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.5 Published 2016-05-01

	427	Practice of proton and heavy ion radiotherapies for head and neck malignancies
		Kong Lin,Lu Jiande
		Radiotherapy is an important therapeutic method in the management of head and neck cancer. However, since the head and neck region has many important functions of the human body, radiotherapy may cause serious sequelae. Proton and heavy ion radiotherapies have better radiophysical and biological properties compared with conventional proton beam and are beneficial to tumor control and protection of normal tissue. The advantages of proton and heavy ion radiotherapies have been demonstrated in soft tissue tumors (especially skull base chordoma and chondrosarcoma), malignant melanoma, and adenoid cystic carcinoma resistant to conventional protons in the head and neck region, and the safety of proton and heavy ion radiotherapies have been confirmed in reirradiation for recurrent tumors.
		2016 Vol. 25 (5): 427-431 [Abstract] ( 2663 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	432	Influence of neutrophil-lymphocyte ratio on radiosensitivity and prognosis in patients with nasopharyngeal carcinoma
		Li Xiaohui,Xu Bingqing,Gao Jin,Xia Yunfei
		Objective To investigate the influence of neutrophil-lymphocyte ratio (NLR) on radiosensitivity and prognosis, the relationship between NLR and clinical features, and the clinical value of NLR in patients with nasopharyngeal carcinoma (NPC). Methods 2006 to 2011 in the cancer center of Zhongshan University admitted to the newly diagnosed nasopharyngeal cancer patients in 266 cases. The association of pretreatment NLR with radiotherapy doses 20, 40, and 60 Gy and therapeutic effect at 3 months after radiotherapy was analyzed, as well as the influence of NLR on overall survival (OS), local recurrence-free (LRF), and distant metastasis-free (DMF) rates. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis. Results NLR showed differences across patients with different T stages and sexes (P=0.039,0.032). The patients with NLR≤3 had significantly higher OS, LRF, and DMF rates compared with those with NLR>3(P=0.004,0.025,0.045). As NLR increased, the radiosensitivity in patients with NPC was reduced gradually, and radiosensitivity showed a significant difference between sensitive group and moderately sensitive group (P=0.043). When the radiotherapy dose was 40 Gy, the tumor regression group had a lower NLR than the residual tumor group (P=0.025). Conclusions In patients with NPC, an increased pretreatment NLR is an adverse prognostic factor, and NLR can be used as a simple and convenient method to evaluate the prognosis of patients with NPC.
		2016 Vol. 25 (5): 432-435 [Abstract] ( 2444 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	436	Influence of neutrophillymphocyte ratio on radiosensitivity and prognosis in patients with nasopharyngeal carcinoma
		Li Xiaohui,Xu Bingqing,Gao Jin,Xia Yunfei
		Objective To investigate the influence of neutrophil-lymphocyte ratio (NLR) on radiosensitivity and prognosis, the relationship between NLR and clinical features, and the clinical value of NLR in patients with nasopharyngeal carcinoma (NPC). Methods 2006 to 2011 in the cancer center of Zhongshan University admitted to the newly diagnosed nasopharyngeal cancer patients in 266 cases. The association of pretreatment NLR with radiotherapy doses 20, 40, and 60 Gy and therapeutic effect at 3 months after radiotherapy was analyzed, as well as the influence of NLR on overall survival (OS), local recurrence-free (LRF), and distant metastasis-free (DMF) rates. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis. Results NLR showed differences across patients with different T stages and sexes (P=0.039,0.032). The patients with NLR≤3 had significantly higher OS, LRF, and DMF rates compared with those with NLR>3(P=0.004,0.025,0.045). As NLR increased, the radiosensitivity in patients with NPC was reduced gradually, and radiosensitivity showed a significant difference between sensitive group and moderately sensitive group (P=0.043). When the radiotherapy dose was 40 Gy, the tumor regression group had a lower NLR than the residual tumor group (P=0.025). Conclusions In patients with NPC, an increased pretreatment NLR is an adverse prognostic factor, and NLR can be used as a simple and convenient method to evaluate the prognosis of patients with NPC.
		2016 Vol. 25 (5): 436-437 [Abstract] ( 2158 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	438	An analysis of clinical and dosimetric factors for postradiation nasopharyngeal necrosis in intensity-modulated radiotherapy for nasopharyngeal carcinoma
		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 influencing factors for postradiation nasopharyngeal necrosis (PRNN) by analyzing clinical characteristics, prognosis, and dosimetry of PRNN after initial intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods A retrospective analysis was performed among 1217 patients with NPC who received initial IMRT from 2001 to 2013. Twenty-one patients were diagnosed with PRNN by clinical symptoms, endoscopy, magnetic resonance imaging, and pathological evidence (not including local recurrence). The clinical characteristics and prognosis were summarized and the radiotherapy plans were reassessed for dosimetric evaluation. Results In the 21 patients with PRNN, 17 were male and 4 female;one patient was in stage T₂, 3 in stage T₃, and 17 in stage T₄. The median volume of gross tumor was 83 cm³. All patients received radiotherapy with a prescribed dose of 73.92 Gy except one patient with stage T₂ disease who received a prescribed dose of 69.96 Gy. The time to PRNN after radiotherapy ranged between 1.8 and 21.9 months (median time=6.2 months). The incidence of massive nasopharyngeal bleeding was 48%(10/21). In the 21 patients, 6 recovered form PRNN, 15 remained ill, and 8 patients died, consisting of 4 who died of massive nasopharyngeal bleeding, 3 of cachexia with multiple organ failure, and 1 of multiple bone metastases. Conclusions PRNN is one of the severe adverse reactions after IMRT for NPC. The development of PRNN is related to advanced T stage, large tumor volume, poor nutritional status, infection, radiotherapy dose, and intense treatment. Massive nasopharyngeal bleeding and cachexia are the primary causes of death in patients with PRNN.
		2016 Vol. 25 (5): 438-442 [Abstract] ( 2377 ) [HTML 1KB] [ PDF 419KB] ( 0 )

	443	Therapeutic effects of intensity-modulated radiotherapy and three-dimensional conformal radiotherapy in patients with stage Ⅲ N (+) esophageal cancer:a comparative study
		Zhang Andu,Han Chun,Wang Lan,Xu Shan,Zhu Longyu,Kong Jie,Gao Chao,Li Xiaoning
		Objective To investigate the therapeutic effects and adverse effects of three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in patients with stage Ⅲ N (+) esophageal cancer. Methods A total of 428 patients with esophageal cancer who were treated from 2003 to 2012 and met the inclusion criteria were enrolled, and among these patients, 293 received 3DCRT and 135 received IMRT. The median radiation dose was 60 Gy. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis. Results The 1-, 3-, and 5-year local control rates in 3DCRT group and IMRT group were 65.1%/40.6%/37.5% and 70.0%/57.0%/49.4%, respectively (P=0.025). The 1-, 3-, and 5-year overall survival (OS) rates in 3DCRT group and IMRT group were 56.0%/22.3%/15.7% and 53.3%/29.2%/17.8%, respectively (P=0.394). Compared with the 3DCRT group, the IMRT group had a significantly higher mean lung dose (P=0.001) and significantly lower lung V₂₀, V₂₅, V₃₀, and V₃₅(P=0.007, 0.000, 0.000, and 0.000). Compared with the 3DCRT group, the IMRT group had significantly higher incidence rates of grade Ⅱ and Ⅲ acute radiation esophagitis and grade Ⅱ acute radiation pneumonitis (P=0.000, 0.006, and 0.043). Of all patients, 343 patients died, and the main cause of death was local factors (60.6%), followed by distant metastasis (25.1%). The IMRT group had a significantly lower proportion of patients who died of local factors than the 3DCRT group (51.0% vs. 64.5%, P=0.021). Conclusions IMRT is effective in the treatment of esophageal cancer, and compared with 3DCRT, it significantly improves the local control rate. However, IMRT does not improve the long-term OS rate. The main cause of death is local factors, followed by distant metastasis. The patients receiving IMRT have a significantly lower proportion of those who die of local factors than the patients receiving 3DCRT.
		2016 Vol. 25 (5): 443-446 [Abstract] ( 2520 ) [HTML 1KB] [ PDF 448KB] ( 0 )

	447	Prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy and surgery
		Hao Daxuan,Yang Yuanyuan,Li Xue,Wu Xiaoyuan,Chen Yongshun,He Chunyu,Wang Wen,Liu Jinsong,Wang Jianhua
		Objective To analyze the prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy and surgery. Methods A retrospective analysis was performed among 74 patients with esophageal squamous cell carcinoma who received neoadjuvant chemoradiotherapy and surgery from January 2007 to April 2014. All patients had preoperative stage cT_3-4N_0-1M₀, consisting of 26 patients with stage cⅡ disease and 48 patients with stage cⅢ disease. Overall survival rates were estimated by the Kaplan-Meier method and compared using the Log-rank test for univariate analysis. Cox regression analysis was performed to provide multivariate analysis. Results The 1-, 3-, and 5-year overall survival (OS) rates were 85.7%, 50.0%, and 37.4% in patients with grade 1 tumor regression, 84.8%, 50.1%, and 46.3% in patients with grade 2 tumor regression, and 93.8%, 85.6%, and 85.6% in patients with grade 3 tumor regression, respectively (P=0.049). The 1-, 3-, and 5-year OS rates were 93.8%, 86.5%, and 86.5% in patients with pathologic complete response (pCR) and 85.2%, 52.4%, and 44.5% in patients without pCR, respectively (P=0.015). The 1-, 3-, and 5-year OS rates were 96.5%, 60.9%, and 57.1% in patients without pathologic lymph node metastasis (ypN-) and 57.1%, 35.7%, and 35.7% in patients with pathologic lymph node metastasis (ypN+), respectively (P=0.015). The 1-, 3-, and 5-year OS rates were 93.3%, 70.0%, and 62.1% in downstaged patients and 66.7%, 16.7%, and 16.7% in patients not downstaged, respectively (P=0.000). The multivariate analysis revealed that the ypN status and downstaging were independent prognostic factors for survival in patients (P=0.028;P=0.015). Conclusions Postoperative tumor regression grading is closely associated with prognosis. Particularly, patients with pCR have substantially improved survival. The ypN status and downstaging are independent prognostic factors for survival.
		2016 Vol. 25 (5): 447-451 [Abstract] ( 2364 ) [HTML 1KB] [ PDF 355KB] ( 0 )

	452	Prognostic value of FDG PET-CT metabolic parameters before treatment in patients with esophageal cancer receiving radiotherapy
		Xie Yanting,Zheng Rong,Wu Ning,Zhang Wenjie,Liang Ying,Liu Ying,Li Xiaomeng,Liang Meng,Xiao Zefen,Zhou Zongmei,Feng Qinfu,Wang Lyuhua,Li Yexiong
		Objective To investigate the prognostic value of metabolic parameters, maximum standard uptake value (SUV_max), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and PET tumor length(PTL), in primary lesions of esophageal cancer on FDG PET-CT imaging in patients receiving radiotherapy or combined radiotherapy. Methods A total of 55 patients with stage Ⅰ-IV esophageal cancer who received PET-CT radiotherapy localization in our hospital from 2006 to 2012 were enrolled. The association of sex, age, primary lesion, TNM stage, SUV_max, MTV, TLG, PTL, and therapeutic methods with the patient’s prognosis was analyzed. The receiver operating characteristic curve was used to determine the cut-off values of SUV_max, MTV, TLG, and PTL, and the patients were divided into higher-value group and lower-value group. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis. Results The median overall survival (OS) time for all patients was 19.1 months (95%CI 8.1-30.1), and the 1-, 2-, 3-, and 4-year OS rates were 59%, 45%, 35%, and 26%, respectively. The group with lower values of SUV_max(<11.4), MTV (<8.27cm³), TLG (<35.21), and PTL (<5.8 cm) had better prognosis than those with higher values (P=0.002, 0.021, 0.044, and 0.000).Conclusions SUV_max, MTV, TLG, and PTL before treatment have certain values in predicting the prognosis of patients with esophageal cancer. Risk stratification can be performed for these patients before radiotherapy according to these parameters, in order to develop individualized treatment regimens and improve prognosis.
		2016 Vol. 25 (5): 452-456 [Abstract] ( 2521 ) [HTML 1KB] [ PDF 469KB] ( 0 )

	457	Concurrent chemoradiotherapy with nimotuzumab and capecitabine for patients with unresectable, postoperative residual, or recurrent gastric cancer:a prospective study
		Lu Ningning,Jin Jing,Ren Hua,Tamg Yuan,Wamg Xin,Jiang Liming,Li Ning,Feng Yanru,Wang Shulian,Wang Weihu,Song Yongwen,Liu Yueping,Fang Hui,Zhang Jiajia,Li Shuai,Li Yexiong
		Objective To investigate the adverse effects and short-term therapeutic effect of concurrent chemoradiotherapy with nimotuzumab and capecitabine for patients with unresectable, postoperative residual, or recurrent gastric cancer. Methods A prospective phase Ⅱ study was performed in patients with pathologically confirmed gastric cancer. Inclusion criteria were as follows:unresectable, postoperative residual, or recurrent gastric cancer in which lesions could be measured;lesions which could receive radiotherapy;expected survival time>3 months. All patients received intensity-modulated radiotherapy (54 Gy in 30 fractions for planned gross tumor volume, 45 Gy in 25 fractions for the prophylactic area in lymph nodes) and concurrent capecitabine (1 600 mg/m² per day for 35 days) and nimotuzumab (200 mg once a week). Common Terminology Criteria for Adverse Events, version 3.0 and Response Evaluation Criteria in Solid Tumors were used to evaluate acute adverse effects and short-term therapeutic effect. ResultsA total of 30 patients were enrolled from 2010 to 2013. The median age was 57 years (range 35-66 years). There were 23 patients with postoperative residual or recurrent gastric cancer and 7 with unresectable gastric cancer. Twenty-eight patients received chemotherapy before being enrolled in this study and achieved stable disease or progression. During concurrent chemoradiotherapy, 5 patients (17%) experienced grade 3 acute adverse events, mainly thrombocytopenia (10%). At one month after treatment, the in-field objective response rate and stable disease rate were 43%(complete response 4%, partial response 39%) and 50%, respectively, and the systemic objective response rate and stable disease rate were 32% and 43%, respectively. Conclusions In patients with unresectable, postoperative residual, or recurrent gastric cancer, concurrent chemoradiotherapy with nimotuzumab and capecitabine has good safety, tolerability, short-term therapeutic effect, and in-field control. Clinical Trial Registry ClinicalTrials.gov, registration number:NCT01180166.
		2016 Vol. 25 (5): 457-461 [Abstract] ( 2581 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	462	Relationship of expression of APAF-1 and COX-2 with pathologic complete response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma
		Peng Haihua,Yu Xin,Xi Shaoyan,Zhang Tian,Dong Jun,You Kaiyun,Cai Muyan,Wang Chengtao,Zhang Huizhong,Wen Bixiu,Gao Yuanhong
		Objective To investigate the relationship of expression of apoptosis protease-activating factor 1(APAF-1) and cyclooxygenase-2(COX-2) with pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (neo-CRT) for locally advanced rectal adenocarcinoma. Methods Paraffin-embedded tumor tissue sections were collected from 82 patients with locally advanced rectal adenocarcinoma who received neo-CRT and radical surgery from 2005 to 2012. Immunohistochemical assay was used to determine the expression of APAF-1 and COX-2. Postoperative pathological tissue sections were reassessed for evaluation of tumor regression grade (0-4, pCR=4) after radiochemotherapy. The relationship of expression of APAF-1 and COX-2 with pCR was analyzed by chi-square test or Fisher′s exact test. Logistic regression analysis was used to predict the influencing factors for pCR. Results The numbers of patients with grade 0, 1, 2, 3, and 4 tumor regression were 0, 6(7%), 33(40%), 20(24%), and 23(28%), respectively. Patients with high expression of APAF-1 had a significantly higher incidence of pCR than those with low expression of APAF-1(37% vs. 17%, P=0.047), while patients with low expression of COX-2 had a significantly higher incidence of pCR than those with high expression of COX-2(38% vs. 15%, P=0.028). Patients with high expression of APAF-1 and low expression of COX-2 had a significantly higher incidence of pCR than patients with high expression of APAF-1 and COX-2, patients with low expression of APAF-1 and COX-2, and patients with low expression of APAF-1 and high expression of COX-2(56% vs. 14%;56% vs. 17%;56% vs. 15%;P=0.005). The expression of APAF-1 was positively correlated with pCR (P=0.042), while the expression of COX-2 was negatively correlated with pCR (P=0.024). ConclusionsThe expression of APAF-1 and COX-2 is correlated with pCR to neo-CRT for locally advanced rectal adenocarcinoma. The measurement of expression of both APAF-1 and COX-2 holds promise for prediction of pCR.
		2016 Vol. 25 (5): 462-466 [Abstract] ( 2316 ) [HTML 1KB] [ PDF 1459KB] ( 0 )

	467	Different fractionation schedules of radiotherapy in preoperative concurrent chemoradiotherapy for rectal cancer:a clinical study
		Luo Yan,Wang Wenling,Han Lei,Dong Hongmin,Wang Gang,Wang Zhiyong,Hu Yinxiang,Zhang Ruyi,Zhen Yunhuan,Wang Zejun
		Objective To investigate the efficacy and safety of preoperative modified short-course chemoradiotherapy and conventionally fractionated chemoradiotherapy for rectal cancer. Methods A total of 60 patients with resectable rectal cancer were randomized into preoperative modified short-course chemoradiotherapy group (group A, 30 patients, 30 Gy in 10 fractions) and conventionally fractionated chemoradiotherapy group (group B, 30 patients, 45 Gy in 25 fractions), and surgery was performed at 2 weeks and 6-8 weeks after chemoradiotherapy, respectively. Results Group A and group B had pathologic downstaging rates of 30% and 67%(P=0.004), sphincter preservation rates of 53% and 68%(P=0.291), RO resection rates of 97% and 100%(P=0.236), 3-year overall survival rates of 83% and 88%(P=0.717), 3-year locoregional recurrence rates of 10% and 7%(P=0.639), and 3-year distant metastasis rates of 27% and 30%(P=0.774). In these two groups, the patients with or without the downstaging phenomenon had a 3-year overall survival rate of 97% or 74%(P=0.016). The incidence rates of grade 1-3 radiodermatitis, grade 2 radiation enteritis, and grade 2 leucopenia, anastomotic leak, and delayed wound healing were similar between the two groups (P=0.092-0.717). Conclusions Both preoperative modified short-course chemoradiotherapy and conventionally fractionated chemoradiotherapy can be used as the regimen of preoperative neoadjuvant chemoradiotherapy in patients with resectable rectal cancer, and preoperative modified short-course chemoradiotherapy has a short treatment cycle, a short time of hospital stay, and a low cost, and is easily accepted by patients.
		2016 Vol. 25 (5): 467-471 [Abstract] ( 2259 ) [HTML 1KB] [ PDF 339KB] ( 0 )

	472	Disscussion and analysis of the effect of adjuvant radiotherapy after neoadjuvant chemotherapy for stage T_1-2N₁M₀ breast cancer
		Tang Mengqiu, Wu Shikai,Sun Bing, Huang Zhou,Zhao Rugang,Wang Junliang,Shen Ge,Song Santai
		Objective To evaluate the effects and significance of adjuvant radiotherapy after neoadjuvant chemotherapy on local recurrence (LR) rate in patients with stage T_1-2N₁M₀ breast cancer. Methods Clinical data were collected from patients with stage T_1-2N₁M₀ breast cancer who were admitted to our hospital and treated with neoadjuvant chemotherapy from 2005 to 2010. The clinical outcomes in those patients were analyzed after treatment with adjuvant radiotherapy. A total of 144 patients with a median age of 45 years (23-72 years) were enrolled as subjects. Results In the 144 patients, 30 patients (21%) who had pathological complete response (pCR) in primary breast tumor and axillary lymph node received adjuvant radiotherapy;10 out of 45 patients who had pCR in axillary lymph node alone did not receive adjuvant radiotherapy;6 out of 69 patients who still had axillary lymph node metastasis after treatment did not receive adjuvant radiotherapy;all of the rest received adjuvant radiotherapy. In all patients, the median follow-up time was 88 months;46 patients (32%) had relapse and metastasis. The 5-year LR rate was 3.0% in patients with pCR. In patients with pCR in axillary lymph node metastasis after neoadjuvant chemotherapy, there was no significant difference in the 5-year LR rate between patients treated with and without radiotherapy (7% vs. 16%,P=0.181). In patients with axillary lymph node metastasis after neoadjuvant chemotherapy, there was also no significant difference in the 5-year LR rate between patients treated with and without radiotherapy (15.9% vs. 33.3%,P=0.267). In all patients, those with pCR had significantly longer disease-free survival (DFS) time than those without pCR (P=0.017). Conclusions Patients with pCR to neoadjuvant chemotherapy have longer DFS time than those without pCR. The LR rate is relatively lower in patients with pCR undergoing adjuvant radiotherapy. Patients with pCR in axillary lymph node metastasis do not benefit from postoperative adjuvant radiotherapy. However, adjuvant radiotherapy is helpful in patients with axillary lymph metastasis after neoadjuvant chemotherapy who have high LR rates
		2016 Vol. 25 (5): 472-476 [Abstract] ( 2137 ) [HTML 1KB] [ PDF 354KB] ( 0 )

	477	Efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma
		Wu Wanli,Yuan Shuhui,Lou Hanmei,Zhang Ping,Yu Aijun
		Objective To investigate the efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma. Methods A total of 62 patients with cervical adenosquamous carcinoma, 149 patients with cervical adenocarcinoma, and 2687 patients with cervical squamous cell carcinoma, all of whom were in stage Ⅰ_B-Ⅱ_A and were treated from 2006 to 2012, were enrolled, and some of them received postoperative pelvic radiotherapy±para-aortic extended field radiation±afterloading radiotherapy. The chemotherapy regimen consisting of DDP, TP, and FP was given to these patients. The chi-square test was used for comparison of general clinical data, the Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Results Cervical adenosquamous carcinoma and adenocarcinoma had no significant differences in clinicopathological features (P=0.107-0.639). The high-risk patients with adenocarcinoma had a higher recurrence rate than their low-risk counterparts even after adjuvant radiotherapy or chemoradiotherapy (P=0.000).In the patients treated with surgery and radiotherapy, those with adenosquamous carcinoma had the shortest median survival time, followed by those with adenocarcinoma and squamous cell carcinoma (P=0.134,0.787);in the patients treated with surgery and concurrent chemoradiotherapy, those with adenocarcinoma had the shortest median survival time , followed by those with adenosquamous carcinoma and squamous cell carcinoma (P=0.131,0.643), and the median survival time showed a significant difference between the patients with adenocarcinoma and those with squamous cell carcinoma (P=0.000). In the patients with adenosquamous carcinoma and adenocarcinoma, the patients treated with postoperative concurrent chemoradiotherapy had higher incidence rates of short-term adverse reactions than those treated with postoperative radiotherapy (P=0.037,0.003), but the incidence rates of long-term adverse reactions showed no difference between the two groups of patients (P=0.861,0.655). In the patients with adenosquamous carcinoma, the patients treated with postoperative concurrent chemoradiotherapy had a lower rate of distant metastasis (P=0.003) and prolonged median overall survival anddisease-free survival (both increased by 17 months)(P=0.811,0.799), as compared with those treated with postoperative radiotherapy, while in the patients with adenocarcinoma, the median overall survival anddisease-free survival were reduced by 11 and 9 months, respectively (P=0.330,0.115). ConclusionsCompared with postoperative radiotherapy, postoperative concurrent chemoradiotherapy for early-stage high-risk cervical adenosquamous carcinoma can reduce the rate of distance metastasis. Compared with radiotherapy, postoperative concurrent chemoradiotherapy for adenosquamous carcinoma and adenocarcinoma cannot improve survival time.
		2016 Vol. 25 (5): 477-480 [Abstract] ( 2697 ) [HTML 1KB] [ PDF 361KB] ( 0 )

	481


		2016 Vol. 25 (5): 481-482 [Abstract] ( 2148 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	483	Correlation between ICRU reference point dose and dose-volume parameters of organs at risk in three-dimensional conformal brachytherapy for locally advanced cervical cancer
		Zhao Hongfu,Han Dongmei,Cheng Guanghui,Shi Dan,Zhu Yonggang,Zhao Zhipeng,Ge Yuxin
		Objective To investigate the correlation between ICRU reference point dose and dose-volume parameters of organs at risk (OARs) under different bladder and rectal filling status in three-dimensional conformal brachytherapy for locally advanced cervical cancer. Methods A total of 31 patients who received magnetic resonance imaging-guided three-dimensional conformal brachytherapy for cervical cancer in 96 fractions were enrolled. The ICRU rectal and bladder reference points were determined in the treatment planning system, and the doses at these points were recorded and compared with the dose-volume parameters of the rectum and bladder. The paired t-test was used to analyze the differences between them. Results Bladder D_ICRU was lower than bladder D_{0.1 cm³} and D_{1 cm³}(P=0.000 and 0.000), higher than bladder D_{5 cm³} and D_{10 cm³}(P=0.000 and 0.000), and similar to bladder D_{2 cm³}(P=0.345). Under the bladder filling status, bladder D_ICRU was lower than D_{2 cm³}. Rectal D_ICRU was lower than rectal D_{0.1 cm³} and D_{1 cm³}(P=0.000 and 0.002), higher than rectal D_{5 cm³} and D_{10 cm³}(P=0.000 and 0.000), and similar to rectal D_{2 cm³}(P=0.058). The ICRU bladder and rectal reference point doses were positively correlated with corresponding D_{2 cm³}. In the case of bladder volume ≥200 cm³, the ICRU bladder reference point dose underestimated bladder D_{2 cm³}. In the case of rectal volume ≥37 cm³, the ICRU rectal reference point dose overestimated rectal D_{2 cm³}. Conclusions In three-dimensional conformal brachytherapy, it is generally safe to use D_{2 cm³} as an index to evaluate OARs, but when the bladder or rectum is in an empty status, the ICRU bladder or rectal reference point doses should be considered.
		2016 Vol. 25 (5): 483-487 [Abstract] ( 2269 ) [HTML 1KB] [ PDF 2110KB] ( 0 )

	489	A Monte Carlo-based dosimetric study of the GZP ⁶⁰Co source
		Wang Xianliang,Yuan Ke,Tang Bin,Kang Shengwei,Li Jie,Xiao Mingyong,Li Xiaolan,Li Lintao,Wang Pei
		Objective To simulate and calculate the dosimetric parameters of the GZP ⁶⁰Co source that has been clinically used in high-dose-rate brachytherapy. Methods The EGSnrc Monte Carlo software was used to simulate and calculate the dosimetric parameters of a well known BEBIG ⁶⁰Co source (Co0.A86). The results were compared with the actual parameters to verify the feasibility of this method. A Monte Carlo model of the GZP ⁶⁰Co source for high-dose-rate brachytherapy was established to simulate and calculate its dosimetric parameters in the same way. Results For the BEBIG ⁶⁰Co source, the results were well accorded with the standard. The air-kerma strength per unit activity (S_K/A) and dose rate constant(Λ) deviated from the standard by 0.2% and 1.0%, respectively. The curves of the radial dose function g_L (r) and the anisotropy function F (r,θ)fit well. For the GZP ⁶⁰Co source, the S_K/AandΛvalues were calculated as 3.011×10^-7 cGycm²h^-1Bq^-1 and 1.118 cGyh^-1U^-1 in channel 1&2 and 3.002×10^-7 cGycm²h^-1Bq^-1 and 1.110 cGyh^-1U^-1 in channel 3. The g_L (r), F (r,θ), and dose rate per unit air-kerma strength ina liquid water phantom were listed as the American Association of Physicists in Medicine recommended. Conclusions The results can be used in planning system and quality control for the GZP ⁶⁰Co source.
		2016 Vol. 25 (5): 489-495 [Abstract] ( 2136 ) [HTML 1KB] [ PDF 803KB] ( 0 )

	496	Elementary properties of thermoluminescent dosimeter in dosimetry for tumor radiotherapy
		Jiang Fenfen,Wang Pei,Kang Shengwei,Qi Guohai,Xiao Mingyong,Li Jie
		Objective To explore the elementary properties of LiF (Mg, Cu, and P) thermoluminescent dosimeter (TLD) in dosimetry for tumor radiotherapy, and to provide a reliable basis for thermoluminescent dosimetry in clinical radiotherapy. Methods ⁶⁰Coγ-ray and 6 MV X-ray were used for evaluation of the dispersion, repeatability, and dose response of LiF TLD. To meet the requirement of clinical radiotherapy, the effects of energy, dose (50-600 cGy), radiation dose rate (50-600 MU/min), and the angle of incidence for accelerator gantry (0°-±90°) on TLD were determined and the respective correction factors were calculated. Results The errors of repeatability and dispersion of TLD were less than ±3%. There was a linear relationship between readout and irradiation dose within a certain range of irradiation dose. The minimal relative deviation of 0.3% was obtained when 6 MV X-ray was used with a dose rate of 300 MU/min and an angle of incidence of 0°. Conclusions LiF TLD shows excellent repeatability, low dispersion, high stability, and strong linear correlation. It meets the international criteria and can be used for dose measurement in tumor radiotherapy.
		2016 Vol. 25 (5): 496-499 [Abstract] ( 2404 ) [HTML 1KB] [ PDF 310KB] ( 0 )

	500	Image quality and dose calculation of megavoltage computed tomography in helical tomotherapy
		Yue Qi,Duan Jimei,Wang Zhiwei,Yang Xiumei,Gu Dan,Li Rongqing
		Objective To quantitatively investigate the image quality and dose calculation accuracy of megavoltage computed tomography (CT) in helical tomotherapy. Methods The megavoltage CT was used to scan the Cheese phantom, and the geometric accuracy of images, noise, image uniformity, spatial resolution, density-CT value conversion, and dose calculation accuracy were analyzed and compared with conventional kilovoltage CT. Results The geometric accuracy of megavoltage CT images was within 2 mm in three directions. The megavoltage CT was inferior to kilovoltage CT in terms of image noise, uniformity, and spatial resolution. The dose-volume histogram (DVH) in dose reconstruction based on CT images was well consistent with DVH in the kilovoltage CT plan. Conclusions The megavoltage CT can obtain images with accurate geometric dimensions and has a low imaging dose and accurate dose calculation, which meets clinical requirements.
		2016 Vol. 25 (5): 500-503 [Abstract] ( 2291 ) [HTML 1KB] [ PDF 564KB] ( 0 )

	504	Effects of spine tracking parameters on the positioning errors of cyberknife
		Zhao Rui,Wang Zhenyue,Li Sha,Lu Jun
		Objective To investigate the effects of spine region of interest (ROI), tracking range, and real-time image contrast ratio on the positioning errors of cyberknife. Methods The LTT dynamic phantom was used to develop a spine tracking plan and perform treatment, and the target positioning system was used to preset the phantom and obtain real-time preset image and positioning error. Based on the real-time preset image, spine ROI, tracking range, and real-time image contrast ratio were changed to observe the changes in positioning error and related parameters. Pearson correlation analysis was performed. Results The change in tracking range did not change the positioning error in spine tracking, and tracking range was not correlated with positioning error (R=0, P=1). The changes in ROI and image contrast ratio did not affect the translation error, but affected the rotation error, especially the rotation error in left-right direction (r=0.533 and 0.693, P=0.002 and 0.026). The image contrast ratio had the most obvious effect, with an amplitude of variation up to 2.2°. Conclusions The change in tracking range does not affect the positioning errors in spinal tracking, but the changes in ROI and image contrast ratio can cause varying degrees of changes in positioning errors, which should be taken seriously in cyberknife treatment.
		2016 Vol. 25 (5): 504-507 [Abstract] ( 2165 ) [HTML 1KB] [ PDF 1155KB] ( 0 )

	508	Effect of amplitude of respiratory movements on dose distribution of static intensity-modulated radiotherapy
		Liu Lingling,Fei Zhenle,Li Bingbing,Wang Hongzhi
		Objective To study the effect of amplitude of respiratory movements on dose distribution of static intensity-modulated radiotherapy (IMRT), and to provide a basis for dose correction against respiratory movements. Methods A two-dimensional matrix driven by the QUASAR program-controlled respiratory movement instrument was used to simulate human respiratory movements in the head/foot direction. The dose distribution was evaluated on the isocenter plane with different amplitudes of respiratory movements. The Verisoft software and absolute dose analysis were used to analyze dose distribution, percentage errors of absolute dose, and passing rates of radiation field for both collected data and planned dose distribution. Results In spite of little effect on dose distribution in target volume, respiratory movements increased the dose outside the marginal target volume along the movement direction. When the respiratory amplitude was lower than 6 mm, the passing rate of γ distribution met the requirement of clinical dose verification;when the respiratory amplitude was larger than 8 mm, the passing rate of γ distribution was reduced with the increasing respiratory amplitude and fell below the clinical standard. Conclusions Respiratory movements have a blurring effect on static IMRT. It is possible to introduce some compensation methods to static IMRT in the treatment of tumor with periodic respiratory movements. The normal tissue at the edge of target volume along the respiratory movement direction is exposed to a higher radiation dose than expected. Therefore, the radiation dose for the normal tissue around target volume should be made as low as possible in the radiotherapy plan. For the patients with relatively large respiratory amplitude, action should be taken to lower respiratory amplitude and elevate the radiation dose in target volume.
		2016 Vol. 25 (5): 508-512 [Abstract] ( 3725 ) [HTML 1KB] [ PDF 859KB] ( 0 )

	513	Radiosensitizing effect and mechanism of 2′-hydroxyflavanone in prostate cancer cells
		Wang Wen,Xiong Wei,Li Xiaoying,Gao Xianshu,Sun Shaoqian,Li Yi
		Objective To study the radiosensitizing effect of 2′-hydroxyflavanone (2′-HF) on prostate cancer cells, and to preliminarily investigate its mechanism. Methods Colony formation assay, tert-butylhydroperoxide (TBHP) oxidative stress assay, Hoechst staining, and apoptosis flow cytometry using Annexin V-FITC and propidium iodide (PI) were performed to measure the impact of 2′-HF on the radiosensitivity of VCaP prostate cancer cells. Western blot was used to determine the effects of 2′-HF on expression of AKT, phosphorylated AKT (p-AKT), and aldo-keto reductase 1C3(AKR1C3) in VCaP cells and preliminarily investigate the mechanism. Data were analyzed by t test and factorial analysis of variance. Results The results of colony formation assay indicated that after exposure to radiation, VCaP cells treated with 2′-HF had a significantly lower proliferation level than cells in the control group (P=0.010), yielding a sensitization enhancement ratio of 1.19. The results of TBHP oxidative stress assay suggested that VCaP cells treated with 2′-HF had significantly weaker anti-oxidative capacity than cells in the control group (P=0.015). Hoechst staining and apoptosis flow cytometry with Annexin V-FITC and PI indicated that 2′-HF treatment plus irradiation significantly enhanced apoptosis in VCaP cells (P=0.001. The results of Western blot suggested that 2′-HF treatment significantly inhibited the protein expression of p-AKT and AKR1C3 in VCaP cells (P=0.013 and P=0.016). Conclusions 2′-HF can enhance the radiosensitivity of prostate cancer cells, which is probably associated with its inhibitory effects on AKT pathway and AKR1C3 expression in prostate cancer cells.
		2016 Vol. 25 (5): 513-518 [Abstract] ( 3395 ) [HTML 1KB] [ PDF 1393KB] ( 0 )

	519	Effect of ATM on low-dose hyper-radiosensitivity in A549 cells synchronized at G₂ phase
		Xiao Zhuya,Sun Huaping,Luo Ting,Chen Sheng,Chen Weihong,Cheng Jing
		Objective To investigate the low-dose hyper-radiosensitivity (HRS)/induced radioresistance (IRR) in A549 cells synchronized at G₂ phase and the role of ATM kinase in the process. Methods Human lung adenocarcinoma cell line A549 was synchronized at G₂ phase by aphidicolin. The ATM-specific activator and inhibitor, chloroquine and KU55933, were used to regulate the activity of ATM. The colony formation assay was used to evaluate cell survival. Flow cytometry was used to determine the cell cycle of radiation-exposed A549 cells synchronized at G₂ phase. Immunofluorescence was used to observe the dynamics of γ-H₂AX fluorescence and evaluate the efficiency of DNA repair in A549 cells synchronized at G₂ phase. Western blot was used to detect the expression of phosphorylated ATM (Ser1981) and ATM. Results A549 cells synchronized at G₂ phase had substantially enhanced HRS than non-synchronized cells. The dose-induced transition from HRS to IRR was in accordance with the dose-response pattern of early G₂/M checkpoint. However, with the same threshold dose, the activation of early checkpoint occurred earlier and lasted longer than normal. The activation of ATM kinase inhibited HRS and enhanced DNA repair, while the inhibition of ATM kinase enhanced HRS and hindered DNA repair. Conclusions ATM kinase-mediated early G₂+M checkpoint is a molecular switch for HRS in synchronized A549 cells. Low-dose irradiation with G₂-phase synchronization and ATM inhibitor can enhance the low-dose radiosensitivity.
		2016 Vol. 25 (5): 519-523 [Abstract] ( 3328 ) [HTML 1KB] [ PDF 929KB] ( 0 )

	524


		2016 Vol. 25 (5): 524-525 [Abstract] ( 2264 ) [HTML 1KB] [ PDF 458KB] ( 0 )

	526	Clinical value of hippocampal gyrus protection in whole brain radiotherapy
		Dong Xin,Zhou Zongmei
		At present, conventional whole brain radiotherapy is the standard treatment for brain metastases and prophylactic cranial irradiation, and it can improve patients’ clinical symptoms and survival. However, whole brain radiotherapy may induce cognitive function impairment and affect patients’ long-term quality of life. The newest radiotherapy technology can protect the hippocampal gyrus during whole brain radiotherapy and then protect cognitive function and improve quality of life. This article reviews the methods and clinical value of hippocampal gyrus protection in whole brain radiotherapy, as well as related advances.
		2016 Vol. 25 (5): 526-529 [Abstract] ( 3368 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	530	Influence of induction chemotherapy on target volume and dosimetry of intensity modulated radiotherapy for locally advanced nasopharyngeal carcinoma
		Wang Jia,Xiao Feng,Liu Feng,Xi Xuping
		As induction chemotherapy goes on, target volume, dose distribution in the surrounding organs at risk (OARs), and target dose conformity all change. Therefore, the question is how to develop reasonable radiotherapy plans in clinical practice. Induction chemotherapy followed by radiotherapy is commonly used around the world, but it is recommended to delineate the target volume based on the gross tumor volume before induction chemotherapy and not to reduce the dose. This point of view lacks the basis of evidence-based medicine. The experts and scholars in China clarify the advantages of radiotherapy plans after induction chemotherapy from the aspects of reducing the target volume, reducing the volume of high-dose region in the target volume, increasing the uniform dose coverage in target volume, reducing dose to OARs, and increasing dose conformity. However, at present, there are no objective data on its long-term efficacy and benefit. Besides, no consensus has been reached on how to delineate the target volume and determine the dose distribution after induction chemotherapy, and further studies are needed.
		2016 Vol. 25 (5): 530-533 [Abstract] ( 3394 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	534	Current status of research on concurrent chemoradiotherapy after surgery for esophageal cancer
		Kang Jingjing,Hui Zhouguang
		Currently, resectable esophageal cancer is commonly initially treated with surgery in China, but the optimal postoperative treatment remains unclear. Postoperative concurrent chemoradiotherapy can improve local control and reduce distant metastasis and may become the preferred treatment for patients after surgery for esophageal cancer. By summarizing the studies on concurrent chemoradiotherapy after surgery for esophageal cancer, this review points out that postoperative concurrent chemoradiotherapy can improve the overall survival of patients with positive lymph nodes and has tolerable adverse effects, but the populations who can benefit from this treatment, the optimal radiotherapy dosage, target volume, and chemotherapy regimen of postoperative concurrent chemoradiotherapy await further investigation.
		2016 Vol. 25 (5): 534-535 [Abstract] ( 2374 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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