Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2016 Vol.25 Issue.2 Published 2016-02-15

	93	The brief history of radiation oncology in Taiwan
		Wu Jiaming
		We can look back by means of the development history of equipment,members and technology for giving readers a clear and a general scheme and a better understanding of the establishment and development of the brief history of radiation oncology in Taiwan. This article is not also to give publicity and recognition to Taiwan radiation oncology sociality,but also provide the opportunity for further communication and development in this field between main land China,Hong Kong and Taiwan.
		2016 Vol. 25 (2): 93-94 [Abstract] ( 2902 ) [HTML 1KB] [ PDF 337KB] ( 0 )

	95	Patterns of local-regional failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma
		Kong Fangfang,Ying Hongmei,Huang Shuang,Du Chengrun,Zhou Junjun,Chen Junchao,Chen Xiaohui,Sun Lining,Hu Chaosu
		Objective To investigate the dosimetric patterns of local-regional failure after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC), and to provide a clinical basis for further improvement in the therapeutic effect for NPC. Methods The patterns of local-regional failure in 364 previously untreated NPC patients without distant metastasis who were admitted to our hospital from December 2007 to April 2012 were analyzed. The failures were classified as “in-field failure” if V_recur within the 95% isodose curve (V_95%) was ≥95%, “marginal failure” if V_95% was less than 95% and not less than 20%, or “out-field failure” if V_95% was<20%. The Kaplan-Meier method was used to calculate survival rates. Results The median follow-up was 40 months (range 3-84 months). The 3-year local failure-free survival, regional failure-free survival, distant metastasis-free survival, overall survival, and progression-free survival were 94.1%, 95.4%, 86.5%, 90.9%, and 78.7%, respectively. A total of 35 patients experienced local-regional recurrence, and in-field recurrence, marginal recurrence, and out-field failure accounted for 81.1%, 8.1%, and 10.8%, respectively. Conclusions In-field failures are the main dosimetric patterns of local-regional recurrence after IMRT for NPC, suggesting that radiation resistance of tumor cells is an important reason for local-regional failure.
		2016 Vol. 25 (2): 95-99 [Abstract] ( 2808 ) [HTML 1KB] [ PDF 357KB] ( 0 )

	100	Therapeutic effects of various surgical procedures combined with radiotherapy in treatment of Kadish stage B/C esthesioneuroblastoma
		Yin Zhenzhen,Gao Li,Luo Jingwei,Yi Junlin,Huang Xiaodong,Wang Kai,Qu Yuan,Zhang Shiping,Li Suyan,Xiao Jianping,Xu Guozhen
		Objective To investigate the therapeutic effects of various surgical procedures combined with radiotherapy in treatment of esthesioneuroblastoma. Methods The clinical data of 53 patients with locally advanced esthesioneuroblastoma who underwent surgery combined with radiotherapy in our hospital were analyzed retrospectively, and the tumor resection rate and therapeutic effect were compared between various surgical procedures. Percentages were compared using the chi-square test. The survival data were estimated using the Kaplan-Meier methods. Results The median follow-up was 70 months, and the 5-year overall survival and disease-free survival were 86% and 74%, respectively. The patients were divided into the open surgery group with 31 patients and the endoscopic surgery group with 22 patients. The endoscopic surgery group had a higher residual tumor rate than the open surgery group (64% vs. 42%,P=0.166), and the patients with Kadish stage C disease in the endoscopic surgery group had a residual tumor rate of 78%. The 5-year overall survival and disease-free survival for patients with a complete tumor resection and those with residual tumor were 91% vs. 80% and 82% vs. 67%, respectively. Although the endoscopic surgery group had a higher residual tumor rate than the open surgery group, the 5-year overall survival and disease-free survival were 83% vs. 86%(P=0.560) and 77% vs. 71%(P=0.188),respectively. The analysis showed that in the endoscopic surgery group, more patients received a dose higher than 66 Gy in the postoperative radiotherapy (P=0.011), and the 5-year overall survival and disease-free survival for patients receiving>66 Gy and ≤66 Gy were 100% vs. 67%(P=0.092) and 100% vs. 50%(P=0.052),respectively. Conclusions Surgery combined with radiotherapy can achieve a good therapeutic effect in patients with modified Kadish stage B/C esthesioneuroblastoma. The indications for endoscopic surgery should be followed strictly, and at present, endoscopic surgery is not suitable for the patients with Kadish stage C esthesioneuroblastoma or with involvement of the frontal sinus. As for the patients with unknown resection margin status, the dose of postoperative radiotherapy should be more than 66 Gy.
		2016 Vol. 25 (2): 100-104 [Abstract] ( 2833 ) [HTML 1KB] [ PDF 373KB] ( 0 )

	105	Significance of regions of abdominal lymph node metastasis for target volume delineation in postoperative radiotherapy for patients with recurrent esophageal carcinoma after radical surgery
		Chen Junqiang, Chen Ming, Lin Yu, Su Tingfeng, Li Jiancheng,Li Jiancheng,Wu Junxin,Pan Jianji
		Objective To analyze the regions of abdominal lymph node metastasis in recurrent thoracic esophageal squamous cell carcinoma (TE-SCC) after radical surgery, and to guide the design of target volume in postoperative adjuvant radiotherapy. Methods Patients with TE-SCC who were admitted to our hospital from February 2005 to April 2013 were enrolled as subjects. All patients were diagnosed with abdominal lymph node metastasis by imaging after R₀ radical surgery. The exact regions of abdominal lymph node metastasis were classified according to the 7^th edition of American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer, and then retrospectively analyzed. The difference of two group was analyzed by χ² test. Results Among the 1593 eligible patients, 148(9.3%) were diagnosed with abdominal lymph node metastasis after surgery. In the 148 patients, the abdominal lymph node metastasis rates in the upper, middle, and lower thoracic esophagus were 2.3%, 7.8%, and 26.6%, respectively (P=0.000);the incidence rates of pathological stages T_1/2 and T_3/4 were 8.7% and 9.5%, respectively (P=0.601);the incidence rates of 0-2 and ≥3 metastatic lymph nodes in postoperative pathological examination were 4.8% and 20.1%, respectively (P=0.000). The abdominal lymph node metastasis rate was the highest in the para-aortic lymph node (16a2), followed by para-aortic lymph node (16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery (64.9%, 41.2%, 37.8%, 32.4%, and 20.9%), yielding an overall metastasis rate of 91.9%. Conclusions The major regions of abdominal lymph node metastasis in esophageal carcinoma after radical surgery include para-aortic lymph nodes (16a2 and 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery. These regions are the abdominal target volumes of postoperative adjuvant radiotherapy.
		2016 Vol. 25 (2): 105-108 [Abstract] ( 3029 ) [HTML 1KB] [ PDF 307KB] ( 0 )

	109	A comparative study of new clinical staging systems for esophageal carcinoma treated with non-surgical therapy
		Zhu Shuchai,Yao Weinan,Li Juan,Li Hongyun,Liu Zhikun,Shen Wenbin,Yan Ke
		Objective To evaluate the predictive values of different systems for clinical staging of esophageal carcinoma in one group of patients and improve the criteria for T staging,and to provide a basis for accurate clinical staging. Methods A retrospective study was performed in 701 patients with esophageal carcinoma who received radical radiotherapy in our hospital. The prognosis was performed according to American Joint Committee on Cancer (AJCC) tumor-node-metastasis staging system,Chinese 2004 staging system,the draft of Chinese 2009 staging system,and gross tumor volume of the primary tumor (GTV-T). Results In terms of T stage,patients evaluated according to the AJCC staging system were in relatively early stages;23.1% of them were in stage T₁,and the survival curves of T₃ and T₄ patients were close to each other;the survival curves plotted according to the Chinese 2004 staging system were well separated,but relatively few patients were in stages T₁ and T₄,yielding an uneven distribution;according to the draft of Chinese 2009 staging system,the survival curve of T₃ patients intersected that of T₄ patients,and up to 43.2% of patients were in stage T₄.The new T staging was performed based on GTV and the extent of tumor invasion into the adjacent tissue and organ,and the results showed that there was no intersection between survival curves and a relatively balanced T stage distribution. In terms of N staging,patients were divided into stages N₀,N₁,and N₂.The TNM staging was performed by a combination of N staging and new T staging,resulting in significant separation between survival curves (P=0.000). Conclusions The combination of T staging,which is based on GTV and the extent of tumor invasion,and N staging,which is based on metastasis of lymph nodes,can accurately predict the survival of non-surgically treated patients with esophageal carcinoma.
		2016 Vol. 25 (2): 109-113 [Abstract] ( 2902 ) [HTML 1KB] [ PDF 419KB] ( 0 )

	114	Continuous intravenous pumping (CIP) of recombinant human endostatin (Endostar) combined with concurrent radiochemotherapy in patients with unresectable stage Ⅲ non-small-cell lung cancer:preliminary data of a prospective multicenter phaseⅡclinical trial
		Ma Honglian,Hui Zhouguang,Zhao Lujun,Xu Yujin,Zhai Yirui,Eu Runye,Pang Qingsong,Zhu Guangying,Li Dongming,Tang Yu,Liang Jun,Kong yue,Chen Ming,Wang Lyuhua
		Objective Preclinical models have shown that recombinant human endostatin (Endostar) can transiently normalize the tumor vasculature to make it more efficient for oxygen delivery,which provides a treatment window of enhancing tumor radiosensitivity. This study is to evaluate the safety and efficacy of continuous intravenous pumping (CIP) of Endostar combined with standard concurrent radiochemotherapy for unresectable stage III non-small-cell lung cancer (NSCLC). Methods In this prospective study,patients with unresectable stage III_A or III_B NSCLC received CIP of Endostar (7.5 mg/m²) over 5 days at week 1,3,5,and 7.During week 2-8,patients received two 28-day cycles of etoposide 50 mg/m² on day 1-5 and cisplatin 50 mg/m² on day 1,8,with concurrent thoracic radiation of 60-66 Gy in 30-33 fractions over 6-7 weeks. Acute toxicities were evaluated using CTCAE 3.0.Tumor response was evaluated using RECIST 1.1 criteria. Results Between Nov.2012 and Jun.2015,63 patients were eligible for toxicity and efficacy evaluation,including 52(83%) male and 11(16%) female,41(65%) with squamous cell carcinoma,19(30%) with adenocarcinoma,1(2%) with large cell carcinoma and 2(3%) with undifferentiated carcinoma,and 27(43%) with stageIII_A disease and 36(57%) with III_B disease,respectively. The median age was 59(31-69) years. All patients completed the treatment as planned,except that 2 patient missed one cycle chemotherapy for unrecovered grade 2 renal function impairmentandgrade Ⅳ myelosuppression. There were 8(13%),40(64%),11(18%) and 4(6%) patients achieved complete response,partial response,stable disease and progressive disease,respectively. The objective remission rate (ORR) is 76%.There were 23 patients (37%) with grade 3+4 neutropenia,9(14%) with grade 3+4 anemia,and 10(16%) with grade 3+4 thrombocytopenic. Two patients (5%) developed grade 3 nausea/vomiting. Grade 3 acute esophagitis,grade 1+2 and grade 3 pneumonitis were observed in 8(13%),12(19%) and 2(3%) patients,respectively. No grade 2 cardiovascular toxicity was observed.Up to the last follow-up,the median follow-up time was 13.6 months.21 deaths were observed,including 15 died of cancer progression. The median PFS was 14.8 months. The 1-year PFS,OS was 51%,78%,respectively. Conclusions For patients with unresectable stageIII NSCLC,CIP of Endostar enhanced patient compliance,and combined with concurrent radiochemotherapy is tolerable and the short term outcomes are promising. Long term survival data await further follow up.Clinical Trial Registry ClinicalTrials.gov,registration number:NCT01733589.
		2016 Vol. 25 (2): 114-118 [Abstract] ( 4563 ) [HTML 1KB] [ PDF 412KB] ( 0 )

	119


		2016 Vol. 25 (2): 119-120 [Abstract] ( 2291 ) [HTML 1KB] [ PDF 224KB] ( 0 )

	121	Prognostic significance of FDG PET/CT parameters in patients with non-small cell lung cancer of radiotherapy
		Liang Meng,Zheng Rong,Wu Ning,Zhang Wenjie,Liang Ying,Liu Ying,Li Xiaomeng,Fang Yan,Chen Cong,Zhou Zongmei,Xiao Zefen,Feng Qinfu,Wang Lyuhua,Li Yexiong
		Objective To investigate the metabolic parameters of primary lesions of non-small cell lung cancer (NSCLC) obtained by ¹⁸F-FDG PET/CT and their prognostic values in patients with NSCLC who underwent radiotherapy. Methods The clinical data of 170 NSCLC patients who underwent PET/CT scan before the first course of radiotherapy in Cancer Hospital, Chinese Academy of Medical Sciences, from January 2007 to December 2013 were analyzed retrospectively. The prognostic values of clinical factors, maximum standard uptake value (SUV_max) standard uptake value (SUV_{mean), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were analyzed. The Kaplan-Meier method was applied for univariate survival analysis, the log-rank test was applied to compare the survival rate between groups, and the Cox proportional hazards regression was applied for multivariate survival analysis;P<0.05 was consideredstatistically significant. The number of patients who received the follow-up visit at 5 years were 48. Results The 5-year overall survival was 24.7%. The univariate analysis showed that age, N stage, clinical TNM stage, tumor size, SUV_max, MTV, and TLG were the prognostic factors in NSCLC patients who underwent radiotherapy (P=0.001-0.040). The Cox proportional hazards regression analysis of the above parameters showed that age and MTV of the primary lesion were the independent prognostic factors for overall survival (P=0.016,0.005). Conclusions Age, N stage, clinical TNM stage, tumor size, SUV_max, MTV, and TLG are the prognostic factors in NSCLC patients undergoing radiotherapy, while age and MTV of the primary lesion are the independent prognostic factors.}
		2016 Vol. 25 (2): 121-125 [Abstract] ( 2988 ) [HTML 1KB] [ PDF 812KB] ( 0 )

	126	Association between hyponatremia and prognosis of patients with small cell lung cancer
		Kong Yue,Xu Yujin,Tang Huarong,Wang Jin,Hu Xiao,Ma Honglian,Yu Bingqi,Chen Jianxiang,Zheng Yuanda,Wang Shengye,Chen Ming
		Objective To investigate the association between hyponatremia and the prognosis of patients with small cell lung cancer (SCLC). Methods The clinical data of 489 patients with SCLC who were treated in Zhejiang Cancer Hospital from January 1, 2010 to December 31, 2012 were retrospectively analyzed.110 patients have hyponatremia in all patients.Hyponatremia incidence was compared with χ² test. Survival rates were calculated by the Kaplan-Meier method and compared by the log-rank test. The Coxproportional hazards model was applied to analyze the prognostic factors including hyponatremia. ResultsBefore initial treatment, after 2 cycles of chemotherapy, after radiotherapy, and after the end of the last treatment, the incidence of hyponatremia was 17.9%, 13.3%, 12.5%, and 18.9%, respectively;the 3-years survival rate were 10.1% vs. 21.1%(P=0.000),14.7% vs. 20.5%(P=0.022),12.1% vs. 28.3%(P=0.000),7.0% vs. 21.8%(P=0.000) with hyponatremia than normal blood sodium, respectively. The Cox regression analysis showed that the relative risk of death in patients with hyponatremia was elevated 1.297 times (95%CI=1.160-1.449, P=0.000), 1.366 times (95%CI=1.023-1.825,P=0.035), 1.770 times (95%CI=1.168-2.682,P=0.007), and 1.507 times (95%CI=1.167-1.944,P=0.002) in before initial treatment, after 2 cycles of chemotherapy, after radiotherapy, and after the end of the last treatment. Conclusion Hyponatremia is an independent prognostic factor for patients with SCLC.
		2016 Vol. 25 (2): 126-130 [Abstract] ( 3109 ) [HTML 1KB] [ PDF 369KB] ( 0 )

	131	A clinical study of interstitial lung disease induced by TKI concurrent radiotherapy
		Liang Hui,Ding Meiqian,Wu Ningbo,Wu Houhai
		Objective To investigate the influence of radiotherapy with concurrent oral epidermal growth factor receptor (EGFR) and tyrosine kinase inhibitor (TKI) for advanced non-small cell lung cancer (NSCLC) on the incidence of interstitial lung disease (ILD),and to analyze the risk factors for the pathogenesis of ILD. Methods The incidence of ILD in 72 patients with NSCLC who were admitted to Department of Radiotherapy Oncology of Lu′an Hospital of Traditional Chinese Medicine and treated with radiotherapy with concurrent oral EGFR-TKI from January 2010 to January 2014 was analyzed retrospectively,and some patients were selected as controls to compare the difference in the incidence of ILD between the TKI concurrent radiotherapy group and the other groups. The univariate analysis using chi-square test and multivariate logistic regression analysis were applied to analyze the risk factors for the incidence of ILD in the patients receiving TKI concurrent radiotherapy. Results The TKI concurrent radiotherapy group had a significantly higher incidence rate of ILD than the palliative chemotherapy group,single TKI group,and concurrent chemoradiotherapy group (19.4% vs. 2.5%,12%,and 7.5%,P=0.045).The multivariate regression analysis showed that male sex,long-term smoking,underlying lung disease,tumor volume>5 cm,and application of conventional radiotherapy were the risk factors for the pathogenesis of ILD in the TKI concurrent radiotherapy group. Conclusions Radiotherapy with concurrent TKI for advanced NSCLC may increase the incidence of ILD.
		2016 Vol. 25 (2): 131-134 [Abstract] ( 2602 ) [HTML 1KB] [ PDF 330KB] ( 0 )

	135	Reduction of seminal vesicle after androgen deprivation therapy:effects of neo-adjuvant or monal therapy to the target volume of seminal vesicles in prostate cancer radiotherapy
		Qi Xin,Gao Xianshu,Li Feiyu,Zhang Ming,li Hongzhen,Zhao Bo,Ma Mingwei,Wang Dian
		Objective To clarify the morphological reduction of seminal vesicle (SV) after neo-adjuvant androgen deprivation (NHT),and determine the optimal SV target volume for prostate cancer radiotherapy. Methods MR images both before and after NHT (median 5 months) were collected from thirty-one patients with cT_2-4N₀M₀ prostate cancer. SV volume was measured in axial T₁WI,while SV length was obtained in a reconstructed oblique coronary plane through its long axial from a 3D sequence. The difference was analyzed with paired t-test method. Results SV significantly decreased after NHT (volume:(12.5±4.5) cm² to (7.3±2.1) cm²,length:(34.1±5.7) mm to (29.7±5.2) mm).The reduction rate of volume,length,anterior-posterior diameter and left-right diameter was (39.3±13.6)%,(12.9±5.2)%,(26.2±9.8)%,(17.4±11.0)%,respectively. For SV with and without MR detected involvement,length shortening were (16.7±4.8)% and (11.1±4.4)%(P=0.000);for involved SV and lesions within,volume reduction were (41.0±16.0)% and (66.3±14.4)%(P=0.000),both indicating a more sensitive response to NHT of the involved portion than normal SV.40%(8/20) SV showed diffuse lower signal but no residual lesion after NHT. Conclusions After NHT the SV volume shrinkage was obviously,which may reduce the SV target volume and enable sparing of the surrounding normal tissues. Compare with the anterior-posterior diameter and left-right diameter,the reduction rate of the length is smaller,which suggests that it may be not reasonable to reduce the extent of SV included into CTV for the patients who have received NHT.
		2016 Vol. 25 (2): 135-139 [Abstract] ( 2758 ) [HTML 1KB] [ PDF 1260KB] ( 0 )

	140	Treatment outcome and prognosis of patients with stage I-II nasal-type natural killer/T-cell lymphoma receiving induction chemotherapy with GELOX regimen and radical radiotherapy
		Li Yiyang,Niu Shaoqing,Wen Ge,Wang Qiaoxuan,Wang Hanyu,Feng Lingling,Xia Yunfei,Zhang Yujing
		Objective To investigate the treatment outcome and prognostic factors in patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma (ENKTL) who underwent chemotherapy with GELOX (gemcitabine,oxaliplatin,and L-asparaginase) regimen combined with radiotherapy. Methods The clinical data of 74 patients with stage I_E-II_E ENKTL who were admitted from 2007 to 2013 were analyzed retrospectively,and based on the chemoradiotherapy regimen and whether they underwent radiotherapy,these patients were divided into three groups. The 47 patients in group A received the preferred chemotherapy with GELOX regimen and then radical radiotherapy;the 10 patients in group B received another regimen at first,then received GELOX as the rescue chemotherapy,and underwent radiotherapy;the 17 patients in group C underwent the chemotherapy with GELOX regimen and did not receive radiotherapy. The median number of cycles of chemotherapy was 3,and the median dose of radiotherapy was 54.6 Gy in 20-30 fractions. Results The complete response (CR) rate after chemotherapy was 34% and the CR rate after radiotherapy was 90%.The 2-year overall survival (OS) and progression-free survival (PFS) rates were 88% and 79%,respectively. The CR rate and 2-year OS and PFS rates for group A+C were 73%,92%,and 84%,respectively. Group A had significantly higher OS and PFS than group B and group C (96%/84% vs. 50%/45% and 47%/40%;all P<0.05).The univariate analysis showed that elevated lactate dehydrogenase level and no response after chemotherapy were the adverse prognostic factors for OS and PFS,and extensive local invasion was the adverse prognostic factor for OS.The multivariate prognostic analysis indicated that no response after chemotherapy was the adverse prognostic factor for OS and PFS. Conclusions The patients with early-stage ENKTL can achieve a good outcome after induction chemotherapy with GELOX regimen combined with radical radiotherapy,but this regimen has no ideal efficacy when applied alone or as rescue chemotherapy.
		2016 Vol. 25 (2): 140-145 [Abstract] ( 3448 ) [HTML 1KB] [ PDF 393KB] ( 0 )

	146	A study of stability training and reliability of bladder filling before radiotherapy for pelvic tumors
		Muyasha·Abulimiti,Zhou Weibing,Liu Haifeng,Zhu Hong
		Objective To explore the reliability of patients’ sensation of the need to urinate,and to investigate the optimal volume and duration of bladder filling and training method for the stability of bladder filling. Methods From 2014 to 2015,Fifty patients with pelvic tumor were divided into group A and group B,according to whether they had the history of diseases or surgery in the pelvis or urinary system. Both groups received training of the sensation of the need to urinate. The training required patients to drink a fixed volume of water every time they emptied the bladder. The bladder capacity was measured by a bladder scanner (BladderScan BVI 9400),and a rating scale of the sensation of the need to urinate was completed at 30 min,45 min,1 h,and over 1 h when the patient sensed the limit for bladder capacity. The optimal volume and duration of bladder filling or optimal frequency for the training were explored. The paired t-test method was performed for the difference between the predictive value and the measured value,Pearson method was performed for correlation between the sensation of the need to urinate and the measured value. Results In the A and B groups,there was no significant difference between the predicted value and measured value (A:predicted value and measured value P=0.777,B:predicted value and measured value P=0.061),suggesting that the measured value could be used to reflect the predictive value. Compared with group B,group A had a higher correlation between the sensation of the need to urinate and the measured value (r_A=0.812,r_B=0.762).The correlation between the predictive value and the measured value became the highest at 45 min and 1 h (r=0.858 and 0.916),and the corresponding bladder filling volume and score of the sensation of the need to urinate were 330-450 ml and 4-6,respectively. The correlation between the predictive value and the measured value increased with the frequency of the training (r₂=0.914,r₃=0.917,r₄=0.930,r₅=0.951,r₆=0.962). Conclusions Before radiotherapy,patients with pelvic tumor should received at least 4-6 rounds of the training of bladder filling. Patients should drink 800-1400 ml of water every time they empty the bladder,and the optimal bladder filling volume and the reliable and stable sensation of the need to urinate will be achieved after 45 min-1 h. For the patients with the history of urinary system diseases or pelvic surgery,the bladder filling volume needs to be measured using a bladder scanner (BladderScan BVI 9400) during the training before radiotherapy.
		2016 Vol. 25 (2): 146-154 [Abstract] ( 2831 ) [HTML 1KB] [ PDF 619KB] ( 0 )

	155	The application and comparison of two image guide systems for the therapy of head and neck tumor
		Ying Wei,Tang Dewen,He Youan,Zhang Dekang
		Objective To compare the ExacTrac X-ray and CBCT image guide system for the head and neck cancer patients in radiotherapy. Methods Twenty head and neck cancer patients were randomly chosen and divided two Group. In group A (10 patients),the cross X-ray radiation photos were matched with the DRR after positioning with the infrared markers. Obtain the setup errors on three directions and rotation errors. Then adjustment of error with 6D treatment bed,record time set-up and registration. In group B (10 patients),the CBCTimages were matched with reference CT data after manual positioning. Obtain the setup errors on three directions and around the vertical axis direction errors. Then adjustment of error,record the time of set-up and registration. Groups were compared using the paired t-test. Results For group A and B group,the translation errors were (0.59±0.25) mm,(0.62±0.25) mm,(1.56±0.28) mm,and (0.52±0.31) mm,(0.74±0.17) mm,(1.58±0.34) mm on horizontal,vertical,up-down directions,respectively (P=0.43,0.21,0.90).For group A,the rotation errors were (0.54±0.17)°,(0.72±0.27)°,(0.44±0.22)°,respectively;with (1.26±0.33)°on vertical directions on B group (P=0.01).The time of set-upregistration on group A was significantly less than group B (108.0 s vs.165.8 s,P=0.00). ConclusionsFor the head and neck cancer patients in raditherapy,the image guide systems is feasible. The rotation errors of ExacTrac X-ray slightly less than CBCT.The time of set-up and registration of ExacTrac X-ray significantly less than CBCT,but the image resolution of ExacTrac X-ray inferior for CBCT.
		2016 Vol. 25 (2): 155-157 [Abstract] ( 2907 ) [HTML 1KB] [ PDF 1037KB] ( 0 )

	158	Using MRI simulation in radiotherapy of lung cancer with post-obstructive lobar collapse:a preliminary study
		Zhao Dan,Yu Rong,Hu Qiaoqiao,ZHang Jian,Wu Hao,Yu Huiming,Geng Jianhao,Qi Liping, Zhu Guangying
		Objective To study the potential of MRI simulation in lung cancer patients with post-obstructive lobar collapse (POLC). Methods 14 patients with POLC were enrolled. Before radiotherapy,two sets of simulating images were obtained for each patient using CT and MRI with T₁/T₂-weighted and diffuse-weighted images (T₁W/T₂WI/DWI). Simulating MRI were fused with corresponding simulating CT for dose calculation. Contrast-to-noise-ratios (CNRs) of tumor and POLC on T₂WI and DWI were measured and calculated. The GTV and OARs were delineated separately by radiation oncologists both on simulating CT and MRI. Plan_CT and Plan_MRI/CT were carried out on CT sets with same beam number and direction. Dose distributions of OARs were compared on the basis of DVH. Results 12 out of 14 cases were distinguishable by T₂WI and all the 6 cases could be figured out by DWI. The mean volume of GTV_MRI was significantly smaller than GTV_CT(149.317±229.670 cm³ vs.178.073±236.604 cm³,P=0.000).The mean CNR of DWI was much higher than T₂WI (77.295±49.273 vs.12.942±5.553,P=0.027).The DVH comparison showed OARs of Plan_MRI got less exposure compared to those of Plan_CT. with no significant differences in HI and CI (The mean dose of lung with cancer was lower (P=0.002),and withno cancer similar (P=0.052). Total lung mean dose was lower (P=0.009),and with esophagus lower (P=0.038). The maximal dose of spinal cord was lower (P=0.038). The V₅,V₁₀ of lung and V₂₅ of heart were lower (P=0.010,0.031,0.044). Conclusions MRI simulation with coregistered simulating CT is more competent than CT simulation alone,in identifying and defining the borderlines of tumor masses and reducing the exposure of OARs.
		2016 Vol. 25 (2): 158-159 [Abstract] ( 2975 ) [HTML 1KB] [ PDF 885KB] ( 0 )

	160	Development and evaluation of a predicting model of dose volume histograms of parotid in NPC IMRT planning
		Huang Botian, Zhu Jinhan, Yan Xin, Liu Boji, Hu Jiang, Qi Zhenyu
		Objective To study the mathematical predicting model of parotid DVH for the NPC IMRT planning,and its accuracy with the analysis of medical data. Methods 50 NPC radiotherapy treatment plans with same beam setup were chosen as sample data set, then their parotid DVHs and distance of voxels in the parotid to the target volumes were calculated with self-developed program to form the distance to target histogram (DTHs);principal component analysis was applied to DVHs and DTHs to acquire their principal components (PCs),and then nonlinear multiple variable regression was used to model correlation between the DTHs’ PCs, parotids volume, PTVs and the DVHs. Another 10 plans were chosen as test data set to evaluate the efficacy and accuracy of the final model by comparing the DVHs calculated from our model with those calculated from the TPS. Results Up to 97% information of DTHs and DVHs can be represented with 2 to 3 components, the average fitting error of sample data set was (0±3.5)%;in the 10 test cases, the shapes of DVH curves calculated from predicting model was highly the same with those from the TPS, the average modeling error was (-0.7±4.4)%,the accuracy of prediction was up 95%. Conclusions Our developed model can be used as a quality evaluating tool to predict and assure the dose distribution in parotid of NPC radiotherapy treatment planning effectively and accurately.
		2016 Vol. 25 (2): 160-163 [Abstract] ( 3033 ) [HTML 1KB] [ PDF 1516KB] ( 0 )

	164	The application of the proton and carbon ion treatment equipment imaging system in prostate cancer therapy
		Zhou Dan,Fu Shen,Li Ping,Yao Jiaxi
		Objective To evaluate the accuracy of the patient positioning in prostate cancer therapy with the kilo-volt X-ray imaging system. Methods From June to August in 2014,14 patients with prostate cancer were treated by carbon ion beam with the Siemens proton and carbon ion equipment. X-ray orthogonal images was made twice by the imaging system before treatment. All the images were fused with the planning digitally reconstructed radiograph ones by automatic and manual method. We got positioning error data in six directions:lateral,longitudinal,vertical,isocentre,roll and pitch. The data were analyzed to study the situation. Results A total of 644 pairs of images from 14 patients were obtained during treatment. The average error in six directions is 0.34 cm,0.30 cm,0.79 cm,0.3°,1.1° and 0.5°.The patients′ positioning error had no obvious change in all directions with fractions. There was no significant deviation between the two groups of images,either. But error in pitch and vertical direction is much larger. Conclusions The bony landmarks of the orthogonal filed images are clear. Photography lasts short time by the imaging system. DRR images are 3D and we can get images in six directions,but the development of soft tissue is weak. Positioning error we get cannot be match with the one of actual situation.
		2016 Vol. 25 (2): 164-167 [Abstract] ( 2643 ) [HTML 1KB] [ PDF 1064KB] ( 0 )

	168	Study of sensitivity for detecting small positional deviation of MLC by 3D Detector array Delta-4
		Ni Xinye,Gao Liugang,Lin Tao
		Objective To study the detective sensitivity for position of multi-leave collimators (MLC) using Delta-4. Methods First,the small positional deviation of MLC was simulated and measured using the linac (Varian,Trubeam) equipped with EPID.Then,two beam fields 2.0 cm (x)×6.0 cm (y),7.0 cm (x)×6.0 cm (y) were designed,the x₁ and x₂ of MLC were expanded 0.1 mm,0.2 mm,0.3 mm...0.9 mm and 1.0 mm,2.0...5.0 mm to external simultaneously,different parameters of 3 mm/3%,2.5 mm/2.5%,2 mm/2%,1.5 mm/1.5% and 1 mm/1% were used in Gamma analysis to analyze the difference between dose distribution detected by Delta-4 and original dose distribution with unexpanded MLC position derived from TPS. Results For 2.0 cm (x)×6.0 cm (y) beam field,the pass rate of original dose distribution was 100%,and that decreased to 95.5% when x₁,x₂ of MLC were expanded 0.3 mm to external,and decreased to 89.4% when expanded 0.5 mm at 2.5 mm/2.5% statistical standards. For 7.0 cm (x)×6.0 cm (y) beam field,the pass rate of original dose distribution was 96.5%,and that decreased to less than 95% when x₂,x₂ of MLC were expanded 0.3 mm to external,and passing rate was above 90% when MLC expanded less than 0.5 mm at 1.5 mm/1.5% statistical standards. Conclusions For MLC’s positional deviation in decimillimeter level,raise standards of Gamma analysis properly may improve the capability of Delta-4 for detecting small positional deviation,but it won’t detect all the positional deviation of MLC in decimillimeter level. For different size of beam field,it is proposed to use different analytical standards for Delta-4.
		2016 Vol. 25 (2): 168-171 [Abstract] ( 2846 ) [HTML 1KB] [ PDF 1145KB] ( 0 )

	172	Radiotherapy patients with identification study on continuous quality improvement
		Yang Yugang,Qi Hongzhi,Xu Lin,Hao Jie,Shang Ge,Bao Yongxing
		Objective To study the recogniting patients identity for the safety and reliability of radiotherapy.Methods Through PDCA 4 footwork,namely,plan,do,check,action the technicians in the hospital to improve patients' identity verification.Results After 4 months of PDCA cycle,the patient identity verification qualified rate increase gradually,from 88.17% up to 99.07%,the privacy of patients satisfaction rate rose from 52.69% to 98.15%.The patients identification accuracy rate of 100%,technicians working efficiency has been greatly improved.Conclusions The measure of patient identification can improve the working process of radiotherapy for safety and efficiency and can get better privacy protection.
		2016 Vol. 25 (2): 172-174 [Abstract] ( 2574 ) [HTML 1KB] [ PDF 356KB] ( 0 )

	175	Role of radiotherapy combined with halofuginone in enhancing therapeutic effect on Lewis lung cancer transplanted in mice and related mechanisms
		Lin Runlong,Yi Shuai,Gong Linlin,Liu Weishuai,Wang Peng,Liu Ningbo,Zhao Lujun,Wang Ping
		Objective To investigate the role of radiotherapy combined with halofuginone in enhancing the therapeutic effect on Lewis lung cancer (LLC) and influence on tumor invasion and metastasis, and to explore possible molecular mechanisms. Methods The model mice with LLC xenograft were randomly divided into blank control group, halofuginone group, irradiation group, and combination group. On day 3 after the treatment ended, 4 mice in each group were randomly sacrificed, and immunohistochemistry and enzyme-linked immunosorbent assay (ELISA) were performed. The other mice were observed for survival time and liver/lung metastases. Analysis of variance was applied for comparison of results between groups. Results On the ninth day of treatment, the mean tumor volume was 175.2 mm³ in the blank control group, 118.5 mm³ in the halofuginone group, 106.6 mm³ in the irradiation group, and 85.6 mm³ in the combination group (P=0.000). The median survival times for these groups were 39 days, 61.5 days, 78.5 days, and 84.5 days, respectively (P=0.002). The combination group had the lowest number of liver and lung metastases. The results of immunohistochemistry and ELISA showed that compared with the blank control group, the irradiation group had a higher level of transforming growth factor-β₁(TGF-β₁), while the combination group had a lower level of TGF-β₁. The combination group had a lower mean tumor vascular density than the blank control group. The blank control group and the irradiation group had higher expression levels of collagen, while the halofuginone group and the combination group had lower expression levels of collagen. Conclusions Radiotherapy combined with halofuginone may enhance the effect of antitumor therapies, and potential mechanisms still need further investigation.
		2016 Vol. 25 (2): 175-178 [Abstract] ( 3835 ) [HTML 1KB] [ PDF 1576KB] ( 0 )

	179	Relationship between the expression of long-non-coding RNA (lncRNA) HOTAIR and cellular radiosensitivity in esophageal squamous cell carcinoma
		Da Chunli,Wang Ruozheng,Li Yu,Li Yawei,Liu Kai
		Objective To investigate the relationship between the expression level of HOTAIR and cellular radiosensitivity in esophageal squamous cell carcinoma (ESCC). Methods Four ESCC cell lines (K150, K450, TE-1, and Eca109) were used in this study. Quantitative real-time polymerase chain reaction was applied to measure the expression level of HOTAIR in the above cell lines;colony-forming assay was applied to measure the survival fraction of different cells irradiated by different doses of X-ray. The t-test or analysis of variance was applied for analysis of differences. The correlation analysis was used by Pearson methods. Results The four cell lines all showed high expression levels of HOTAIR and radioresistance. Compared with the other three cell lines, Eca109 had a lower expression level of HOTAIR, a lower survival fraction at each radiation dose point, and significantly lower D₀ and D_q. The mRNA expression level of HOTAIR and radiosensitivity were K150<TE-1<K450<Eca109 from low to high. The correlation analysis of the expression level of HOTAIR and D₀/D_q revealed that the expression level of HOTAIR was positively correlated with SF₂ and D₀(r=0.643 and 0.777,respectively,both P<0.05). Conclusions There is a significant correlation between the expression level of HOTAIR and cellular radiosensitivity, and the expression level of HOTAIR may be an indicator to predict cellular radiosensitivity.
		2016 Vol. 25 (2): 179-183 [Abstract] ( 2948 ) [HTML 1KB] [ PDF 399KB] ( 0 )

	184


		2016 Vol. 25 (2): 184-185 [Abstract] ( 2610 ) [HTML 1KB] [ PDF 1080KB] ( 0 )

	186	Recent advances in preoperative intensity-modulated radiation therapy (IMRT) for rectal cancer
		Yang Yongqiang,Zhu Yaqun,Tian Ye
		More than 20 studies published during the past 10 years concerning preoperative radiotherapy in rectal cancer were reviewed carefully. And we evaluated the role of IMRT being routinely used in preoperative treatment of rectal cancer.
		2016 Vol. 25 (2): 186-189 [Abstract] ( 3014 ) [HTML 1KB] [ PDF 344KB] ( 0 )

	190	Recent advances of gold nanoparticles for cancer radiotherapy
		Yang Ruijie,Xie Yaoqin,Wang Junjie
		Based on a review of currently published 40 papers (20 published in recent 5 years, 20 published in recent 10 years) on gold nanoparticles for cancer radiotherapy, the general characteristics, theoretical studies, in vitro experiment, in vivo experiment,and the clinical prospects of targeted radiotherapy with gold nanoparticles were reviewed. Three key aspects guarantee further investigation for the full understanding of the radiosensitization effect of gold nanoparticles:the cellular localization and tissue distribution of nanoparticles and influential factors;the micro dose enhancement effect of gold nanoparticles, and the molecular biological mechanism. More cross disciplinary collaboration, research, development and translation are needed before gold nanoparticles are put into clinical trials.
		2016 Vol. 25 (2): 190-193 [Abstract] ( 2910 ) [HTML 1KB] [ PDF 762KB] ( 0 )

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