Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2015 Vol.24 Issue.3 Published 2015-05-30

	Head and Neck Tumors Abdominal Tumors Review Thoracic Tumors News Conference

Thoracic Tumors

	227	Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of esophageal carcinoma:an analysis of 349 patients
		Wang Jun, Wang Li, Wang Yi, Yang Congr-ong, Cao Feng, Liu Qing, Jing Shao-wu
		Objective To observe the efficacy and adverse reactions of intensity-modulated radiotherapy (IMRT) with or without chemotherapy in the treatment of esophageal carcinoma, and to explore the influencing factors for prognosis. Methods The short-term outcomes and acute adverse reactions in 349 patients with esophageal carcinoma who received IMRT with or without chemotherapy from 2006 to 2012 were retrospectively analyzed. The 1-, 3-, and 5-year local control (LC) rates and overall survival (OS) rates were calculated with the Kaplan-Meier method. The influencing factors for survival were analyzed using the Cox regression model. Results The sample sizes at 3 and 5 years were 174 and 63, respectively. For all patients, the 1-, 3-, and 5-year LC rates were 72.9%, 61.2%, and 58.4%, respectively, and the 1-, 3-, and 5-year OS rates were 66.5%, 39.1%, and 24%, respectively. According to the results of subgroup analysis, the 1-, 3-, and 5-year LC and OS rates in patients with a tumor volume of<54.73 cm³ were significantly higher than those in patients with a tumor size of ≥54.73 cm³(P=0.001 and 0.000). There were no significant differences in 1-, 3-, and 5-year LC rates between patients with and without lymph node metastasis (P=?). However, the 1-, 3-, and 5-year OS rates were significantly lower in patients with lymph node metastasis than in patients without lymph node metastasis (62.7% vs. 83.1%;35.9% vs. 53.3%;20.4% vs. 38.3%;P=0.003). There were significant differences in the 1-, 3-, and 5-year LC and OS rates between patients with complete response, partial response, and no response (P=0.000 and 0.000). The incidence rates of grade ≥2 acute radiation pneumonitis and grade ≥3 acute radiation esophagitis were 11.3% and 9.0%, respectively. The tumor volume, short-term outcome, and lymph node metastasis were the influencing factors for OS (P=0.038, 0.000, and 0.008). Conclusions IMRT with or without chemotherapy is effective and safe in the treatment of esophageal carcinoma. The prognosis becomes poor along with increased tumor volume and regional lymph node metastasis. The evaluation of short-term outcomes is closely correlated with LC and OS.
		2015 Vol. 24 (3): 227-231 [Abstract] ( 4021 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	232	Clinical efficacy of neoadjuvant chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma
		Liu Shiliang^*,Xi Mian,Yang Yadi,Zhao Lei,Fu Jianhua,Liu Mengzhong
		Objective To explore the efficacy of neoadjuvant chemoradiotherapy (CRT) followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC), and to investigate the correlation between a clinical complete response (cCR) and a pathologic complete response (pCR). Methods One hundred and fifty-eight patients with locally advanced thoracic ESCC from 2001 to 2013 were retrospectively analyzed. All patients received concurrent chemoradiotherapy followed by surgery. Platinum-based chemotherapy regimens were adopted in chemotherapy and a prescribed dose of 40 Gy in 20 fractions, 5 fractions per week, was used in radiotherapy. The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method, and pairwise comparisons and univariate prognostic analyses were performed using the log-rank test. Multivariable prognostic analyses were performed using the Cox regression model. Results The pCR rate was 41.1% in all patients. After the treatment with neoadjuvant CRT, 32(72.7%) out of 44 patients with a cCR had a pCR, but only 33(28.9%) out of 114 patients with a non-cCR had a pCR (P=0.000). The sensitivity, specificity, positive predictive value, and negative predictive value of a cCR in predicting a pCR were 49.2%, 87.1%, 72.7%, and 71.1%, respectively. The 3-year sample size was 91. The 3-year OS and DFS rates in all patients were 53.9% and 48.6%, respectively. Patients with a cCR had significantly higher 3-year OS and DFS rates than those with a non-cCR (P=0.012;P=0.026), while patients with a pCR had significantly higher 3-year OS and DFS rates than those with a non-pCR (P=0.000;P=0.000). The multivariate analyses demonstrated that the pathologic response after CRT and chemotherapy regimen were the influencing factors for OS. The most common grade ≥3 acute adverse reaction was leucopenia (34.2%). Conclusions With a high pCR rate and tolerable adverse reactions, neoadjuvant CRT followed by surgery is a safe and effective option for locally advanced ESCC. The cCR rate after CRT is closely correlated with the pCR and OS rates.
		2015 Vol. 24 (3): 232-236 [Abstract] ( 3667 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	237	Concurrent chemoradiotherapy should be used with caution in elderly patients
		Wang Peng, Liu Weishuai, Xu Liming, Wang Shuai, Pang Qingsong, Yuan Zhiyong, Wang Jun,Zhao Lujun, Wang Ping
		Objective We aimed to investigate whether the standard approach of concurrent chemotherapy and radiation is an appropriate choice for elderly patients with limited-stage small-cell lung cancer (LS-SCLC). Methods A total of 168 LS-SCLC patients who had received thoracic radiotherapy from January 2006 to December 2011 at our institution were included in this retrospective study. Patients aged 65 years or older were defined as elder,and we compare concurrent chemoradiotherapy (CCRT) to sequential chemoradiotherapy (SCRT) in the elderly group (53 patients) and in its younger (153 patients) counterpart. Results The follow-up rate was 95.2%(each of the two groups lost in 4 patients).The median OS and PFS for the entire cohort was 24.6 months and 15.4 months. Among the elderly patients, the median OS were 15.9 and 24.6 months (P=0.013) in the CCRT and SCRT subgroups, respectively, and the toxicity were similar except for that more grade 3/4 hematological toxicity events were observed in the CCRT subgroup (13.3% versus 2.6%, P=0.170). Among the young patients, the median OS was 39.6 months in the CCRT subgroup and 24.5 months in the SCRT group (P=0.018), and no significant differences occurred in toxicity between the two subgroups (P=0.250-0.757). Conclusions Concurrent chemoradiotherapy should be used with caution in elderly patients, and sequential chemotherapy may be an alternative choice.
		2015 Vol. 24 (3): 237-240 [Abstract] ( 3075 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	241	Impact of dose-volume parameters on radiation-induced late pericardial effusion
		Long Shujing,Wang Jun, Wang Yi,Cao Feng, Jiao Wenpeng, Li Na, Wu Yajing, Guo Yin
		Objective To evaluate the impact of dose-volume parameters on the incidence of radiation-induced late pericardial effusion in patients with thoracic cancer. Methods Contrast-enhanced chest CT and echocardiography were applied in 49 patients with thoracic cancer who received radiotherapy to investigate the incidence of radiation-induced late pericardial effusion. The heart dose-volume parameters were analyzed to explore the physical influencing factors for radiation-induced late pericardial effusion. Results During the observation period, the incidence rate of radiation-induced late pericardial effusion was 28.6%(14/49), which included 12 patients with small amount and 2 patients with medium amount of pericardial effusion. The V₃₀ and V₃₅ of the heart were significantly higher in patients with radiation-induced pericardial effusion than in patients without (P=0.035 and 0.038, respectively). Multivariate analysis showed that the V₃₀ of the heart was the influencing factor for radiation-induced late pericardial effusion (P=0.036). The receiver operating characteristic (ROC) curve was used to determine the appropriate threshold for V₃₀. The area under the ROC curve was 0.695, the accuracy of prediction was close to medium level, and the cut-off value was 33.0%. The incidence rate of radiation-induced late pericardial effusion in patients with 33.0% or greater V₃₀ of the heart was significantly higher than that in patients with less than 33.0% V₃₀(43.5% vs. 15.4%, P=0.030). The sensitivity and specificity of prediction using V₃₀ were both 71.4%. Conclusions Pericardial effusion is a common manifestation of radiation-induced late heart damage. The incidence of pericardial effusion is associated with V₃₀ and V₃₅ of the heart, and V₃₀ is the influencing factor. Increased sample size is needed to validate the results and reach a final conclusion.
		2015 Vol. 24 (3): 241-244 [Abstract] ( 3310 ) [HTML 1KB] [ PDF 0KB] ( 0 )

News

	231


		2015 Vol. 24 (3): 231-231 [Abstract] ( 2209 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	245	Significance of postoperative radiotherapy for stage Ⅱ/Ⅲ upper rectal cancer
		Wang Xin,Jin Jing,Ren Hua,Feng Yanru,Liu Wenyang,Xiao Qin,Li Ning,Fang Hui,Jing Hao,Lu Ningning,Tang Yu,Deng Lei,Wang Jianyang,Yu Zihao,Liu Xinfan,Song Yongwen,Wang Weihu,Wang Shulian,Liu Yueping,Li Yexiong
		Objective To investigate the value of postoperative adjuvant chemoradiotherapy (CRT) in the treatment of stage II/III upper rectal cancer. Methods A total of 3995 patients with rectal cancer were admitted to our hospital from 2000 to 2010. Among them, patients who were pathologically diagnosed with adenocarcinoma and underwent radical surgery were enrolled as subjects for retrospective analyses. Moreover, all selected patients had the lower margin of the tumor located within 10-16 cm from the anal verge, as determined by a colonofiberscope before surgery, and were pathologically staged as T_3-4 or N_0-2M₀ after surgery, according to the 7^th edition of American Joint Committee on Cancer tumor-node-metastasis staging system. Results A total of 547 patients were enrolled as subjects. The 5-year sample size was 249. In all patients, the 5-year overall survival (OS), disease-free survival, local recurrence-free survival (LRFS), and distant metastasis-free survival rates were 79.0%, 76.8%, 94.0%, and 80.1%, respectively. One hundred and fifty-five patients were enrolled into either postoperative concurrent CRT group or postoperative non-CRT group, with the baseline characteristics balanced between the two groups by the propensity-score matching method (1∶1). Patients who were staged as pT_4b and had paracancerous nodules and lymph node metastases (stage N₂) were enrolled into high-risk group. In the high-risk group, patients treated with postoperative CRT had significantly higher LRFS and OS rates than those treated with only surgery (96.3% vs. 82.0%, P=0.044;81.6% vs. 59.1%, P=0.019). Conclusions Radical surgery achieves a good prognosis in patients with stage II/III upper rectal cancer, and postoperative CRT can further reduce the locoregional recurrence rate. Particularly, postoperative CRT/RT can substantially improve local and long-term outcomes in patients with high-risk factors.
		2015 Vol. 24 (3): 245-250 [Abstract] ( 3792 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	251	A prospective study of intensity-modulated radiotherapy with integrated boost after breast conservative surgery in breast cancer patients
		Peng Ran, Wang Shulian, Jin Jing,Liu yueping,Wang Weihu,Song Yongwen,Ren Hua,Liu Xinfan,Li yexiong,Yu Zihao
		Objective To prospectively evaluate the efficacy and toxicity of intensity modulatedradiotherapy (IMRT) with integrated boost after conservative surgery in breast cancer patients. MethodsFrom January 2006 to June 2010, 128 patients with stages I-III breast cancer treated with breast conservative surgery were recruited. All patients received whole breast IMRT with integrated tumor bed boost. A total dose of 50 Gy in 25 fractions with 2 Gy per fraction was delivered to the whole breast, while 60 Gy with 2.4 Gy per fraction was delivered to the tumor bed concomitantly. Supraclavicular fossa was irradiated to 50 Gy in 9 patients (7.1%) who had more than 3 involved axillary lymph nodes. 104 patients (81.3%) received chemotherapy. 93(94.9%) of the 98 patients who had positive hormone receptor received endocrine therapy. Cosmetic evaluation is based on the Harvard system. Acute and late toxicities were scored according to CTCAE version 3. Survival rates were calculated by Kaplan-Miere method. Results The following-up rate was 100%. The 5-year locoregional recurrence-free survival, disease-free survival and overall survival was 98.4%, 97.7%, and 95.3%, respectively. The acute skin toxicity was grade 1 in 65.6%, grade 2 in 15.6%, and grade 3 in 2.3% of all patients. Grade 2 radiation pneumonitis (RP) developed in 4.7% of this cohort, grade 1 in 22.5%. Grade 1-2 arm edema developed in 28.9%. One patient (0.8%) developed whole breast depigmentation. Four patients (3.1%) developed chromatosis.77.3% of patients had"excellent or good" cosmetic outcome at 5 years, compared to 85.9% of patients before radiotherapy. However, 28 patients (21.9%) had"fair" cosmetic outcome and 1 patient had"poor" appearance at 5 years. Eighteen patients (14.1%) experienced improved cosmetic outcome at 5 years compare to that before radiotherapy while 34 patients (26.6%) had an inferior appearance. Conclusions IMRT with integrated boost after breast-conserving surgery for breast cancer patients is well tolerated, with relatively good cosmetic outcome and moderate toxicity. Meanwhile, 5-year local control and survival are excellent.
		2015 Vol. 24 (3): 251-255 [Abstract] ( 3778 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	256	Effect of distribution of ipsilateral supraclavicular lymph node metastasis on target volume delineation in breast cancer:an analysis of 55 patients
		Jing Hao^*, Wang Shulian, LI Jing, Xue Mei, Xiong Zukun, Jin Jing, Wang Weihu, Song Yongwen, Liu Yueping, Ren Hua, Fang Hui, Liu Xinfan, Yu Zihao, Li Yexiong
		Objective To retrospectively investigate the effect of the distribution of supraclavicular lymph node metastasis (LNM) on clinical target volume (CTV) delineation in radiotherapy for breast cancer. Methods Fifty-five patients with breast cancer who underwent helical computed tomography (CT) scan and were diagnosed with supraclavicular LNM were enrolled as subjects and their CT images were collected. The metastatic lymph nodes in 55 patients were recreated proportionally on the CT images of a standard patient with breast cancer with reference to normal anatomy in the supraclavicular area. The relationship between the distribution of supraclavicular LNM and the CTV recommended by the Radiation Therapy Oncology Group (RTOG) and other literature was analyzed. Results Sixty percent of LNM were pathologically confirmed and distant metastasis occurred in 64% of supraclavicular LNM. Ninety-one percent and eighty-two percent of patients had centers of LNM in the internal and external regions of the supraclavicular area, respectively. Sixty-six percent of patients had LNM located in the subclavian venous confluence. The CTV recommended by literature covered the centers of all LNM in only 20%-42% of patients, while the CTV recommended by the RTOG guide covered the centers of all LNM in only 26% of patients. Seventy-one percent and sixty-six percent of patients had the centers surpassing the lateral and posterior edges of the CTV, respectively. According to the distribution of LNM mentioned above, we expanded the CTV in the supraclavicular area by extending the lateral and posterior edges to the natural anatomical barriers and the new CTV covered the centers of all LNM in up to 82% of patients. Conclusions The locations of supraclavicular LNM surpass the range, particularly the lateral and posterior edges, of the CTV defined by the RTOG guide. Therefore, the CTV in the supraclavicular area needs to be extended to cover those regions mentioned above.
		2015 Vol. 24 (3): 256-261 [Abstract] ( 3636 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	262	Clinical characteristics and prognostic analysis of young patients with stage I_B-II_A cervical cancer
		Zhang Gongyi,Zhang Rong,Zeng Jing, Lei Chengzhi, Wu Lingying
		Objective To investigate the clinicopathological features, survival, and the impact of postoperative adjuvant radiotherapy on the ovarian function in patients less than or equal to 35 years of age with stage I_B-II_A cervical cancer. Methods One hundred and eighty-six patients who were admitted to our hospital from 2000 to 2011 were retrospectively analyzed. An equal number of patients older than 35 years of age with cervical cancer within the same period were used as stage-marched controls. The Kaplan-Meier method was used to calculate the survival rates, and the log-rank test was used for pairwise comparison and univariate prognostic analyses. The Cox proportional hazards model was used for multivariate prognostic analyses. Results The patients less than or equal to 35 years of age had a significantly higher incidence of non-squamous carcinoma but significantly lower incidence rates of deep stromal invasion and lymph-vascular space invasion (LVSI) compared with the control group (P=0.000;P=0.008;P=0.000). Though young patients had significantly higher 5-year disease-free survival (DFS) and overall survival (OS) rates than the control group (93.7% vs. 84.5%, P=0.005;96.1% vs. 89.5%, P=0.033), age was not an independent prognostic factor (P=0.202;P=0.950). Among patients less than or equal to 35 years of age, lymph node metastasis and LVSI were independent prognostic factors for DFS (P=0.000;P=0.000), while LVSI and initial tumor size were independent prognostic factors for OS (P=0.000;P=0.000). There was no significant difference in the incidence of normal ovarian function between young patients treated withand without adjuvant radiotherapy after ovarian transposition (63% vs. 73%, P=0.422). Conclusions Patients less than or equal to 35 years of age with stage I_B-II_A cervical cancer have a better prognosis than the control group. However, age is not an independent prognostic factor. Postoperative adjuvant radiotherapy will not impair the function of transposed ovaries.
		2015 Vol. 24 (3): 262-266 [Abstract] ( 3830 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	267	Dosimetric study of three-dimensional image-quided brachytherapy combined with intracavitary/interstitial brachytherapy in locally advanced cervical cancer
		Zhang Ning^*, Zhao Zhipeng, Cheng Guanghui,He Mingyuan, Zhao Hongfu, Ge Yuping
		Objective To explore the dosimetric advantages of computed tomography-based and ultrasound-guided three-dimensional image-quided brachytherapy (3D-IGBT) combined with intracavitary/interstitial (IC/IS) brachytherapy for locally advanced cervical cancer. Methods A total of 45 patients with FIGO (2009) stage I_B2-IV_A locally advanced cervical cancer who received radical external beam radiotherapy and 3D-IGBT combined with IC/IS brachytherapy in our hospital from 2013 to 2014 were analyzed. After the treatment with ¹⁹²Ir-based IC/IS brachytherapy, patients had needles removed from the original images and received treatment only from IC radiation sources. Dosimetric differences in the planning D₉₀ for high-risk clinical target volume (HR-CTV), D₉₀ for intermediate-risk CTV (IR-CTV), and D_{2 cm³} for the bladder, rectum, sigmoid colon, and small intestines were determined and analyzed by paired t-test. Results A total of 260 after-loading treatment plans, including IC/IS treatment plans for 130 patients and IC treatment plans for 130 patients, were made. The D₉₀ for HR-CTV and D₉₀ for IR-CTV in the IC/IS brachytherapy group were significantly higher than those in the IC brachytherapy group (P=0.000;P=0.000). Moreover, the average D_{2 cm³} values for the bladder and rectum were significantly reduced in the IC/IS brachytherapy group compared with those in the IC brachytherapy group (P=0.000;P=0.006). Conclusions The 3D-IGBT combined with IC/IS brachytherapy not only achieves a higher dose for the target volume, but also reduces the radiation dose to the bladder and rectum in the treatment of locally advanced cervical cancer.
		2015 Vol. 24 (3): 267-270 [Abstract] ( 3549 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	271	Clinical efficacy of CyberKnife radiosurgery in treatment of adrenal metastases:a study of 42 patients
		Zhao Xianzhi, Zhuang Hongqing, Yuan Zhiyong,Wamg Jingsheng, Dong Yang, Chen Huaming, Li Fengtong, Song Yongchun, Wang Ping
		Objective To investigate the safety and efficacy of stereotactic body radiotherapy (SBRT) in the treatment of patients with adrenal metastases. Methods The clinical data of 42 patients with adrenal metastases who were treated with CyberKnife radiosurgery from 2006 to 2013 were retrospectively analyzed. Short-term outcomes at 1 month after treatment were evaluated. The evaluation was performed using RECIST 1.1 criteria by the World Health Organization. The adverse reactions were assessed using RTOG/EORTC radiation injury grading criteria, and the overall survival (OS) and local control (LC) rates were calculated using the Kaplan-Meier method. Results Among 47 targets in 42 patients, 14 lesions showed a complete response, and 13 lesions showed a partial response, with an overall response rate of 57%. The sample sizes at 1 year and 2 years were 25 and 19, respectively. The 1-and 2-year LC rates were 87% and 60%, respectively. The 1-and 2-year OS rates were 53% and 41%, respectively, and the 1-and 2-year progression-free survival (PFS) rates were 17% and 8%, respectively. The PFS was substantially improved in patients with a gross target volume less than 2.5 cm³, a biologically equivalent dose higher than 80 Gy, and older than 60 years of age. The adverse reactions after treatment were mainly grade 1 or 2 gastrointestinal reactions including fatigue, anorexia, nausea, and vomit, and grade 1 or 2 bone marrow suppression. Only one patient showed grade 3 gastrointestinal reactions. Conclusion SBRT is a safe and effective method in the treatment of adrenal metastases with mild adverse reactions and good LC rates.
		2015 Vol. 24 (3): 271-274 [Abstract] ( 3456 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	275	Preliminary results of a prospective multicenter study on clinical staging system for nasopharyngeal carcinoma
		Lin Shaojun^*, Chen Xiaozhong, He Xia, Li Jingao, Gao Li, Chen Nianyong, Zhao Chong, Mai Haiqiang, Pi Zhengchao, Xie Conghua, Zong Jingfeng, Xu Yuanji, Lang Jinyi, Pan Jianji
		Objective To compare patient distributions and prognostic value between the 2008 and the 7^th edition of the International Union against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging systems for nasopharyngeal carcinoma (NPC), and to investigate their rationality. Methods The clinical data of 1508 patients with untreated NPC (without distant metastasis) who were admitted to 9 national cancer centers from 2009 to 2010 were analyzed. All patients were staged according to the above two staging systems in order to evaluate the agreement in patient distributions between the two staging systems and analyze the 3-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates. The LRFS, DMFS, and OS rates were calculated using the Kaplan-Meier method, and pairwise comparisons were performed using the log-rank test. Results There were no significant differences in patient distributions with T, N, and clinical staging classifications between the two systems (Kappa=0.80, 0.60, and 0.60). The OS curves with clinical staging classification and the LRFS curves with T staging classification were also similar. However, in both staging systems, the OS curves with stage I and stage II were similar, and the LRFS curves with stages T₁-T₃ were close or even overlapped. There were no significant differences in the DMFS curves between stages N₀ and N₁ in the 2008 staging system, as well as between stages N₁ and N₂ in the UICC/AJCC staging system. Conclusions In the two staging system, the patient distributions and prognoses of clinical and T staging classifications are similar, whereas the prognoses of N staging classification are different. The prognoses of clinical, T, and N staging classifications need to be improved for both staging systems.
		2015 Vol. 24 (3): 275-279 [Abstract] ( 3860 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	281	Evaluation of significance of the 7^th edition of the International Union against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma with intensity-modulated radiotherapy
		Jiang feng, Hu Fujun, Hu Qiaoying, Feng Xinglai, Li Bing, Bao Wuan, Qin Weifeng, Jing Qifeng, Chen Yuanyuan, Tao Qiu, Piao Yongfeng, Hua Yonghong,Jin Ting,Tao Changjuan, Chen Xiaozhong
		Objective To evaluate the rationality and applicability of the 7^th edition of the International Union against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system for nasopharyngeal carcinoma (NPC) in patients staged by magnetic resonance imaging (MRI) and treated with intensity-modulated radiotherapy (IMRT). Methods The clinical outcomes of 720 patients diagnosed with stage M₀ NPC who were staged by MRI and treated with IMRT in our hospital from 2007 to 2011 were retrospectively analyzed, and the reliability of T and N staging in prediction of clinical outcomes in patients was evaluated. The survival rates were calculated using the Kaplan-Meier method, and pairwise comparisons were made using the log-rank test. Multivariate prognostic analyses were performed using the Cox regression model. Results The 7^th edition of UICC/AJCC T stag was an independent prognostic factor for overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and distant metastasis-free survival (DMFS) rates (P=0.013, 0.025, 0.001, and 0.002). However, differences between stages T₁, T₂, and T₃ were not significant (P=0.054-0.626). Patients with stage T₃ NPC had a similar level of risk for local recurrence and distant metastasis compared with patients with stage T₂ NPC (P=0.796). The N stage was an independent prognostic factor for DFS and DMFS rates (P=0.005 and 0.000). There were no significant differences in DFS and DMFS rates between stages N₀ and N₁(P=0.549 and 0.707). In stages N₀-N₁, retropharyngeal lymph node metastasis only was not an independent prognostic factor for OS, DFS, and DMFS (P=0.360, 0.083, and 0.062). Conclusions The 7^th edition of UICC/AJCC staging system for NPC is still valuable for prediction of the prognosis of patients staged by MRI and treated by IMRT. Optimization of the staging system can improve the prognostic accuracy.
		2015 Vol. 24 (3): 281-284 [Abstract] ( 4104 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	285	Evaluation of staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy
		Zeng Lei, Gong Xiaochang, Ao Fan, Tang Yiqiang, Shu Yuxian, Wan Guifen, Xiao Yun, Liao Yulu, Huang Min, Xie Chen, Jiang Chunling,Li Jingao
		Objective To evaluate the 7^th edition of the International Union against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system for nasopharyngeal carcinoma (NPC), and to provide a basis for its further revision. Methods Three hundred and twenty-three patients who were pathologically diagnosed with NPC (without distant metastasis) and received radical intensity-modulated radiotherapy (IMRT) in our hospital from 2005 to 2011 were enrolled as subjects. All patients were staged according to the 7^th edition of the UICC/AJCC staging system. The overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were calculated using the Kaplan-Meier method, and pairwise comparisons were made by the log-rank test. Multivariate prognostic analyses were performed using the Cox regression model. Results The 5-year sample size was 45. There were no significant differences in 5-year LRFS between stages T₁ and T₂, as well as between stages T₂ and T₃(P=0.055;P=0.746). The current stages T₂, T₃, and T₄ with only medial pterygoid muscle were combined into stage T₂, and the rest of stage T₄ were down-staged to stage T₃. In the new T staging system, the LRFS curves of stages T₁, T₂, and T₃ were substantially separated. There were no significant differences in 5-year DMFS between stage N₂ and N_3a, between stage N₂ and N_3b, and between stages N_3a and N_3b (P=0.272;P=0.063;P=0.810). Multivariate analyses demonstrated that cervical lymph node metastasis was the only independent prognostic factor for DMFS (P=0.037). The current stage N_3a with cervical lymph node metastasis on one side was down-staged to stage N₁, and the current stage N_3a with cervical lymph node metastasis on both sides to stage N₂. In the new N staging system, the DMFS curves of stages N₀, N₁, N₂, and N₃ were substantially separated. There were no significant differences in 5-year OS between stages I and II, as well as between stages III and IV_a (P=0.434;P=0.951). The current stages T₁N_0-1, T₂N_0-1, T_1-3N₂/T₃N_0-1, and T_1-3N₃ were classified into stage I_a, I_b, II, and III, respectively. In the new staging system, the 5-year OS curves of stages Ia, Ib, II, and III were substantially separated. Conclusions There are several deficiencies in the 7^th edition of the UICC/AJCC staging system. The proposed new staging system can achieve a better prognosis, though further validations with a larger sample size are needed. DOI:10.3760/cma.j.issn.1004-4221.2015.03.014 作者单位:330029 南昌,江西省肿瘤医院放疗科通信作者:李金高,Email:lijingao@hotmail.com
		2015 Vol. 24 (3): 285-288 [Abstract] ( 3616 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	290	Efficacy of induction chemotherapy with TPF plus concurrent IMRT with paclitaxel or cisplatin in treatment of locally advanced nasopharyngeal carcinoma
		Ma Faqiang^*, Jin Feng, Wu Weili, Li Yuanyuan,Long Jinghua, Lu Fangyang,Bi Ting,Li Zhuoling, He Qianyong, Qu Bo
		Objective To evaluate the efficacy of docetaxel, cisplatin, and 5-fluorouracil (TPF)-based induction chemotherapy plus concurrent intensity-modulated radiotherapy (IMRT) with paclitaxel or cisplatin in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods From 2008 to 2012, 263 patients with locally advanced NPC were enrolled as subjects. A prescribed dose of 69.96-73.92 Gy in 33 fractions was applied to the primary nasopharyngeal gross tumor volume and the positive lymph nodes, 60.06 Gy in 33 fractions to the clinical target volume, and 50.96 Gy in 25 fractions to the negative lymphatic drainage volume. All patients were treated with two or three cycles of TPF-based induction chemotherapy (docetaxel 75 mg/m²;cisplatin 75 mg/m²;5-fluorouracil 750 mg/m²·d^－1), followed by two cycles of concurrent IMRT with paclitaxel (135 mg/m² on days 1 and 22) for 128 patients and with cisplatin (100 mg/m² on days 1 and 22) for 135 patients. The survival rates were calculated with the Kaplan-Meier method and analyzed by the log-rank test. Multivariate prognostic analysis was performed using the Cox regression model. Results With a sample size of 42 patients, the 5-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 81.6%, 76.1%, 92.3%, 88.5%, and 80.4%, respectively. Patients treated with induction chemotherapy plus concurrent IMRT with cisplatin had significantly higher OS (93.5% vs. 74.7%, P=0.035), PFS (80.1% vs. 72.7%, P=0.034), LRFS (95.9% vs. 88.8%, P=0.020), and DMFS (83.5% vs. 77.5%, P=0.033) than those treated with concurrent IMRT with paclitaxel. Due to concurrent chemoradiotherapy, the incidence rates of grade ≥3 leucopenia, gastrointestinal reactions, oral mucositis, and radiodermatitis were 33.1%, 11.8%, 26.3%, and 11.1%, respectively. The incidence rates of grade 1 xerostomia, grade 2 xerostomia, grade 3 hearingloss, and grade 3 trismus were 50.3%, 12.6%, 3.4%, and 3.3%, respectively. ConclusionsCompared with TPF-based induction chemotherapy plus concurrent IMRT with paclitaxel, concurrent IMRT with cisplatin yields higher OS, PFS, LRFS, and DMFS as well as tolerable acute adverse reactions in the treatment of locally advanced NPC.
		2015 Vol. 24 (3): 290-294 [Abstract] ( 3880 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	295	A study of influencing factors and predictors for radiation encephalic necrosis after CyberKnife radiotherapy
		Guo Yihang, Zhuang Hongqing, Yuan Zhiyong, Wang Ping
		Objective To investigate the influencing factors and predictors for radiation encephalic necrosis after CyberKnife radiotherapy. Methods Ninety-four patients (104 targets) with primary or metastatic intracranial tumors who were treated with CyberKnife radiotherapy from 2006 to 2011 were retrospectively analyzed. All surgeries adopted skull tracking modes with a dose of 12-45 Gy in 1-8 fractions prescribed to 60%-87% isodose line. Radiation encephalic necrosis was determined by imaging or pathological examination. Logistic regression analysis was used to analyze the relationship between radiation encephalic necrosis and factors including diabetes, cardio-cerebrovascular diseases, target volume, isodose line, prescribed dose, number of fractions, combination with whole-brain irradiation (WBI), and biologically equivalent dose (BED). Predictability and critical threshold of all influencing factors forradiation encephalic necrosis were determined by the receiver operating characteristic (ROC) curve. ResultsTwelve targets (11.54%) had radiation encephalic necrosis. According to the result of logistic regression analysis, BED, combination with WBI, and number of fractions were influencing factors for radiation encephalic necrosis. In the ROC curves, the areas under curves for the above three factors were 0.892±0.034, 0.650±0.072, and 0.712±0.064, respectively, indicating that only BED can well predict radiation encephalic necrosis after CyberKnife radiotherapy with a dose threshold of>7410 cGy. Conclusions BED, combination with WBI, and number of fractions are influencing factors for radiation encephalic necrosis. BED is the best predictor of radiation encephalic necrosis with a dose threshold of>7410 cGy.
		2015 Vol. 24 (3): 295-298 [Abstract] ( 3287 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2015 Vol. 24 (3): 299-299 [Abstract] ( 3091 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	301	Dosimetric effects of different fusion methods during intensity-modulated radiotherapy for nasopharyngeal carcinoma
		Chen Bo, Yi Junlin, Gao Li, Huang Xiaodong, Luo Jingwei, Qu Yuan, Men Kuo, Zhang Zong, Wang Kai, Zhang Shiping, Xiao Jianping,Xu Guozhen
		Objective To compare the dosimetric effects of simulation and correction fusion (SF), automatic and visual correction fusion (AF), and bone fusion (BF) during the course of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods Fifteen patients with stage III-IV_a NPC treated with IMRT had planning CT scans before and after 20-25 fractions of radiotherapy. SF, AF, and PF methods were separately used to undertake the fusion between the first and second planning CT images. New treatment isocenters were the shadow cast of the initial isocenter on the second planning CT images with the three fusion methods;initial treatment planning was transferred to the second planning CT according the new treatment isocenter, and new dosimetric distribution was calculated. The fusion parameters of the three fusion methods, as well as dosimetric changes in the target volume and normal tissue, were compared with paired t-test. Results There were relatively small differences in fusion parameters between SF and AF methods;the paired difference means in translation in all directions were less than 0.13 cm, and the paired difference means in rotation in all directions were less than 0.40 degree. BF fusion parameters differed widely from others, especially in rotation, and the paired difference means were more than 0.71 degree. The three fusion methods have similar dosimetric effects on the target volume and normal tissue,but had a significant dosimetric effect on the neck region, with a significant decrease in GTV_nd D₉₅(P=0.039). D_max and D_{1 cm³} for the brain stem remained unchanged or showed an increasing trend with the BF method, but they showed a decreasing trend with the SF and AF methods. Conclusions Different fusion methods would lead to different results in the research on dosimetric changes in the target volume and normal tissueduring the IMRT for NPC, so the fusion method should be introduced in the reports of these research. TheBF method is not recommended because its dosimetric effect on the neck region is great, resulting in a big DOI:10.3760/cma.j.issn.1004-4221.2015.03.018 基金项目:北京希望马拉松专项基金资助(LC2012B36) 作者单位:100021 北京协和医学院中国医学科学院肿瘤医院放疗科通信作者:高黎,Email:li_gao2008@outlook.comdifference from the actual dose distribution. The SF and AF methods have similar dosimetric effects, which are close to the actual situation.
		2015 Vol. 24 (3): 301-305 [Abstract] ( 3592 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	306	Dosimetry study of volumetric-modulated arc therapy for single brain metastasis
		Xu Yingjie, Xiao Jianping, Ma Pan, Men Kuo, Zhang Yongqian, Dai Jianrong
		Objective To evaluate the plan quality of volumetric modulated arc therapy (VMAT) in single brain metastasis compared with the stereotactic arc therapy (S_ARC). Methods 31 patients were replanned using VMAT and S_ARC technique. Prescription dose is 40 Gy delivered in 4 fractions covering at least 95% of the target volume while keeping minimum doses to the volume of normal brain tissue. The plans were assessed and compared using the conformity indexes (CI),gradient indexes (GI), the mean dose of normal brain tissue, the volumes of normal brain tissue receiving 4 Gy doses, the number of monitor unit and treatment times. A paired t test or non-parametric Wilcoxon signed rank test was performed to analyze the difference between these two plans. Results VMAT plans increased dose conformity, but not dose gradient, compared with S_ARC plans. The median dose conformity index values were 0.815, 0.818, and 0.779(P=0.000,0.000), and the median dose gradient score index values were 5.865, 5.706, and 3.133(P=0.000,0.000,0.000), in single arc, double arc VMAT plans and S_ARC plans, respectively. The mean dose of normal brain tissue was higher in VMAT plans. And the volume of the normal brain tissue receiving doses of 4 Gy in VMAT plans was significantly larger than the volume in S_ARC plans. The VMAT plans got higher MU number (P=0.000,0.000). And the mean treatment times were (2.7±0.1) min,(2.8±0.1) min, and (7.6±0.2) min in single arc, double arc VMAT plans and S_ARC plans, respectively (P=0.000,0.000). Conclusions The dosimetry of VMAT plan can meet the requirements of clinical, and is recommended in the treatment of big volume single brain metastasis or single brain metastasis in cerebellum.
		2015 Vol. 24 (3): 306-309 [Abstract] ( 3495 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	310	Monte carlo simulation based dose optimization of intra-operative radiotherapy for breast cancer and its clinical application
		Yang Bo^*, Wang Zhenwu, Kong Xudong,Kong Dong, Wei Xianding, Chen Jianjiang, Meng Dong, Sun Chunlei
		Objective To study Monte Carlo simulation to guide the dose optimization of intra-operative radiotherapy (IORT) for breast cancer, and evaluating its effects of clinical application. Methods The MCBEAM program of MCTP is used to establish the model of the accelerator using for breast cancer patients′ IORP. The preoperative CT images are edited to intra-operative states using independent developed editor, then determing the target at the intra-operative states and setting equivalent material and lead of different thicknesses in front of and behind the target. Calculating with the MCSIM program to get the optimal combination of the equivalent material and lead. There are 23 patients who accepted IORT with the optical combination of themselves, and the situations of wounds healing, reactions of radiotherapy, cosmetic effects and the recurrence of cancer are observed. Results By adding 2-3 mm equivalent material in front of the target and 5 mm equivalent material and 2 mm lead behind the target, the 90% isodose curve almost wraps around the target volume;and the V₉₀>90% and the V₁₁₀<4%. The average dose of lung is less than 1 Gy. The 23 patients′ wounds healed well, and there are no wounds′ infection and radiotherapy reaction;after the healing of wounds and half a year after the operation, the excellent rate of breasts′ appearance is over 80%, and no tumor recurrence was found. Conclusions The method of MC guided dose optimization of IORT for breast cancer is reliable, the dose distribution of target volume is uniform. There were no adverse reactions to radiotherapy and the cosmetic effect is satisfying. This method is well worthy of clinical popularizing.
		2015 Vol. 24 (3): 310-313 [Abstract] ( 3289 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	318	The application of volumetric modulated arc therapy in esophageal carcinoma
		Liu Lihong,Wang Lan,Han Chun,Zhang Jing,Tian Hua,Li Xiaoning
		Objective To compare the dosimetric difference between volumetric modulated arc therapy (VMAT) and static intensity modulated radiotherapy (IMRT) for esophageal carcinoma. Methods Thirty patients were selected in this study, including 5 cases in the cervical, 5 the lower thorax, 10 the upper thorax and 10 the middle thorax. VMAT plans with a single arc and IMRT plans with five fields designed for each patients. Planning target volume (PTV) were prescribed to 60 Gy in 30 fractions. Delta 4 was used to verifie the dosimetric of treatment plans. Using paired t-test or Wilcoxon signed-test to compare the dose distribution on planning and organs at risk (OAR). The monitor units and treatment time were also evaluated to measure the treatment efficiency. Results All the VMAT and IMRT plans can satisfy the clinical dosimetry requirements. VMAT had better conformal index for PTV than IMRT (P=0.008). VMAT was better than IMRT by reducing the D_max of spinal cord (P=0.032),while the V₃₀,V₄₀ and D_mean of heart were significantly higher (P=0.041,0.012,0.002).For cervicals, the V₅, V₁₀, V₁₅ and mean dose of lung were significant higher in VMAT than those in IMRT (P=0.002- 0.002,0.002). For uppers, the values of heart V₃₀ and D_mean were significantly larger in VMAT than IMRT (P=0.030,0.026). However, the D_max of spinal cord in VMAT was lower than IMRT (P=0.006). For middles, VMAT reduced V₁₀, V₁₅, V₂₀ of lung (P=0.015,0.028,0.041). There were no significant differences between VMAT and IMRT in the lowers (P=0.262- 0.998). The 3 mm/3% γ pass rate was 92.75% for VMAT and 92.98% for IMRT (P=0.826). The average MU of VMAT (460.66 MU) was reduced by 11.84%compared with IMRT (522.55 MU)(P=0.001). The delivery time of VMAT (139.6 s)compared with IMRT (298.73 s) was reduced by an average of 53.27%(P=0.000). ConclusionsCompared with IMRT, VMAT improved the OARs dose sparing and the target CI with similar dose distribution to the target. VMAT required fewer MU, shorten the treatment time significantly. The implementation of Synergy is stable and reliable.
		2015 Vol. 24 (3): 318-321 [Abstract] ( 3881 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	323	Application of octavius 4D system in volumetric modulated arc therapy dose verification
		Li Bingbing^*,Liu Lingling,Fei Zhenle
		Objective To study the feasibility of dose verification with Octavius 4D system in volumetric modulated arc therapy (VMAT). Methods Twenty patients were treated with the VMAT. Their treatment plans were performes and then acquired the measured data with the Octavius 4D system. In addition, the treatment plans are used in the CT phantom for Octavius 4D system, and acquire the simulated data. We use the γ pass rate to analysis the measured and simulated results for the conditions:the dose deviations are 2%3%5%, the displacement deviations are 2 mm/3 mm/5 mm and the thresholds are 5%10%, and got the Gamma pass rate and fitness of profile curve. Results The distributions of measured and simulated dose are matched well, and the fitness of profile curve are also matched well. The averaged Gamma pass rate is 97.78% in the case 3 mm 3%10%. Conclusions Octavius 4D system can meet the dose verification for VMAT treatment. The measured plane is always following the rotating frame and perpendicular to the beam.
		2015 Vol. 24 (3): 323-326 [Abstract] ( 3690 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	327	A clinical application research of 3D dose verification for esophageal carcinoma intensity-modulated radiation therapy with Compass
		Xing Xiaofen,Chu Xuegang,Zheng Xuliang,Cui Tong,Liu Jianting
		Objective To study the clinical application of Compass system,a novel 3D quality assurance system for the verification of esophageal carcinoma intensity-modulated radiotherapy (IMRT) plan. Methods 12 esophageal carcinoma IMRT plans were optimized with Eclipse 8.6 treatment planning system (TPS),and then Compass reconstructed 3D dose distributions with the patient anatomy. Comparison was performed among the reconstructed and calculated with TPS, Dose-volume parameters (γ pass rate、 average dose deviation) to the planning target volume (PTV) and critical structures were quantitative valuated. Furthermore two-dimensional dose verification were performed use MatriXX,γ pass rate were evaluated with 3%/3 mm criteria. Results The γ pass rate of actual gantry angle was found generally declined seemingly compared with 0 degree gantry angle in two dimensional verification,difference was statistically significant (P=0.018-0.001).In 3D dose verification,the γ volume of PTV were exceed 93%, the deviation of D₉₅, D₅₀, D₂ were less than 3%;The γ volume of lungs and heart were exceed 95%, the average dose deviation were less than 3%;The γ pass rate of spinal cord and trachea were exceed 98%. The independent check verified more conformed with the TPS calculated. Dose deviations appeared in the radiation field edge area. Conclusions 3D dose verification can provide more information to comprehensively evaluate the plan which is benefit for evaluating the clinical value of verification.
		2015 Vol. 24 (3): 327-330 [Abstract] ( 3439 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	331	To study the feasibility of defining the internal gross tumor volume for hepatocellular carcinoma applying the enhanced 4DCT images obtained by deformable registration technology
		Xu Hua, Gong Guanzhong, Chen Jinhu, Shang Dongping, Liu Tonghai,Zhu Jian,Lu Jie
		Objective To study the feasibility of defining the internal gross tumor volume (IGTV) of hepatocellular carcinoma applying the enhanced four-dimensional computed tomography (4DCT) images with deformable registration technology. Methods Ten HCC patients who accepted radiation therapy were selected in this study. The 4DCT in free breathing, non-enhanced 3DCT and arterial phase enhanced 3DCT in end inspiration breath holding associated with active breathing coordinator were acquired sequentially. 4DCT were sorted into ten series CT images according to breath phase, and named CT₀₀, CT₁₀…CT₉₀. Gross tumor volume (GTV) were contoured on different CT series and the IGTV₁ was merged by ten phases GTVs of 4DCT. The GTV of enhanced 3DCT was registered to different CT series of 4DCT and the IGTV_DR was obtained by merging the GTVs after deformable registration. The target volumes differences were compared by paired t-test. Results The edge of tumor was difficult to define on 4DCT and non-enhanced 3DCT images. The enhanced 3DCT image showed clearer tumor edge, and the GTV increased by mean 37.99% compared to GTV on 4DCT different series images and non-enhanced 3DCT image (P=0.002). The GTV after deformable registration on 4DCT different phase images increased by mean 36.34%(P=0.011), which were similar to GTV on enhanced 3DCT image (P=0.632). The IGTV_DR increased by 19.91%(P=0.017), compared to IGTV₁. Conclusions The contrast-enhanced 4DCT image which was obtained by combining enhanced 3DCT and 4DCT images with deformable registration technology could raise the position precision of the HCC IGTV effectively.
		2015 Vol. 24 (3): 331-334 [Abstract] ( 3489 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	335	Study on radiotherapy method with simulation phantom for breast cancer after radical mastectomy
		Guo Jian^*, Qin Songbin, Cai Xiaojun, Xu Xiaoting, Wang Lili. Zhan Wei, Chen Long, Zhou Juying
		Objective To study the dose distribution of five clinical technologies commonly used in simulation phantom of breast cancer after radical mastectomy are observed and analyzed by using MOSFET detector. The dose validation from TPS plan is tested for clinical treatment. Methods High simulation inhomogeneous equivalent phantom of human body is used to simulate the typical patient after the operation of left breast cancer. The kay points and other points on behalf of depth to the region of interest with side of the chest wall are marked. Five radiotherapy plans (FIF-IMRT、IMRT、3DCRT、6 MeV-electron beam,9 MeV-electron beam) were designed separately on TPS based on phantom image series. After confirmed, the plans are delivered to the phantom and the dosimetrical quantities are measured. Using analysis of variance test the difference in the five methods. Results FIF-IMRT,IMRT,3DCRT,6 MeV-electron beam,9 MeV-electron beam,Five method actual measured doses respectively:Surface 74.32 cGy,69.21 cGy, 73.97 cGy,75.86 cGy,81.41 cGy (F=3.36,P<0.05);0.5 cm Depth 95.59 cGy,93.37 cGy,96.78 cGy,99.63 cGy,94.97 cGy (F=2.40,P>0.05);1.0 cm Depth 103.42 cGy,102.53 cGy,103.48 cGy,88.89 cGy,101.36 cGy (F=7.19,P<0.05);Nearly chest wall of lung 82.74 cGy,68.24 cGy,85.34 cGy,21.49 cGy,75.02 cGy (F=46.43,P<0.05). Compared to the dose value in TPS, dose delivered to Surface is lower at 8.04%(－6.57% to －11.93%),points at 0.5 cm is lower at 1.95%(2.15% to －5.90%), points at 1 cm ishigher at 0.65%(－2.87% to 3.22%),lung is lower at 3.53%(3.90% to －8.93%). ConclusionsMOSFET detector with the corresponding simulation phantom can be used to measure the actual dose in a portion of body, and to evaluate the dosimetrical characteristics of different radiotherapy techniques. MOSFET detector is suitable for real-time, in vivo measurement of radiation dose during radiotherapy in breast cancer patients, so that the physicians are able to change treatment plan in time to ensure the accuracy of target dose. DOI:10.3760/cma.j.issn.1004-4221.2015.03.026 作者单位:215006 苏州大学附属第一医院放疗科(郭建、秦颂兵、徐晓婷、王利利、詹蔚、陈龙、周菊英);上海交通大学医学院附属苏州九龙医院(蔡晓君) 通信作者:秦颂兵,Email:qin92244@163.com
		2015 Vol. 24 (3): 335-339 [Abstract] ( 3441 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	340	Dosimetry verification of virtual wedge using a two-dimensional ionisation chamber array
		Yu Lang, Yang Bo, Li Nan, Jiang Fei, Qiu Jie, Zhang Fuquan
		Objective To investigate the virtual wedge (VW) dosimetric parameters with the ionization chamber array Matrixx^envlution. Methods Using Matrixx^envlution and solid water to measure and calculate Siemens accelerator′s VW angle and VW factors of different fields and compare the wedge field dose distribution to that of treatment planning system (TPS) by gamma analysis, summarized the measurement results of 50 times. Results The γ pass rate (3 mm/ 3%) of 15°and 30°VW in both direction were (91.47±1.76)%,(92.99±1.54)% and (93.27±1.24)%,(93.27±1.68)%, respectively, with the increase of filed size and the VW angle,but for 20 cm×20 cm field and VW 60°, the result was not very good. The largest angle deviation< 2°except small field size and wedge angle, VW factors were approximately equal to 1,the maximum deviation was no more than 0.05, plan dose distribution and themeasured dose distribution have good consistency except large field with large wedge angle. Conclusions Matrixx^envlution used in the measurement of VW dosimetric parameters which can obtain all parameters for angle calculation and dose plane analysis with only once positioning, and become more rapid, convenient, economical and practical one of quality assurance tools for VW dose verification.
		2015 Vol. 24 (3): 340-342 [Abstract] ( 3268 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	344	Androgen-like effects of Cordyceps sinensis and its impact on the radiosensitivity of VCaP prostate cancer cells
		Ma Mingwei^*, Gao Xianshu, Yu Hongliang, Qi Xin, Sun Shaoqian, Li Xiaoying, Ma Yuanyuan
		Objective To investigate the androgen-like effects of Cordyceps sinensis (CS) and its impact on the radiosensitivity of VCaP prostate cancer cells. Methods The hormone levels and weightindex of reproductive organs in mice were determined after gavage with CS. Clonogenic assay was performed to determine the impact of CS on the radiosensitivity of VCaP cells. The 3-(4, 5-dimethylthiazol-2-yl)-5(3-carboxymethonyphenol)-2-(4-sulfophenyl)-2H-tetrazolium assay, flow cytometry, and tumor xenografts in nude mice were performed to determine the effects of CS on the proliferation of VCaP cells (androgen receptor-positive) and PC-3 cells (androgen receptor-negative) in vitro and in vivo. Serum prostate-specific antigen (PSA) levels in nude mice were evaluated. Data were analyzed by one-way analysis of variance or t-test. Results The testosterone level and weight of prostate in mice were significantly higher in the CS group than in the control group ((8.28±1.94) vs. (2.08±1.24) ng/ml, P=0.023;(0.53±0.04) vs. (0.31±0.04) mg/g, P=0.006). The radiosensitivity enhancement ratio (ratio of D₀ values) was 0.80. The viability of VCaP cells was significantly higher in the CS group than in the control group (1.32±0.07 vs. 0.66±0.02, P=0.000), and colony forming efficiency was significantly enhanced in the CS group than in the control group (57.0%±1.9% vs. 47.0%±0.6%, P=0.005). VCaP tumor xenografts in nude mice were inclined to grow faster in the CS group than in the control group, and the serum PSA level in the CS group was significantly higher than that in the control group ((0.66±0.04) vs. (0.26±0.06) ng/ml, P=0.000). However, CS had no effect on PC-3 cells at the working concentration. Conclusions CS has the androgen-like effects. It may also promote the proliferation and reduce the radiosensitivity of androgen receptor-positive VCaP cells.
		2015 Vol. 24 (3): 344-348 [Abstract] ( 3716 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	349	Effects of 5-azacytidine on radiation-induced epithelial-mesenchymal transition in rat alveolar type Ⅱ epithelial cell line
		Wang Yacheng, Li Xin, Chen Jing, Mei Zijie, Xie Conghua
		Objective To investigate the effects of 5-azacytidine on radiation-induced epithelial-mesenchymal transition in rat alveolar type Ⅱ epithelial cell line (RLE-6TN) and explore their working mechanisms, and to provide experimental evidence for the potential drug-based treatment of radiation-induced pulmonary fibrosis. Methods RLE-6TN cells were cultured in vitro and divided into four groups according to the experimental purposes:control group (C), radiation group (R), 5-azacytidine group (A), and radiation followed by 5-azacytidine group (R+A). The microstructural changes in cells were determined by transmission electron microscopy. Inverted phase-contrast microscopy revealed the morphological changes in cells. The mRNA expression levels of E-cadherin and α-SMA were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The protein expression levels of E-cadherin, GSK3β, and p-GSK3β(Ser9) were measured by Western blot. The one-way analysis of variance was used for pairwise comparison. Results The cells in group R became spindle-like. Similar morphological changes were not observed in cells in group R+A. Osmiophilic lamellar bodies disappeared at last in cells in group R. RT-PCR results showed that compared with group C, group R had a significantly lower mRNA expression level of E-cadherin ((0.23±0.06) vs.(1.00±0.00),P=0.002)) and a significantly higher mRNA expression level of α-SMA ((2.91±0.01) vs.(1.00±0.00),P=0.000)). However, compared with group R, group R+A had a significantly higher mRNA expression level of E-cadherin ((0.47±0.05) vs. (1.00±0.00),P=0.024)) but a significantly lower mRNA expression level of α-SMA ((2.50±0.02) vs.(1.00±0.00),P=0.037)). The results of Western blot showed that the protein expression level of E-cadherin was significantly reduced ((0.07±0.01) vs.(0.48±0.02),P=0.028)), while the proteinexpression level of p-GSK3β was significantly increased in Group R than in Group C ((0.85±0.04) vs.(0.23±0.03),P=0.031)). However, compared with group R, group R+A had a significantly lower protein expression level of E-cadherin ((0.25±0.00) vs.(0.07±0.01),P=0.024)) and significantly less up-regulation of the protein expression level of p-GSK3β((0.39±0.03) vs.(0.85±0.04),P=0.014)). Conclusions X-ray radiation can induce the epithelial-mesenchymal transition in epithelial cells. 5-azacytidine suppresses radiation-induced epithelial-mesenchymal transition by inhibition of the activity of p-GSK3β in RLE-6TN cells.
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