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.3 Published 2016-03-01

	Head and Neck Tumors Abdominal Tumors Thoracic Tumors Physics·Biology·Technique Review Articles Investigation Report

Investigation Report

	195	A brief history of Macau radiotherapy development
		Xiao Guangli
		Review the history of radiation therapy service in Macau,and the evolution of radiation technology,equipment and staffs of past and now were included. We hope provide an clear understanding of cancer radiotherapy condition in Macau and looking forward to academic exchange in radiation oncology in future.
		2016 Vol. 25 (3): 195-196 [Abstract] ( 2519 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	197	Proposal for the 8^th edition of AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy
		Pan Jianji,Wai Tong Ng,Zong Jingfeng,Lucy L.K.Chan,Brian O’Sullivan,Lin Shaojun,Henry C.K.Sze,Chen Yunbin,Horace C.W.Choi,Guo Qiaojuan,Wai Kuen Kan,Xiao Youping,Xu Wei,Quynh Thu Le,Christine M.Glastonbury,A.Dimitrios Colevas,Randal S.Weber,Jatin P Shah,Anne W.M.Lee
		Objective An accurate staging system is crucial for cancer management. With the development of cancer staging systems and therapeutic methods, the applicability and improvement of staging systems should be evaluated constantly. Methods The clinical data of 1609 nasopharyngeal carcinoma patients without metastasis at initial diagnosis, who were admitted to two tumor centers in Hong Kong and Mainland China and received intensity-modulated radiotherapy (IMRT), were analyzed retrospectively based on the 7^th edition of the American Joint Committee on Cancer (AJCC) or International Union Against Cancer (UICC) staging system, and all the patients underwent magnetic resonance imaging (MRI) before treatment. Results Among the T₃/T₄ patients without involvement of other anatomic structures, overall survival (OS) showed no significant differences between the patients with masticator space (medial pterygoid muscle and/or lateral pterygoid muscle) involvement, prevertebral muscle involvement, and parapharyngeal space involvement. The OS was similar between the patients with extensive soft tissue (soft tissues other than the structures mentioned above) involvement and those with intracranial involvement or cranial nerve involvement. Only 2% of the patients had lymph node metastasis>6 cm above the supraclavicular fossa (SCF), with an OS similar to that of the patients with lower cervical lymph node metastasis. Replacing SCF with the lower neck (below the caudal border of the cricoid cartilage) did not affect the risk difference between different N stages. With the proposed T and N staging systems, the OS showed no significant differences between T₄N_0-2 and T_1-4N₃ patients. Conclusions After a review by AJCC/UICC staging system preparatory committees, the changes recommended for the 8^th edition include changing medial pterygoid muscle or lateral pterygoid muscle involvement from T₄ to T₂, adding prevertebral muscle involvement to T₂ stage, replacing SCF with the lower neck and combining this with a maximum lymph node diameter of>6 cm as N₃ stage, and integrating T₄ and N₃ as stage ⅠVA. These changes result in a better risk difference between adjacent stages and achieve the optimal balance between clinical practicability and global applicability.
		2016 Vol. 25 (3): 197-206 [Abstract] ( 4182 ) [HTML 1KB] [ PDF 2090KB] ( 0 )

	207	Prognostic values of ¹⁸F-FDG PET/CT parameters in patients with nasopharyngeal carcinoma
		Wang Chengtao,Ouyang Bin,Zhang Tian,Dong Jun,Kenneth S.HU,Wen Bixiu
		Objective At present,nasopharyngeal carcinoma (NPC) is a head and neck cancer with special geographical distribution and biological behavior. Studies have shown that ¹⁸F-FDG PET/CT parameters have certain prognostic values in patients with NPC in high-incidence areas. The aim of this study is to investigate the prognostic values of ¹⁸F-FDG PET/CT parameters in patients with NPC in low-incidence areas. Methods The clinical data of 83 NPC patients who were diagnosed and treated in Beth Israel Medical Center,Albert Einstein Medical College from January 2003 to December 2013 were analyzed retrospectively. Based on ¹⁸F-FDG PET/CT images,gross tumor volume (GTV) was delineated using the gradient method to obtain ¹⁸F-FDG PET/CT parameters:maximum standardized uptake value (SUV_max),metabolic tumor volume (MTV),and total lesion glycolysis (TLG). Results The number of patients followed was 37 at 3-years time. For all patients,the 3-year failure-free survival,locoregional relapse-free survival,and metastasis-free survival rates were 74%,88%,and 85%,respectively. The univariate analysis showed that SUV_max of the primary tumor (P=0.004) and TLG (P=0.014) were prognostic factors for 3-year locoregional relapse-free survival rate,and SUV_max of the primary tumor (P=0.024) and TLG (P=0.033) were prognostic factors for 3-year failure-free survival rate. The multivariate analysis showed that SUV_max of the primary tumor was the independent prognostic factor for 3-year failure-free survival rate. Conclusion SUV_max of the primary tumor before treatment is the independent prognostic factor for failure-free survival in patients with NPC.
		2016 Vol. 25 (3): 207-211 [Abstract] ( 3157 ) [HTML 1KB] [ PDF 430KB] ( 0 )

	212	Failure in region of parotid gland after definitive intensity-modulated radiotherapy for Nasopharyngeal Carcinoma
		Wang Hongzhi,Luo Jingwei,Yi Junlin,Huang Xiaodong,Zhang Shiping,Qu Yuan,Xiao Jianping,Li Suyan,Gao Li,Xu Guozhen
		To investigate the potential risk factors for parotid gland failure after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods The clinical data of 1096 NPC patients who underwent IMRT in our hospital from January 2005 to December 2012 were analyzed retrospectively. Among these patients, 13 patients experienced parotid gland recurrence, and the recurrence in 12 patients was analyzed. A case-control study was performed with the side of the parotid gland with recurrence as the case group and the side of the parotid gland without recurrence as the control group. The association of parotid gland failure with the extent of tumor invasion, IMRT dose distribution, and local recurrence was analyzed. The differences between groups were analyzed with χ² test or Fisher′s the exact probability test. Results Among the 12 patients, 11 had stage III-IV primary NPC;after definitive IMRT, 9 had local tumor residues. The median time of parotid gland recurrence was 16(8-43) months. Of all the patients who experienced recurrence, 8 had recurrence in the superficial lobe of the parotid gland, 1 in the deep lobe, and 3 in both superficial and deep lobes. Recurrence was in the same side of primary tumor (P<0.001). Compared with the controls, the side of the parotid gland with recurrence had higher rate of cervical puncture/surgery (P=0.025). Parotid gland recurrence was often complicated by ipsilateral lymph node recurrence (67% vs. 8%, P=0.003), as well as the tendency of ipsilateral primary lesion recurrence (42% vs. 8%;P=0.059). Conclusions For NPC patients, the recurrence rate in the parotid gland is very low. Parotid gland recurrence may be related to locally advanced NPC, residues after treatment, the history of cervical puncture/surgery, and locoregional recurrence. The low radiotherapy dose in the parotid gland caused by IMRT may be an important reason for parotid gland recurrence.
		2016 Vol. 25 (3): 212-215 [Abstract] ( 2567 ) [HTML 1KB] [ PDF 442KB] ( 0 )

	216	Treatment outcomes of primary suprasellar and pineal germinoma and related therapeutic strategies:an analysis of 41 patients
		Lian Xin,Hou Xiaorong,Liu Zhikai,Yan Junfang,Shen Jie,Hu Ke,Zhang Fuquan
		Objective To investigate the treatment outcomes of 41 patients with suprasellar and pineal germinoma who are treated in our department in recent 18 years,and to explore related therapeutic strategies. Methods　A total of 41 patients with concurrent suprasellar and pineal germinoma who were treated in our department from January 1996 to August 2013 were enrolled. There were 35 male patients and 6 female patients,and the median age was 16 years (range 5-39 years).Five patients had pathologically confirmed germinoma and 36 patients had clinically diagnosed germinoma. Conventional radiotherapy was performed for 33 patients,and intensity-modulated radiotherapy was performed for 8 patients. Combined-modality chemoradiotherapy was performed for the 5 patients with pathologically diagnosed germinoma. The 6 MV X-ray was applied for radiotherapy;6 patients received whole ventricular irradiation and a boost in tumor region,16 received whole-brain radiotherapy and a boost in tumor region,and 19 received craniospinal irradiation and a boost in tumor region. The median radiation dose for tumor region was 45.0 Gy (37.8-50.0 Gy),and the median dose for prophylactic irradiation was 25.0 Gy (17.8-35.0 Gy).The survival was caculated using Kaplan-Meier method. Results The number of patients followed were 26 at 5-years. The 5-year overall survival rate and relapse-free survival rate were 95% and 85%,respectively. Relapse and metastasis were noted in 8 patients,and 3 of them died. There were 4 patients with spinal cord metastasis,1 patient with ventricular dissemination,and 3 patients with periventricular relapse. Among the 22 patients who did not undergo spinal irradiation,4(18.2%) experienced spinal cord metastasis,and all the other 19 patients who underwent spinal irradiation did not experience spinal cord metastasis. The 8 patients undergoing intensity-modulated radiotherapy and the 5 patients undergoing combined-modality chemoradiotherapy did not experience treatment failure during follow-up. Conclusions Radiotherapy for intracranial germinoma has a good therapeutic effect,and the patients with suprasellar and pineal germinoma who do not undergo spinal cord irradiation have a high failure rate. It is suggested to perform spinal cord irradiation for patients with suprasellar and pineal lesions.
		2016 Vol. 25 (3): 216-219 [Abstract] ( 2549 ) [HTML 1KB] [ PDF 309KB] ( 0 )

Thoracic Tumors

	220	Clinical efficacy of preoperative three-dimensional radiotherapy with or without concurrent chemotherapy for esophageal carcinoma
		Deng Wei,Wang Qifeng,Xiao Zefen,Zhou Zongmei,Zhang Hongxing,Chen Dongfu,Feng Qinfu,Liang Jun,Hui Zhouguang,Lyu Jima,He Jie,Gao Shugeng,Xue Qi,Mao Yousheng,Sun Kelin,Liu Xiangyang,Fang Dekang,Cheng Guiyu, Wang Dali,Li Jian
		Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma. Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS. The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed. The overall survival (OS) and disease-free survival (DFS) were calculated by the Kaplan-Meier method,and the survival difference and univariate prognostic analyses were performed by the log-rank test. The Cox proportional hazards model was used for multivariate prognostic analysis. Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients. There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521). The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively. There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953). The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001). The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020). The surgery-related mortality was 7.8% in all patients. Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis (P=0.023). Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate. Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.
		2016 Vol. 25 (3): 220-225 [Abstract] ( 2675 ) [HTML 1KB] [ PDF 483KB] ( 0 )

	234	Value of nutritional risk screening-2002 in evaluating nutritional status of patients with esophageal cancer undergoing radiotherapy
		Yu Bingqi,Wang Jin,Xie Shuping,Xu Yujin,Tang Huarong,Ma Honglian,Hu Xiao,Kong Yue,Zheng Yuanda,Wang Shengye,Chen Jianxiang,Chen Ming
		Objective To apply Nutritional Risk Screening-2002(NRS-2002) to perform primary screening for nutritional risk in patients with esophageal cancer who undergo radiotherapy, and assess their nutritional status, and to investigate the value of NRS-2002 in such patients. Methods A total of 97 patients who were diagnosed with esophageal cancer and underwent radiotherapy in Zhejiang Cancer Hospital from January 2010 to April 2014 were analyzed retrospectively. The Kaplan-Meier method was applied to analyze the difference in survival, and the chi-square test and the Pearson correlation analysis were applied to analyze the correlation between NRS-2002 score and blood parameters. Results Of all patients, 26.8% had nutritional risk before radiotherapy, which gradually increased with the progress of radiotherapy. The 1-year overall survival rates of the patients with NRS-2002 scores of ≤3 and ≥4 on admission were 91.1% and 61.9%, respectively (P=0.010). As for the patients with the highest NRS-2002 scores of ≤2 and ≥3 during treatment, the 1-year overall survival rates were 94.2% and 77.5%, respectively (P=0.012). As for the patients with the lowest NRS-2002 scores of ≤3 and ≥4 during treatment, the 1-year overall survival rates were 91.3% and 54.5%, respectively (P=0.018). The NRS-2002 score was correlated with prealbumin on admission and at week 1 of radiotherapy (P=0.000 and 0.002), and the NRS-2002 score was correlated with albumin at week 3 of radiotherapy (P=0.036). The multivariate analysis showed that the TNM stage of esophageal cancer and the highest NRS-2002 score during treatment were the independent prognostic factors in esophageal cancer (P=0.001 and 0.005). Conclusions The patients with esophageal cancer undergoing radiotherapy have high nutritional risk, and NRS-2002 score is the independent prognostic factor in these patients and can be used as a tool for primary screening for nutritional risk.
		2016 Vol. 25 (3): 234-237 [Abstract] ( 2684 ) [HTML 1KB] [ PDF 412KB] ( 0 )

	238	Association of local factors with treatment failure patterns in esophageal squamous cell carcinoma without clinical metastasis
		Shen Wenbin, Gao Hongmei, Zhu Shuchai, Li Youmei, Liu Zhikun, Cao Yankun, Li Shuguang,Su Jingwei, Li Juan
		Objective To investigate the association of local factors with local recurrence (LR) and distant metastasis (DM) in patients with esophageal squamous cell carcinoma (ESCC) who do not experience clinical metastasis. Methods A total of 236 eligible ESCC patients were analyzed retrospectively, and the association of lesion length on esophagography, maximum tumor diameter, and tumor volume with survival and treatment failure pattern was analyzed. Kaplan-Meier test and Cox regression were used for survival analysis and to identify prognostic factors. Results The 1-, 3-, and 5-year overall survival rates, LR rates, and DM rates were 88.6%,52.4%,30.2%, 15.5%,35.6%,45.8%, and 9.0%,22.2%,30.6%, respectively. The multivariate analysis showed that short-term treatment outcome and maximum tumor diameter were independent prognostic factors for overall survival rate (P=0.000,0.019);sex, maximum tumor diameter, irradiation method, and short-term treatment outcome were independent prognostic factors for LR (P=0.039,0.003,0.045,0.000);maximum tumor diameter was the independence factor for DM (P=0.035). In the patients receiving elective nodal irradiation and involved-field irradiation, the maximum tumor diameter was the prognostic factor for LR (P=0.008,0.001), and the lesion length on esophagography, maximum tumor diameter, and tumor volume were prognostic factors for DM (P=0.009,0.023,0.014). Conclusions In ESCC patients without clinical metastasis, local factors are significantly associated with LR and DM, among which maximum tumor diameter is the most important factor.
		2016 Vol. 25 (3): 238-238 [Abstract] ( 2019 ) [HTML 1KB] [ PDF 361KB] ( 0 )

	239	*Clinical value of induction chemotherapy plus concurrent radiochemotherapy for locally advanced non-small cell lung cancer:a Meta* analysis**
		Jing Shaowu,Wang Jun,Cheng Yunjie,Liu Qing,Wu Fengpeng,Yang Congrong,Wang Yi,Cao Feng,Jiao Wenpeng
		Objective To investigate the clinical effect of induction chemotherapy plus concurrent radiochemotherapy in the treatment of locally advanced non-small cell lung cancer (NSCLC) through a meta-analysis. Methods CBM, CNKI, Cochrane Library, PubMed, and EMbase were searched for the articles on comparison between induction chemotherapy plus concurrent radiochemotherapy and concurrent radiochemotherapy for patients with locally advanced NSCLC. According to the inclusion and exclusion criteria, the data on short-term outcome and survival were collected. A Meta-analysis was performed to evaluate the clinical effect of induction chemotherapy followed by concurrent radiochemotherapy. Results A total of 5 articles were included, which involved 845 patients. The results showed that the short-term outcome and the 2-and 3-year survival rates were similar between patients receiving induction chemotherapy plus concurrent radiochemotherapy and those receiving concurrent radiochemotherapy (OR=0.875, 95% CI 0.507-1.510, P=0.631;HR=0.770, 95% CI 0.515-1.151, P=0.203;HR=0.809, 95% CI 0.559-1.172, P=0.262), but the patients receiving induction chemotherapy plus concurrent radiochemotherapy showed a significantly higher incidence rate of grade ≥3 leukopenia than those receiving concurrent radiochemotherapy alone (OR=0.637, 95% CI 0.435-0.931, P=0.020). Conclusions Induction chemotherapy plus concurrent radiochemotherapy shows no significant advantages over concurrent radiochemotherapy alone in the short-term outcome and 2-and 3-year survival rates, but it significantly increases myelosuppression. Since there are few studies involving a limited number of cases included in this analysis, more multicenter randomized trials are needed to provide more detailed data and further clarify the clinical value of induction chemotherapy plus concurrent radiochemotherapy.
		2016 Vol. 25 (3): 239-243 [Abstract] ( 2835 ) [HTML 1KB] [ PDF 349KB] ( 0 )

Physics·Biology·Technique

	226


		2016 Vol. 25 (3): 226-227 [Abstract] ( 2143 ) [HTML 1KB] [ PDF 208KB] ( 0 )

	260	Commissioning of Axesse accelerator for volumetric modulated arc therapy
		Yang Ruijie,Zhang Xile,Xie Yaoqin,Wang Junjie
		Objective To test the accuracy and reliability of Axesse accelerator for volumetric modulated arc therapy (VMAT). Methods The accuracy and reliability of Axesse accelerator for VMAT were tested in a stepwise manner, from the simple to the complex and from the part to the whole. For the parts of the system, the stability of dosimetric output and the position accuracy of multi-leaf collimator (MLC) were tested. For the process of the system, the variable VMAT dose rates and gantry speed modulation, the MLC speed and dose rate modulation, and dosimetric verification in patients were tested. Results Compared with fixed gantry irradiation, the variation in dosimetric output was below 1.0% for rotary irradiation including the slide rotary irradiation of the dynamic MLC. The MLC position error of 0.5 mm was visible using the electronic portal imaging system of Axesse, iViewGT 3.40. The MLC position accuracy was within 1 mm for fixed gantry irradiation and rotary irradiation. In the range of the dose rate applied in clinical practice, the testing results of variable VMAT dose rates and gantry speeds as well as variable dose rates and MLC speeds showed that the variation between different strip-field beam intensities was below 2.0%. Using a gamma criterion of 3 mm/3%, the pass rates in dosimetric verification of patients with cervical cancer, prostate cancer, and breast cancer were 96.52%, 95.72%, and 98.83%, respectively. Conclusions The Axesse system can precisely control MLC motion, variable dose rates, and gantry speeds in VMAT. The Axesse system is accurate and reliable for VMAT.
		2016 Vol. 25 (3): 260-265 [Abstract] ( 2629 ) [HTML 1KB] [ PDF 1756KB] ( 0 )

	266	Analyzing of correlation between the setup error and the couch position in radiotherapy
		Fu Guishan,Cheng Bin,Qin Shirui,Wang Qian,Li Wei,Dai Jianrong
		Objective To investigate the correlation between setup error and couch position error in radiotherapy. Methods A total of 25 patients with thoracic and abdominal tumors who recently finished image-guided radiotherapy were randomly selected. The data on couch position during treatment were obtained through the record validation system, and then the couch position error was calculated. The Pearson correlation analysis was used to investigate the correlation between setup error and couch position error during treatment. Results In the ≥5 setup errors among the 25 patients, the correlation coefficient between random setup error and random couch position error was 0.83(P=0.00), and the correlation coefficient between systematic setup error and systematic couch position error was 0.36(P=0.11). Conclusions In radiotherapy, the random setup error is highly correlated with the random couch position error, while a moderate or low correlation exists between the systematic setup error and the systematic couch position error.
		2016 Vol. 25 (3): 266-269 [Abstract] ( 2629 ) [HTML 1KB] [ PDF 339KB] ( 0 )

	270	Establishment of quality control evaluation system for 3D-ultrasound-based image-guided radiotherapy
		Wei Xiaobo,Hu Qiang,Mu Jinming,Xu Guoping,ChenYuan,Cheng Changhai,Li qilin,Pei Honglei
		Objective To analyze the stability and accuracy of the equipment for three-dimensional ultrasound-based image-guided radiation therapy (3DUS-IGRT) in daily practice, and to provide a basis for clinical application of radiotherapy for soft tissue tumors. Methods A specific calibration phantom was used for continuous calibration and quality control of the 3DUS-IGRT equipment in a year. The method for daily quality control of ultrasound-guided equipment was explored, and its stability and accuracy were monitored. Results The phantom position errors in both Sim and Guide stations of the 3DUS-IGRT equipment were within 1 mm. Conclusions The 3DUS-IGRT equipment has a stable performance with the support of a complete set of stringent and accurate calibration and quality control, which provides a new image-guided method for precise radiotherapy for soft tissue tumors.
		2016 Vol. 25 (3): 270-274 [Abstract] ( 2595 ) [HTML 1KB] [ PDF 1035KB] ( 0 )

	275	Imaging dose and risk of Varian thoracic cone beam CT to the ICRP computational reference phantom
		Zhang Yibao,Deng Jun,Hu Qiaoqiao,Yue Haizhen,Wu Hao
		Objective To investigate the dose distribution and radiation risk of Varian thoracic cone beam computed tomography (CBCT) with default parameters with reference to Monte Carlo simulation and International Commission on Radiological Protection (ICRP) report 110. Methods EGSnrc/BEAMnrc code was used to simulate the material, thickness, and geometry of the kV CBCT source (kVS) to establish the kVS model. A benchmarked MCSIM code was applied to calculate the dose distribution in the ICRP phantom after the scan with the standard thoracic parameters (110 kV, 20 mA, and 262 mAs), and the conversion coefficient of absolute dose was obtained in a spherical phantom following the TG-61 protocol. The results of Monte Carlo simulation were validated by PDD and Profile in a water phantom and the measurement of the absolute dose in the computed tomography dose index (CTDI) phantom and Alderson phantom. The models including BEIR VⅡ were used to evaluate the radiation risks. Results With reference to the criterion of 3%/1 mm, the uncertainties of PDD and Profile were less than 2%. The difference between the measured and calculated values was<2.9% in the CTDI phantom and ≤0.05 cGy in the Alderson phantom. In the ICRP110 phantom, the doses to the left lung, right lung, left breast, right breast, heart, thyroid, trachea, cancellous bone, and cortical bone were 1.28, 1.39, 1.74, 1.80, 1.46, 0.48, 0.88, 0.85, and 1.84 cGy, respectively. The relative risks of ischemic heart disease, breast cancer, lung cancer, thyroid cancer, and tracheal cancer in a standard scan were 1.001, 1.009, 1.019, 1.000, and 1.008, respectively. Conclusions The accumulated dose and long-term risks of CBCT during image-guided thoracic radiotherapy cannot be neglected and should be effectively controlled.
		2016 Vol. 25 (3): 275-278 [Abstract] ( 3027 ) [HTML 1KB] [ PDF 789KB] ( 0 )

	279	Verification and calibration of leaf position of a multi-leaf collimator by ionization chamber arrays
		Huang Yanqiu,Qiu Lingping,Zhou Chunjun
		Objective To verify and adjust the leaf position accuracy of a multi-leaf collimator (MLC) in a linear accelerator. Methods Ionization chamber arrays (StarTrack, IBA) were used to measure the leaf position accuracy of a MLC in a linear accelerator (Precise, ELEKTA) and adjust the leaves out of tolerance. Results After the adjustment of leaf position of the MLC, the analysis of the verification films taken at the offset position showed that the leaf position of the MLC was accurate. Conclusions The method developed in this study is convenient and simple for measurement and calibration of leaf position of the MLC in the linear accelerator, which meets the MLC position accuracy requirement for the linear accelerator.
		2016 Vol. 25 (3): 279-281 [Abstract] ( 2575 ) [HTML 1KB] [ PDF 1617KB] ( 0 )

	282	Effect of single high-dose irradiation on rat hepatic stellate cells,transforming growth factor β,and PI3K/Akt signaling pathway molecule p-Akt (S473)
		Xiao Lei,Wu Ge,Wang Yunlian,Cheng Wei,Ainiwar·Aimulula,Mao Rui,Zhang Hua,Zhang Hua,Bao Yongxing
		Objective To investigate the effect of single high-dose irradiation on rat hepatic stellate cells (HSCs),transforming growth factor β(TGF-β),and PI3K/Akt signaling pathway. Methods A total of 40 healthy male Sprague-Dawley rats were randomly divided into model group (30 rats) and control group (10 rats).The rats in the model group were given single 6 MV X-ray irradiation of the right liver at a dose of 30 Gy,and those in the control group were given sham irradiation with the same method. At 3,5,and 10 days after irradiation,10 rats in the model group and 3-4 rats in the control group were randomly selected to measure the changes in the serum levels of aspartate aminotransferase (AST),alanine aminotransferase (ALP),alkaline phosphatase (ALP),total bilirubin (TB),and direct bilirubin (DB).Hematoxylin-eosin (HE) staining and Masson staining were applied for liver tissues to observe the pathomorphological changes,and immunohistochemistry was used to measure the expression of transforming growth factor-beta 1(TGF-β₁),alpha-smooth muscle actin (α-SMA),and p-Akt (S473) in liver tissues. Results At 3,5,and 10 days after irradiation,the model group showed increases in the serum levels of AST,ALT,ALP,TB,and DB,and had significantly higher serum levels of these indices than the control group. The HE staining and Masson staining showed that compared with the control group,the rats with acute liver injury induced by radiation in the model group had a significant formation of collagen fibers around the hepatic sinusoids. Immunohistochemistry showed that with the prolonged time after irradiation,the expression of TGF-β₁,α-SMA,and p-Akt (S473) was gradually enhanced after irradiation,and IPP analysis showed significant differences between the two groups (P<0.000). Conclusions During the process of acute radiation-induced liver injury induced by single high-dose irradiation,with the activation of HSCs,the secretion of TGF-β₁ is increased and the PI3K/Akt signaling pathway is activated.
		2016 Vol. 25 (3): 282-286 [Abstract] ( 2246 ) [HTML 1KB] [ PDF 717KB] ( 0 )

	233


		2016 Vol. 25 (3): 233-233 [Abstract] ( 2058 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	287


		2016 Vol. 25 (3): 287-287 [Abstract] ( 1936 ) [HTML 1KB] [ PDF 186KB] ( 0 )

	300


		2016 Vol. 25 (3): 300-300 [Abstract] ( 1090 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	244	Effect of MRI-guided intensity-modulated radiotherapy with bone marrow protection on hematologic toxicity in patients with rectal cancer undergoing concurrent chemoradiotherapy
		Wang Jianyang,Tian Yuan,Tang Yuan,Wang Xin,Li Ning,Ren Hua,Fang Hui,Feng Yanru,Wang Shulian,Song Yongwen,Liu Yueping,Wang Weihu,Li Yexiong,Jin Jing
		Objective To reduce the radiation dose to the hematopoietic bone marrow (hBM) and acute hematologic toxicity (HT) in patients with rectal cancer undergoing intensity-modulated radiotherapy (IMRT). Methods The previously untreated patients with rectal cancer were enrolled in a prospective study. Pelvic magnetic resonance imaging (MRI) was used to determine and delineate the distribution of hBM,and dose limitations were set (V₅<95%,V₁₀<90%,V₂₀<80%,V₃₀<65%).The neoadjuvant therapeutic regimen included concurrent IMRT (95% PTV 50 Gy/25 fractions,2 Gy/fractions),oxaliplatin 50 mg/m²,qw,and capecitabine 1650 mg/m²,1 fractions/d (twice a day during radiotherapy). Results A total of 35 patients were enrolled and completed the therapeutic regimen. The incidence of grade 2-4 HT was 31.4%;among these patients,9(26%) experienced leucopenia,6(17%) experienced neutropenia,1(3%) experienced erythropenia,and 1(3%) experienced thrombocytopenia. No patients experienced grade ≥3 anemia. The multivariate logistic linear regression analysis showed that hBM-V₅ was significantly correlated with the lowest counts of leukocytes (P=0.005),neutrophils (P=0.002),and platelets (P=0.017). Conclusions The radiation dose to the hBM in the pelvis on MRI is significantly correlated with the incidence and severity of acute HT in patients with rectal cancer undergoing neoadjuvant concurrent chemoradiotherapy.Clinical Trial Registry ClinicalTrials.gov,registration number:NCT01863420.
		2016 Vol. 25 (3): 244-248 [Abstract] ( 2908 ) [HTML 1KB] [ PDF 603KB] ( 0 )

	249	Image registration and target volume margins in cone-beam computed tomography-guided intensity-modulated radiotherapy for prostate cancer
		Li Ming,Gao Hong,Xiu Xia,Hou Xiuyu,Xu Yonggang,Zhong Qiuzi,Zhao Ting,Lin Hailei,Li Gaofeng
		Objective To analyze the data from intensity-modulated radiotherapy (IMRT) for prostate cancer guided by kilovoltage cone-beam computed tomography (CBCT), and to provide a clinical basis for selecting the optimal image registration method and reasonable target volume margins. Methods A total of 16 patients with prostate cancer who received radical IMRT were enrolled, and CBCT for online position verification was performed 214 times. The images were obtained after conventional skin marking and laser alignment, and automatic registration, bone registration, soft tissue registration, and manual registration were performed for CBCT images and planned CT images. The differences between these four registration methods were evaluated, and the margins for extending clinical target volume into planning target volume (PTV) were calculated. Results The setup errors in left-right, anterior-posterior, and cranial-caudal directions for automatic registration, bone registration, soft tissue registration, and manual registration were-0.6±2.8 mm/-0.6±4.5 mm/-0.6±3.8 mm,-0.7±2.7 mm/-0.9±4.5 mm/-0.8±4.1 mm,-0.8±2.6 mm/-0.3±4.4 mm/-1.1±4.0 mm, and-0.6±2.9 mm/-0.7±5.1 mm/-0.9±3.9 mm, respectively. There were no significant differences between the four registration methods. The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions were calculated as 4.7 mm, 5.2 mm, and 6.5 mm, respectively. Conclusions With a comprehensive consideration of various factors, a default setting of automatic registration and manual fine adjustment is appropriate for CBCT-guided radiotherapy for prostate cancer. The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions are 4.7 mm, 5.2 mm, and 6.5 mm, respectively.
		2016 Vol. 25 (3): 249-254 [Abstract] ( 2755 ) [HTML 1KB] [ PDF 470KB] ( 0 )

	255	A dosimetric comparison of static intensity-modulated radiotherapy,volumetric-modulated arc therapy,and helical tomotherapy after surgery for gastroesophageal junction adenocarcinoma
		Wang Xin,Tian Yuan,Jin Jing,Hu Zhihui,Tang Yuan,Zhang Jiajia,Feng Yanru,Ren Hua,Li Ning,Liu Wenyang,Li Yexiong
		Objective To investigate the effects of different irradiation techniques on dose distribution in target volume and normal tissues after the radical surgery for gastroesophageal junction adenocarcinoma,and to provide the optimal regimen for clinical treatment. Methods A total of 9 patients with gastroesophageal junction adenocarcinoma who underwent radical esophagus-proximal gastrectomy or total gastrectomy were enrolled. The therapeutic regimens of five-field static intensity-modulated radiotherapy (IMRT),volumetric-modulated arc therapy (VMAT),and helical tomotherapy (HT) were designed for each patient,and the dose-volume histogram was used to evaluate the effects of different irradiation techniques on the conformity index (CI) and homogeneity index (HI) of target volume and the surrounding normal tissues. The prescribed dose was 45 Gy at 1.8 Gy/fraction. The patients received oral S-1 as concurrent chemotherapy at a dose of 80 mg/(m²·d) twice a day during radiotherapy. Results Compared with IMRT and VMAT,HT had better CI and HI of the target volume,as well as a better protective effect on the intestinal tract and bone marrow. Compared with IMRT and HT,VMAT had a lower V₂₀ and V₃₀ for the left kidney and a lower V₃₀ for the heart,while IMRT had lower V₅ and V₁₀ for both lungs;V₂₀ and mean dose showed no significant differences between the three techniques. HT had the highest mean sub-field hop count,followed by IMRT and VMAT. Conclusions IMRT,VMAT,and HT can meet the clinical requirements,but besides ensuring the best CI and HI of the target volume,HT has a good protective effect on the intestine and spinal cord and can help to reduce the incidence of adverse events in patients.
		2016 Vol. 25 (3): 255-259 [Abstract] ( 2760 ) [HTML 1KB] [ PDF 794KB] ( 0 )

Review Articles

	288	The application of PET/CT to predict prognosis of radiotherapy of NSCLC
		Liang Meng,Zheng Rong
		Conventional CT plays an important role in the diagnosis, staging, radiotherapy target delineation, and prognosis of NSCLC, but it still has many limitations. PET/CT has been widely used in the diagnosis and treamtent of lung cancer. In particular, PET/CT metabolic parameters have great guiding significance in the prognosis of NSCLC patients undergoing radiotherapy, and may be superior to many clinical indices. This review summarizes the advances in the application of PET/CT in the prognostic evaluation of NSCLC patients undergoing radiotherapy.
		2016 Vol. 25 (3): 288-291 [Abstract] ( 2740 ) [HTML 1KB] [ PDF 367KB] ( 0 )

	292	Research progress of axillary management approach for 1-2 sentinel lymph node positive early stage breast cancer patients
		Zhang Li,Yu Xiaoli,Guo Xiaomao
		Sentinel lymph node biopsy has been the standard axillary intervention for breast cancer patients with clinical negative axillary lymph nodes. Complete axillary dissection could be omitted for patients with negative sentinel lymph nodes. While, the optimal axillary intervention for patients with 1-2 positive sentinel lymph nodes remained controversial. This review introduced the latest research results of the axillary management for early stage breast cancer patients with 1-2 positive sentinel lymph nodes.
		2016 Vol. 25 (3): 292-295 [Abstract] ( 3278 ) [HTML 1KB] [ PDF 352KB] ( 0 )

	296	The effect of brain metastases from NSCLC and treatment targeted plus radiotherapy on EGFR mutations
		Cao Jianzhong,Li Hongwei
		Brain metastases (BM) are one of the main cause of death in patients with non small cell lung cancer (NSCLC).The prognosis is still poor,despite standard therapy based on surgery and radiotherapy. In recent years,with the deepening understanding of molecular mechanisms in lung cancer,epidermal growth factor receptor (EGFR) mutation might be considered as an effective therapeutic target for NSCLC with BM.Therefore,we review the current knowledge about the correlation between EGFR mutation with prevalence and prognosis in BM.
		2016 Vol. 25 (3): 296-299 [Abstract] ( 2867 ) [HTML 1KB] [ PDF 346KB] ( 0 )

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