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.4 Published 2015-07-03

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

Thoracic Tumors

	359	A prospective, multicenter, phase II clinical study of three-dimensional radiotherapy with concurrent chemotherapy for stage IV non-small-cell lung cancer—PPRA-RTOG003
		Ma Zhu, Lu Bing, Li Tao, Li Jiancheng, Wang Xiaohu, Lu You, Chen Ming, Bai Yuju, Su Shengfa, Hu Yinxiang, Ouyang Weiwei, Li Qingsong, Li Huiqin, Wang Yu,Zhang Bo
		Objective To investigate the efficacy and safety of three-dimensional radiotherapy (3DRT) with concurrent chemotherapy for stage IV non-small-cell lung cancer (NSCLC). Methods A total of 198 eligible patients from 2008 to 2012 were enrolled as subjects. With an age ranging between 18 and 80 years and a Karnofsky Performance Status (KPS) score of 70 or more, those patients had no contraindication for radiotherapy and chemotherapy, and were newly diagnosed with stage IV NSCLC confirmed by histology or cytology, as well as limited metastatic disease (≤3 organs). Survival rates and acute toxicities in those patients were evaluated. Results The 3-year follow-up rate was 98.5% and the 3-year sample size was 165. The median overall survival (OS) and progression-free survival (PFS) were 13.0 months (95%CI,11.7-14.3 months) and 9.0 months (95%CI,7.7-10.3 months), respectively, while the 1-, 2-, and 3-year OS rates were 53.5%, 15.8%, and 9.2%, respectively. Multivariate analysis showed that a primary tumor volume smaller than 134 cm³, a stable or increased KPS score after treatment, and a radiation dose of 63 Gy or more were independent prognostic factors for longer survival time (P=0.008;P=0.010;P=0.014). The incidence rates of grade 3-4 neutropenia, thrombocytopenia, anemia, grade 3 radiation esophagitis, and grade 3 radiation pneumonitis were 37.9%, 10.1%, 6.9%, 2.5%, and 6.6%, respectively. The maincause of death was distant metastasis, and only 10% of the patients died of recurrence alone. Conclusions 3DRT with concurrent chemotherapy achieves satisfactory treatment outcomes with tolerable toxicities for stage IV NSCLC. Primary tumor volume, change in the KPS score after treatment, and radiation dose are independent prognostic factors for OS.Clinical Trial Registry Chinese Clinical Reistry,registration number:ChiCTRC10001026.
		2015 Vol. 24 (4): 359-363 [Abstract] ( 4017 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	367	The patterns of lymph node metastasis in adenocarcinoma of esophagogastric junction:a reference for target volume delineation in radical radiotherapy
		Wang Jun,Zhang Yanjun,Liu Qing,Guo Yin,Li Na,Wu Yajing,Wang Yi,Cao Feng,Jing Shaowu,Yang Congrong
		Objective To analyze the patterns and distribution of lymph node metastasis in patients with adenocarcinoma of the esophagogastric junction (AEG). Methods The pathological data of 393 patients with AEG from 2006 to 2009 were analyzed. The patterns and distribution of lymph node metastasis were analyzed in patients with different Siewert subtypes, depths of tumor invasion, and maximum diameters of the tumor, and the high-risk lymphatic drainage areas were investigated. Between-group comparison was performed by χ² test. Results The metastatic rate and ratio of abdominal lymph nodes in AEG were 69.2% and 31.31%, respectively. The incidence rates of lymph node metastasis in the cardia, lesser curvature, left gastric artery, splenic artery, splenic hilum, mesenteric root, and abdominal aorta were the highest. The metastatic rate and ratio of mediastinal lymph nodes were 16.4% and 8.3%, respectively. The incidence rates of lymph node metastasis in the lower paraesophageal, esophageal hiatus, and superior diaphragmatic areas were the highest. Compared with Siewert type II and type III AEG, Siewert type I AEG had a significantly higher mediastinal lymph node metastatic rate (P=0.003) and a significantly lower abdominal lymph node metastatic ratio (P=0.002).The metastatic ratios of lymph nodes in multiple abdominal regions were higher in patients with stage T₃+T₄ AEG and a maximum tumor diameter of ≥6 cm than in the control group, while the metastatic ratios of mediastinal lymph nodes in groups with different maximum tumor diameters were similar. The metastatic ratios of lymph nodes in the greater curvature, hepatoduodenal ligament, and inferior diaphragmatic areas were lower than 10% in all groups. Conclusions In radiotherapy for AEG, the abdominal high-risk lymphatic drainage areas involve the cardia, lesser curvature, left gastric artery, splenic artery, splenic hilum, mesenteric root, and abdominal aorta, while the mediastinal high-risk lymphatic drainage areas involve the lower paraesophageal, esophageal hiatus, and superior diaphragmatic areas. In addition, the personalized target volume design should be based on the patterns of lymph node metastasis with different Siewert subtypes and clinical pathological characteristics.
		2015 Vol. 24 (4): 367-370 [Abstract] ( 4364 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	373	A pathological comparative study of diffusion-weighted imaging and computed tomography in determination of lesion length for esophageal carcinoma
		Wang Lan^*,Han Chun,Zhu Shuchai,Shi Gaofeng,Liu Junfeng,Liu Lihong,Wang Qi,Liu Lei,Wang Guangda
		Objective To investigate the accuracy of measurement of lesion length by computed tomography (CT) scan and diffusion-weighted imaging (DWI) for esophageal carcinoma, and to provide an optimized imaging method as a reference for target delineation in esophageal carcinoma. Methods Thirty-five patients with thoracic esophageal carcinoma from 2012 to 2013 were prospectively enrolled as subjects. All patients underwent examinations of esophageal endoscopy, CT scan of the thorax and abdomen, and DWI before radical surgery. Lesion lengths were measured by the above methods and compared with the real length of pathological specimen resected at surgery. The consistency between the lesion length measured by each imaging method and the pathological standard were evaluated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. Results Four patients had no hyperintense signal on DWI, resulting in a false-negative rate of 11% in all patients and a false-negative rate of 44%(4/9) in patients with stage T₁ esophageal carcinoma. Thirty-one patients had lesion lengths measured by DWI for analysis. The tumor length of pathological specimen after surgery was 4.58 cm, while the tumor lengths measured by endoscopy, CT scan, and DWI with b-values of 600, 800, and 1000 s/mm² were 4.56, 5.58, 4.41, 3.99, and 3.83 cm, respectively. The ICC values were 0.703, 0.764, 0.946, 0.890, and 0.882, respectively, with P value of 0.000 for all. According to the results of the Bland-Altman method, the highest degree of consistency was achieved between the tumor lengths measured by endoscopy and DWI with a b-value of 600 s/mm² and the pathological standard. Conclusions The esophageal tumor lengths measured by DWI are close to the real tumor length of the pathological specimen, in which the lesion length measured by DWI with a b-value of 600 s/mm² is most reliable. However, the value of DWI in the early diagnosis of esophageal carcinoma is limited.
		2015 Vol. 24 (4): 373-376 [Abstract] ( 4216 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	364


		2015 Vol. 24 (4): 364-366 [Abstract] ( 2959 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	371


		2015 Vol. 24 (4): 371-372 [Abstract] ( 2483 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	438	The research of IMRT plan optimization on dose limitation of sub regional auditory organ
		Guo Ming,Wamg Shengzi,Wu Zhaoxia,Ma Changming,Wang Lei,Ni Xiaochen,Zhu Feng
		Objective To investigate the effects of reducing the auditory organ dose by limitation of sub regional auditory organ in IMRT plan. Methods Total 223 cases of nasopharyngeal carcinoma patients were divided into group A and group B. In group A, the IMRT plans of 114 patients were designed by limiting overall auditory organ dose. In group B, the IMRT plans of 109 patients were designed by limiting sub regional auditory organ dose. According to the Clinical prescription, the IMRT plans were designed. Paried t-test was difference between groups. Results By comparing the two groups of auditory organ dose, in all stages, the tympanic cavity D_mean average in group B decreased by T₁ vs. 17.7%,T₂ vs. 22.4%,T₃ vs. 15.7% and T₄ vs. 14.2%(P=0.000,0.000,0.000,0.000);cochlea D_mean average decreased by T₁ vs. 11.0%, T₂ vs. 20.1%, T₃ vs. 10.0% and T₄ vs. 9.0%(P=0.004,0.000,0.007,0.036);vestibule D_mean average decreased by T₁ vs. 22.6%, T₂ vs. 31.8%, T₃ vs. 20.6% and T₄ vs. 21.4%, significantly less than in group A (P=0.000,0.000,0.000,0.000). The bony portion of eustachian tube D_mean average in group B decreased were not significantly less than in group A (decreased by 3.4%,6.8%,3.6%,0.1%;P=0.291,0.006,0.155,0.963). Conclusions In IMRT plan, optimization on dose limitation of sub regional auditory organs were used to reduce the auditory organ dose and decrease the radiation damage to auditory organ.
		2015 Vol. 24 (4): 438-441 [Abstract] ( 4127 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	442


		2015 Vol. 24 (4): 442-443 [Abstract] ( 2717 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	444	Comparing different image registration methods in kilovolt cone-beam computed tomography image-guided radiotherapy for liver cancer
		Wang Jianting, Liu Ming, Zhai Fushan, Wang Anfeng, Cao Xiaohui, Bao Chaoen
		Objective To study the methods of matching kilovolt CBCT image with planning CT scan. Methods A total of 121 CBCT scans were matched with planning CT scan using a manual and four automatic match methods by four observers in the offline. In the manual match, the live contour was used as a surrogate for image registration. Four automatic match methods, including routine soft-tissue match, routine bone match, automatic liver match and vertebral body match, were performed using image registration sofeware. First, the stability of the sofeware was tested. Then, the reproducibility of the same automatic match method was evaluated by comparing different observers’ match results. After the manual match by four observers, the mean of the match results was used as a standard to compare with others. The differerces was test by McNemar method. Results In the uniform match factors, automatic match result would not change. The reproducibility of routine soft-tissue and bone match are best, automatic vertebral body match is better than automatic liver match. Howerver, the automatic liver match result is the most similar to manual match, the percentages of match result have an absolute error no more than 3 mm in left-right, superior-inferior and anterior-posterior directions are 84.3%, 77.7% and 92.6%. Conclusions Automatic liver match can be used in image-guided radiotherapy for liver cancer, however, it should be performed by experienced oncologist and technologist together in each fraction, after that, the matching result should be adjusted carefully according to live contour.
		2015 Vol. 24 (4): 444-448 [Abstract] ( 3985 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	449	The technique and development of total skin electron irradiation—Taiwan experiences
		Wu Jiaming^*,Ye Shian,Ren Yimin
		Objective The aim of this study is to present two novel technique-Lying on position and rotational board TSEI in which uniform dose to the whole body as well as the soles and vertex of scalp can be achieved in one electron beam treatment fraction. Methods Patients are treated with two groups in prone and supine position by leaning on inner rotational board in prone and supine position, each group can further be separated into two subgroup with tilting and rotation positions for treatment. By incorporating all these setting on the aswirl board with the optimal gantry angle, the patient will final accumulate compensated dosages on whole body surface. Results The dose uniformity for the rotational board-TSET or Lying on position could be control within ±10%. Conclusions The two TSEItechnique-Lying on and Rotational board TSEI techniques presented in this study is able to deliver a uniform dose to the patient’s skin surface as well as to the vertex and the soles all in one time, eliminating the troubles of having to further boost fields for these two regions when using the Stanford Six Field Technique.
		2015 Vol. 24 (4): 449-453 [Abstract] ( 3540 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	454	The effect of the shrinkage of thermoplastic mask on patient positioning
		Zhang Yin, Dai Jianrong,Li Minghui,Fu Guishan
		Objective This study analyzes the effect of the shrinkage of thermoplastic mask on patient positioning. Methods Design of the two test. Test 1:thermoplastic film shrinkage test. Get some thermoplastic film by the size of 10 cm×5 cm, extrude it at a certain rate after heated. Measure the length of thermoplastic film on different time, and calculate the contraction. Test 2:phantom test. Take advantage of head and neck phantom, and simulate the procedure that from making mask for patients to radiation therapy. Measure the off set of isocenter which caused by the contraction of thermoplastic mask. Results The largest shrinkage of thermoplastic had happened in 20 minutes. Different tensile ratio had little effect on the shrinkage. The offset of isocenter which caused by the shrinkage of thermoplastic mask were:LR (－0.1±0.3) mm,SI (－0.2±0.2) mm, AP (0.6±0.4) mm,respectively. There was little change in the course of six weeks (P=0.185-0.961). Conclusions The cooling time should be more than 20 minutes, when making a mask for the patient. The setup errors which caused by the shrinkage of thermoplastic mask is at an acceptable level on this premise.
		2015 Vol. 24 (4): 454-456 [Abstract] ( 4085 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	457	Investigation of CT numbers correction of kilo-voltage cone-beam CT images for accurate dose calculation
		Wang Xuetao^*, Bai Sen, Li Guangjun, Jiang Xiaoqin, Su Chen, Li Yanlong, Zhu Zhihui
		Objective To study CT numbers correction of kilo-voltage cone-beam CT (KV-CBCT) images for dose calculation. Method Aligning the CBCT images with plan CT images, then obtain the background scatter by subtracting CT images from CBCT images. The background scatter is then processed by low-pass filter. The final CBCT images are acquired by subtracting the background scatter from the raw CBCT. KV-CBCT images of Catphan600 phantom and four patients with pelvic tumors were obtained with the linac-integrated CBCT system. The CBCT images were modified to correct the CT numbers. Finally, compare HU numbers between corrected CBCT and planning CT by paired T test. Evaluate the image quality and accuracy of dose calculation of the modified CBCT images. Results The proposed method reduces the artifacts of CBCT images significantly. The differences of CT numbers were 232 HU, 89 HU, 29 HU and 66 HU for air, fat, muscle and femoral head between CT and CBCT respectively (P=0.39,0.66,0.59,1).The differences of CT numbers between CT and CBCT was reduced to within 5 HU. And the error of dose calculation with corrected CBCT images was within 2%. Conclusions The CT numbers of corrected CBCT are similar with plan CT images and dose calculations based on the modified CBCT show good agreement with plan CT.
		2015 Vol. 24 (4): 457-461 [Abstract] ( 4101 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	462	Real-time patient transit dose verification of volumetric modulated arc therapy by a 2D ionization chamber array
		Liu Xiao^*, Wang Yunlai, Ju Zhongjian, Xu Wei, Jin Liyuan
		Objective To study the real-time dose verification with 2D array ion chamber array in volumetric modulated arc therapy (VMAT) with a 2D array ion chamber array. Methods The 2D ion chamber array was fixed on the panel of electronic portal imaging device (EPID). Source-detector distance (SDD) was 140 cm. 8 mm RW3 solid water was added to the 2D array to improve the signal noise ratio. Patient plans for esophageal, prostate and liver cancers were selected to be delivered on the cylindrical Cheese phantom 5 times in order to validate the reproducibility of doses. Real-time patient transit dose measurements were performed at each fraction. Dose distributions were evaluated using gamma index criteria of 3 mm DTA and 3% dose difference referred to the first time result. Results The gamma index pass rate in the Cheese phantom were about 98%;the gamma index pass rate for esophageal, prostate and liver cancer patient were about 92%, 92% and 94%, respectively. Gamma pass rate for all single fraction were more than 90%. Conclusions The 2D array is capable of monitoring the real time transit doses during VMAT delivery. It is helpful to improve the treatment accuracy.
		2015 Vol. 24 (4): 462-465 [Abstract] ( 3601 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	466	A study of radiosensitizing effect of PKM2 silencing in lung adenocarcinoma cells and xenografts
		Wang Huanhuan, Zeng Xianliang,Meng Maobin, Qian Dong,Ying Guoguang, Zhao Lujun, Yuan Zhiyong, Wang Ping
		Objective To investigate the impacts of pyruvate kinase M2 isoform (PKM2) silencing on the radiosensitivity of lung adenocarcinoma cell line (A549 cells) and the radiation synergy of xenografts, and to explore their mechanisms. Methods Plasmid pshRNA-PKM2 for interference with PKM2 expression was transfected into A549 cells, and empty vector-transfected cells and untransfected cells were set as controls. The silencing efficiency of pshRNA-PKM2 and the expression level of microtubule-associated protein 1 light chain 3(LC3) were measured by Western blot assay. The radiosensitizing effects in A549 cells and xenografts after PKM2 silencing were determined by colony-forming assay and xenografts growth curves. Autophagy formation in A549 cells and xenografts was analyzed by transmission electron microscopy, and the expression level of PKM2 in xenografts was measured by immunohistochemistry. Comparison between groups was made by Student′s t-test, and the body weights of nude mice and xenograft volumes were subjected to analysis of variance for continuous variables. Results Stable A549 cell lines transfected with pshRNA-PKM2 were successfully produced. Transfection with pshRNA-PKM2 significantly down-regulated PKM2 expression in A549 cells and xenografts (P=0.001;P=0.000). The sensitizer enhancement ratios for A549 cells and xenografts were 1.47 and 2.00, respectively. Interference with PKM2 expression enhanced radiation-induced autophagy formation and significantly increased the ratio of LC3-II/I (P=0.0001). ConclusionsSilencing of PKM2 expression may enhance the radiosensitivity of A549 cells and xenografts by regulation of autophagy, which holds promise for becoming an effective radiosensitizing target for non-small cell lung cancer, but still needs to be confirmed by further studies.
		2015 Vol. 24 (4): 466-470 [Abstract] ( 3623 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	471	Effect of 17-allylamino-17-demethoxygeldanamycin on radiosensitivity of human lung cancer cell line
		Wang ye^*,Xue Lian,Yu Dong
		Objective To study the radiosensitizing effect of 17-allylamino-17-demethoxygeldana- mycin(17-AAG) on human non-small cell lung cancer cell line (A549 cells), and to investigate its possible mechanism. Methods The growth inhibition effect of 17-AAG on A549 cells was determined using the MTT assay. The radiosensitizing effect of the drug on cells was analyzed using the multi-target single-hit model fitting the colony survival curve. The impacts of the drug on cell aging and DNA damage repair were evaluated using β-galactosidase staining and γ-H2AX immunofluorescence, respectively. Between-group comparison was performed by paired t test or analysis of variance. Results The suppression of cell proliferation by 17-AAG was both dose-dependent and time-dependent (P=0.01-0.05). The radiation group treated with the drug had a lower colony forming efficiency than the radiation-only group. When 50 nmol/L 17-AAG was applied, the radiosensitivity enhancement ratios were 1.79(the ratio of D₀ values) and 2.30(the ratio of D_q values), respectively. The percentage of senescent cells at 72 hours after exposure was significantly higher in cells exposed to the drug and radiation of 4 Gy X-ray than in the drug-only group (30.48% vs. 9.18%, P=0.00) or in the radiation-only group (30.48% vs. 12.30%, P=0.00). Immunofluorescent staining showed that 17-AAG delayed the DNA damage repair. Conclusions17-AAG has growth inhibition and radiosensitizing effects on human lung cancer A549 cells. Induction of cell aging and delay of DNA damage repair may be involved in the radiosensitizing mechanism.
		2015 Vol. 24 (4): 471-473 [Abstract] ( 3476 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	377	Preliminary results of a phase Ⅱ prospective clinical study of early-stage nasal NK/T-cell lymphoma with extended involved-field intensity-modulated radiotherapy
		Niu Shaoqing^*, Zhang Yujing, Wen Ge, Li Yiyang, Feng Lingling,Wang Hanyu,Wen Bixiu
		Objective To investigate the feasibility of the scheme of target volume delineation with extended involved-field intensity-modulated radiotherapy (IMRT) for patients with early-stage nasal NK/T-cell lymphoma (NC-NKTL). Methods Twenty-one patients with stage I_{E-II_E NC-NKTL were treated with short-course chemotherapy combined with radiotherapy from 2011 to 2013. The majority of patients received the GELOX regimen. All patients received extended involved-field IMRT with a dose of 54.6 Gy in 26 fractions for gross tumor volume, 50.7 Gy in 26 fractions for high-risk clinical target volume (CTV), and 45.5 Gy in 26 fractions for low-risk CTV. The dose distribution, short-term treatment outcomes, and adverse reactions were analyzed. Results The 2-year sample size was 12. The 2-year follow-up rate was 100%. The 2-year local control rate (LRC) was 100%. The 2-year overall and progression-free survival rates were 90.5% and 90.5%, respectively. The median coverage rates of planning target volumes with 90% of the prescribed doses of 54.6 Gy, 50.7 Gy, and 45.5 Gy were 99.8%, 99.6%, and 99.7%, respectively. No grade 3 or 4 adverse reactions were observed in patients. Conclusions The scheme of target volume delineation and dose configuration in our study not only achieves excellent target volume coverage, but also reduces adverse reactions in patients, which achieves a 2-year LRC ideal for patients with early-stage NC-NKTL.}
		2015 Vol. 24 (4): 377-381 [Abstract] ( 4145 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	382	Clinical outcome and prognosis of Waldeyer’s ring diffuse large B-cell lymphoma:an analysis of 200 patients
		Xu Yonggang,Li Yexiong,Wang Weihu, Jin Jing, Wang Shulian, Liu Yueping, Song Yongwen, Ren Hua, Fang Hui, Liu Qingfeng, Wu Runye, Qi Shunan, Chen Bo
		Objective To evaluate the clinical features, treatment outcome, and prognostic factors in patients with primary Waldeyer’s ring diffuse large B-cell lymphoma (WR-DLBCL). Methods This study included 200 patients with a confirmed diagnosis of primary WR-DLBCL admitted to our hospital from 2000 to 2013, who consisted of 50 stage I patients, 125 stage II patients, and 25 stage III-IV patients. Most patients received 4-6 cycles of CHOP or CHOP-based chemotherapy with or without involved field radiotherapy (Waldeyer′s ring+cervical lymph node region). Results The 5-year sample size was 71. The 5-year overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) rates for the whole group were 78%, 72%, and 87%, respectively. In the 175 early stage patients, chemoradiotherapy resulted in significantly higher OS, PFS, and LRC than chemotherapy alone (86% vs. 70%, P=0.001;84% vs. 58%, P=0.000;97% vs. 66%, P=0.000).Univariate analysis showed that age, tumor size, stage, lactate dehydrogenase level, and International Prognostic Index were prognostic factors for OS, PFS, and LRC (P=0.000-0.036), while the prognostic factors for PFS also included Eastern Cooperative Oncology Group score and cervical nodal involvement (P=0.018). Multivariate analysis showed that age and stage were prognostic factors for OS and LRC (P=0.003-0.022), and age was the prognostic factor for PFS (P=0.000). Conclusions WR-DLBCL has distinct clinical features and favorable prognoses. For early stage patients, combined-modality therapy results in significantly higher OS, PFS, and LRC.
		2015 Vol. 24 (4): 382-386 [Abstract] ( 4310 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	387	Value of postoperative adjuvant radiotherapy for pT₃N₀ rectal cancer
		Wang Yu,Chen Shu,Wu Shenghong,Chen Luchuan,Bai Penggang,Wu Junxin,Pan Jianji
		Objective To evaluate the value of adjuvant radiotherapy after radical resection for pT₃N₀ rectal cancer. Methods The clinical data of 125 patients with pT₃N₀ rectal cancer who were diagnosed and given total mesorectal excision in our hospital from 2003 to 2010 were retrospectively analyzed. All patients received postoperative adjuvant chemotherapy, while 40 out of them received postoperative adjuvant radiotherapy in addition. Survival rates were estimated using the Kaplan-Meier method, and univariate prognostic analysis was performed using the log-rank test. Multivariate analysis of influencing factors for local recurrence (LR) rate was performed using the Cox regression model. Results The 5-year sample size was 35. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 82.3% and 72.4%, respectively. There was no significant difference in the 5-year OS rate between the postoperative chemoradiotherapy group and the postoperative chemotherapy group (72% vs. 83%, P=0.911). Multivariate analysis suggested that the number of lymph nodes and perirectal fat infiltration were independent prognostic factors for LR rate (P=0.045;P=0.021). There was no significant difference in LR rate between the low-risk group (no high-risk factors) and the high-risk group (the number of high-risk factors ≥1)(2.5% vs. 11.8%, P=0.060). Conclusions Postoperative radiotherapy cannot improve the OS and LR rates for pT₃N₀ rectal cancer without any high-risk factors. The value of postoperative adjuvant radiotherapy for pT₃N₀ rectal cancer needs further evaluation.
		2015 Vol. 24 (4): 387-391 [Abstract] ( 4003 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	392	Clinical efficacy of CyberKnife radiotherapy for locally advanced pancreatic carcinoma
		Song Yongchun, Yuan Zhiyong, Li Fengtong, Dong Yang, Zhuang Hongqing, Wang Jingsheng, Chen Huaming, Wang Ping
		Objective To assess the efficacy and safety of CyberKnife radiotherapy in the treatment of locally advanced pancreatic carcinoma. Methods The data of 59 patients with locally advanced pancreatic carcinoma who were treated with CyberKnife radiotherapy from 2006 to 2014 were retrospectively analyzed. The tumor volume ranged from 13.0 cm³ to 125.1 cm³ with a median value of 27.1 cm³. A dose of 35-50 Gy (median value=45 Gy) in 3-8 fractions (median value=5 fractions) was prescribed. The tumor progression was evaluated based on computed tomography. The overall survival (OS) and local progression-free survival (LPFS) rates were calculated using the Kaplan-Meier method. Results The 1-and 2-year sample sizes were 26 and 17, respectively. The 1-and 2-year OS rates were 54% and 35%, respectively, while the 1-and 2-year LPFS rates were 91% and 70%, respectively. The median OS and LPFS times were 12.5 and 10.9 months, respectively. The overall incidence of grade 1-2 acute and late gastrointestinal toxicity was 61%. One patient with grade 3 late gastrointestinal toxicity had incomplete intestinal obstruction. Conclusions CyberKnife radiotherapy can achieve excellent treatment outcomes and mild complications in the treatment of locally advanced pancreatic carcinoma.
		2015 Vol. 24 (4): 392-394 [Abstract] ( 3690 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	395	A study of changes in volume and location of target areas and organs at risk in intensity-modulated radiotherapy for cervical cancer
		Chen Jianwu^*,Liu Ping,Chen Wenjuan,Bai Penggang,Li Jiangshan,Ni Xiaolei,Chen Kaiqiang,Li Qixin
		Objective To investigate the changes in volume and spatial location of target areas and normal tissues before and during intensity-modulated radiotherapy (IMRT) for cervical cancer by quantitative means. Methods Forty patients with cervical cancer who were treated with IMRT were enrolled as subjects. Computed tomography (CT) was performed before IMRT and during IMRT when a dose of 27 Gy (15 fractions) was reached. Clinicians delineated the target areas and organs at risk in the two groups of CT images. The target areas and organs at risk in one group of images were mapped to the other group of CT image by image registration using the Pinnacle treatment planning system. Volume changes in target areas and organs at risk were analyzed, and changes in the spatial location were evaluated by volume difference method and Dice similarity method. Comparison was made by paired t-test. Results There were significant differences in gross target volumes of primary tumor lesions(GTV-T) and pelvic metastatic lymph nodes (GTV-N) before and during IMRT (P=0.000;P=0.000). According to the evaluation by volume difference method, the average rate of change in GTV-T was (38.64±19.50)% with a range between 3.16% and 86.49%, while the average rate of change in GTV-N was (42.49±25.68)% with a range between 2.79% and 87.42%. In the organs at risk, the bladder had the maximum rate of volume change, the average of which was (55.13±33.40)% with a range between 3.25% and 116.01%. According to the evaluation by Dice similarity method, the average Dice similarity coefficient for GTV-T was 0.50±0.18 with a range between 0.10 and 0.85, while the average Dice similarity coefficient for GTV-N was 0.31±0.20 with a range between 0.00 and 0.71. The rectum had the minimum Dice coefficient in the organs at risk, theaverage of which was 0.57±0.14 with a range between 0.18 and 0.76. Conclusions For patients with cervical cancer to receive IMRT, since there are substantial changes in volume and spatial location of target areas and normal tissues before and during treatment, it is quite necessary to modify the treatment regimen in time in order to provide adequate doses for target areas and avoid overdose for organs at risk.
		2015 Vol. 24 (4): 395-398 [Abstract] ( 4049 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	400	Paired observation of californium-252 neutron intraluminal brachytherapy combined with external-beam radiotherapy with and without lead shielding for cervical cancer
		Dai Zhuojie,Lei Xin,Chen Yonghong,Liu Jia
		Objective To compare the efficacy between californium-252(²⁵²Cf) neutron intraluminal brachytherapy combined with external-beam radiotherapy with lead-shielding pelvic parallel opposing field technique and non-lead-shielding four-field box technique for cervical cancer. Methods A total of 52 patients with stage Ⅱ_{a-Ⅲ_{b cervical squamous cell carcinoma who were admitted to our hospital from 2004 to 2007 were enrolled as subjects and paired by clinical stage, age, tumor size, and degree of anemia. The 26 pairs of patients were divided into lead-shielding pelvic parallel opposing field group (lead-shielding group) and non-lead-shielding four-field box group (non-lead-shielding group). For all patients in both groups, ²⁵²Cf neutron brachytherapy was added in external-beam radiotherapy. The local control (LC), overall survival (OS), and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The difference in the incidence of late complications was analyzed using the McNemar method. Results There were significant differences in 5-year LC, OS, and DFS rates between the lead-shielding group and the non-lead-shielding group (85% vs. 81%, P=0.014;89% vs. 73%, P=0.013;89% vs. 73%, P=0.013). There was also significant difference in the incidence of late complications between the lead-shielding group and the non-lead-shielding group (12% vs. 23%, P=0.008). Conclusions When intraluminal brachytherapy combined with external-beam radiotherapy is used to treat cervical cancer, the centers of the front and back fields should be shielded by lead, regardless of whether the parallel opposing field technique or the four-field box technique is used.}}
		2015 Vol. 24 (4): 400-402 [Abstract] ( 4070 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	408	A comparative study of CT-and MRI-based three-dimensional conformal brachytherapy for locally advanced cervical cancer
		Zhu Yonggang, Zhao Hongfu, Cheng Guanghui, He Mingyuan, Shi Dan, Zhao Zhipeng
		Objective To compare target volume and dosimetry between computed tomography (CT)-and magnetic resonance imaging (MRI)-guided three-dimensional (3D) conformal brachytherapy for locally advanced cervical cancer, and to provide evidence for optimization of the image-guided approach and improvement of treatment regimen. Methods Thirteen patients with locally advanced cervical cancer who were treated with radical radiotherapy in our hospital in 2014 were enrolled as subjects. All patients received MRI-guided 3D conformal intracavitary/interstitial brachytherapy. All patients received MRI and CT scans for each brachytherapy fraction, based on which the target volume delineation, intracavitary/interstitial regimen design, and intracavitary-only treatment regimen design were performed. Comparison of data between MRI and CT scans was performed using paired t test. Results The width and volume of the high-risk clinical target volume (HR-CTV) were significantly smaller in the MRI simulation than in the CT simulation ((38.0±9.4) mm vs. (45.1±8.7) mm, P=0.000;(34.2±15.3) cm³ vs. (42.9±20.4) cm³, P=0.002), and the width, thickness, and volume of the intermediate-risk clinical target volume (IR-CTV) were also significantly smaller in the MRI simulation than in the CT simulation ((58.8±9.4) mm vs. (65.4±10.3) mm, P=0.000;(34.8±6.3) mm vs. (37.5±6.3) mm, P=0.001;(90.9±28.5) cm³ vs. (109.0±36.4) cm³, P=0.000). The D₉₀ values for HR-CTV and IR-CTV were significantly higher in the MRI simulation than in the CT simulation (87.6 Gy vs. 85.8 Gy, P=0.013;67.7 Gy vs. 66.3 Gy, P=0.005), while the average D_{2 cm³} values for the bladder and rectum were significantly lower in the MRI simulation than in theCT simulation (73.1 Gy vs. 75.5 Gy, P=0.011;61.0 Gy vs. 65.7 Gy, P=0.000). ConclusionsCompared with the MRI simulation, the CT simulation overestimates the width of target volume. MRI has substantial advantages in dosimetry for target volume and normal tissues. The intracavitary/interstitial treatment can make up the reduced dose for the target volume resulting from the CT simulation.
		2015 Vol. 24 (4): 408-412 [Abstract] ( 3981 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	399


		2015 Vol. 24 (4): 399-399 [Abstract] ( 1697 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review

	403


		2015 Vol. 24 (4): 403-407 [Abstract] ( 2699 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	413


		2015 Vol. 24 (4): 413-416 [Abstract] ( 2595 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	417	A multicenter, prospective, randomized study of intensity-modulated radiotherapy combined with different chemotherapy regimens for locally advanced nasopharyngeal carcinoma
		Deng Lin^*,Wang Rensheng,Wu Fang,Tang Chunyuan,Feng Guosheng,Li Guisheng,Liu Meilian,Yan Haolin
		Objective To evaluate the efficacy and toxicity of induction chemotherapy with nedaplatin and docetaxel plus concurrent intensity-modulated radiotherapy (IMRT) with nedaplatin or cisplatin in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods A total of 223 patients with pathologically diagnosed locally advanced NPC in five treatment centers from 2011 to 2012 were randomly divided into two groups. In the test group, one hundred and thirteen patients received two cycles of induction chemotherapy with docetaxel (65 mg/m² on day 1) and nedaplatin (80 mg/m² on day 1) plus concurrent IMRT with nedaplatin (40 mg/m² on day 1). In the control group, 110 patients received two cycles of induction chemotherapy with the same regimens plus concurrent IMRT with cisplatin (40 mg/m² on day 1). The survival rates were calculated with the Kaplan-Meier method and the differences in the survival rates between the two groups were analyzed using the log-rank test. Comparison of the incidence rates of adverse reactions between the two groups was made by the chi-square test. Results The follow-up rate was 99.1%.The response rates at 3 months after treatment in the two groups were both 100%. The 2-year local recurrence-free, regional recurrence-free, distant metastasis-free, and overall survival rates were 94.0%, 94.2%, 88.2%, and 90.3%, respectively, in the test group, versus 93.4%, 94.1%, 86.7%, and 87.3% in the control group (P=0.757、0.478、0.509、0.413). The incidence rates and severity of leucopenia, neutropenia, and thrombocytopenia were significantly higher in the test group than in the controlgroup (P=0.027,0.028,0.035). The incidence rates and severity of hemoglobin reduction and nausea/vomiting were significantly lower in the test group than in the control group (P=0.000,0.023). There were no significant differences in the incidence rates of mucositis and xerostomia between the two groups (P=0.483,0.781). Conclusions The short-term efficacy of induction chemotherapy with nedaplatin and docetaxel plus concurrent IMRT with nedaplatin is similar to that with cisplatin in the treatment of locally advanced NPC. The mild gastrointestinal reactions can be tolerated by patients. However, the severe myelosuppression should be closely monitored during the treatment.
		2015 Vol. 24 (4): 417-420 [Abstract] ( 4224 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	421	Post-treatment prognostic score model establishment and stratified therapy for newly diagnosed metastatic nasopharyngeal carcinoma
		Lan yuhong^*, Tian Yunming, Bai Li, Zeng Lei, Xiao Weiwei, Lu Taixiang, Han Fei
		Objective To establish a post-treatment prognostic score model for newly diagnosed metastatic nasopharyngeal carcinoma, and to investigate the feasibility of stratified therapy. Methods A total of 263 eligible patients with newly diagnosed metastatic nasopharyngeal carcinoma from 2002 to 2010 were enrolled as subjects. The primary tumor was treated with conventional radiotherapy, three-dimensional conformal radiotherapy, or intensity-modulated radiotherapy, and radiation areas included nasopharyngeal tumor and cervical lymphatic drainage region. The metastatic bone tumor was mainly treated with conventional external radiotherapy, while the metastatic liver or lung tumor was mainly treated with surgical resection, radiotherapy, or radiofrequency ablation. The first-line therapy for most of patients was cisplatin-based combination chemotherapy. Factors including the general characteristics, tumor status, and therapy for patients were involved in multivariate analysis, and a prognostic model was established based on the n value (HR=eⁿ) of the prognostic factors. Results The factors influencing the overall survival (OS) in patients were a Karnofsky performance score (KPS) not higher than 70(P=0.00), multiple organ metastases (P=0.00), combination with liver metastasis (P=0.00), a number of metastases not less than 2(P=0.00), a level of lactate dehydrogenase (LDH) higher than 245 IU/L (P=0.00), a number of chemotherapy cycles ranging between 1 and 3(P=0.00), a poor response for metastatic tumor (stable disease or progressive disease)(P=0.00), and primary tumor not treated with radiotherapy (P=0.01). Based on the prognostic score, patients were divided into low-risk group (0-1.5 points), intermediate-risk group (2.0-6.5 points), and high-risk group (≥7.0 points), and the 5-year OS rates in the three groups were 59.0%, 25.1%, and 0%, respectively. Conclusions The prognosticscore model based on the KPS, serum level of LDH, multiple organ metastases, combination with liver metastasis, and number of metastases can effectively predict the survival in patients. Active treatment including at least 4 chemotherapy cycles and radiotherapy for primary tumor can prolong the survival time of patients in the low-and intermediate-risk groups. However, patients in the high-risk group were mainly treated with palliative radiotherapy due to no improvement in the survival by radiotherapy for primary tumor.
		2015 Vol. 24 (4): 421-426 [Abstract] ( 4332 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	427	The role of transoralsonography guiding fine-needle aspiration biopsy in the diagnosis of retropharyngeal or parapharyngeal masses identified on the images of treated patients with malignant carcinoma
		Zhang Youwang^*, Huang Yafang, Ying Hongmei, Kong lin, Wu Yongru, Du Chengrun, Hu Chaosu
		Objective To investigate the role of transoralsonography guiding fine-needle aspiration biopsy in the diagnosis of retropharyngeal or parapharyngeal masses identified on the CT, MRI or PET-CT images of treated patients with malignant carcinoma. Methods From 2002 to 2013,this study recruited fifty-five patients with a history of cancer, of which 50 were treated with radiation treatment, including 46 nasopharyngeal carcinoma, 3 esophagus squamous cell carcinoma and1 lung apex carcinoma. There were 4 patients with a history of 1 thyroid papillary carcinoma, 1 buccal mucosa squamous cell carcinoma,1 glottis squamous cell carcinoma and 1 sigmoid colon adenocarcinoma treated with surgery. The rest one patient with nasal olfactory neuroblastoma was treated by postoperative radiation. The enlarged retropharyngeal lymph nodes in 44 cases and parapharyngeal masses in 10 cases were identified on CT or MRI imges. The enlarged retropharyngeal lymph node in the rest case was identified on PET-CT. With transoral ultrasound examination, all lesions were with hypo-intensity echo. Cystic areas were noted on occasion. Biopsy was performed in all cases. Results After cytology examination, carcinoma cells were detected in 37 retropharyngeal lymph nodes, with a detection rate of 82%(37/45). In the 10 parapharyngeal masses, carcinoma cells were detected in 3 lesions, with a detection rate of 30%. Conclusions Transor alsonography guiding fine-needle aspiration biopsy can be useful in the cytopathology diagnosis of retropharyngeal or parapharyngeal masses identified on the CT, MRI or PET-CT images of treated patients with malignant carcinoma,which facilitates, early diagnosis and treatment for patients.
		2015 Vol. 24 (4): 427-430 [Abstract] ( 3021 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	431	Safety analysis of Intensity-modulated radiation therapy of glioblastoma with simultaneous integrated boost technique
		Wang Zheng^*,Jiang Wei,Pang Qingsong,Wang Ping
		Objective To investigate clinical efficacy of simultaneous integrate boost for glioblastoma with intensity-modulated radiotherapy (SIB-IMRT). Methods A total of 46 patients with glioblastoma who underwents SIB-IMRT from January 2013 to August 2014,were retrospectively analyzed. Toxicity after completion of SIB-IMRT were assessed. Kaplan-Meier method was used to analyze survival and progression-free survival. Multivariate analyses were performed to determine significant prognostic factors. Results There was no patients delayed by more than grade 3 radiation toxicity. The median overall survival and 1-year survival rates was 69 weeks and 73%,respectively. The progression free survival and 1-year progression-free survival rate were 43 weeks and 39%,respectively. The pattern of failure was identical (9 Local, 7 distant and 0 marginal recurrence). Multivariate analyses show that temozolomide concurrent chemoradiotherapy were independent factors correlated to prognosis. Conclusions The preliminary results demonstrate that SIB-IMRT for glioblastoma appear to be effective and safe. With the limted number of patients in this group,SIB-IMRT could be used for treating glioblastoma with caution,which deserves further study.
		2015 Vol. 24 (4): 431-433 [Abstract] ( 3798 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	434	Preliminary efficacy of bevacizumab for cerebral radiation necrosis
		Pan Mianshun, Li Yong, Qiu Shujun,Chen Lei,Shao Xianjun,Zhang Li, Zhang Guoyu, Zhuge Fenghua
		Objective To evaluate the preliminary clinical efficacy of bevacizumab for cerebral radiation necrosis (CRN). Methods Nineteen patients with CRN for whom the treatment with steroids and mannitol failed were retrospectively analyzed with a total of 22 lesions. Except for 5 lesions confirmed by pathological evidence, all lesions were confirmed by the following imaging evidence:1. computed tomography (CT)-or magnetic resonance imaging (MRI)-enhanced lesions showed loss of tension and were accompanied by substantial edema;2. CT-or MRI-enhanced lesions had a low perfusion pressure;3. magnetic resonance spectroscopy indicated that the enhanced areas had a decreased choline peak;4. positron emission tomography showed that the fluorodeoxyglucose uptake was substantially reduced in the enhanced areas. All patients were given 5 mg/kg bevacizumab at an interval of 14 days for 2-6 cycles. MRI examination was performed in each cycle before treatment, and the enhanced lesions on T₁-weighted images (T₁WI) and edema on T₂-weighted images (T₂WI) were compared before and after treatment. The clinical symptoms, Karnofsky Performance Status (KPS), and adverse reactions in all patients were evaluated. Comparison before and after treatment was performed by paired t test. Results All 19 patients completed the treatment successfully and there were no severe adverse reactions. The clinical symptoms of patients were substantially improved after the second cycle of treatment, and the KPS score increased by 26.8 on average. The visible volume of enhanced lesions on MRI T₁WI was significantly reduced by 54.8% after treatment (P=0.000), while the visible volume of edema on MRI T₂WI was reduced by 80.7% after treatment (P=0.000). The follow-up time ranged from 3 to 12 months with a mean value of 5.6 months. Eleven patients kept clinical improvement in CRN, four patients had recurrence, and four patients died from tumor progression. Conclusions Bevacizumab is preliminarily confirmed to substantially improve the clinical symptoms and quality of life in patients with CRN.
		2015 Vol. 24 (4): 434-437 [Abstract] ( 4105 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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