis in bones have a better autcomes than those with visceral organs involved. Locoregional treatment significantly improved the overall survival in patients with single metastasis.
		2014 Vol. 23 (3): 177-180 [Abstract] ( 3900 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	181	Clinical features of distant lymph node metastasis in early-stage extranodal nasal-type NK/T-cell lymphoma after treatment
		Chen Bo, Li Yexiong, Liu Qingfeng, Wang Weihu, Jin Jing, Wang Shulian, Liu Yueping, Song Yongwen, Fang Hui, Ren Hua, Wu Runye, Liu Xinfan, Yu Zihao
		Objective To analyze the incidence and risk factors for distant lymph node metastasis in stage Ⅰ_E and Ⅱ_E upper aerodigestive tract natural killer (NK)/T-cell lymphoma (UADT-NKTCL) after treatment. Methods From December 1979 to December 2012, 468 patients with stage Ⅰ_E and Ⅱ_E UADT-NKTCL were treated;170 patients were treated with radiotherapy alone, 19 patients with chemotherapy alone, 278 patients with radiotherapy and chemotherapy, and one patient with anti-inflammation therapy. The incidence of distant lymph node metastasis was calculated by the Kaplan-Meier method. Results The median follow-up was 35 months. Thirty-two patients had distant lymph node metastasis, accounting for 6.8% of all patients and 19.8% of 162 patients who had disease progression or recurrence;the 2-year incidence of distant lymph node metastasis was 6.4%. Twenty-three (71.9%) of the 32 patients had distant organ metastasis. Mesenteric lymph nodes were most affected in distant lymph node metastasis. The univariate analysis showed that extranasal UADT-NKTCL, stage Ⅱ_E, and not achieving a complete response (non-CR) after the first course of treatment were high-risk factors for distant lymph node metastasis. The multivariate analysis showed that stage Ⅱ_E and non-CR after the first course of treatment were identified as independent risk factors for long-term recurrence, with hazard ratios of 2.82(1.37—5.82, P=0.005) and 3.01(1.16—7.78, P=0.023). For patients with stage Ⅱ_E disease, those receiving combined-modality therapy had a significantly lower incidence of distant lymph node metastasis than those receiving radiotherapy alone and chemotherapy alone (2-year incidence of distant lymph node metastasis:12.5% vs 35.1% and50.0%, P=0.011). Conclusions The incidence of distant lymph node metastasis is low in patients with stage Ⅰ_E and Ⅱ_E UADT-NKTCL after treatment. However, the patients with stage Ⅱ_E disease or non-CR after the first course of treatment still have a high risk of distant lymph node metastasis. Patients with stage Ⅱ_E UADT-NKTCL should be treated by combined-modality therapy to reduce the incidence of distant lymph node metastasis.
		2014 Vol. 23 (3): 181-186 [Abstract] ( 3988 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	187	Long-term efficacy of CHOP-based chemotherapy alone or combined with radiotherapy for adolescent/childhood primary systemic anaplastic large-cell lymphoma
		Fang Hui, Zhang Ximei, Jin Jing, Wang Weihu, Song Yongwen, Liu Yueping, Wang Shulian, Ren Hua, Yu Zihao, Liu Xinfan, Li Yexiong
		Objective To investigate the long-term efficacy of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-based chemotherapy alone or combined with regional radiotherapy for adolescent/childhood primary systemic anaplastic large-cell lymphoma (ALCL). Methods A retrospective analysis was performed on the medical records of 28 patients not older than 21 years with a confirmed diagnosis of primary systemic ALCL, who were admitted to our hospital from January 1998 to December 2010. Of 12 stage Ⅰ/Ⅱ patients, 2 received chemotherapy alone, and 10 received chemotherapy and radiotherapy;of 16 stage Ⅲ/IV patients, 14 received chemotherapy alone, and 2 received chemotherapy and radiotherapy. CHOP regimen was adopted in 15 patients, and CHOP regimen combined with other high-intensity regimens was adopted in 13 patients. There were 3—17 chemotherapy cycles (median:6 cycles). Radiotherapy was performed mainly by involved field radiation, with a dose of 39.6—50.0 Gy (median:45 Gy). Results After the first course of treatment, 25(89%) of all patients achieved a complete remission (CR), and 3 patients experienced disease progression. With a median follow-up of 45.3 months, the 5-year event-free survival (EFS) and overall survival (OS) for all patients were 80% and 93%, respectively. The 5-year OS was 100% for patients achieving a CR after treatment, versus 0% for those not achieving a CR (P=0.000). The 5-year EFS was 38% for patients with involvement of ≥2 extranodal organs, versus 85% for those with involvement of<2 extranodal organs (P=0.010). Conclusions CHOP chemotherapy combined with regional radiotherapy (for patients with localized disease) is an effective treatment for adolescent/childhood primary systemic ALCL, but long-term follow-up is needed to investigate treatment-related toxicities.
		2014 Vol. 23 (3): 187-189 [Abstract] ( 3452 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	194	Predictive value of apparent diffusion coefficient for efficacy of preoperative chemoradiotherapy for locally advanced rectal cancer
		Xiao Qin^*, Ye Feng, Jin Jing, Li Yexiong, Ouyang Han, Zou Shuangmei, Wang Weihu, Wang Shulian, Liu yueping, Song Yongwen, Ren Hua, Fang Hui, Wang xin, Liu Xinfan, Yu Zihao
		Objective To investigate the value of apparent diffusion coefficient (ADC) in predicting the efficacy of preoperative chemoradiotherapy (PCRT) for locally advanced rectal cancer. Methods From 2007 to 2011, 70 patients with histopathologically proven clinical stage Ⅱ/Ⅲ rectal cancer were enrolled prospectively. All patients received PCRT, with radiotherapy (44.0—50.4 Gy/22—28 fractions) delivered to the pelvis and concurrent chemotherapy with capecitabine (1650 mg/m² per day, d 1—35) and oxaliplatin (50 mg/m², once weekly, 5 times), and radical surgery performed at 4—8 weeks after PCRT. Diffusion-weighted MRI was performed in all patients before PCRT, and ADC values were calculated. The pathologic tumor regression grade was assessed after surgery. The difference in ADC between groups was analyzed by nonparametric Mann-Whitney U test. Survivals were analyzed by the Kaplan-Meier method and compared by the log-rank test. Results Among 70 patients, 7(10%) achieved a pathological complete response (pCR), and 38(54%) were downstaged. With a median follow-up of 34 months, 22(31%) patients experienced recurrence. The mean ADC values before, during, and after PCRT (pre-ADC, during-ADC, and post-ADC) were (1.09±0.19)×10^－3 mm²/s,(1.28±0.19)×10^－3 mm²/s, and (1.47±0.24)×10^－3 mm²/s, respectively. The mean pre-ADCs for favorable groups (pCR, downstaging,and no recurrence) were significantly lower than those for unfavorable groups (P=0.049,0.001, and0.029). When a pre-ADC value of 1.06×10^－3 mm²/s was used as the cut-off value for predictingdownstaging, the area under the receiver operating characteristic curve was 0.737(95%CI=0.618—0.856). The 3-year disease-free survival and distant metastasis-free survival for patients with pre-ADCs of<1.06×10^－3 mm²/s were 86% and 90%, respectively, which were significantly higher than those for patients with pre-ADCs of ≥1.06×10^－3 mm²/s (58% and 60%)(P=0.010 for both). Conclusions Pre-ADC correlates to the efficacy of PCRT for locally advanced rectal cancer, so it has good prognostic value for this disease after PCRT.
		2014 Vol. 23 (3): 194-198 [Abstract] ( 3737 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	199	Comparison of concurrent chemoradiotherapy with capecitabine and oxaliplatin versus capecitabine alone in stage Ⅱ/Ⅲ rectal cancer patients after radical operation
		Feng Yanru, Jin Jing, Wang Xin, Xiao Qin, Wang Weihu, Wang Shulian, Liu Yueping, Song Yongwen, Ren Hua, Fang Hui, Li Ning, Li Yexiong, Liu Xinfan, Yu Zihao
		Objective To compare the efficacy of concurrent chemoradiotherapy (CCRT) with capecitabine and oxaliplatin versus capecitabine alone in stage Ⅱ/Ⅲ rectal cancer patients after radical operation. Methods A retrospective analysis was performed on the clinical data of 675 patients with stage Ⅱ/Ⅲ rectal cancer who received postoperative concurrent chemoradiotherapy (CCRT) with capecitabine (CAP group, n=427) or capecitabine and oxaliplatin (CAPOX group, n=248) from 2002 to 2010. The treatment modality was total mesorectal excision+CCRT±adjuvant chemotherapy. Radiotherapy was delivered to the true pelvis at a dose of 45.0—50.4 Gy/25 fractions. Results The propensity score matching method (1∶1) was applied to balance the baseline characteristics and assign 248 patients to each group. The 5-year sample sizes for CAP group and CAPOX group were 81,104. There were no significant differences between the two groups in 5-year overall survival (78.1% vs. 74.9%, P=0.547), disease-free survival (74.4% vs. 67.9%, P=0.292), locoregional control (94.5% vs. 92.8%, P=0.484), and distant metastasis-free survival (77.1% vs. 70.9%, P=0.364). But grade 3/4 toxicities occurred in24.6% of patients in the CAP group, versus 38.3% in the CAPOX group (P=0.001). Conclusions CCRT with oxaliplatin and capecitabine has no survival advantage over CCRT with capecitabine alone and increases the incidence of toxicities in stage Ⅱ/Ⅲ rectal cancer patients after radical operation. CCRT with capecitabine alone is still the standard regimen.
		2014 Vol. 23 (3): 199-204 [Abstract] ( 3755 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	205	Comparison of acute toxicities between IMRT and VMAT in preoperative concurrent chemoradiotherapy for rectal cancer
		Ren Hua, Jin Jing, Xiao Qin, Feng Yan-ru, Fang Hui, Li Ning, Wang Xin, Wang Weihu, Wang Shulian, Song Yongwen, Liu Yueping, Yu Zihao, Liu Xinfan, Dai Jianrong, Li Yexiong
		Objective To compare the acute toxicities and tolerance between static intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in the preoperative concurrent chemoradiotherapy for rectal cancer. Methods From 2006 to 2013, 242 rectal cancer patients received VMAT (n=61) or IMRT (n=181). The IMRT group was further divided into 7-field IMRT subgroup (n=44) and simplified IMRT (sIMRT) subgroup (n=137). All patients received preoperative radiotherapy to the pelvis at a dose of 50 Gy/25 fractions in 5 weeks, concurrently with capecitabine (1650 mg/m²/day) and oxaliplatin (50 mg/m²/week) for 5 weeks. Comparison between groups was made by grouped t test. Results Nineteen (7.9%) of all patients discontinued radiotherapy due to toxicities, with 4.9% in VMAT group and 8.8% in IMRT group (P=0.325);also, no significant difference in the incidence of toxicities was found between the 7-field IMRT and sIMRT subgroups (8.0% vs 11.4%, P=0.498). The most common acute toxicities in all patients were leucopenia (69.4%, grade ≥3 5.8%), diarrhea (65.5%, grade ≥3 20.7%), and radiodermatitis (62.0%, grade ≥3 7.9%). There were no significant differences in the incidence of most common acute toxicities between the VMAT and IMRT groups (68.9% vs 69.6%, P=0.911;63.9% vs 67.4%, P=0.620;65.6% vs 60.8%, P=0.504), but the VMAT group had a significantly lower incidence of weight loss than the IMRT group (3.3% vs 12.7%, P=0.036). The incidence of most common acute toxicities showed no significant differences between the 7-fieldIMRT and sIMRT subgroups (65.9% vs 70.8%, P=0.539;63.6% vs 68.6%, P=0.540;59.1% vs 61.3%, P=0.793). Among grade ≥3 toxicities, vomiting occurred less frequently in the sIMRT subgroup than in the 7-field IMRT subgroup (0 vs 6.8%, P=0.002). Conclusions For patients with rectal cancer, IMRT and VMAT in preoperative concurrent chemoradiotherapy are well tolerable and lead to similar incidence of acute toxicities. The differences in certain adverse reactions between 7-field IMRT and sIMRT need to be investigated.
		2014 Vol. 23 (3): 205-209 [Abstract] ( 3966 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	210	Distribution of residual cancer cells in bowel wall and its associated factors in patients with rectal cancer after preoperative VMAT with concurrent chemotherapy
		Xiao Lin^*, Deng Wenjing, Huang Rong, Zhou Guanqun, Xiao Weiwei, Chen Li, Qiu Bo, Chang Hui, Gao Yuanhong, Liu Mengzhong
		Objective To investigate the distribution of residual cancer cells (RCCs) in the bowel wall and its associated factors among patients with rectal cancer after preoperative volumetric modulated arc therapy (VMAT) with concurrent chemotherapy. Methods A retrospective analysis was performed on the clinical data of 178 patients with locally advanced rectal cancer who received VMAT with concurrent chemotherapy followed by surgery in our hospital from April 2011 to April 2013. There were 124 males and 54 females,and the age range was from 23 to 84 years.T₁, T₂, T₃, and T₄ rectal cancer was found in 1, 2, 73, and 102 patients, respectively. All the RCCs in surgical specimens from different layers of the bowel wall were evaluated pathologically. Between-group differences were evaluated by Fisher′s exact test, and the associations of preoperative T and N stages with postoperative ypT and distribution of RCCs in the bowel wall were determined by Spearman rank correlation test. Results The rates of RCCs in the mucosa, submucosa, muscularis propria, and subserosa/perirectal fat surgical specimens were 15.2%, 27.0%, 46.6%, and 46.1%, respectively, for all patients, and were 20.0%, 36.7%, 69.2%, and 68.3%, respectively, for 120 patients with ypT_2-4 disease. Of all patients surgically treated, 52 had ypT₀ disease, 2 had ypT_is disease, 4 had ypT₁ disease, 38 had ypT₂ disease, 77 had ypT₃ disease, and 5 had ypT₄ disease. The rate of ypT₀ in 36 ypN (+) patients was significantly lower than that in 140 ypN₀ patients (3% vs. 35.7%, P=0.000), yet its rate of RCCs in the subserosa/perirectal fat wassignificantly higher than that in ypN₀ patients (83% vs. 36.4%,P=0.000). The rate of ypT₀ wassignificantly higher in 73 T₃ patients than in 102 T₄ patients(37% vs. 21.6%, P=0.025).Conclusions Most RCCs in the bowel wall of patients treated with preoperative VMAT with concurrent chemotherapy are distributed within or below the muscularis propria, which are significantly associated with ypT, ypN, and T stages.The value of biopsy for primary rectal lesions after neoadjuvant CRT may be very limited.
		2014 Vol. 23 (3): 210-213 [Abstract] ( 3786 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	216	Correlations between displacements of GTV, surgical clips, and skin markers in external-beam partial breast irradiation:a study based on 4DCT
		Ding Yun, Li Jianbin, Wang Wei, Ma Zhifang, Wang Suzhen, Wang Jinzhi
		Objective To investigate the correlations between the displacements of surgical clips, skin markers and the gross tumor volume (GTV) delineated by surgical clip and seroma based on four-dimensional computed tomography (4DCT) during normal breathing. Methods On each of the 10 respiratory phases of 4DCT with 15 patients of breast cancer, the surgical cavity, which was defined as GTV and formed by both surgical clips and seroma, all surgical clips in the cavity, and skin markers on the skin were delineated by the same radiation oncologist. The center displacements of GTV, selected boundary surgical clips and skin markers in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were recorded and analyzed by Pearson method. Results In the AP direction, there was a positive correlation between the displacements of the GTV and the inner clip (r=0.643, P=0.013). In the SI direction, the displacement of GTV was positively correlated with those of the lower clip and the skin marker at anterior body midline (r=0.857 and 0.643, P=0.002 and 0.013). In the LR and AP directions, there was a positive correlation between the displacements of the outer clip and the ipsilateral skin marker (r=0.757 and 0.697, P=0.001 and 0.025), but they were negatively correlated with each other in the SI direction (r=－0.647, P=0.043). In the AP direction, there was a positive correlation between the displacements of the inner clip and the skin marker at the anterior body midline (r=0.738, P=0.015). Conclusions The correlations between the displacement of GTV delineated by surgical clips and seroma and the displacements of surgical slips and skin markers vary under different conditions, and so does the correlation between the displacements of surgical clips and skin markers.
		2014 Vol. 23 (3): 216-219 [Abstract] ( 3407 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	186


		2014 Vol. 23 (3): 186-176 [Abstract] ( 2082 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review

	190


		2014 Vol. 23 (3): 190-193 [Abstract] ( 3366 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	230


		2014 Vol. 23 (3): 230-233 [Abstract] ( 3602 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	214


		2014 Vol. 23 (3): 214-215 [Abstract] ( 2853 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	224


		2014 Vol. 23 (3): 224-225 [Abstract] ( 3179 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	252	Deviation analysis of plan verification results of 260 volumetric modulated arc therapy plans
		Wang Bin, Chen Lixin, Zhang Dandan, Hu Jiang, Liu Boji, Chen Along
		Objective To investigate the γ pass rate and contributing factors by summarizing the plan verification results of 260 volumetric modulated arc therapy (VMAT) plans. Methods From 2010 to 2012,two different detector arrays (MapCheck₂,Sun,Nuclear,USA;Delta₄ScandiDos,Swenden) were used for plan verification in 260 patients. The measured dose distributions were compared with the calculation results of treatment planning system using γ pass rate (P_γ≤1 for 2%/2 mm, 3%/3 mm and 5%/3 mm, threshold 10%).And the results were put under independent-samples t test. The impact of multi-leaf collimator (MLC) on the γ pass rate (3%/3 mm) was analyzed. Results The average γ pass rates of 2%/2 mm, 3%/3 mm and 5%/3 mm of 260 VMAT plans were 91.7%, 98.5% and 99.7%, respectively. Among 260 VMAT plans, 3 VMAT plans (1.2% of the total) failed to meet the clinical acceptable pass rate and needed to be redesigned or re-optimized. The γ pass rate of 2%/2 mm was slightly different between two measurement devices (90.0% vs 93.5%,P=0.000), while the γ pass rate of 3%/3 mm showed no significant difference between two measurement devices and two accelerators (98.5% vs 98.5%,P=0.926 and 98.5% vs 98.6%,P=0.670). The γ pass rate (3%/3 mm) of the treatment plan before MLC calibration was 61.1%, compared to 94.1% after calibration. Conclusions Most dose verification results of treatment plans can meet the clinical requirement.Gantry rotation may influence the γ pass rate of VMAT dose verification under stricter pass rate standard (2%/2 mm). MLC calibration is essential for VMAT.
		2014 Vol. 23 (3): 252-255 [Abstract] ( 3769 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	256	Analysis of the setup errors of a stereoscopic two-dimensional kilo-voltage XGS-10 system for head-and-neck region intensity-modulated radiotherapy
		Zhang Sujie, Chen Xiaopin
		Objective To analyze the discrepancies between position adjustments obtained with the stereoscopic 2DKV XGS-10 system and the Varian OBI system for head-and-neck region IMRT treatments, and to compare for image acquisition and registration time. Methods CBCT images were obtained with OBI system and 2DKV images were acquired by XGS-10 system for 30 head-and-neck patients prior to Varian-21EX IMRT treatment. The images were registered with planning image for localization, and position adjustments were given in LR, SI and AP directions, then the discrepancies between them were analyzed.0n the comparison of the two different systems, the Pearson coefficient was used to analyzed the correlation and 95%CI analysis to discern the consistence. Results Analysis of images acquired for the 30 patients yielded the following results:position adjustments with XGS-10 system were (－1.03±2.15) mm,(0.86±2.59) mm,(0.42±1.66) mm in LR, SI and AP directions, whereas (0.00±1.68) mm,(1.53±2.12) mm,(0.10±1.54) mm with CBCT in LR, SI and AP directions. The discrepancies were (－1.03±1.24) mm,(－0.68±1.78) mm and (0.32±1.61) mm in LR, SI and AP directions. The correlation coefficients between them were 0.817, 0.731 and 0.495 in LR, SI and AP directions.95%CI were (－1.47—－0.59),(－1.32—0.04),(－0.26—0.90) mm. The average image acquisition and registration time were 10 s and<15 s in XGS-10 system, with 3 min and 8 min in OBI system. Conclusions Both of XGS-10 system and OBI system could be used to improve patient position accuracy,but XGS-10 system could cut down the total time.
		2014 Vol. 23 (3): 256-258 [Abstract] ( 3790 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	259	Study on dosimetric verification of VMAT treatment planning for chest esophageal carcinoma
		Li Jun^*, Zhang Xizhi, Hua Wei,Zhang Xianwen, Tang Xiaobin, Chen Da
		Objective To study the dosimetry characteristics of VMAT plan in the esophageal carcinoma radiotherapy. Methods Application of 0.6 cm³ ionization chamber and COMPASS three-dimensional dose verification system, 20 cases of upper and middle chest esophageal carcinoma on the VMAT plans for absolute dose and relative dose verification. Dose volume histogram (DVH) comparison treatment target, lungs, heart, and differences in the spinal cord irradiation dose and volume, and analyses γ pass rate of GTV, CTV, PTV and organs at risks. Results The center dose of upper and middle chest esophageal carcinoma accurate rates were above 99%. Thoracic segment esophageal:GTV, PTV and organs at risks of γ pass rate above 97%. D_95% and D_mean of GTV, CTV and PTV were relatively undervalued within 3%. D_1% of spinal cord is 2.21% overvalued. Left and right pulmonary V₅ were slightly overvalued by about 0.5%, V₁₀—D₃₀, D_mean undervalued within 2%. In period of middle chest esophageal carcinoma:the gamma passed rate of GTV, CTV, PTV and organs at risks of above 97%, GTV, CTV, PTV D_95%, D_mean were relatively undervalued within 2%. Spinal cord D_1% is 2.04% overvalued. Left and right pulmonary V₅—D₃₀ to V₁₀ as a trend of gradually to be underestimated, at 1.5%. Heart D_mean was undervalued by 2.68%. Conclusion VMAT technology is applicable in the chest esophageal carcinoma radiotherapy.
		2014 Vol. 23 (3): 259-261 [Abstract] ( 3813 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	262	Dosimetric comparison of Cervix uteri irradiation with 9 equal spaced fields IMRT and beam angle optimized IMRT
		Pang Tingtian, yang Bo,Zhang Fu-quan,Qiu Jie
		Objective To study the dosimetry characteristics of 9 equal spaced fields and 9 fields with beam angle optimization (BAO) process for cervix uteri. Methods 12 cervix uteri cancer patients CT Images were transferred into Eclipse planning system. Each patient, the 9 equal spaced fields and 9 fields by BAO process were IMRT plan designed with the same CT image. Make a evaluation of dose distribution for target volume and OARs, and paired t test for them. Results Comparing to 9 equal spaced fields IMRT plan, the quality of 9 fields IMRT plan with BAO process the the PTV V_95% was 99.31% vs 99.42%,P=0.020, at the same time V_105%,V_110%,D_max,D_mean got 60.54% vs 47.92%,P=0.013;7.14% vs 0.37%,P=0.000;56.62 Gy vs 55.47 Gy,P=0.000;53.29 Gy vs 52.72 Gy,P=0.000, the CI and HI was 0.85 vs 0.89,P=0.000;0.10 vs 0.13,P=0.000.For organs at risk, bladder V₄₀ was increased by 4.7%(P=0.013);the D₄₀ of rectum was 0.5 Gy higher (P=0.004);the small bowel′s DVH showed that V₄₀ and D_max increased by 0.6%(P=0.015) and 1.4 Gy (P=0.000), D_mean of bone marrow were raised separately by 1.3 Gy (P=0.000),the spinal cord′s dose D_{0.1 cm³} was also increased by 2.0 Gy (P=0.000). Conclusion The quality of 9 equal spaced fields IMRT plan will be better than those achieved by BAO process optimized plans.
		2014 Vol. 23 (3): 262-264 [Abstract] ( 3723 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	265	Analysis of electron beam output factors by Monte Carlo method
		Chi Zifeng^*, Liu Dan, Zhang Yong, Li Runxiao, Jing Zhonghao, Feng feng, Han Chun
		Objective To investigate the application of the Monte Carlo dose calculation of output factors for electron beams in radiotherapy. Methods The code EGS4/MCTP was used to simulate the head of a medical linear accelerator (Varian 23EX) to calculate the output factors for 6 MeV,9 MeV and 18 MeV electron beams. The source-to-surface distance used was 100 cm. The field sizes ranged from 2 cm×2 cm to 25 cm×25 cm. The calculated output factors agreed with the corresponding measured factors which were measured by the IBA Phantom system to within 2%. Then, the output factors of direct articles and indirect articles which were under different energy and various cone-insert combinations were calculated by the code EGS4/MCTP. Results The calculated output factors agreement with the measurements is found to be mostly under the 1% level. The variation of output factors depends on the characteristics of the beams and themodifications that the various cone-insert combinations introduce to these characteristics. Conclusions Monte Carlo dose calculations for electron beams in homogeneous water phantoms have been demonstrated to be accurate under the 1% level in comparison with measurements. The output factors were influenced by energy and cone-insert combinations in complex ways.
		2014 Vol. 23 (3): 265-268 [Abstract] ( 3570 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	269	The research on the factors of effecting with γ passing rate of delivery quality assurance for helical tomotherapy
		Yue Qi, Duan Jimei, Wang Zhiwei, Gu Dan, Yang Xiumei, Li Rongqing
		Objective To investigate the factors of effecting with γ index analysis of delivery for helical tomotherapy (HT). Methods Measuring γ index with the ArcCheck device for introduced errors in HT. The errors include setup errors in three-dimensional, the gantry angle error, calculating the dose in the phantom, low dose rate. All the results were compared with the 3%/3 mm and 2%/2 mm criteria. The effect of the accuracy in the application of kilovoltage computed tomography (KVCT) and mega-voltage computed tomography (MVCT) images in HT was also analyzed. Paired-t test method was used for difference compared. Results When the errors were introduced to the HT, theγ passing rate of left-right, superior-inferior, anterior-posterior direction dropped 2.7%, 7.2%, 3.6% under the 3%/3 mm criteria (P=0.002,0.022,0.007), with 4.6%,15.7%,7.6% under the 2%/2 mm criteria (P=0.001,0.003,0.002) respectively. There was no statistical significance for theγ passing between scanning the ArcCheck phantom with the KVCT and MVCT under the 3%/3 mm and 2%/2 mm criteria (98.6% vs 98.7%,P=0.859 and 92.7% vs 92.8%,P=0.984). Conclusions The errors of the setup position and machine paraments can lead to the dose delivery errors in HT, the quality accurance of machine and plan should be enhanced to minimize the dose errors. The results also showed that there is no difference of KVCT and MVCT image on the delivery of HT.
		2014 Vol. 23 (3): 269-271 [Abstract] ( 3943 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	272	Pro-invasive effect of irradiation on human glioblastoma cell line U₈₇ and its possible mechanism
		Lyu Xiaojuan^*, Han Na, Zhang Mengxian, Dong Zhen
		Objective To study the pro-invasive effect of irradiation on human glioblastoma cell line U₈₇ and its possible mechanism. Methods Cultured U₈₇ cells received different doses of irradiation (0, 2, and 4 Gy). The change in cellular invasiveness was measured using the real-time cell analyzer system. The activities of matrix metalloproteinase-2(MMP₂) and matrix metalloproteinase-9(MMP₉) in U₈₇ cells were measured by gelatin zymography before and after irradiation. The content and distribution of intracellular β-catenin after irradiation were determined by immunohistochemistry. The mRNA levels of Wnt/β-catenin target genes were measured by real-time quantitative PCR. Results After irradiation, the invasiveness of U₈₇ cells increased significantly (P<0.01), which was dose-dependent within a certain dose range;the activities of MMP₂ and MMP₉ in U₈₇ cells increased significantly (P=0.031 for MMP₂;P=0.004 for MMP₉);the content of β-catenin in U₈₇ cells increased significantly (P<0.01), with translocation from the cell membrane and adherens junctions to the nucleus;the mRNA levels of Wnt/β-catenin-related genes (FZD₇ and TCF₁) increased significantly (P<0.01), and the transcription of Wnt/β-catenin target genes, especially those related to migration and invasion such as MMP₂, MMP₇, MMP₉, and CD₄₄, was significantly enhanced (P<0.05). Conclusions Irradiation can promote the invasion of glioblastoma U₈₇ cells, possibly by activating the Wnt/β-catenin pathway and enhancing the transcription of migration-and invasion-related genes.
		2014 Vol. 23 (3): 272-275 [Abstract] ( 3400 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	220	Analysis of doses to lymph node drainage areas during involved-field irradiation for esophageal cancer
		Shen Wenbin^*, Gao Hongmei, Zhu Shuchai, Li Youme, Cao Yankun, Li Shuguang, Su Jingwei, Liu Zhikun, Li Juan
		Objective To analyze the doses to lymph node drainage areas during involved-field irradiation (IFI) in three-dimensional conformal radiotherapy (3DCRT) for esophageal cancer (EC). Methods A retrospective analysis was performed on the clinical data of 81 patients with medically inoperable thoracic EC who received IFI from 2000 to 2004. The lymph node drainage areas were delineated based on the lesions, and the dose-volume parameters of the planning target volume (PTV) of each lymph node drainage area was analyzed. Results The median values of V₃₀, V₃₅, V₄₀, V₄₅, and V₅₀ were 73%, 70%, 67%, 64%, and 58%, respectively. The prescribed dose was not significantly correlated with V₃₀ and V₃₅(P=0.215,0.054), but significantly correlated with V₄₀ and V₅₀(P=0.027,0.002,0.000);the number of radiation fields was not significantly correlated with V₃₀ and V₄₅(P=0.438,0.535,0.425,0.313), but significantly correlated with V₅₀(P=0.045);the length of lesion on barium meal examination and volume of PTV were significantly correlated with V₃₀ and V₅₀(all P<0.05). The one-way analysis of variance showed that the V_x value of upper-thoracic segment was greater than those of middle-and lower-thoracic segments (P=0.028,0.045);the values of V₃₀ and V₃₅ varied significantly between different lesions, but there were no significant differences in the values of V₄₀ and V₅₀(P=0.076,0.173,0.695). The V_x value had no significant impact on the long-term survival of patients (all P>0.05). Conclusions The lymph node drainage areas of EC receive a considerable dose with IFI in 3DCRT, which may play a certain role in preventing regional lymph node metastasis, but more clinical studies are needed.
		2014 Vol. 23 (3): 220-223 [Abstract] ( 3759 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	226	Comparison between IGTVs based on ten phases of 4DCT and nine PET-CT SUV thresholds in primary thoracic esophageal cancer
		Guo Yanluan^*, Li Jianbin, Zhang Yingjie, Wang Wei, Shao Qian, Xu Min, Fan Tingyong, Shang Dongping, Fu Zheng
		Objective To compare the volume, conformity index (CI), and degree of inclusion (DI) between internal gross tumor volumes (IGTVs) delineated based on ten phases of four-dimensional computed tomography (4DCT) and nine positron emission tomography (PET)-CT standardized uptake value (SUV) thresholds. Methods Fifteen patients with thoracic esophageal cancer sequentially underwent 3DCT, 4DCT, and FDG PET-CT of the thorax simulation. IGTVs were delineated on ten phases of 4DCT images and then combined to obtain IGTV₁₀. IGTV_PET2.0, IGTV_PET2.5, IGTV_PET3.0, IGTV_PET3.5, IGTV_PET20%, IGTV_PET25%, IGTV_PET30%, IGTV_PET35%, and IGTV_PET40% were delineated on PET images based on different SUV thresholds (≥2.0, 2.5, 3.0, and 3.5) and percentages of SUV_max(≥20%, 25%, 30%, 35%, and 40%). The volume, CI, and DI were compared between IGTVs by paired t test. The correlations of centroid distance with CI and DI were determined by Pearson correlation analysis. Results The volumes of IGTV_PET2.5 and IGTV_PET20% were similar to that of IGTV₁₀, with volume ratios of 0.92(P=0.985) and 1.08(P=0.886), respectively. The CIs of IGTV_PET2.0 vs IGTV₁₀, IGTV_PET2.5 vs IGTV₁₀, and IGTV_PET20% vs IGTV₁₀ were similar (0.53, 0.52, and 0.53;P=0.432, 1.00, and 0.414), but they were significantly higher than the CIs of other IGTV_PET vs IGTV₁₀(0.33—0.50, P=0.000—0.047). No significant differences existed between the DIs of IGTV₁₀ in IGTV_PET2.5(0.67) and IGTV₁₀ in IGTV_PET20%(0.70)(P=0.542) and between the DIs of IGTV_PET2.5 in IGTV₁₀(0.74) and IGTV_PET20% in IGTV₁₀(0.72)(P=0.539). Conclusions IGTV_PET2.5 and IGTV_PET20% have similar volumes and good spatial matching compared with IGTV₁₀.
		2014 Vol. 23 (3): 226-229 [Abstract] ( 3539 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	234	Phase Ⅰ clinical trial of nimotuzumab in combination with concurrent chemo-radiotherapy in patients diagnosed with locally advanced non-small cell lung cancer
		Wang Xiaozhen, Zhang Tao, Zhai Yirui, Liang Jun, Lyu Jima, Hui Zhouguang, Zhou Zongmei, Feng Qinfu, Xiao Zefen, Chen Dongfu, Zhang Hongxing, Wang Luhua
		Objective To observe the feasibility of nimotuzumab in combination with concurrent chemo-radiotherapy in locally-advanced non-small cell lung cancer (NSCLC). Methods From 2011 to 2012, Untreated stage Ⅲ_A/Ⅲ_B NSCLC patients were chosen and divided into three weekly dose level of nimotuzumab:100 mg, 200 mg and 400 mg,3—6 cases per group. If one of the first three patients experienced DLT, three additional patients were recruited to that dose level. If DLTs were observed in 50% patients in any cohort, dose escalation was stopped and that dose was designated the maximum tolerated dose. Intensity-modulated radiotherapy (IMRT) was taken, with total dose of 60—66 Gy in 30—33 fractions. Concurrent cisplantin and etoposide chemotherapy were performed. After concurrent treatment, consolidation weekly nimotuzumab treatment was performed until 16 weeks or disease progression observed. Assessment of efficacy and safety were performed via RECIST and CTC AE V3.0, respectively, maximum change in tumor volume and survival were calculated. Results Totally 9 cases enrolled. All three dose level were well tolerated, no dose-limiting toxicity observed. The most commonly reported severe adverse events were grade 3 hematological, including leucopenia (66%), neutropenia (66%), anemia (11%),and thrombocytopenia (22%). Most common non-hematological toxicity are esophagitis, grade 1(44%) or 2(22%), grade 1 radiation pneumonitis (44%), and grade 1 nausea/vomiting (44%). Mean total tumor volume decrease was 88%. With median survival of 26.4 months, the total 1 year and 2 year overall survival, disease free survival and progression free survival were 78% and 67%, 56% and 44%, 78% and 56%, respectively. Conclusion Weekly 100 mg, 200 mg and 400 mg nimotuzumab in combination with concurrent chemoradiotherapy can be well tolerated in locally advanced non-small cell lung cancer.
		2014 Vol. 23 (3): 234-238 [Abstract] ( 3573 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	239	Differences in delineation of organs at risk lead to dose uncertainties during intensity-modulated radiotherapy for nasopharynx carcinoma
		Qian Jianjun, Xing Pengfei, Lu Xueguan, Tian Ye
		Objective To assess the differences in delineation of organs at risk (OAR) and dosimetry between junior and senior physicians during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and to evaluate the role of specific training in reducing the differences. Methods Sixteen patients newly diagnosed with NPC were selected in the study. The OAR was delineated separately by three junior physicians and three senior physicians, and the geometric and dosimetric differences were assessed relative to the reference OAR. Delineation was performed again for the two OARs with the biggest difference after specific training in the two groups of physicians, and the differences were evaluated again. The difference was determined by paired t test. Results The maximum dose differences (D_max) of OAR in the junior and senior physicians were (2.33±12.06)%(－48.06%—137.82%) and (0.09±4.72)%(－49.54%—42.96%), respectively (P=0.039), and the difference in the optic chiasm was the greatest ((5.85±19.63)%∶(1.36±4.64)%,P=0.042). The mean dose differences (D_mean) of OAR in the junior and senior physicians were (3.10±8.07)%(－46.76%—59.76%) and (－0.93±2.03)%(－45.54%—35.69%), respectively (P=0.021), and the difference in the parotid gland was the greatest ((13.23±13.39)%∶(3.20±6.71)%,P=0.002). In the secondary delineation after training, the D_max of the optic chiasm in the junior and senior physicians was (1.68±3.34)% and (1.50±1.87)%, respectively (P=0.841), and the difference in junior physicians was reduced significantly compared with before training ((1.68±3.34)%∶(5.85±19.63)%,P=0.048);the D_mean of the parotid gland in the junior and senior physicians was (2.46±3.06)% and (1.35±3.00)%, respectively (P=0.274), significantly reduced compared with before training ((2.46±3.06)%∶(13.23±13.39)%,P=0.002;(1.35±3.00)%∶(3.20±6.71)%,P=0.033). Conclusions The differences in delineation of OAR lead to dose uncertainties during IMRT for NPC, and specific training can improve the accuracy of delineation.
		2014 Vol. 23 (3): 239-243 [Abstract] ( 3731 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	244	Outcomes of tongue squamous cell carcinoma treated with different treatment modalities
		Wang Boqing, Liu Pan, Zhao Huarong, Huerxidan·Niyazi, Zhang Songan, Bao Yongxing
		Objective To analyze the therapeutic effects of different treatment modalities in patients with tongue squamous cell carcinoma. Methods A retrospective analysis was performed on the complete clinical and follow-up data of 132 patients with pathologically confirmed tongue squamous cell carcinoma, who were initially treated at the First Affiliated Hospital of Xinjiang Medical University from 2003 to 2011. The Kaplan-Meier method was used to calculate the overall survival (OS) rates for patients who received surgery alone (S), radiotherapy alone (R), surgery plus radiotherapy (S+R), chemotherapy plus surgery (C+S), chemotherapy plus radiotherapy (C+R), and surgery, radiotherapy, and chemotherapy (S+R+C). The OS was compared between these groups by log-rank test. Multivariate analysis was performed using the Cox proportional hazard model to establish independent treatment modalities as prognostic factors. Results The follow-up rate was 100%. The 3-year sample size was 94. The 3-year OS rate for all patients was 72.7%. The univariate analysis showed that among 70 stage Ⅰ and Ⅱ patients, the S, R, S+R, C+S, and S+R+C groups had 3-year OS rates of 86%, 67%, 97%, 100%, and 82%, respectively (P=0.018);among 62 stage Ⅲ and IV patients, the S, R, S+R, C+S, C+R, and S+R+C groups had 3-year OS rates of 38%, 14%, 92%, 40%, 14%, and 67%, respectively (P=0.000). The multivariate analysis showed that S+R and S+R+C were independent prognostic factors (P=0.000 and 0.005). Conclusions Surgery alone or combination therapy including surgery has a good therapeutic effect for stage Ⅰ—Ⅱ tongue squamous cell carcinoma, while S+R and S+R+C are better treatment modalities for stage Ⅲ—IV disease;however, advanced patients have a poor prognosis after being treated with R and C+R modalities.
		2014 Vol. 23 (3): 244-247 [Abstract] ( 3499 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	248	Clinical application of BOLD-FMRI in guiding protection of the motor cortex during postoperative radiotherapy for brain astrocytoma
		He Hong^*, Guo Yanhong, Wang Minglei, Xia Xinshe, Zhu Kai, Wang Xiaodong, Zhe hong
		Objective To investigate the clinical value of blood oxygen level-dependent functional magnetic resonance imaging (BOLD-FMRI) in guiding the dose reduction and functional protection of the motor cortex during postoperative radiotherapy for brain astrocytoma. Methods This study included 27 brain astrocytoma patients with tumors near the motor cortex, who underwent routine MRI and BOLD-FMRI before postoperative radiotherapy. The location and scope of the motor cortex, which were acquired based on BOLD-FMRI results, were marked on positioning CT images, so that the motor cortex would be dealt with as organs at risk. The dose to the motor cortex was reduced as much as possible while ensuring the therapeutic dose to the target area. Finally, the radiotherapy plan that would reduce the mean received dose of the motorcortex was formulated and compared with the routine plan that could not reduce the received dose. Results With the protective radiotherapy plan, the mean received dose of the motor cortex decreased 0.76%—59.20%(mean 30.78%) on the affected side and 23.33%—68.30%(mean 48.07%) on the unaffected side;the coefficients of variation were 71.41% on the affected side and 36.71% on the unaffected side. Conclusions BOLD-FMRI can help to reduce the received dose of the motorcortex while ensuring the therapeutic dose to the target area when formulating the postoperative radiotherapy plan for brain astrocytoma, thus protecting the motor function and improving patients′ quality of life.
		2014 Vol. 23 (3): 248-251 [Abstract] ( 3831 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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