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.6 Published 2014-10-25

	Head and Neck Tumors Review Thoracic Tumors Physics·Biology·Technique Special Feature Physics·Biology·Technique Notes of meeting

Special Feature

	463	Locally advanced prostate cancer: combination of high-dose high-precision radiotherapy and androgen deprivation therap
		Michel Bolla,René-Olivier Mirimanoff
		Locally advanced prostate cancer entails a risk of local, regional and systemic relapse requiring the combination of a loco-regional treatment, namely external beam radiotherapy(EBRT) to control the pelvic-confined disease, combined with a systemic therapy, namely androgen-deprivation therapy(ADT), to potentiate irradiation and to destroy the infra-clinical androgen-dependant disease outside the irradiated volume. Many phases III randomized trials have paved the way in establishing the indications of this combined approach, which requires a long term ADT(≥2 years) with LHRH agonists. The duration of ADT may be reduced to 6 months should there be a significant comorbidity, a reluctance from the patient or a poor tolerance. A multidisciplinary approach will enable physicians to tailor the treatment strategy and a close cooperation between the specialists and the general practitioners will be set up to prevent as much as possible the side-effects of ADT.
		2014 Vol. 23 (6): 463-467 [Abstract] ( 2857 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	468	Dose coverage of axillary levels I-III and sentinel lymph node area by inverse-planned intensity-modulated radiotherapy for whole breast irradiation in patients with breast cancer after breast-conserving surgery
		Zhang Li, Wang Yujie, Yu Xiaoli, Chen Jiayi, Chen Lanfei, Wang Junqi, Liu Guangyu, Guo Xiaomao.
		Objective To evaluate the dose coverage of axillary levels I-III and the sentinel lymph node (SLN) area by multi-field inverse-planned intensity-modulated radiotherapy (IMRT) for whole breast irradiation in patients with early breast cancer after breast-conserving surgery. Methds A retrospective analysis was performed on the clinical data of 40 patients with early breast cancer who underwent breast-conserving surgery and SLN biopsy in Fudan University Shanghai Cancer Center from 2008 to 2012. After surgery, inverse-planned IMRT for whole breast irradiation was performed at a dose of 50 Gy/25 fractions. The axillary levels I-III were delineated according to the RTOG criteria, and the SLN CTV was defined as 2 cm in diameter around the clip. Dose-volume parameters were used to calculate the dose distribution of these lymph node areas. Results The mean doses delivered to axillary levels I, II, and III were (33.0±7.5) Gy, (17.9±11.3) Gy, and (7.3±6.6) Gy, respectively. The percent volumes receiving at least 95% of the prescribed dose for axillary levels I, II, and III were (29.9±17.7)%, (9.0±14.5)%, and (0.1±0.3)%, respectively. All SLNs were located in axillary level I area;the mean dose received by the SLN area was (43.0±10.0) Gy, and 58%(19/33) of SLNs received a dose greater than 45 Gy. Conclusions The multi-field inverse-planned IMRT offers a limited dose coverage to axillary levels I-III in patients receiving inverse-planned IMRT for whole breast irradiation. For those patients with SLN micrometastases and without axillary lymph node dissection, we need to keep an eye on the dose coverage of the axillary area.
		2014 Vol. 23 (6): 468-471 [Abstract] ( 3420 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	472	Impact of oral contrast agent for assisting in outlining small bowel on pelvic VMAT dose in patients with cervical cancer
		Gu Wendong, Li Qilin, Gao Min, Pei Honglei, Wu Changping.
		Objective To investigate the impact of oral contrast agent for assisting in outlining the small bowel on pelvic volumetric modulated arc therapy (VMAT) dose in patients with cervical cancer. Methds Nine cervical cancer patients for postoperative radiotherapy underwent CT scans, and the target volumes and organs at risk including the small bowel were contoured. The VMAT plan was designed for each case. Then another plan was generated by re-calculating the radiation dose after changing the electron density of the small bowel. The first plan (plan A) was the conventional VMAT plan, and the second one (plan B) specified the electron density of the small bowel. Paired t-test was used to compare the dose distribution between the two plans. Results The D₉₈, D₅₀, conformity index, and homogeneity index of plans A and B were 4989.1 vs. 5000.1 cGy (P=0.026), 5208.6 vs. 5191.6 cGy (P=0.005), 0.766 vs. 0.765(P=0.920), and 0.081 vs. 0.074(P=0.055), respectively. The volumes of the small bowel receiving at least 30 Gy for plans A and B were 309.3 vs. 314.3 cm³(P=0.207), while bladder V₄₅ of the two plans was 52.4% vs. 51.1%(P=0.168). To achieve the same prescribed dose, plan A and plan B needed 893.3 MU and 865.8 MU (P=0.093). Conclusions The contrast agent filling the small bowel does not lead to a significant increase in the pelvic VMAT dose in patients with cervical cancer after surgery.
		2014 Vol. 23 (6): 472-474 [Abstract] ( 3416 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	475	Study on early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy
		Shan Bin, Meng Xiangying, Wu Shikai, Diao Tianxi.
		Objective To develop an early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy (RABASBCR) and to avoid the misdiagnosis of this disease. Methds A systematic search of PubMed for published reports of RABASBCR cases was performed. The clinical manifestations and radiological features in the early stage of disease, as well as biopsies, were analyzed to screen out valuable markers for early diagnosis and develop the early diagnosis strategy for RABASBCR. Results Fifty-five original articles involving 80 RABASBCR patients were selected for this analysis. Twenty-four (30%) of the 80 patients were misdiagnosed;the median time of misdiagnosis was 3 months (1-24 months). The earliest symptom was skin changes in 76(95%) of the 80 patients. The misdiagnosis rates of ultrasound, mammography, computed tomography, and magnetic resonance imaging for RABASBCR were 9/9, 31/32, 2/2, and 1/5, respectively. The misdiagnosis rates of fine needle biopsy, core needle biopsy, and incisional biopsy were 7/14, 12/25, and 10/26, respectively. Conclusions By analyzing published case reports, we have set up the early diagnosis strategy for RABASBCR with reference to the Cahan criteria.
		2014 Vol. 23 (6): 475-478 [Abstract] ( 3137 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	479	A comparative study of failure patterns of definitive treatment of esophageal cancer with elective nodal irradiation and involved-field irradiation
		Dong Hui, Zhu Shuchai, Su Jingwei, Shen Wenbin, Liu Zhikun, Li Juan
		Objective To compare the failure pattern between esophageal cancer patients receiving definitive elective nodal irradiation (ENI) and involved-field irradiation (IFI) and to investigate the reasons and influential factors for locoregional recurrence and metastasis. Methds A retrospective analysis was performed on the clinical data of 245 patients with esophageal cancer who received definitive radiotherapy in our hospital from January 2006 to December 2012. One hundred and twenty-six patients received ENI, and the other 119 patients received IFI. Failure patterns were analyzed after treatment. Locoregional failures included local esophageal lesion uncontrol or recurrence and regional lymph node recurrence or metastasis. Distant metastases included distant organ metastasis and distant lymph node metastasis. Comparison of failure pattern between the two therapies was made by chi-square test. Results One hundred and sixty-three patients had failure after treatment. Locoregional failure was observed in 92 patients, distant metastasis in 36 patients, and locoregional failure plus distant metastasis in 35 patients. The 1-, 3-, and 5-year overall failure rate for the ENI group were 35.4%, 62.5%, and 69.0%, respectively, versus 46.5%, 71.5%, and 81.5% for the IFI group (P=0.036). The 1-, 3-, and 5-year locoregional failure rates for the ENI group were 29.9%, 48.4%, and 50.0%, respectively, versus 39.6%, 62.1%, and 71.4% for the IFI group (P=0.003). Conclusions For esophageal cancer patients receiving definitive radiotherapy, ENI can significantly reduce locoregional failures and increase locoregional control, thus improving the long-term survival.
		2014 Vol. 23 (6): 479-484 [Abstract] ( 3899 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	485	Prognostic reanalysis of stage IV non-small cell lung cancer treated by chemotherapy with concurrent three-dimensional radiotherapy
		Ouyang-Wei Wei, Lu Bing, Su Shengfa, Hu Yinxiang, Ma Zhu, Li Qingsong, Geng Yichao, Chen Xiaxia, Yang Wengang, Li Huiqin.
		Objective To further analyze the prognostic factors in stage IV non-small cell lung cancer (NSCLC) treated by chemotherapy with concurrent three-dimensional radiotherapy. Methds We enrolled 201 patients with stage IV NSCLC in this study from January 2003 to July 2010 and analyzed overall survival (OS) in 159 patients (three-dimensional radiotherapy>36 Gy) and progression-free survival (PFS) in 120 patients. Platinum-based doublets chemotherapy was performed, and the median number of cycles was 4;the median dose to the planning target volume was 63 Gy. Survival rates were calculated by the Kaplan-Meier method and compared by the log-rank test. The time of multivariate prognostic analysis with the Cox model was increased from 3 years to 5 years. Results The 1-, 2-, 3-, and 5-year OS rates were 40.1%, 17.3%, 10.2%, and 5.1%, respectively, and the median survival time was 10 months. The short-term complete response, partial response, stable disease, and progressive disease rates were 7.5%, 66.0%, 19.5%, and 6.9%, respectively, and the median survival times were 19, 13, 8, and 6 months, respectively (P=0.000). The 1-, 2-, 3-, and 5-year PFS rates and median survival times of patients undergoing 4 to 5 cycles of chemotherapy with radiotherapy doses of ≥63 Gy and<63 Gy were 77.4% vs. 32.6%, 36.2% vs. 21.7%, 27.2% vs. 0%, 15.9% vs. 0%, and 20 vs. 9 months, respectively (P=0.002). According to multivariate analysis, 4 to 5 cycles of chemotherapy, stable or increased Karnofsky Performance Scale score after treatment, and gross tumor volume<175 cm³ were independent prognostic factors for a better OS (P=0.035, 0.000, and 0.008, respectively). Radiation dose to the primary tumor≥63 Gy resulted in a better PFS (P=0.051), which was of borderline significance. ConclusionsChemotherapy (4-5 cycles) with concurrent three-dimensional radiotherapy (≥63 Gy) may significantly prolong PFS and OS in patients with stage IV NSCLC.
		2014 Vol. 23 (6): 485-488 [Abstract] ( 3267 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	489


		2014 Vol. 23 (6): 489-490 [Abstract] ( 3062 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	491	Variations of spatial position and overlap ratio for GTV₅₀ and IGTV of primary thoracic esophageal cancer during radiotherapy:a study based on 4DCT scans
		Wang Jinzhi, Li Jianbin, Wang Wei, Zhang Yingjie, Ding Yun, Liu Tonghai, Shang Dongping.
		Objective To investigate the variations of the spatial position and overlap ratio for gross tumor volume (respiratory phase 50%)(GTV₅₀) and internal gross tumor volume (IGTV) of primary thoracic esophageal cancer during conventional fractionated radiotherapy based on repeated four-dimensional computed tomography (4DCT) scans. Methds Thirty-three patients with thoracic esophageal cancer underwent contrast-enhanced 4DCT scans before radiotherapy and at the 10^th and 20^th fractions of radiotherapy. Scans were registered to the baseline 4DCT scan using bony landmarks. The GTV₅₀ was delineated by the same radiotherapist on each 4DCT imaging data set, and the IGTV was constructed accordingly. The target volume, degree of inclusion (DI), and matching index (MI) were compared in different phases. Results The volumes of GTV₅₀ and IGTV decreased along with treatment course. No significant changes in the centroid position were observed for the GTV₅₀ and IGTV. The median DIs of the target volumes at the 10^th and 20^th fractions in the original target volume were 0.75 and 0.63(P=0.000) for GTV₅₀ and were 0.79 and 0.66(P=0.000) for IGTV, while the median MIs were 0.61 and 0.56(P=0.002) for GTV₅₀ and were 0.68 and 0.58(P=0.005) for IGTV. A positive correlation between the variation of volume ratio and the variation of DI was found for GTV₅₀ and IGTV (r=0.632, r=0.783), and the variation of volume ratio was also positively correlated with the variation of MI (r=0.387, r=0.483);the 3D vector was negatively correlated with the MI (r=－0.455, r=－0.438). Conclusions During conventional fractionated radiotherapy, the variation of spatial position is less than 0.8 cm for GTV₅₀ and IGTV of primary thoracic esophageal cancer, and the decline of the target leads to varying degrees of decreases in DI and the MI.
		2014 Vol. 23 (6): 491-494 [Abstract] ( 3625 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	495	Clinical effects of IMRT combined with EGFR monoclonal antibody, concurrent chemoradiotherapy, and IMRT alone in nasopharyngeal carcinoma patients:a retrospective case-control study
		Yin Zhenzhen, Yi Junlin, Huang Xiaodong, Luo Jingwei, Wang Kai,Gao Li, Qu Yuan, Zhang Shiping, Xiao Jianping, Xu Guozhen.
		Objective To compare the treatment outcomes and toxicities in nasopharyngeal carcinoma patients who receive intensity-modulated radiotherapy (IMRT) combined with epidermal growth factor receptor (EGFR) monoclonal antibody, IMRT with concurrent chemotherapy, and IMRT alone. Methds Sixty-eight previously untreated patients with stage Ⅱ-IV_b nasopharyngeal carcinoma (NPC) who received IMRT combined with cetuximab or nimotuzumab from January 2008 to September 2012 were included in BRT group;the BRT group was matched with 136 patients treated with concurrent chemoradiotherapy (CCRT) and 136 patients treated with IMRT alone at a ratio of 1∶2 using SAS software. The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Prognostic factors were analyzed by the Cox model. Results The sample sizes of the BRT group, IMRT group, and CCRT group were 14,69,47, respectively. The 3-year overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) of all patients were 91.2%, 80.2%, 93.1%, and 87.2%, respectively. The 3-year OS rates of BRT group, IMRT group, and CCRT group were 91.9%, 92.1%, and 89.9%, respectively (P=0.379);the 3-year DFS rates of BRT group, IMRT group, and CCRT group were 82.1%, 77.9%, and 81.6%, respectively (P=0.594);the 3-year LRC rates of BRT group, IMRT group, and CCRT group were 98.2%, 90.6%, and 93.0%, respectively (P=0.249);the 3-year DMFS rates of BRT group, IMRT group, and CCRT group were 85.2%, 85.2%, and 90.3%, respectively (P=0.383). Multivariate prognostic analysis showed that T stage and concurrent use of EGFR monoclonal antibody were influential factors for LRC (P=0.034 and 0.032). Conclusions IMRT alone yields a good treatment outcome in NPC patients. Although there were no significant differences in OS between the three groups, the BRT group showed an increasing trend in LRC.
		2014 Vol. 23 (6): 495-499 [Abstract] ( 3416 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	500	Radiation doses to axillary lymph nodes in patients with early breast cancer receiving field-in-field forward-planned intensity-modulated radiotherapy for whole breast irradiation after breast-conserving surgery
		Zhu Chuanying, Cai Gang, Hu Weigang, Yang Zhaozhi, Yu Xiaoli, Guo Xiaomao, Shao Zhimin, Jiang Guoliang, Chen Jiayi.
		Objective To evaluate the radiation doses to the axillary lymph nodes in patients with early breast cancer receiving field-in-field forward-planned intensity-modulated radiotherapy (FIF-FP-IMRT) for whole breast irradiation after breast-conserving surgery, and to analyze the factors influencing the doses to the axillary lymph nodes. Methds Thirty-seven patients with breast cancer treated by breast-conserving surgery were evaluated. All patients received FIF-FP-IMRT for whole breast irradiation (not involving regional lymph nodes). Delineation of axillary levels I-III, interpectoral lymph nodes, and axillary vein was made on CT images, and a dosimetric analysis was made using 3D treatment planning software. Theinfluential factors for the dose distribution in axillary lymph nodes were analyzed by paired t-test. ResultsThe mean percent volumes receiving at least 95% of the prescribed dose (50 Gy/25 fractions for whole breast PTV)(V₉₅) for axillary levels I, II, and III and interpectoral lymph nodes were 34.7%, 6.1%, 0.4%, and 39.6%, respectively, and the mean doses to axillary levels I, II, III and interpectoral lymph nodes were 30.8 Gy, 15.7 Gy, 5.0 Gy, and 28.8 Gy, respectively. The mean V₉₅ values for the lymph node areas below and above the axillary vein were 45.6% and 0.7%, respectively, and the mean doses were 38.2 Gy and 6.7 Gy, respectively. The distance between the upper border of the radiation field and the humeral head was the only significant factor influencing the mean dose to the lymph node area below the axillary vein (P=0.037). Conclusions In FIF-FP-IMRT for whole breast irradiation, the actual dose delivered to the axillary lymph nodes below the axillary vein cannot be neglected and should be taken into consideration when analyzing the local control of the axillary lymph nodes after breast-conserving surgery.
		2014 Vol. 23 (6): 500-504 [Abstract] ( 3609 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	505	The effect of carbon fiber couch on dose distribution of conformal intensity modulated plan
		Fu Qingguo, Zhu Xiaodong,Yang Haiming,Wei Dang, Liu Zhijie
		Objective To evaluate the effect of carbon fiber couch on dose distribution of radiotherapy planning and verification pass rate. Methds Establishing the carbon fiber treatment couch model in Pinnacle8.0m Treatment Planning system (TPS), and then this model was used to correct dose calculations of oblique fields in the treatment plans of 10 cases of nasopharyngeal carcinoma, 10 cases of breast cancer and 10 cases of lung cancer and evaluate the effect of carbon fiber couch on the whole dose distribution of the plans. Then these plans were measured by three-dimensional dose verification equipment Delta4 to confirm the improvement extent of Gamma pass rate after considering the carbon fiber treatment couch. Results For the majority of plans, when the carbon fiber couch was taken into consideration, the target doses was significantly reduced (4772 cGy-7266 cGy vs.4859 cGy-7347 cGy, P=0.000-0.002) and the relative deviation of D₉₅ was 1% to 3%.Measurement results of Delta4 showed that Gamma pass rate (3 mm/3% criteria) increased in all plans (96.4%-98.8% vs.93.4%-97.3%,P=0.000), some of that were up to 5 percentage when the couch model was applied. Conclusions Target doses will be overestimated if the treatment couch is ignored in TPS measurement., However it should arouse enough attention when the disease with smaller doses corresponding gradient.
		2014 Vol. 23 (6): 505-508 [Abstract] ( 3618 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review

	509


		2014 Vol. 23 (6): 509-512 [Abstract] ( 3299 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	515


		2014 Vol. 23 (6): 515-518 [Abstract] ( 3305 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	546


		2014 Vol. 23 (6): 546-548 [Abstract] ( 3050 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	549


		2014 Vol. 23 (6): 549-551 [Abstract] ( 2864 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	552


		2014 Vol. 23 (6): 552-554 [Abstract] ( 3274 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	513	Effect of the setup error on the dosimetric verification for the volumetric modulated arc therapy
		Sun Xiaohuan, Tan Lina, Ma Kui, Xiao Feng.
		Objective To evaluate the effect of the setup error on the dosimetric verification for the nasopharyngeal carcinoma patients and cervical carcinoma patients treated with volumetric modulated arc therapy (VMAT). Methds VMAT plans for 10 cervical cancer patients and 10 nasopharyngeal carcinoma patients were transplanted into the Delta4 phantom and calculate the dose,next,implement the treatment on the Varian iX linear accelerator. on the Varian iX linear accelerator. To simulate the setup error by moving the treatment couch in, out, up, down, left, right by 3 mm,5 mm,7 mm. Thereby study the effect of the setup error on the pass rate of the dose verification. Results The results for the dose distribution using the gamma evaluation method showed that the pass rate (3%/3 mm) was less than 90% when the setup error were greater than 3 mm and 5 mm for the nasopharyngeal carcinoma patients and the cervical carcinoma patients. The pass rate of head direction were (64.7±8.2)% and (63.3±3.6)% on setup error of 5 mm and 7 mm for nasopharyngeal carcinoma patients and cervical carcinoma patients, respectively. Conclusions Setup error has great effect on the dose verification of the VMAT plans, the greater of the setup error, the lower of the pass rate. The setup error of head direction is more sensitive than other directions especially.
		2014 Vol. 23 (6): 513-514 [Abstract] ( 3663 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	519	Dosimetric evaluation for head and neck cancer patients treated with helical TomoTherapy
		Zhang Yongqian, Zhang Fuli, Wang Yadi, Gao Junmao, Xu Weidong, Jiang Huayong, Yao Bo, Lu Na, Chen Diandian
		Objective To compare the differences between planning dose and actual dose of targets and organs at risk (OAR) for head and neck cancer patients with helical tomotherapy (HT). Methds 12 head and neck patients with HT were enrolled in this study. Prior to each treatment fraction, an MVCT scan was performed. The MVCT images of the first fraction of each week since the second week treatment were chosen, and dose distributions were recalculated on the MVCT images in Planned Adaptive application of HT, which were the actual dose of each fraction. Each single dose distribution and the corresponding CT image were sent to commercial software (MIM5.5), and deformable image registration was performed to the CT images, and the sum of actual dose was acquired. Dose distribution of targets and OAR of initial treatment plan (Plan-1) and the actual dose distribution (Plan-2) were compared. Results There were no significant differences between Plan-1 and plan-2 for D₂, D₅₀ of GTV (P=0.07,0.07) and D₂ of PTV (P=0.08). D₉₅, D₉₈ and D₁₀₀ of GTV in Plan-2 were lower than in Plan-1, with 2.1%, 2.7% and 5.6%(P=0.02,0.02,0.02), respectively. D₅₀, D₉₅, D₉₈ and D₁₀₀ of PTV in Plan-2 were lower than in Plan-1, with 0.8%, 1.9%, 3.9% and 13.5%(P=0.01,0.00,0.00,0.01), respectively. Dose of spinal cord was higher in Plan-2 than in Plan-1, increasing by an D_max of 1.2%(P=0.04). Conclusions In radiotherapy for head and neck cancer actual dose of targets was lower than initial plan dose. Max dose of the spinal cord, however, was higher than in initial plan. For patients who have a significant anatomic change, in order to achieve the best therapeutic effect, modification of targets and treatment plan at the appropriate time is essential.
		2014 Vol. 23 (6): 519-522 [Abstract] ( 3564 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	523	Treatment and dosimetry advantage between FF-IMRT, VMAT, and HT in cervix uteri radiotherapy
		Yang Bo,Pang Tingtian,Liu Xia, Liu Nan, Hu Ke,Qiu Jie,Zhang Fuquan.
		Objective To investigate dosimetric advantage of fixed field intensity-modulated radiotherapy (FF-IMRT), volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) for cervix uteri cancer. Methds CT datasets of ten patients with cervix uteri cancer were enrolled in the study. FF-IMRT,VMAT and HT plans were designed on Eclipse and HT treatment planning system. Plans were optimized with the aim to assess OAR while enforcing highly conformal target coverage. Institutional dose-volume constraints used in cervix uteri cancer were kept the same for three techniques. The different of three plan was play by single factor analysis of variance and compared to two groups by LSD method. ResultsAll FF-IMRT,VMAT and HT resulted in equivalent target coverage but HT had an improved homogeneity index (P=0.000) and conformity index (P=0.000),or PTV of 105% prescription dose (47.12% ,45.83% and 0.05% ,P=0.000) and lowest D_max dose (54.53 Gy , 53.65 Gy , 52.69 Gy, P=0.000).Compared with FF-IMRT and VMAT, the bladder V₄₀ and D_max of HT were lowest (50.01%,46.84%,42.98%,P=0.001 and 54.49 Gy,52.96 Gy,52.78 Gy,P=0.000), with the rectum V₄₀ lowest (54.61%,48.34%,46.78%,P=0.006),the intestine D_max lowest (54.53 Gy,53.65 Gy,52.66 Gy,P=0.000) and marrow D_max lowest (54.51 Gy,54.44 Gy,52.13 Gy,P=0.000). But the delivery MU per fraction were highest (1429.20 MU,617.80 MU,7002.04 MU, P=0.000). Conclusions HT technology is feasible for clinical applications in cervical uteri cancer and can be used as a new method to promote.
		2014 Vol. 23 (6): 523-526 [Abstract] ( 3452 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	527	The research on the factors of effecting the CT number and noise of TomoTherapy MVCT
		Yue Qi, Duan Jimei, Wang Zhiwei, Gu Dan, Yang Xiumei, Li Rongqing.
		Objective To study the CT number and noise of HT MVCT on different dose rate and scanning thickness. Methds The CT number of different relative electron density were measured in the MVCT image of Cheesephantom with tissue substitute plugs scanned with different dose rate and slice thickness. The physical density corresponding to the CT number was plotted as the image value to density table (IVDT). The noise was measured in the MVCT image of Cheesephantom with solid water plugs scanned with different dose rate and slice thickness. Results There was a significant different of the CT number of the plugs with different dose rates (P=0.000),it shows a positive correlation between the varied CT number and density (R²=0.846), there is larger impact on the high density number. There was still a significant effect on the noise with different dose rate (P=0.000 density), the noise increase as the dose rate decrease. There was no significant effect on IVDT (P=1.000) and noise (P=0.667) with different slice thickness. Conclusions The CT number and the noise vary with the dose rate, the QA of MVCT should be performed regularly to assure the quality of image and the accuracy of dose calculating on MVCT in adaptive.
		2014 Vol. 23 (6): 527-529 [Abstract] ( 3750 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	530	A phantom study for the reconstruction defects of moving target volume decision by spiral CT
		Li Chengjun, Xu Liming, Li Changhu.Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan 430060,China
		Objective To investigate reasonable method of deciding internal target volume (ITV) by comparing physical phantom volumes (including moving volume) with reconstruction volumes of spiral CT scanning. Methds The various-volume wax blocks which were labeled No.1-9 were made and put on the respiratory motion simulator. The range of motion was set 2.5 cm and frequency 18 beats/min. All blocks were scanned 10 times continuously and imported into the Eclipse TPS. All blocks volumes were calculated and then compared with the true physical volumes and paired t-test. Results The reconstruction volumes of 1-9 blocks were bigger than their stationary volumes (121.77 cm³vs. 103.14 cm³,P=0.038), but significantly smaller than their moving volumes (121.77 cm³vs.161.75 cm³,P=0.045). The results can be gotten in different volume block scanning. The relative deviation of reconstruction volumes and the moving volumes tends to increase as the stationary physical volume decreases. Conclusions As to moving targets, conventional spiral CT scanning speed is too fast to collect all volume information of targets. So the one-time-scanning volume does not represent the ITV.
		2014 Vol. 23 (6): 530-534 [Abstract] ( 3357 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	535	Detection and correction of the accuracy of gamma knife treatment positioned by MRI
		Li Shengyuan, Li Xiaoyang, Yan Zheng, Gao Li, Zhou Xuan, Hui Lulu.
		Objective To investigate MRI localization the accuracy and correct the deviation for gamma knife treatment. Methds With 25-point-matrix tank, the deviation of MRI localization and its regularities could be identified after the comparison between the coordinates of MRI localization and the ones which have already been verified by CT within the deviation of 0.5 mm. Then the original MRI coordinates will be corrected by the acquired mean deviation and the geometric distortion of images. Afterwards the corrected coordinates will be compared with the standard ones and finally validated by exposure film. ResultsThere are no significant deviations on x-and z-axis after measurement in three hospitals, y-axis, however, bears deviation of (1.94±0.45) mm for hospital A,(－2.22±0.29) mm for hospital B,(－1.25±0.21) mm for hospital C,respectively. Furthermore there also exists geometric distortion of 1% on y-axis in hospital A. The corrected coordinates on y-axis (y_c) will be calculated from the formula:Y_c=(Y－M)+GD (Y₀－Y)(Y:the original coordinates on y-axis, M:the mean of deviation on y-axis, GD:the geometric distortion,Y₀:the coordinate on y-axis of the central point among the 25-point matrix).Once completed, the corrected coordinates of MRI localization is of no significant difference with the standard coordinates verified by CT. Even the deviation of focal spot on validation film is within 0.5 mm. Conclusions The 25-point-matrix tank in the multi-point measurement of the accuracy and the correction of deviation for gamma knife treatment is feasible to determine whether MRI can be utilized in the localization for head gamma knife treatment.
		2014 Vol. 23 (6): 535-539 [Abstract] ( 3267 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	540	Experimental study on optimized fractionated radiation schedule for subclinical breast cancer
		Wan Aiying, Xu Xin, Yang Weizhi.
		Objective To determine the optimized fractionated radiation schedule by comparing the dose-response relationship between different fractionated radiation schedules with a total dose of 40 Gy or 60 Gy in subclinical breast tumor. Methds Balb/c nude mice bearing subclinical human breast cancer (injected subcutaneously into the hind legs with 1.5×10⁵ or 3.1×10⁵ exponentially growing MCF-7 cells) were assigned randomly to blank control group (without radiation), conventionally fractionated radiation group (200 cGy, once daily, 10 times/week), hyperfractionated radiation group (160 cGy, twice daily with an interval of 6 h, 5 times/week), first hypofractionated radiation group (300 cGy, once daily, 5 times/week), and second hypofractionated radiation group (400 cGy, once every other day, 3 times/week);the total dose was 40 Gy or 60 Gy. The measurement indices were tumor formation rate, short-term tumor control rate, long-term tumor control rate, the time of tumor recurrence, and the maximum diameter of the bottom of tumor. The observation lasted 24 weeks. Data were compared between these groups by chi-square test. Results With a total dose of 40 Gy (the number of injected cells was 1.5×10⁵, the tumor formation rate of the blank control group was 2/8), hyperfractionated radiation was the optimized schedule. With a total dose of 60 Gy (the number of injected cells was 3.1×10⁵, the tumor formation rate of the blank control group was 11/11), the first hypofractionated radiation (300 cGy, once daily, 5 times/week) was the optimized schedule (P=0.001);the short-term and long-term tumor control rates of the conventionally fractionated radiation group, hyperfractionated radiation group, second hypofractionated radiation group, and first hypofractionated radiation group were 0/0(tumor formation rates:8/8 and 8/8), 50%/25%(tumor formation rates:4/8 and 6/8), 25%/25%(tumor formation rates:6/8 and 6/8)), and 67%/67%(tumor formation rates:4/12 and 4/12), respectively. Conclusions The optimized fractionated radiation schedule for subclinical breast cancer and its total dose vary with the number of injected tumor cells. When the tumor formation rate is 100%, hypofractionated radiation (300 cGy, once daily, 5 times/week) is the optimized schedule in terms of long-term tumor control.
		2014 Vol. 23 (6): 540-542 [Abstract] ( 3148 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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Notes of meeting

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		2014 Vol. 23 (6): 555-556 [Abstract] ( 2683 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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