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Chinese Journal of Radiation Oncology
 
2016 Vol.25 Issue.6
Published 2016-05-24

Head and Neck Tumors
Thoracic Tumors
Review Articles
Investigation Research
Abdominal tumor
Physics·Biology·Technology
Investigation Research
541 An investigation of the basic situation of radiotherapy in mainland China in 2015
Lang Jinyi,Wang Pei,Wu Dake,Zhong Hailuo,Lu Bing,Deng Xiaowu,Wang Lyuhua
Objective To conduct the 7th investigation by Chinese Society of Radiation Oncology, Chinese Medical Association, and to further investigate the current situation of radiotherapy in mainland China, reasonably allocate personnel and equipment resources, and promote the development of radiotherapy in China. Methods From October 8, 2015 to December 2015, the office for investigation of radiotherapy information was established, the list and contact information of radiotherapy units were provided by each province, and a special data submission system was used for a complete, rapid, and efficient investigation through the Internet. Results As of January 20, 2016, there were 1413 radiotherapy units in the mainland China with 52,496 employees in total, among which there were 15 839 radiotherapy physicians (4824 with senior professional titles), 8452 technical therapists (260 with senior professional titles), 3292 physicists (562 with senior professional titles), and 938 maintenance engineers (120 with senior professional titles). In the aspect of radiotherapy equipment, there were 1930 linear accelerators, 96 Co-60 teletherapy units, 173 X-knife units, 212 γ-knife units, 382 Ir-192 brachytherapy units, 436 Co-60 brachytherapy units, 1051 X-ray simulators, 1353 CT simulators, 642 MRI simulators, 978 sets of multileaf collimators, 1922 sets of treatment planning systems, and 974 sets of radiotherapy network systems. As for quality control devices, there were 1792 dosimeters, 2143 ionization chambers, 935 two-dimensional array dosimeters, 540 three-dimensional dosimetric verification systems, 596 three-dimensional water tanks, 844 anthropomorphic phantoms, and 1168 water equivalent phantoms. In the aspect of therapeutic situation, there were 102,170 beds (including beds in departments of oncology in general hospitals), 76612 episodes per day, and 919339 episodes per year. Conclusions The results of this investigation show significant increases in radiotherapy units, personnel, and equipment in recent years in mainland China. The distribution of radiotherapy units and equipment and the structure of radiotherapy personnel are becoming more reasonable, but there are still some problems. In some regions, current radiotherapy equipment cannot meet the medical needs, and there is a lack of professional technical personnel.
2016 Vol. 25 (6): 541-545 [Abstract] ( 5842 ) [HTML 1KB] [ PDF 772KB] ( 0 )
Head and Neck Tumors
546 Difference in normal tissue complication probability of lower cranial nerves between target volumes recommended by Radiation Therapy Oncology Group and China in intensity-modulated radiotherapy for T1-2 nasopharyngeal carcinoma
Qian Jianjun,Sun Yanze,Zhou Gang,Tian Ye,Lu Xueguan
Objective To investigate the difference in normal tissue complication probability (NTCP) of lower cranial nerves (LCNs) between target volumes recommended by Radiation Therapy Oncology Group (RTOG) and China in intensity-modulated radiotherapy (IMRT) for T1-2 nasopharyngeal carcinoma (NPC), and to provide the evidence of dose-volume effect for the protection of LCNs in IMRT for NPC. Methods A total of 20 patients with T1-2 NPC who were treated from 2013 to 2015 were enrolled, and LCNs were delineated on CT images. Target volume delineation and treatment plan designing were performed according to the method recommended by RTOG0225(RTOG target volume delineation method) or the Chinese Working Committee for Clinical Staging of NPC in 2010(Chinese target volume delineation method), and the differences in the dose to LCNs and NTCP were calculated. Results In the RTOG and Chinese Methods for target volume delineation, Dmax to the left and right LCNs was 7450±273 cGy/7294±309 cGy and 7361±160 cGy/7190±395 cGy, respectively (P=0.018 and 0.042), Dmean was 6735±285 cGy/6660±333 cGy and 6446±429 cGy/6299±467 cGy, respectively (both P=0.000), and the NTCP was 60%±10%/57%±13% and 51%±15%/45%±17%, respectively (both P=0.000). Conclusions It is feasible to precisely delineate target volume with the LCNs as a routine OAR and predict NTCP in IMRT for T1-2 NPC. The NTCP of the LCNs is closely associated with target volume dose and irradiated volume. The dose to the LCNs and NTCP determined by the Chinese target volume delineation method are significantly lower than those determined by the RTOG method.
2016 Vol. 25 (6): 546-551 [Abstract] ( 3603 ) [HTML 1KB] [ PDF 752KB] ( 0 )
552 Value of diffusion-weighted imaging after transient taste stimulation in evaluation of salivary gland function before and after radiotherapy:a preliminary study
Xu Liang,Tian Ye,Xu Yingying,Qian Jianjun,Zu Yaqun,Fan Qiuhong,Zhang Liyuan,Zhao Danlei,Shen Junkang
Objective To investigate the value of diffusion-weighted imaging (DWI) after transient taste stimulation in evaluating salivary gland function before and after radiotherapy (RT), as well as the correlation between apparent diffusion coefficient (ADC) and other evaluation methods. Methods A total of 30 patients with nasopharyngeal carcinoma (NPC) underwent dynamic DWI after taste stimulation before and after RT from 2010 to 2014. The characteristics of ADC changing curves for each salivary gland were analyzed. The paired t-test was used for comparison of the time to ADC peak, resting ADC, maximum ADC after stimulation, and maximum ADC increase rate. Pearson correlation analysis was used to investigate the correlation between ADC of the salivary gland and salivary flow rate, as well as the correlation of ADC of the salivary gland after RT with Common Terminology Criteria for Adverse Events (CTCAE) grade and visual analog scale (VAS) score. Results Before and after RT, ADCs of each salivary gland reached the peak value at the first scan after taste stimulation (30 s). The resting ADCs and maximum ADC after stimulation of each salivary gland increased significantly after RT (P=0.000,0.000,0.000 and 0.001.0.000,0.000), while the maximum ADC increase rate after stimulation showed no significant differences between the salivary glands (P=0.213, 0.122, and 0.839). Before RT, the resting ADC of submandibular gland was positively correlated with salivary flow rate of all glands (r=0.364, P=0.048). Conclusions DWI after transient taste stimulation can effectively show the dynamic changes in ADCs of all salivary glands after RT for NPC and has a great potential in evaluating salivary hypofunction and dynamically monitoring functional changes of the salivary glands.
2016 Vol. 25 (6): 552-556 [Abstract] ( 3528 ) [HTML 1KB] [ PDF 1327KB] ( 0 )
557 Volumetric and dosimetric comparison in adaptive radiotherapy for patients with head and neck cancer:a systematic review and Meta-analysis
Zhang Biao,Jia Pengfei,Tang Lemin

Objective To perform a systematic review and Meta-analysis on volumetric and dosimetric changes in target volumes and organs at risk (OARs) in adaptive radiotherapy (ART) for patientswith head and neck cancer (HNC), and to investigate the role of ART in the treatment of HNC. Methods Literature retrieval was performed to include related studies, and the parameters of primary tumor, GTV-T and GTV-N, parotid volume, D95 and Dmean of target volumes, Dmean of ipsilateral and contralateral parotid volume (I-PG and C-PG), and Dmax of the spinal cord and brainstem. Results A total of 17 studies involving 336 patients were included in the meta-analysis. Primary tumor and parotid volume changed significantly. The volumes of GTV-T, GTV-N, and I-PG were significantly reduced during the 15-20th radiotherapy and after the 20th radiotherapy (P<0.05), and the C-PG was significantly reduced after the 20th radiotherapy (P=0.004). The analysis of actual dose showed that the D95 and Dmean of primary tumor showed no significant differences, and during the 15-20th radiotherapy, the Dmax of the spinal cord was increased by 2.26 Gy (P=0.000), while the Dmax of the brainstem showed no significant changes before the 20th radiotherapy and was increased by 1.78 Gy after the 25th radiotherapy (P=0.020). In addition, the Dmean of I-PG was increased by 2 Gy during the 20-25th radiotherapy (P=0.0001), and the Dmean of C-PG was increased before the 20th radiotherapy and showed no significant changes after the 25th radiotherapy (P=0.110). The dosimetric analysis of ART showed that the Dmax of the spinal cord and brainstem was reduced significantly (spinal cord:MD=-2.15, 95% CI-3.12 to -1.18,P=0.000;brainstem:MD=-2.20, 95% CI-3.32 to -1.09, P=0.000). The Dmean of I-PG was reduced by about 3.5 Gy, and the sensitivity analysis revealed that the results of Dmean of C-PG were unstable. Conclusions The volumes of primary tumors and parotid glands change significantly, and the actual doses of OARs (Dmax of the spinal cord and brainstem and Dmean of the parotid glands) significantly increase, while the doses of GTV-T and GTV-N show no significant changes. ART can effectively protect the OARs, and patients with locally advanced HNC who receive concurrent chemoradiotherapy can obtain good dose gains from ART plan performed during the 15-20th radiotherapy and at about the 25th radiotherapy.

2016 Vol. 25 (6): 557-564 [Abstract] ( 3761 ) [HTML 1KB] [ PDF 1571KB] ( 0 )
Thoracic Tumors
565 Clinical features of esophageal cancer patients with long-term survival and related factors for treatment 
Wang Lan,Han Chun,Liu Lihong,Kong Jie,Zhu Longyu,Zhang Andu,Han Jing,Gao Chao,Li Xiaoning,Tian Hua,Ren Xuejiao
Objective To investigate the clinical features of esophageal cancer patients with long-term survival after precise radiotherapy, related factors for treatment, and the conditions for survival benefits, and to provide a reference for clinical practice. Methods A retrospective analysis was performed for 913 patients with esophageal cancer who received single-dose radiotherapy from 2003 to 2009. The clinical features, related factors for chemoradiotherapy, adverse events, and short-term therapeutic effect were compared between long-term survival group (a survival time of ≥60 months) and non-long-term survival group, and a prognostic analysis was performed. The chi-square test was used for comparison between groups, the Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival difference analysis, and the Cox proportional hazards model was used for multivariate prognostic analysis. Results There were 217 patients in the long-term survival group and 696 in the non-long-term survival group. There were differences in sex, tumor location, length of lesions, transverse diameter, surrounding invasion, non-surgical stage, and gross tumor volume (GTV) between the two groups (P=0.010,0.002,0.000,0.000,0.000,0.000,0.000). The 1-, 3-, 5-, 7-, and 9-year overall survival rates were 72.5%, 35.3%, 25.8%, 19.1%, and 13.9%, respectively, and the median survival time was 21 months. Compared with the non-long-term survival group, the long-term survival group showed a shorter course of radiotherapy and better dose-volume parameters including GTV and planning target volume, and GTV D100 and D95 showed differences between the two groups (P=0.024 and 0.024). Compared with the non-long-term survival group, more patients in the long-term survival group received concurrent chemotherapy and showed a higher degree of acute esophagitis and a better short-term outcome (P=0.018 and 0.000), while no patient experienced extremely severe pneumonia. The patients with a prescribed dose of less than 60 Gy showed worse survival rates than those with a prescribed dose of ≥60 Gy (P=0.027), and the patients receiving concurrent chemoradiotherapy showed better survival rates than those who did not receive concurrent chemoradiotherapy (P=0.076). The multivariate analysis with the Cox proportional hazards model indicated that tumor location, non-surgical stage, GTV, cycles of chemotherapy, and short-term therapeutic effect were independent prognostic factors. Conclusions There are complex prognostic factors for non-surgical treatment for esophageal cancer, and the stage of disease progression determines the prognosis to a large extent. Meanwhile, radiotherapy with a dose of ≥60 Gy, high-quality treatment plan, concurrent chemotherapy, and good tumor response to treatment are factors for survival benefit.
2016 Vol. 25 (6): 565-570 [Abstract] ( 3299 ) [HTML 1KB] [ PDF 1277KB] ( 0 )
571 Postoperative radiotherapy combined with concurrent paclitaxel-nedaplatin chemotherapy for esophageal cancer:a preliminary study 
Kang Jingjing,Hui Zhouguang,Xiao Zefen,Wang Xiaozhen,Liang Jun,Lyu Jima,Zhou Zongmei,Feng Qinfu,Chen Dongfu,Zhang Hongxing,Wang Lyuhua,Yin Weibo

Objective To investigate the safety and preliminary effect of postoperative intensity-modulated radiotherapy (IMRT) combined with concurrent weekly paclitaxel-nedaplatin chemotherapy for patients with esophageal squamous cell carcinoma. Methods A total of 52 patients who were treated from 2010 to 2013 were enrolled. The clinical target volume of IMRT included tumor beds and corresponding lymphatic drainage regions at high risk, and the total radiotherapy dose was 50-60 Gy, 2.0 Gy/fraction, 5 fractions per week. The concurrent chemotherapy consisted of nedaplatin 25 mg/m2 on D1 and paclitaxel 45-50 mg/m2 on D1 and was repeated every week during radiotherapy. Common Terminology Criteria for Adverse Events 4.0 was used to evaluate adverse events, and the Kaplan-Meier method was used for survival analysis. Results All the patients had good tolerance to the treatment, and 51 patients (98%) completed radiotherapy according to the scheduled regimen. The median number of chemotherapy cycles was 4, and 42 patients (81%) completed ≥3 cycles of chemotherapy. Most adverse events were of grade 1-2, and grade 3 adverse events were leucopenia (29%), radiation esophagitis (10%), and anastomotic stenosis (4%). One patient (2%) experienced grade 5 gastroesophageal bleeding. Of all the patients, the median survival time was 38.7 months, and the 1-, 2-, 3-, and 4-year overall survival rates were 83%, 64%, 51%, and 38%, respectively. The overall recurrence rate was 46.2%, and the locoregional recurrence rate and distant metastasis rate were 15% and 37%, respectively. Conclusions Postoperative IMRT combined with concurrent weekly paclitaxel-nedaplatin chemotherapy for patients with esophageal squamous cell carcinoma is safe and effective, and large-scale prospective randomized studies are needed.

2016 Vol. 25 (6): 571-575 [Abstract] ( 3657 ) [HTML 1KB] [ PDF 345KB] ( 0 )
576 Significance of three-dimensional radical radiotherapy dose determined by organ-lesion combination for primary tumor of oligometastatic stage IV NSCLC:a reanalysis of PPRA-RTOG 003
Wang Chunlan,Su Shengfa,Ouyang Weiwei,Ma Zhu,Li Qingsong,Wang Yu,Li Huiqin,Lu Bing

Objective To investigate the influence of three-dimensional radiotherapy dose determined by organ-lesion combination for the primary tumor of oligometastatic stage Ⅳ non-small cell lung cancer (NSCLC) and related factors on survival. Methods Oligometastasis was defined as the metastatic lesion in only one organ or 1 metastatic lesion in each of two organs. A total of 115 patients were enrolled,and the association of dose and related factors with overall survival was investigated. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis,and the Cox regression model was used for multivariate analysis. Results Of all patients,the median survival time (MST) was 14 months,and the 1-,2-,and 3-year overall survival (OS) rates were 55.7%,18.3%,and 11.5%,respectively. All the patients,the patients benefiting from two-cycle chemotherapy,and the patients benefiting from chemoradiotherapy showed prolonged MST,and in patients receiving a primary tumor dose of ≥63 Gy or<63 Gy,the MST was 17 months and 13 months (P=0.046),17 months and 13 months (P=0.037),and 18 months and 14 months (P=0.022),respectively. Radiotherapy for metastatic lesion and effective treatment for primary tumor tended to prolong survival time,and the MST was 17 months and 13 months,respectively (P=0.055 and 0.065).The patients receiving 4-6 cycles of chemotherapy had an MST of 16 months and 13 months,respectively (P=0.165).The patients who received effective chemoradiotherapy,had a primary tumor volume of<120.1 cm3,and had improvement in Karnofsky Performance Scale (KPS) after treatment showed a prolonged MST compared with those who did not respond to chemoradiotherapy and had a large primary tumor volume and a reduction in KPS (15 months vs. 12 months,P=0.036;17 months vs. 11 months,P=0.002;14 months vs. 10 months,P=0.031).The multivariate analysis showed that primary tumor dose and volume (P=0.020 and 0.001) and the change in KPS after treatment (P=0.021) significantly affected survival. Conclusions The doses of chemotherapy and concurrent radical radiotherapy determined by organ-lesion combination for oligometastatic stage Ⅳ NSCLC can significantly prolong survival time,and primary tumor volume and KPS after treatment are the independent prognostic factors for survival.

2016 Vol. 25 (6): 576-580 [Abstract] ( 3973 ) [HTML 1KB] [ PDF 407KB] ( 0 )
581
2016 Vol. 25 (6): 581-582 [Abstract] ( 3177 ) [HTML 1KB] [ PDF 226KB] ( 0 )
Abdominal tumor
583 Efficacy of adjuvant and salvage image-guided radiotherapy in post-radical prostatectomy patients
Zhong Qiuzi,Li Gaofeng,Xiu Xia,Gao Hong,Xu Yonggang,Wu Qinhong,Li Ming,Zhao Ting
Objective To analyze the clinical efficacy and toxicity of adjuvant (ART) and salvage radiotherapy (SRT) after prostatectomy for prostate carcinoma, and to investigate the variation and significance of prostate-specific antigen (PSA) level. Methods A retrospective study was performed on the clinical data of 58 patients receiving intensity-modulated radiotherapy after prostatectomy from November 2008 to August 2015. In those patients, 21 received ART and 37 SRT. The median dose delivered to the 95% planning target volume (PTV) of the prostate and seminal vesicles tumor bed was 74 Gy,and 95% PTV of the pelvic lymph nodes was 50 Gy. The survival rate was calculated by Kaplan-Meier method. Used Pearson correlation analysis. Results The median follow-up time was 36.2 months. The 3-year biochemical relapse-free survival, tumor-specific survival, and overall survival rates were 81.8%, 100%, and 96%, respectively. In all patients, the median time to PSA nadir after radiotherapy was 3 months with a mean level of PSA nadir of 0.04 ng/ml. In patients treated with ART, the median PSA level before radiotherapy was 0.034 ng/ml;the median time from surgery to radiotherapy was 5.4 months;the mean time to PSA nadir after radiotherapy was 4.6 months. In patients treated with SRT, the median PSA level before radiotherapy was 0.540 ng/ml;the median time from surgery to radiotherapy was 69.7 months;the mean time to PSA nadir after radiotherapy was 9.4 months. The incidence rates of grade 1 and 2 short-term genitourinary (GU) toxicity were 55% and 2%, respectively, while the incidence rates of grade 1 and 2 long-term GU toxicity were 10% and 16%, respectively. The incidence rates of grade 1 and 2 short-term gastrointestinal (GI) toxicity were 30% and 8%, respectively, while the incidence rates of grade 1 and 2 long-term GI toxicity were 9% and 3%, respectively. No patients had grade 3 or 4 toxicity. Rectum D50 was significantly related with acute and late GI side effects (P=0.012、0.026). Conclusions Both ART and SRT achieve satisfactory treatment outcomes and low short-and long-term toxicity. Compared with ART, SRT has a longer time to PSA nadir.
2016 Vol. 25 (6): 583-587 [Abstract] ( 3454 ) [HTML 1KB] [ PDF 354KB] ( 0 )
588 Hypofraction radiotherapy by helical tomotherapy for unresectable but confined intrahepatic hepatocellular carcinoma is efficient and safe in comparison with conventional 3-dimension conformal radiotherapy 
Jiang Tao,Zeng Zhaochong,Yang Ping,Hu Yong
Objective To evaluate the safety of helical tomotherapy (HT) for hepatocellular carcinoma confined to the liver, and to investigate the efficacy of HT by comparison with three-dimensional conformal radiotherapy (3DCRT). Methods In June 2011, hypofractionated HT was performed in 35 patients with unresectable hepatocellular carcinoma confined to the liver who had no distant metastasis or tumor thrombosis. The dose in each fraction increased from 2.4 Gy to 5.0 Gy with a median dose of 3.2 Gy. The median dose for the total treatment was 50.0 Gy. Within the same period, 45 patients received conventionally fractionated 3DCRT with a median dose of 54.0 Gy. The adverse reactions, clinical outcomes, and survival time were compared between the two groups. The survival rate was calculated with Kaplan-Meier method,and log-rank test was used to estimate statistical significance of survival differences. Multivariate analysis of survival was carried out with Cox’s regression model. Results There were no significant differences in adverse reactions between the two groups. TheObjective response rate was significantly higher in the HT group than in the 3DCRT group (60% vs. 33%, P=0.024). There was no significant difference in the disease control rate between the two groups (94% vs. 89%, P=0.459). The HT group showed significantly higher 1-, 2-, and 3-year overall survival rates than the 3DCRT group (97% vs. 80%, P=0.025;81% vs. 55%, P=0.008;67% vs. 50%, P=0.048). The multivariate analysis indicated that tumor smaller than 8 cm, transarterial chemoembolization before radiotherapy, and HT were associated with improved survival (P=0.005;P=0.000;P=0.002). Conclusions HT shows an advantage in precise treatment of hepatocellular carcinoma confined to the liver. With acceptable toxicity, hypofractionated HT shortens the treatment duration and improves the survival in patients.
2016 Vol. 25 (6): 588-592 [Abstract] ( 3397 ) [HTML 1KB] [ PDF 482KB] ( 0 )
593 Lymphedema after surgical treatment for breast cancer:a 2-year follow-up study of incidence and risk factors
Liu Fenghua,Hu Yan,Shen Peipei,Liu Xiaoqian,Xie Yuhuan,Zhu Yaqun,Jiang Guoqin,Zhu Xun,Tian Ye

Objective To identify the incidence and risk factors for upper extremity lymphedema within 2 years after surgery in patients with breast cancer. Methods A follow-up study was performed among 157 patients who newly received surgical treatment for breast cancer. Norman questionnaire and circumference measurement were used to evaluate the volume of the upper limb before treatment and at 1, 3, 6, 12, 18, and 24 months after treatment. The incidence of lymphedema was calculated. Based on the results of circumference measurement, the log-rank test and Cox regression were used to analyze the risk factors for lymphedema. Results A total of 141 patients were finally enrolled as subjects. The incidence rates of lymphedema at 1, 3, 6, 12, 18, and 24 months after surgery were 3.5%, 9.2%, 13.5%, 24.8%, 28.4%, and 30.5% by Norman questionnaire, and 1.4%, 3.5%, 9.2%, 20.6%, 27.0%, and 27.7% by circumference measurement. At 24 months after surgery, 31(22.0%) out of 39 patients with lymphedema had mild lymphedema. Axillary lymph node dissection (ALND), radiotherapy, modified radical mastectomy (MRM), and the number of removed axillary lymph nodes were independent risk factors for lymphedema (HR=13.58, 95% CI:2.17-85.00;HR=3.54, 95% CI:1.13-11.07;HR=2.19, 95% CI:1.07-4.49;HR=1.11, 95% CI:1.05-1.16). Conclusions The incidence of lymphedema associated with breast cancer increases gradually within 2 years after surgery, especially fast in the first year. ALND, radiotherapy, MRM, and the number of removed axillary lymph nodes are independent risk factors for lymphedema.

2016 Vol. 25 (6): 593-597 [Abstract] ( 3102 ) [HTML 1KB] [ PDF 420KB] ( 0 )
598 Consistency of bladder filling during radiotherapy for pelvic tumor:a preliminary study
Jiang Xiaobo,Zhong Qingchu,Huang Qunfeng,Liu Jindi,Yao Wenyan,Chen Cui,Yang Xin,Xu Senkui,Wu Jianhua,Lin Chengguang

Objective To investigate a simple and easy method to maintain a stable urine volume and consistent bladder filling during immobilization, CT scanning, plan designing, and radiotherapy using an ultrasonic bladder capacity scanner (BS). Methods A total of 66 patients with pelvic tumor who were admitted to our hospital and received radiotherapy from 2013 to 2014 were enrolled and required to drink 500 ml water after emptying the bladder. BS was used to measure bladder capacity at four time points. Before radiotherapy, 62 patients with pelvic tumor were randomly divided into two groups in a single-blind trial. Both groups were asked to empty the bladder, drink 500 ml water, and wait for a subjective feeling of urgency of urination. The 42 patients in group 1 were asked to hold urine, and bladder capacity was measured and urine volume was recorded when patients complained of “urgency of urination”. The patients in group 2 were told that urine volume should reach the standard in plan designing, and BS was used to determine whether the standard was reached. Results The time from bladder emptying to the subjective feeling of urgency of urination ranged from 0.5 to 1.5 hours;when the patients had a subjective feeling of urgency of urination, the urine volume ranged from 30 to 500 ml. In group 1, when the patients had a subjective feeling of urgency of urination, the difference between the bladder capacity measured and that in plan designing was 30.6%, while in group 2, the difference was 12.6%. Conclusions The use of BS in monitoring bladder capacity helps patients to develop a stable feeling of urgency of urination and reach the bladder capacity in plan designing and thus maintain a consistent degree of bladder filling.

2016 Vol. 25 (6): 598-601 [Abstract] ( 3515 ) [HTML 1KB] [ PDF 355KB] ( 0 )
Physics·Biology·Technology
602 Mechanism of immunogenic cell death induced by microwave ablation in treatment of osteosarcoma
Yu Zhe,Wu Jiachang,Zhang Minghua,Zhou Yong,Fan Qingyu

Objective As a classical approach for hyperthermic ablation,microwave ablation (MWA) has been widely used in the treatment of tumors that cannot be removed by traditional surgery. MWA devitalizes the neighboring tissue and kills tumor cells by thermal diffusion. In the last two decades,this technique has been improved for treating malignant bone tumor in our institute. In situ ablation has already replaced en bloc resection and achieved satisfactory treatment outcomes. This study explores whether tumor cell death induced by MWA would cause the release of immunogenic tumor antigens and tumor-specific immune responses. Methods Three models of MWA were established using osteosarcoma cell lines from the mouse,rat,and human,respectively. The expression of immunogenic molecules was measured during in vitro and in situ ablation with different ablation time and group design. Results The injection of tumor vaccines made from tumor cells or supernatant treated with in vitro ablation resulted in substantial inhibition of tumor cell growth in tumor-bearing animal models. The CD8+ T cells induced by vaccines played a key role in the process. The effector cells released cytokines,IFN-γ and TNF-α,to inhibit tumor cell growth and also trigger Fas/FasL-mediated apoptosis. Conclusions MWA-treated osteosarcoma cells can be used to induce specific antitumor immunogenic effects. Therefore,in situ MWA combined with immunotherapy provides an alternative treatment method for patients who have trouble due to their insensitivity to chemotherapy.

2016 Vol. 25 (6): 602-608 [Abstract] ( 3230 ) [HTML 1KB] [ PDF 2978KB] ( 0 )
609 Commissioning of an atlas-based auto-segmentation software for application in organ contouring of radiotherapy planning
Peng Yinglin,You Yan,Han Fei,Hu Jiang,Wang Mingli,Deng Xiaowu

Objective To perform a preclinical test of a delineation software based on atlas-based auto-segmentation (ABAS), to evaluate its accuracy in the delineation of organs at risk (OARs) in radiotherapy planning for nasopharyngeal carcinoma (NPC), and to provide a basis for its clinical application. Methods Using OARs manually contoured by physicians on planning-CT images of 22 patients with NPC as the standard, the automatic delineation using two different algorithms (general and head/neck) of the ABAS software were applied to the following tests:(1) to evaluate the restoration of the atlas by the software, automatic delineation was performed on copied images from each patient using the contours of OARs manually delineated on the original images as atlases;(2) to evaluate the accuracy of automatic delineation on images from various patients using a single atlas, the contours manually delineated on images from one patients were used as atlases for automatic delineation of OARs on images from other patients. Dice similarity coefficient (DSC), volume difference (Vdiff), correlation between the DSC and the volume of OARs, and efficiency difference between manual delineation and automatic delineation plus manual modification were used as indices for evaluation. Wilcoxon signed rank test and Spearman correlation analysis were used. Results The head/neck algorithm had superior restoration of the atlas over the general algorithm. The DSC was positively correlated with the volume of OARs and was higher than 0.8 for OARs larger than 1 cc in volume in the restoration test. For automatic delineation with the head/neck algorithm using a single atlas, the mean DSC and Vdiff were 0.81-0.90 and 2.73%-16.02%, respectively, for the brain stem, temporal lobes, parotids, and mandible, while the mean DSC was 0.45-0.49 for the temporomandibular joint and optic chiasm. Compared with manual delineation, automatic delineation plus manual modification saved 68% of the time. Conclusions A preclinical test is able to determine the accuracy and conditions of the ABAS software in specific clinical application. The tested software can help to improve the efficiency of OAR delineation in radiotherapy planning for NPC. However, it is not suitable for delineation of OAR with a relatively small volume.

2016 Vol. 25 (6): 609-614 [Abstract] ( 3700 ) [HTML 1KB] [ PDF 1339KB] ( 0 )
615 Role of self-made auxiliary device in precise radiotherapy for pelvic tumor
Bai Fei,Shi Mei,Li Jie,Zhang Lihua,Xu Lin
Objective To investigate the role of self-made auxiliary device in pelvic tumor radiotherapy with phantom immobilization using Varian cone-beam CT (CBCT). Methods A total of 50 patients with pelvic tumor were enrolled and randomly divided into study group and control group according to the order of enrollment. The patients in the study group were immobilized with thermoplastic phantom and self-made auxiliary device, and those in the control group were immobilized with thermoplastic phantom. CBCT scan and online matching were regularly performed before radiotherapy to obtain the setup errors of the left-right (x), cranial-caudal (y), and anterior-posterior (z) directions. The independent-samples t-test was used for comparison between groups. Results The set-up errors in the x-, y-, and z-directions in the study group were 1.56±1.00 mm, 1.60±1.29 mm, and 1.36±1.00 mm, respectively, and those in the control group were 1.76±1.33 mm, 2.76±1.69 mm, and 1.92±0.91 mm, respectively (P=0.551, 0.009, and 0.043). Conclusions Self-made auxiliary device helps to eliminate the errors in the cranial-caudal direction and solve the problem of involuntary activities of the lower limbs.
2016 Vol. 25 (6): 615-617 [Abstract] ( 3360 ) [HTML 1KB] [ PDF 862KB] ( 0 )
618 Comparison of two treatment couch model in Monaco treatment planning system
Zhang Ruohui,Chi Zifeng,Bai Wenwen,Fan Xiaomei,Li Runxiao,Liu Dan,Han Chun

Objective To construct the uniform electron density couch model (model A ED=0.25) and two components non uniform electron density couch model (model B FD=0.5and foam core=0.1) in the Monaco treatment planning system for theiBEAM evo Extension 415,and to compare which model can better quantify the treatment couch influence on radiation dose. Methods Phantom was positioned in the center of the couch,the attenuation of the couch was evaluated with 6 MV for a field size of 10 cm×10 cm. Dose measurements of couch attenuation were performed at gantry angles from 180.0° to 122.8°,using a 0.125cc semiflex ionization chamber (PTW),isocentrically placed in the center of a homogeneous cylindrical phantom. Each experimental setup was first measured on the linear accelerator and then reproduced in the TPS.By adjusting the relative-to water electron density (ED) values of the couch,the measured attenuation was replicated. The model accuracies of the model A and model B were evaluated by comparing the measured and calculated results at the minimum computational grid (2 mm) and maximum computing grid (5 mm),respectively. Results The maximum measured and calculated percentage deviation for the central phantom position was 4.01%.The couch model was included in the TPS with a uniform ED of 0.25 or a 2 component model with a fiber ED=0.5 and foam core ED=0.1.For model A and B under 2 and 5 mm voxel grid size,the mean absorbed dose with couch was reduced to 0.61%,0.84%,0.71% and 0.92% from 2.8% without couch. Conclusions Model A has a good agreement between measured and calculated dose distributions for all different voxel grid sizes and gantry angles. It can accurately describes the dose perturbations due to the presence of the couch and should therefore be used during treatment planning.

2016 Vol. 25 (6): 618-621 [Abstract] ( 3297 ) [HTML 1KB] [ PDF 583KB] ( 0 )
622 Application of a homemade foot-fixator in radiotherapy for lower extremity tumors
Wang Jian,Ni Xinye,Ni Xinchu,Yu Jingping,Sun Wei,Nie Bing,Li Yi,Sun Zhiqiang,Li Dongqing,Wang Jianlin,Sun Suping
Objective To explore the value of a homemade foot-fixator in radiotherapy for lower extremity tumors. Methods Lower limbs of 31 patients were fixed by the foot-fixator during lower extremity radiotherapy. Verification images were taken every week during radiotherapy. Positioning error was analyzed by comparison between verification images and simulated positioning images or digitally reconstructed radiographs generated by the treatment planning system. The comparison was made by paired t-test. Results The positioning errors in the head-foot, anterior-posterior, and left-right directions were 2.39±2.21, 0.22±2.73, and 0.20±2.71 mm, respectively. The positioning error in the head-foot direction was significantly larger than those in the anterior-posterior and left-right directions (P=0.000,0.000). Conclusions The homemade foot-fixator shows satisfactory accuracy and repeatability, which holds promise for wide application in radiotherapy for lower extremity tumors.
2016 Vol. 25 (6): 622-624 [Abstract] ( 3515 ) [HTML 1KB] [ PDF 747KB] ( 0 )
625 A study of the iso-center point coincidence between accelerator and radiotherapy planning system
Sun Xiaoyang,Yang Bo,Pang Haowen,Zhang Guangpeng,Zhang Jing,Chen Renjin,Wu Jingbo
Objective To study the iso-center point coincidence of two accelerators with treatment planning system (TPS) based on γ passing rates of intensity-modulated radiotherapy (IMRT) plan verification. Methods Twenty-one IMRT plans were verified by Varian accelerator and twenty by Elekta accelerator with a gamma criterion of 3 mm/3%. The passing rates were measured when the iso-center point of TPS had -2,-1, 0, 1, and 2 mm shift in the x or y direction. A binomial curve of γ was fit to figure out the values of the two accelerators on the x and y axes when γ value reached the maximum. The γ pass rate difference was analysed by χ2 test. Results The mean values of γ-2-1, γ0, γ1, and γ2 in the x direction were (92.56±3.27)%,(96.53±1.82)%,(96.13±1.41)%,(90.14±2.87)%, and (82.28±4.69)% for Varian accelerator, and (94.82±2.04)%,(97.05±2.02)%,(98.38±1.33)%,(97.96±1.44)%, and (94.49±2.34)% for Elekta accelerator. There was no significant difference in the mean value of γ0between the two accelerators (P=0.332). When γ value reached the maximum, the values on the x and y axes were-0.65 and-0.30 mm for Varian accelerator and 0.01 and 0.30 mm for Elekta accelerator, respectively. Conclusions In the same TPS, different accelerators have different degrees of coincidence of the actual field center point with the iso-center point of TPS, to which more attention should be paid in clinical practice.
2016 Vol. 25 (6): 625-627 [Abstract] ( 3240 ) [HTML 1KB] [ PDF 402KB] ( 0 )
628 Models of acute radiation enteritis:a comparison and evaluation of two modeling methods
Wang Yingjie,Wang Shunjin,Gong Lianggeng,Wu Hailong
Objective To investigate the reliable Methods for establishing models of acute radiation enteritis (ARE) and the criteria used to judge whether the model is successfully established. Methods A total of 98 rats were randomly divided into normal control group (group A), fractionated dose group B (4 Gy/fraction for 3 fractions), fractionated dose group C (4 Gy/fraction for 4 fractions), fractionated dose group D (4 Gy/fraction for 5 fractions), single fraction group E (12 Gy in a single fraction), single fraction group F (16 Gy in a single fraction), and single fraction group G (20 Gy in a single fraction). Abdominal irradiation was performed for all rats, and the changes in body weight and defecation were observed. Magnetic resonance imaging (MRI) was performed on days 3-5 after irradiation, and on the 4th day, anatomy was performed to measure the length of small intestine with edema, blood samples were collected to measure endotoxins, and the specimens of small intestine were collected to observe pathological changes. The independent-samples t-test was used for comparison between groups. Results After irradiation, groups D, E, F, and G experienced varying degrees of diarrhea and had positive results from endotoxins test. Group D had a longer length of small intestine with edema than group C (P=0.00) and had a similar length as group E (P=0.46). Groups E, F, and G showed dilation and dropsy in the intestinal canal on MRI, and groups F and G showed patchy signals of dropsy in the abdominal cavity. Groups F and G showed varying degrees of necrosis in the small intestine and died within 14 days after irradiation. Conclusions When the radiation dose is 33-46 Gy (biologically equivalent dose), both single dose and fractionated dose can successfully establish the model of ARE, while fractionated dose can be better controlled.
2016 Vol. 25 (6): 628-633 [Abstract] ( 3147 ) [HTML 1KB] [ PDF 2787KB] ( 0 )
634 Experimental study on different courses of electro-acupuncture treatment on behavior of model mice with radiographic exposure
Wu Xin,Zheng Wanjun,Li Lin,Gao Jianfeng
Objective To explore the effects of different courses of electro-acupuncture at Baihui, Fengfu, and Shenshu of both sides on the behavior of mice exposed to radiation. Methods Fifty C57BL/6J mice 30 days old were randomly and equally divided into control group, model group (exposure to radiation of 8 Gy), electro-acupuncture group 1(1 week of treatment), electro-acupuncture group 2(2 weeks of treatment), and electro-acupuncture group 3(3 weeks of treatment). The mouse model of radiation-induced brain injury was established by exposure to radiation of 8 Gy and treated with electro-acupuncture. The open field test and Morris water maze test were used to evaluate the cognitive function and spatial learning and memory, respectively. Group t-test difference. Results In the open field test, the model group had significantly fewer vertical or horizontal movements than the control group (P=0.032,0.029,0.028), while the electro-acupuncture groups 2 and 3 had significantly more vertical or horizontal movements than the model group (P=0.001,0.017,0.000). In the Morris water maze test, compared with the control group, the model group had significantly longer latency, a significantly lower frequency of entry into the goal box, and significantly shortened residence time, indicating substantially worse performance of spatial learning and memory (P=0.023,0.001,0.001).Compared with the model group, the electro-acupuncture groups 2 and 3 had significantly shortened latency, a significantly higher frequency of entry into the goal box, andsignificantly longer residence time (P=0.046,0.017,0.049,0.007,0.031,0.009). Conclusions Different courses of electro-acupuncture treatment at Baihui, Fengfu, and Shenshu of both sides can substantially improve the cognitive function and spatial learning and memory in mice exposed to radiation. Particularly, 2 and 3 weeks of electro-acupuncture treatment give the best outcomes.
2016 Vol. 25 (6): 634-637 [Abstract] ( 3163 ) [HTML 1KB] [ PDF 451KB] ( 0 )
638
2016 Vol. 25 (6): 638-639 [Abstract] ( 2832 ) [HTML 1KB] [ PDF 219KB] ( 0 )
640 Myocardial response to ischemia reperfusion injury in rats after X-ray irradiation
Wang Jun,Wu Yajing,Wang Yuan,Wang Sheng,Cao Feng,Wang Yi,Guo Yin

Objective To observe myocardial tolerance to ischemia/reperfusion (I/R) injury in rats after exposure to X-ray irradiation. Methods Twelve male rats were randomly divided into control group and radiation group. The rat model of radiation-induced heart disease was established in the radiation group by precordial irradiation with 20.0 Gy of 6 MV X-ray in a single fraction. At 14 days after model establishment, the Langendorff perfusion technique was performed in the two groups and the cardiac parameters including left ventricular developing pressure (LVDP), left ventricular end diastolic pressure (LVEDP), maximal rate of left ventricular pressure rise/fall (+/-LVdp/dtmax), and coronary flow (CF) were recorded. Myocardial infarct size after I/R was compared between the two groups by 2,3,5-triphenyltetrazolium chloride staining. Results After 30 minutes of ischemia and 60 minutes of reperfusion, the irradiation group had a significantly slower CF than the control group (5.64±0.35 vs. 8.38±0.52 ml/min, P=0.002). Moreover, the irradiation group had substantially poorer recovery of cardiac function in isolated hearts compared with the control group, as shown by a significantly reduced LVDP (25.4±2.31 vs. 52.76±2.76 mm Hg(1 mm Hg=0.133 kPa), P=0.000), significantly reduced+/-LVdp/dtmax (547.04±78.74 vs. 1 100.05±83.35 mm Hg(1 mm Hg=0.133 kPa)/s,P=0.001;-408.81±56.74 vs-813.62±73.82 mm Hg(1 mm Hg=0.133 kPa)/s, P=0.002), and a significantly increased LVEDP (85.29±4.61 vs. 65.65±3.65 mm Hg(1 mm Hg=0.133 kPa), P=0.012). X-ray irradiation induced a significantly increased percentage of myocardial infarct size in rats (44.67%±0.95% vs. 30.46%±0.96%,P=0.000). Conclusions X-ray irradiation can induce coronary injury, reduce myocardial tolerance to I/R injury, and increase myocardial infarct size after I/R in rats.

2016 Vol. 25 (6): 640-645 [Abstract] ( 3060 ) [HTML 1KB] [ PDF 1256KB] ( 0 )
646 Cellular response to fludarabine treatment in combination with different ionizing radiation in renal carcinoma 786-O cells
Song Lei,Liu Yong,Ma Weilin, Chen Linlin,Guo Zhong

Objective To investigate DNA double-strand breaks and radiosensitization in renalcarcinoma 786-O cells induced by fludarabine (FA) combined with different ionizing radiations. Methods The 786-O cells were exposed to FA combined with X-ray or heavy ion beam irradiation. Flow cytometry was used to evaluate the percentage of γH2AX-positive cells and cell cycle. The neutral comet assay was used to detect DNA double-strand breaks. The colony-forming assay was used to evaluate the effects of different treatments on cell survival. Comparison between groups was made by one-way analysis of variance or Dunnet’s t test. Results Compared with FA alone or irradiation alone, FA combined with different ionizing radiations increased DNA double-strand breaks as shown by significantly increased levels of γH2AX (P=0.007,0.001);FA combined with heavy ion beam irradiation lead to a cell cycle block at the radiosensitive G2/M phase and significantly increased the expression of γH2AX in the G2/M phase (P=0.000,0.000);the neutral comet assay revealed that FA combined with irradiation significantly increased DNA sublethal damage (P=0.020,0.060);FA significantly reduced the colony-forming rate after irradiation (P=0.000,0.030;0.001,0.040). Conclusions FA enhances the effects induced by X-ray and heavy ion beam irradiation with different properties. Particularly, FA substantially enhances the cell death induced by heavy ion beam irradiation.

2016 Vol. 25 (6): 646-651 [Abstract] ( 3123 ) [HTML 1KB] [ PDF 1696KB] ( 0 )
652 Enhancement of breast cancer cell radiosensitivity by knockdown of HER-2 and TOP2A
Yuan Peng,Wang Chengzheng,Xu Benling,Yang Hanzhao,Sun Heng,Qin Peng,Wu Junzhao,Xie Tian,Qin Li,Liu Xiao

Objective To study the individual and combined effects of HER-2 and TOP2A on the radiosensitivity of breast cancer SK-Br-3 cells, and to provide a basis for clinical research. Methods To knock down the expression of HER-2 and TOP2A, the recombinant plasmids expressing HER-2 siRNA or/and TOP2A siRNA were constructed and used to transfect SK-Br-3 cells using Lipofectamine 2000. Western blot was used to evaluate the knockdown efficiency two days later. Flow cytometry and MTT assay were used to evaluate apoptosis and proliferation in cells exposed to radiation, respectively. The expression of apoptosis-and proliferation-related proteins, consisting of caspase-3, Bcl-2, and Ki-67, was determined. The colony-formation assay was used to measure radiosensitivity. Results The breast cancer SK-Br-3 cells with HER-2 or TOP2A knockdown had a higher apoptosis rate and a lower proliferation rate after exposure to radiation. The apoptotic marker, activated caspase-3, had elevated expression, while the anti-apoptotic protein Bcl-2 and the proliferation marker Ki-67 had reduced expression. Knockdown of both HER-2 and TOP2A further promoted apoptosis and inhibited proliferation and colony formation, indicating a synergistic effect of HER-2 and TOP2A. Conclusions Knockdown of HER-2 and TOP2A expression elevates the radiosensitivity and apoptosis rate, and reduces the proliferation rate and colony-formation rate in the breast cancer SK-Br-3 cells. Moreover, there is a synergistic effect between HER-2 and TOP2A. The mechanism is probably related to the proliferation-related protein Ki-67 and the apoptosis pathway involving caspase-3 and Bcl-2.

2016 Vol. 25 (6): 652-656 [Abstract] ( 3620 ) [HTML 1KB] [ PDF 834KB] ( 0 )
Review Articles
657 Research advances in the pathogenesis of radiation-induced myocardial damage
Wu Yajing,Wang Jun,Wang Yi
The Medline and CNKI databases were searched with the key words of “radiation-induced myocardial damage, damage pathway, pathogenesis, and intervention”, and 37 articles were obtained. The pathogenesis of radiation-induced myocardial damage may be related to various mechanisms such as oxidative stress, transforming growth factor-β, renin-angiotensin system, mast cells, and endothelial dysfunction. The pathogenesis of radiation-induced myocardial damage is a complex process involving various mechanisms, and currently, there are ongoing studies on the cellular and molecular mechanisms involved in its pathogenesis and interventions.
2016 Vol. 25 (6): 657-660 [Abstract] ( 3272 ) [HTML 1KB] [ PDF 359KB] ( 0 )
661 Research advances in preservation of ovarian function during radiotherapy for cervical carcinoma
Lyu Xiaojuan,Cheng Xiaolong,Yu Hua
At present, reports at home and abroad suggest a low probability of successful preservation of ovarian endocrine function after ovarian shift radiotherapy. After radiotherapy for cervical carcinoma, the ovarian function is associated with various factors, such as radiotherapy dose and method, patient′s age, shift position, and concurrent chemotherapy drugs. Therefore, as for each patient, the dose to the ovarian tissue should be controlled within the individual dose limit to effectively preserve the ovarian function.
2016 Vol. 25 (6): 661-665 [Abstract] ( 3216 ) [HTML 1KB] [ PDF 319KB] ( 0 )
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