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.4 Published 2014-06-29

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

Editorial

	279


		2014 Vol. 23 (4): 279-281 [Abstract] ( 3330 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	282	A phase Ⅰ study of concurrent S-1 and IMRT as adjuvant treatment for locally advanced gastric cancer after operation
		Wang Xin, Jin Jing. Ren Hua, Fang Hui, Wang Weihu, Tang Yu, Liu Yueping, Li Ning, Wang Shulian, Song Yongwen, Li Yexiong Yu Zihao, Liu Xinfan
		Objective To determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of tegafur, gimeracil and oteracil (S-1) which was used concurrently with intensity-modulated radiotherapy (IMRT) for locally advanced gastric cancer after operation. Methods We enrolled patients who were confirmed to have T_xN_1-3M₀ gastroesophageal or gastric adenocarcinoma after complete resection with a negative margin (R₀) or a positive margin (R₁). IMRT was delivered at 45 Gy/25 fractions (5 fractions/week) after R₀ resection or at 45 Gy with a boost dose of 10.8 Gy for anastomosis after R₁ resection. S-1 was orally administered twice every day of radiotherapy at a dose of 30 mg/(m²·d)(level Ⅰ, n=6), 40 mg/(m²·d)(level Ⅱ, n=3), 50 mg/(m²·d)(level Ⅲ, n=6), 60 mg/(m²·d)(level Ⅳ, n=3), 70 mg/(m²·d)(level Ⅴ, n=3), or 80 mg/(m²·d)(level Ⅳ, n=6). ResultsTwenty-seven patients were recruited from 2010 to 2013, with a median age of 54 years (29—65 years) and a male-to-female ratio of 23 vs.4. Grade 1—3 nausea (23 patients, 85%), anorexia (23 patients, 85%), leukopenia (23 patients, 85%), fatigue (19 patients, 70%), and thrombocytopenia (14 patients, 52%) were the most common toxicities. Of four patients who developed grade 3 toxicities, two had leucopenia, and two had DLT (grade 3 nausea and anorexia in one patient at level Ⅰ;grade 3 thrombocytopenia in one patient at level Ⅲ). This study ended with none of the 6 patients who received S-1 at 80 mg/(m²·d)(level Ⅳ) developing DLT. Conclusions S-1 with concurrent IMRT is safe and tolerable for locally advanced gastric cancer patients after operation. The MTD of S-1 is 80 mg/(m²·d), which is recommended as the dose level in phase Ⅱ and Ⅲ studies, and S-1 is orally administered twice every day of radiotherapy. The DLT are nausea, anorexia, and thrombocytopenia.
		2014 Vol. 23 (4): 282-285 [Abstract] ( 3309 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	286	Efficacy of preoperative concurrent chemoradiotherapy in treatment of locally advanced middle-low rectal cancer
		Li Ming, Gao Hong, Li Gaofeng, Xiu Xia, Hou Xiuyu, Xu Yonggang, Zhong Qiuzi
		Objective To evaluate the efficacy and tolerance of preoperative concurrent chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer. Methods From June 2007 to June 2013, 51 untreated patients with histopathologically proven rectal cancer (T₃/T₄ or N (+)) were included in this study. Three-dimensional radiotherapy was delivered to the whole pelvic cavity at 45.0—50.4 Gy/25—28 fractions. Two cycles of chemotherapy with FOLFOX4 or XELOX were given concurrently at weeks 1 and 4 of radiotherapy. Surgery was performed at 4—8 weeks after chemoradiotherapy. Adjuvant chemotherapy with FOLFOX4 or XELOX was given within one month after surgery. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for univariate analysis;the Cox regression model was used for multivariate prognostic analysis. Results Forty-nine patients completed the preoperative chemoradiotherapy and surgery. The median follow-up was 2.9 years. The overall sphincter preservation rate was 65%;the overall downstaging rate was 59%. Ten (20.4%) of all patients achieved a pathologic complete response (pCR). Grade ≥3 toxicities occurred in 25% of all patients, and the overall postoperative complication rate was 31%. The 3-and 5-year sample sizes were 24,12, respectively. The 3-and 5-year overall survival rates were 81% and 69%, respectively;the 3-and 5-year disease-free survival (DFS) rates were 76% and 60%, respectively;the 3-and 5-year local recurrence-free survival (LRFS) rates were 78% and 70%, respectively;the distant metastasis-free survival rates were 82% and 74%, respectively. The multivariate analysis showed that tumor downstaging was an independent prognostic factor for 5-year DFS and LRFS. Conclusions For locally advanced middle-low rectal cancer, preoperative radiotherapy with concurrent FOLFOX4/XELOX chemotherapy can increase pathologic downstaging rate, pCR rate, and sphincter preservation rate. Patients with tumor downstaging may have a better survival advantage.
		2014 Vol. 23 (4): 286-289 [Abstract] ( 3573 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review

	290


		2014 Vol. 23 (4): 290-293 [Abstract] ( 3303 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	365


		2014 Vol. 23 (4): 365-369 [Abstract] ( 3416 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	294	Clinical significance of patterns of intrathoracic lymph node metastasis in non-small cell lung cancer:an analysis of 314 patients
		Zhang Haichen, Shi jingbin,Zha Jiandong
		Objective To investigate the patterns of intrathoracic lymph node metastasis in non-small cell lung cancer (NSCLC) and to provide a theoretical basis for the delineation of radiotherapy target volume. Methods A retrospective analysis was performed on the clinical data of 314 NSCLC patients after operation. Our focus was to investigate the distribution characteristics and metastatic extent of intrathoracic lymph nodes and their relationship with tumor size, pathological type, and primary site. Comparisons between groups were made by one-way analysis of variance. Results The frequencies of metastases to lymph nodes at stations 4, 5, 7, 10, and 11 were all above 12%, while those at stations 1, 2, 3, 6, 8, and 9 were all below 12%. The lymph node metastasis rate was similar on the primary tumor site (P=0.102).The patients with T₃ and T₄ NSCLC had a significantly higher frequency of N₂ lymph node metastasis than those with T₁ and T₂ NSCLC (17.0% vs. 11.6%,P=0.002);the patients with adenocarcinoma had a significantly higher frequency of N₂ lymph node metastasis than those with squamous cell carcinoma (34.5% vs. 23.2%,P=0.008). Conclusions For patients with T₃ and T₄ NSCLC of adenocarcinoma subtype, we should highlight the lymph nodes at stations 4, 5, 7, 10, and 11 when delineating the radiotherapy target volume after operation.
		2014 Vol. 23 (4): 294-296 [Abstract] ( 3703 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	297	Relationship of pulmonary abnormalities on high-resolution CT before radiotherapy with radiation pneumonitis after three-dimensional radiotherapy in patients with lung cancer
		Wang Qi^*, Dai Dong, Zhao Jinkun, Xiao Jianyu, Sun Yao, Zhao Lujun, Yuan Zhiyong, Wang Ping
		Objective To investigate the relationship of pulmonary abnormalities on high-resolution CT (HRCT) before radiotherapy with radiation pneumonitis (RP) after three-dimensional radiotherapy (3DRT) in patients with lung cancer. Methods A retrospective analysis was performed on the HRCT images (before radiotherapy) and clinical data of 262 patients with lung cancer who received 3DRT from January 2009 to April 2011. HRCT showed reticular opacities, honeycomb patterns, ground-glass attenuation, and pulmonary emphysema (PE). Clinical data included general conditions (age, sex, KPS score, history of smoking, chronic obstructive pulmonary disease (COPD), interstitial lung disease, and forced expired volume in one second (FEV₁)/forced vital capacity (FCV)), disease factors (tumor location, histology, and stage), and radiotherapy factors (total dose, minimum lethal dose (MLD), lung V₂₀, surgery, and concurrent chemotherapy). Univariate and multivariate analyses (logistic regression) were used to identify predictive factors for RP. Results On pre-treatment HRCT, 129 patients had reticular opacities, mild in 56 patients, moderate in 49 patients, and severe in 24 patients;37 patients had honeycomb patterns;22 patients had ground-glass attenuation. A total of 154 patients had PE;grade 1 PE was found in 71 patients, grade 2 PE in 55 patients, grade 3 PE in 20 patients, and grade 4 PE in 8 patients. Fifty-eight patients developed RP;among them, 39 patients had grade 1—2 RP, and 19 patients had grade 3—5 RP. In RP patients, 34 had reticular opacities, 38 had PE, 6 had honeycomb patterns, and 2 had ground-glass attenuation, according to the pre-treatment HRCT. Univariate analysis showed that COPD, FEV₁/FCV, V₂₀, MLD, chemotherapy, and PE and reticular opacities on HRCT were associated with RP. Multivariate analysis showed that the predictive factors for grade ≥3 RP were concurrent and induction chemotherapy, severe reticular opacities, and grade 3 PE. Conclusions Pulmonary abnormalities on HRCT before radiotherapy could help to predict the incidence of RP after thoracic radiotherapy in patients with lung cancer.
		2014 Vol. 23 (4): 297-301 [Abstract] ( 3740 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	302	A preliminary study of relationship between incidental irradiation dose to lymph node stations and recurrence in esophageal cancer patients treated by involved-field irradiation
		Shen Wenbi^*,Gao Hongmei, Zhu Shuchai, Li Youmei, Li Shuguang, Cao Yankun, Su Jingwei, Liu Zhikun, Li Juan, Wen shiwan, Wu Yanzhao
		Objective To investigate the relationship between the incidental irradiation dose (IID) to lymph node stations and recurrence in esophageal cancer (EC) patients treated by involved-field irradiation (IFI). Methods A retrospective analysis was performed on the clinical data of 81 EC patients who received radical radiotherapy from 2000 to 2004. The treatment failure mode, IID, and the relationship of IID with recurrence and long-term survival were analyzed. The Kaplan-Meier method was used to calculate overall survival (OS) and local control (LC) rates, and the log-rank test was used for survival difference analysis;the prognostic value of V_PTV-NX was determined by receiver operating characteristic (ROC) analysis, and correlation analysis was performed by Spearman method. Results The follow-up rate was 100%. The 1-, 3-, 5-, and 8-year OS rates were 68%, 33%, 21%, and 11%, respectively, and the 1-, 3-, 5-, and 8-year LC rates were 77%, 46%, 36%, and 20%, respectively. After treatment, locoregional recurrence was found in 21 patients, distant metastasis in 15 patients, and recurrence and distant metastasis in 3 patients. The ROC analysis showed that V_PTV-N40~50 could effectively predict out-field recurrence (P=0.004—0.031), and the optimal cut-off values were 71.5%, 68.5%, and 58.5%, respectively. V_PTV-N40~50 had no significant correlation with long-term OS (P=0.601—0.f826), but showed a significant correlation with out-field recurrence (P=0.005—0.010). There was no significant correlationbetween V_PTV-NX and grade ≥2 radiation injury (r=0.151－0.027,P=0.108—0.809). ConclusionsConsiderable IID to lymph node stations near EC may contribute to the prevention of subclinical lesions in EC patients treated by IFI.
		2014 Vol. 23 (4): 302-305 [Abstract] ( 3544 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	307	Comparison of rationality and prognostic value between clinical staging and pathological staging for esophageal cancer
		Qiao Xue, Zhu Yaqun, Tian Yen
		Objective To investigate the rationality and prognostic value of the Criteria for clinical staging of esophageal cancer treated by non-surgical methods (Draft) by comparison with the criteria for postoperative pathological staging. Methods A retrospective analysis was performed on the clinical data of 162 patients with esophageal cancer who underwent radical resection at the Second Hospital of Soochow University from December 2008 to July 2012. Preoperative clinical staging and postoperative pathological staging were performed, and the Kappa statistic was used to evaluate the agreement between the two staging systems. The Kaplan-Meier method was used to calculate overall survival (OS) rates, and the log-rank test was used for survival difference analysis and univariate analysis. Results The coincidence rates of T, N, and TNM stages were 67.9%, 57.4%, and 67.9%, respectively, and the agreements were moderate, poor, and moderate, with Kappa values of 0.544, 0.302, and 0.509. The follow-up rate was 93.2%. The 1-, 2-, and 3-year sample sizes were 127, 66 and 27, respectively. The 1-, 2-, and 3-year OS rates were 82.6%, 56.2%, and 37.7%, respectively. There were no significant differences in OS between patients with preoperative T₁ and T₂ stages and between patients with preoperative N₀ and N₁ stages (P=0.086,0.101), but significant differences were observed between patients with different T stages, N stages, or TNM stages (P=0.000—0.028). This was in line with the prognostic results based on the postoperative pathological staging. Conclusions The clinical staging criteria (draft) have moderate agreement with the criteria for postoperative pathological staging and have good prognostic value, but they require further refinement and improvement.
		2014 Vol. 23 (4): 307-311 [Abstract] ( 3324 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	312	Value of DWI for early assessment of response to concurrent chemoradiotherapy for esophageal cancer:a preliminary study
		Chen Wei^*, Zhou Shengli, Miao Chongchang, Jiang Xiaodong, Qiao Yun
		Objective To investigate the feasibility and value of diffusion-weighted imaging (DWI) in the prediction and early assessment of response to concurrent chemoradiotherapy (CCRT) for esophageal cancer. Methods A total of 40 patients with pathologically confirmed esophageal cancer who received CCRT were included in the study. Routine 3.0 T MRI and DWI were performed at different time points of treatment. The RECIST standard was adopted to evaluate short-term outcomes and divide the patients into remission group (complete remission and partial remission) and non-remission group (stable disease and progressive disease). Group t-test was used for between-group comparison. The receiver operating characteristic (ROC) curve was used to analyze the change rates of apparent diffusion coefficient (ADC) value at different time points of treatment. Results There were 30 patients in the remission group and 10 patients in the non-remission group. The remission group had a significantly higher increase in ADC value than the non-remission group by the end of the first week of treatment (P=0.000). The maximum diameters of tumors for the emission group and non-remission group at the end of the first week of treatment were not significantly different from those before treatment (66.10 mm vs. 62.63 mm, P=0.407;70.90 mm vs. 68.30 mm, P=0.552). The ADC value before treatment had a negative correlation with the reduction rate of the maximum diameter of tumor (r=－0.680, P=0.000). The area under the ROC curve was the largest at the end of the first week of treatment (Az=0.783). If using 15.5% increase in ADC value by the end of the first week as the threshold value for evaluating tumor response, the sensitivity, specificity, positive predictive value, and negative predictive value were 86.7%, 70.0%, 89.7%, and 63.6%, respectively. Conclusions DWI can be used as a new imaging method for the prediction and early assessment of the response to CCRT for esophageal cancer. The change rate of ADC value by the end of the first week of treatment is sensitive in assessing treatment response, so ADC value can be monitored at this time point.
		2014 Vol. 23 (4): 312-316 [Abstract] ( 3435 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	317	Comparison of internal gross tumor volumes delineated based on MIP images of 4DCT and different SUV thresholds of FDG PET/CT for non-small cell lung cancer
		Duan Yili, Li Jianbin, Zhang Yingjie, Wang Wei, Fan Tingyong, Shao Qian, Xu Min, Guo Yanluan, Shang Dongping, Fu Zheng
		Objective To compare the positional and volumetric differences between internal gross target volumes (IGTV) based on the maximum intensity projection (MIP) images of four-dimensional computed tomography (4DCT) and different standardized uptake value (SUV) thresholds of fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT) for the primary tumor of non-small cell lung cancer (NSCLC). Methods Ten patients with NSCLC sequentially underwent contrast-enhanced 3DCT and 4DCT, as well as FDG PET-CT (with the same body position and positional parameters). IGTV_MIP of the primary tumor was delineated on the MIP images of 4DCT. IGTV_PET2.0, IGTV_PET2.5, IGTV_PET3.0, IGTV_PET3.5, IGTV_PET20%, IGTV_PET25%, IGTV_PET30%, IGTV_PET35%, IGTV_PET40% andIGTV_PETmanwere automatically and manually delineated based on different SUV thresholds of FDG PET/CT and different percentages of SUV_max. The differences in position, volume, matching index (MI), and degree of inclusion (DI) between IGTV_PET and IGTV_MIP were evaluated by paired t-test. Results There were significant differences in center coordinate between IGTV_PET and IGTV_MIP only in z axes (P=0.014—0.044). In terms of volume, IGTV_PET2.0 and IGTV_PET20% were most similar to IGTV_MIP, with volume ratios of 1.02 and 1.06(P=0.806). The highest MI was seen between IGTV_MIP and IGTV_PET2.0 and between IGTV_MIP and IGTV_PET20%(0.46 and 0.45, P=0.603). The DI of IGTV_PET20% or IGTV_PET2.0 in IGTV_MIP was the highest (0.61 or 0.61, P=0.963). Conclusions IGTV_PET2.0 and IGTV_PET20% are most similar to IGTV_MIP in terms of volume and matching index, but neither of them could replace IGTV_MIP in spatial position. When the IGTV of the primary tumor of NSCLC is delineated based on PET-CT, target position correction should be done with reference to 4DCT images while selecting the suitable SUV threshold.
		2014 Vol. 23 (4): 317-321 [Abstract] ( 5392 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	322	Clinical efficacy of daily online image-guided stereotactic body radiation therapy for lung cancer
		Gao Hong,Li Gaofeng,Zhong Qiuzi,Xu Yonggang,Wu Qinhong
		Objective To analyze the clinical efficacy of daily online cone-beam computed tomography (CBCT)-guided stereotactic body radiation therapy (SBRT) for primary and metastatic lung cancer and its related factors. Methods From May 2009 to May 2013, 36 patients with lung cancer were treated with SBRT, including 24 patients with primary lung cancer and 12 patients with metastatic lung cancer. The biologically effective dose at 10 Gy was ≥100 Gy in 85.7% of 42 lesions. Before each delivery, CBCT was acquired, and online automatic or manual registration was performed to make the tumors on CBCT within the planning target volume/primary gross tumor volume;the setup threshold was not set, and the couch was moved for correction. Results The 1-, 2-, and 3-year sample sizes were 36, 29, and 26, respectively. The 1-, 2-, and 3-year local control (LC) rates were 96%, 89%, and 72%, respectively. The 1-, 2-, and 3-year cancer-specific survival (CCS) rates were 82%, 74%, and 64%, respectively. The 1-, 2-, and 3-year overall survival (OS) rates were 78%, 64%, and 53%, respectively. Univariate analysis found no factors associated with LC. Multivariate analysis revealed no factors associated with OS. Both univariate and multivariate analyses showed that only tumor location (central type or peripheral type) was associated with CCS;the mean values (95% confidence intervals) of CCS in patients with central-type and peripheral-type lesions were 21.4 months (13.2—29.6 months) and 42.3 months (35.7—49.0 months), respectively (P=0.024). Conclusions Daily online image-guided SBRT for primary or metastatic lung cancer can lead to a satisfactory LC.
		2014 Vol. 23 (4): 322-325 [Abstract] ( 3731 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	326	Analysis of dose-volume factors for acute left ventricular damage in patients with thoracic cancer after radiotherapy
		Wang Jun, Long Shujing, Jing Shaowu, Wang Yi, Guo Yin, Li Na, Wu Yajing, Liu Qing
		Objective To evaluate the effects of dose-volume parameters on acute radiation-induced left ventricular diastolic and systolic function damages in patients with thoracic cancer after radiotherapy. Methods A total of 109 patients with thoracic cancer admitted to our hospital from 2008 to 2012 were included in the study. Left ventricular function was assessed by Common Terminology Criteria for Adverse Events Version 3.0. The effects of dose-volume parameters on left ventricular damage were analyzed. Results Left ventricular diastolic and systolic function damages occurred in 15 patients (13.8%) and 24 patients (22.0%), respectively. Ejection fraction and fractional shortening showed no significant correlation with dose-volume parameters, while E/A ratio had a significant correlation with many dose-volume parameters. The volumes of left ventricle receiving radiation of ≥50 Gy and ≥55 Gy (V₅₀ and V₅₅) were significantly higher in patients with acute radiation-induced left ventricular diastolic function damage than in those without left ventricular damage (P=0.026;P=0.034). V₅₀ was the independent influential factor for acute radiation-induced left ventricular diastolic function damage (P=0.025). Compared with those before radiotherapy, the average E/A ratios at 3 months after radiotherapy began in patients with V₅₀ of ≥1.78% and V₅₀ of<1.78% were reduced by 25.6% and 11.8%, respectively. Conclusions Radiotherapy for thoracic cancer can lead to left ventricular diastolic and systolic function damages. V₅₀ is the independent influential factor for acute radiation-induced left ventricular diastolic function damage, while there is no correlation between systolic function indices and dose-volume parameters. For patients with V₅₀ of ≥1.78%, the incidence of diastolic function damage increases significantly, and E/A ratio decreases significantly.
		2014 Vol. 23 (4): 326-330 [Abstract] ( 4082 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	306


		2014 Vol. 23 (4): 306-306 [Abstract] ( 2869 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	331	Patterns of lymph node metastases from nasopharyngeal carcinoma:an analysis of 3100 patients based on MRI
		Wang Xiaoshen^*, Hu Chaosu, Ying Hongmei, He Xiayun, Shen Chunying, Zhu Guopei, Kong Lin, Ding Jianhui
		Objective To investigate the patterns of lymph node metastases from nasopharyngeal carcinoma (NPC) based on magnetic resonance imaging (MRI) and to provide a basis for neck irradiation field in intensity-modulated radiation therapy. Methods From 2010 to 2013, 3100 patients newly diagnosed with NPC who underwent MRI were analyzed. All images were evaluated by the multi-disciplinary treatment group for NPC to analyze lymph node metastases. The locations of lymph nodes were determined by the RTOG consensus guidelines published in 2003. Results Of 3100 patients, 2679(86.42%) had lymph node metastases;the detailed distribution was as follows:lateral retropharyngeal region (2012 patients, 64.90%;6 patients were also in the medial group), level Ⅱ_b (2341 patients, 75.52%;492 had the upper border reaching half of C₁ vertebra and 115 had the upper border reaching the skull base), level Ⅱ_a (1798 patients, 58.00%), level Ⅲ(1184 patients, 38.19%), level Ⅳ (350 patients, 11.29%;28 had the lower border beyond the RTOG recommended boundary), level Ⅴ (995 patients, 32.10%;91 had the lymph nodes beyond the RTOG recommended boundary), level Ⅰ_b (115 patients, 3.71%), and parotid region (40 patients, 1.29%). Extensive ipsilateral lymph node metastases were seen in patients with lymph nodes metastases in levels Ⅳ and Ⅴ, and the total numbers of involved nodes were ≥6 and 7. Skip metastasis occurred in 6 patients (0.19%). Conclusions Metastases to retropharyngeal lymph nodes are seen mainly in the lateral group but rarely in the medial group. The upper border of level Ⅱ lymph nodes should be the skull base. Lymph node metastases from NPC are in an orderly manner, and skip metastasis is rarely seen. When level Ⅳ/Ⅴ lymph nodes are involved, there might exist metastases beyond the RTOG recommended boundary. In case of extensive ipsilateral lymph node metastases, the parotid region might be involved.
		2014 Vol. 23 (4): 331-335 [Abstract] ( 3922 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	336	Comparation of set-up errors between two different body positions in precision radiotherapy for esophageal cancer
		Hui Zhouguang^*, Wang Qu, Han Wei, Sun Shuai, Wang Min, Dai Jianrong, Wang Lyuhua
		Objective To compare the effect of set-up errors to two different body positions that are putting arms on the side of the body (A group) or placing arms folded across the elbow on forehead (B group) in esophageal cancer′ fraction radiotherapy. Methods By using case-control study, all supine patients were divided into the A group and the B group. After patients were fixed by thermoplastic membrane, they were located by spiral CT and treated by using IGRT. During treatmwnt, there were three cone-beam CT scans in the first week and then at least one scan weekly. We obtained the linear set-up errors data by using bone registration with manual proofreading in 3 directions that were left and right (x), head and feet (y), abdomen and back (z) by using CBCT. Means were compared by using independent sample t-test, and ratios were compared by chi-square test. Results Every group had 11 cases that the A group had 92 people times and the B group had 87 people times. Absolute set-up errors of two different positions:only x-axis, the mean of the A group was (2.46±1.79) mm. But the mean of the B group was (1.91±1.71) mm, which was significantly less than the A group (P=0.036). Relative set-up errors of two groups:only y-axis, the mean of the B group was (1.91±4.12) mm. The A group was (0.09±3.90) mm, which was significantly less than the B group (P=0.003). There was no significant difference of three-dimensional set-up errors (P=0.751). And there was no significant difference in absolute weekly set-up errors or weekly three-dimensional set-up errors in radiotherapy (P>0.05). Conclusions The each of two body positions in esophageal cancer′ fraction radiotherapy has advantage and disadvantage for set-up errors, but they were in control and didn′t affect the radiotherapy planning. We can choose appropriate treatment position according to clinical practice.
		2014 Vol. 23 (4): 336-339 [Abstract] ( 3616 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	340	Compare the registration results with different registration methods in cone beam CT guided radiotherapy for nasopharyngeal carcinoma
		Li Xiaoyu, Zhou Jidan,Zhong Renming, Li An, Li Shuai
		Objective To compare the results of three different registration methods in the kilovolt CBCT guided IMRT for nasopharyngeal cancer (NPC). Methods Total 560 CBCT images of 24 NPC patients who received kilovolt CBCT guided IMRT were analyzed off line. Three registration methods were used for alignment between CBCT and planning CT, including translational and rotational errors for bone and grey (Bone_T+R,Grey_T+R),only translational errors for grey (Grey_T). The registration results were analyzed by mean paired t-test respectively. Results With method Bone_T+R, the translational errors on x, y and z axes were (－0.11±1.35) mm,(0.40±2.09) mm and (0.95±1.56) mm and the rotational errors were 1.06°±0.67°, 0.01°±1.28° and 0.92°±1.00° respectively. With Grey_T+R, the translational errors on x, y and z axes were (－0.02±1.06) mm,(0.68±1.92) mm and (0.81±1.46) mm and the rotational errors were 0.85°±0.61°, －0.05°±1.32° and 0.91°±0.72° respectively. With Grey_T, the translational errors on x, y and z axes were (0.58±1.02),( 0.52±1.89) and (0.44±1.43) mm. The results of compared mean t-test for different registration methods groups have significant difference (P=0.00—0.01) except for the rotational errors on y and z axes between Bone_T+R and Grey_T+R (P=0.05,0.62). ConclusionsThere have different alignment errors when different registration methods used for NPC kilovolt CBCT guided radiotherapy. If there have correct methods for rotation errors, Grey_T+R registration method may be a better choice. In opposite, Grey_T+R registration method would be used firstly to verify whether the rotational error>2°or 3°. If the rotational error>2°or 3°,the patient should be re-setup. If not,according to these alignment results, the Grey_T method, manual method would be used to compensate the translational errors.
		2014 Vol. 23 (4): 340-343 [Abstract] ( 3778 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	344	Analysis of the intrafraction error in image-guided radiotherapy with thoracic esophageal carcinoma
		Shang kai, Wang Jun, Chi Zifeng, Jing Shaowu, Yang Congrong, Cheng Yunjie, Liu Qing, Wang Yi, Cao Feng
		Objective The purpose of the study was to use the CBCT to evaluate the intrafraction error and its effect on the target volume and organs at risk. Methods Twenty-three patients with thoracic esophageal cancer were enrolled into the study. CBCT scans were performed before and at the end of the irradiation to acquire the intrafraction error. Treatment PLAN₂ and PLAN₃ were simulated according to the intrafraction error. The primary treatment plan was PLAN₁. The dosimetry distribution of target volume and organs at risk of the PLAN₂ and PLAN₃ were analyzed, and then were compared with PLAN₁. The datas was analysed by one-factor ANOVA and matched t-test. Results The median intrafraction error (mm) of the upper, the middle and the lower esophageal carcinoma in x, y, z directions were (1.2±1.5) mm,(1.0±1.0) mm,(1.0±1.0) mm (P=0.138),(1.2±1.0) mm,(1.1±1.0) mm,(1.2±1.0) mm (P=0.656) and (1.3±0.1.1) mm,(1.2±1.0) mm,(0.8±0.7) mm (P=0.003), respectively. The frequency of the intrafraction error within 3 mm in x, y, z directions were 95.2%, 94.5%, 93.9%, respectively. Compared with PLAN₁, the volume of the GTV exposed to 100% prescription dose of the PLAN₃ decreased by 5.55%. There were 3 patients whose prescription dose of the PTV exposed to 95% volume descend more than 5% in PLAN₃. The volume of the lung exposed to 30 Gy was (15.24±2.24)% in PLAN₃,which was lower than (15.67±2.28)% in PLAN₁(P=0.033). There were 4 cases in PLAN₂ and 19 cases in PLAN₃ whose spinal cord received more than 4500 cGy, the maximum dose were 4517.2 cGy and 5045.2 cGy in PLAN₂ and in PLAN₃, respectively. Conclusions The dose distribution of the target volume and organs at risk were influenced by intrafraction error in part. Spinal cord is relatively sensitive to the intrafraction error owing to its tandem belongings. Intrafraction error can result in the over irradiation to the spinal cord for some patients.
		2014 Vol. 23 (4): 344-347 [Abstract] ( 3250 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	348	Target volume definition using 4DCT and dosimetric evaluation for esophageal cancer
		Zhang Ying, Wang Yanqiang, Xiao Zhiqing, Liu Huizhi, Liu Junling, Xue Xiaoying
		Objective To study the PTV by ng 4DCT and compare target, target displacement and dose distribution of 3D and 4D planning for thoracic middle or lower esophageal cancer, evaluate the clinical value of 4DCT in esophageal cancer radiotherapy. Methods From Jan to Dec 2012patients with primary esophageal cancer underwent 3DCT simulation scans first, then followed by 4DCT simulation scan. PTV and OARs were sketched in the ordinary 3DCT and 4DCT respectively. And designing two sets of radiotherapy plan for each patient:3D and 4D plan. We compare PTV, PTV displacement and OARs dosimetry′s differences in the 3D plan and 4D plan. Using the paired t-test or Wilcoxon sign-rank test to compare the difference between the two sets of plans. Results The volume of PTV_4D was larger than the PTV_3D (195.19 cm³ vs.175.67 cm³,P=0.001) in all patients. The center displacement had only significantly difference (displacement was 0.25 cm,P=0.014) in left-right direction for 10 patients of thoracic middle esophageal cancer. The center displacement had no significantly different in the three direction for 9 patients of thoracic under esophageal cancer (P=0.722,0.307,0.208). The dose target area of V₁₀₀, V₉₅ and V₉₀ in Plan-3DC were significantly than those in Plan-3D for 19 patients of thoracic middle-lower esophageal cancer (88.62% vs. 95.69%,P=0.000;95.17% vs. 99.79%,P=0.001;97.19% vs. 99.99%,P=0.001). In 4D plan the lung V₅, V₂₀ and D_mean of heart were higher than that in 3D plan for all patients (39.49% vs. 37.44%,P=0.016;19.93% vs. 18.87%,P=0.018 and 2607.74 cGy vs. 2389.16 cGy,P=0.004). Conclusions 4DCT positioning technology can accuracy determine individualized expanding boundary by target area of radiotherapy for thoracic middle or lower esophageal cancer. The enlarging target volume increase the dose of radiotherapy for lung, and in the dose range in the 4D plan, but the increased dose of heart should be noted.
		2014 Vol. 23 (4): 348-351 [Abstract] ( 3887 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	352	A primary research of intensity-modulated dose verification based on anatomic structure of three-dimensional images
		Chen Along^*, Chen Lixin, Chen Li, Hu Jiang, He Huilang, Xia Jingtao
		Objective To verify IMRT plans in point, planar and 3D dose, and to concretely analyze the dose differences of 3D anatomic structure based on Gamma passing rate. Methods Thimble ion-chamber, Matrixx and ArcCheck were separately used to measure six nasopharyngeal carcinoma treatment plans and six lung cancer treatment plans. The dose measurement deviation of the center point was compared as well as the Gamma passing rate of dose verification under the criteria of both 3%/3㎜ and 2%/2㎜,the group t-test and one-way ANOVA were also proceeded. 3DVH system was used to analyze the dose measurement deviation of target volume (TV) and organ at risk (OAR) through DVH. Results For IMRT and VMAT treatment plans, the mean deviation of point dose was (0.59±1.31)% and (－1.00±1.03)% respectively, and the maximum deviation was less than 3%. Under the criterion of 3%/3㎜, the Gamma passing rate measured by Matrixx, ArcCheck and 3DVH for IMRT plans was 96.28%,97.55% and 99.02% respectively, and for VMAT plans, the corresponding results of three different detectors were 97.24%,99.67% and 98.48%. The results analyzed and compared by 3DVH showed that even under the condition of high Gamma pass rate (more than 95% for a Gamma criterion of 3%/3 mm), the DVH metrics of both TV and OAR in two cases (account for 16.7% of the total plan) were significantly different on the clinical parameters, including GTV, spinal cord and brain stem etc. Conclusions The analysis of dose difference of the measurement results based on Gamma pass rate and on anatomic structure of 3D images can more effectively evaluate the influence of dose error to the implementing of clinical plan and the impact to the clinical treatment.
		2014 Vol. 23 (4): 352-356 [Abstract] ( 3025 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	357	The study of angular dependence of gamma index for Delta4 phantom
		Liu Xianfeng, Jin Fu, Zhong Mingsong, He Yanan, Qiu Da, He Guanglei, Wang Ying
		Objective To study the effect of the uncertain deflection of the Delta4 phantom (ScandiDos AB, Sweden) in setting up on the Gamma index passing rate during the VMAT plan verification. Methods Two patients with head and neck cancer, two with lung cancers and one with pelvic cancer receiving VMAT radiotherapy were randomly chosen. By means of Eclipse8.6 TPS the treatment plans elaborated for the five patients were picked up to make the verification plans and Delta4 was used to perform dose verification On VARIAN Clinac IX. The Delta4 phantom was precisely set up first, and then it was deflected in a given angle towards the horizontal direction in relation to the center of the linear accelerator isocenter to perform the dose verification for 11 times successively. To figure out the relationship between the deflection angle of the Delta4 phantom and the Gamma index passing rate. Results As the Delta4 phantom was deflected by 0.0°, 0.2°, 0.4°, 0.6°, 0.8°, 1.0°, 1.2°, 1.4°, 1.6°, 1.8° and 2.0° in sequence, the measured Gamma index passing rates presented a slight decline, but all greater than 90%(DD 3%, DTA 3 mm). Conclusions In the VMAT plan verification, the Gamma index passing rate of Delta4 has no dependence on the uncertain deflection of the Delta4 phantom provided that the uncertain deflection of the Delta4 phantom is no greater than 2°, but the passing rates of DD and DTA vary significantly with the uncertain deflection of the Delta4 phantom.
		2014 Vol. 23 (4): 357-360 [Abstract] ( 3945 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2014 Vol. 23 (4): 361-362 [Abstract] ( 2921 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2014 Vol. 23 (4): 363-364 [Abstract] ( 2784 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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Cancer Hospital of Chinese
　Academy of Medical
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Chinese Journal of Lung
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