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.7 Published 2016-06-24

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

Investigation Research

	665	A survey of clinical application of image-guided radiotherapy in North China
		Zhang Ke,Chen Jinhu,Bao Chaoen,Guo Yuexin,Wang Keqiang,Liu Jianting,Wu Xiaoli,Dai Jianrong,Yin Yong,Zhai Fushan,Lei Hongchang,Xu Xiao,Xing Xiaofen,Yu Zhilong
		Objective To conduct a survey to investigate the current status of clinical application of image-guided radiotherapy (IGRT) in North China. Methods A census was performed by telephone and email from December 25, 2014 to April 25, 2015. Results In a total of 507 radiation oncology centers in North China, 64 had already purchased IGRT equipment, and 60 had already applied IGRT. A total of 3 407 staff members were involved in the application of IGRT, consisting of 1101 doctors (372 associate or full professors), 325 physicists (42 associate or full professors), 801 technicians (23 associate or full professors), 63 engineers (15 associate or full professors), and 1 117 nurses (55 associate or full professors). There were 163 devices, 91 of which were available for IGRT. The frequency and strategy in the application of IGRT varied among centers. The main components of quality assurance (QA) included spatial resolution, density resolution, uniformity, spatial distortion, consistency between imaging center and treatment center, and signal-to-noise ratio. The inspection was performed monthly. IGRT helped to reduce positioning error and improve treatment accuracy. However, it prolonged treatment duration and increased patient’s exposure to radiation. The design and implementation of appropriate IGRT protocol and strategy need to be individualized. Conclusions Thepopularization of radiation treatment units in China is far below the world level. The current application of IGRT varies a lot among different centers. Standardized procedures need to be made to ensure the robust application and quality of IGRT.
		2016 Vol. 25 (7): 665-670 [Abstract] ( 2542 ) [HTML 1KB] [ PDF 2086KB] ( 0 )

Head and Neck Tumors

	671	Effect of sodium glycididazole on severe radiation-induced mucositis in patients with head and neck squamous cell carcinoma:a randomized phase Ⅱ clinical trial
		Wang Jianyang, Huang Xiaodong,Wang Kai,Wang Huili,Wang Wenqing,Wang Jingbo,Xu Guozhen,Gao Li
		Objective To evaluate the effect of a radiosensitizer, sodium glycididazole (CMNa), on radiation-induced mucositis during concurrent intensity-modulated radiotherapy (IMRT) and chemotherapy (CRT) in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Methods From 2014 to 2015, 63 patients were randomly assigned to CRT+CMNa group and CRT group at a 1:2 ratio. In those patients, 57 completed the treatment. CMNa of 800 mg/m² was administered intravenously 30 min before radiotherapy, three times a week. For CRT, the prescribed radiation doses were 69.96-73.92 Gy in 33 fractions for the planning gross tumor volume (PGTV) and positive lymph nodes, and 60.06 Gy in 33 fractions for the planning target volume (PTV);the dose of cisplatin was 100 mg/m²;IMRT or helical tomography was used in radiotherapy. Results Nineteen patients were enrolled in the CRT+CMNa group and thirty-eight in the CRT group. There were no significant differences in baseline clinical data (P=0.34-1.00), prescribed doses to PGTV ((73.00 ± 2.66) Gy vs.(71.66 ± 3.99) Gy,P=0.19)) and PTV ((60.58 ± 2.27) Gy vs.(59.67 ± 2.08) Gy,P=0.14), and number of chemotherapy cycles (P=0.28) between the two groups. During CRT, the incidence of grade ≥3 radiation-induced mucositis and visual analogue scale (VAS) pain score were both significantly reduced in the CRT+CMNa group than in the CRT group (32% vs. 61%, P=0.04;4.6±1.6 vs. 6.2±1.6, P=0.00). Moreover, there were no significant differences in antibiotic usage and hematologic toxicity between the two groups (P=0.08-0.80). Conclusions In patients with LA-HNSCC, CMNa can reduce the incidence of radiation-induced mucositis and pain score during CRT.
		2016 Vol. 25 (7): 671-675 [Abstract] ( 1985 ) [HTML 1KB] [ PDF 911KB] ( 0 )

	676	Effects of positioning robusntness on dosimetry for intensity-modulated radiation therapy and volumetric modulated arc therapy
		Zhang Biao,Jia Pengfei,Tang Lemin
		Objective To compare the effects of positioning robustness on dose distribution between intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for head and neck tumor, and to evaluate their needs for image-based guidance. Methods Thirty patients with nasopharyngeal carcinoma undergoing IMRT were enrolled as subjects. The VMAT plans were designed according to the clinical dosimetric requirements and the dose calculation was made by the AAA method. For the two plans in each patient, the isocenters were shifted by ±1.0, ±3.0, and ±5.0 mm along the original x, y, and z axes to simulate the impacts of positioning errors in left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions, respectively, on dose distribution. The dose-volume histogram parameters were analyzed in 60 references and 1080 re-calculated plans. Comparison was made by paired t-test. Results When the error was 1 mm, the average deviations of gross tumor volume (GTV) D₉₈, clinical target volume (CTV) D₉₅ and heterogeneity index, and planning gross tumor volume (PGTV) V₉₅ were<0.5%. When the error was 3 mm, the average dose deviations of GTV and CTV were<1.0% and significantly larger in VMAT than in IMRT;the average dose deviation of PGTV was large (GTV D₉₈,P=0.00;CTV D₉₅,P=0.00);the average deviations of PGTV_nx V₉₅ and PGTV_nd V₉₅ were significantly smaller in IMRT than in VMAT (1.64% vs. 1.95%, P=0.01;1.73% vs. 2.63%, P=0.00). The deviations of parameters became larger with the increasing positioning error and were significantly larger in VMAT than in IMRT (GTV D₉₈,P=0.00;CTV D₉₅,P=0.00;CTV HI;P=0.00;PGTV V₉₅;P=0.01). Compared with the target volume, D_max to the spinal cord and brain stem had larger deviations. However, there were no significant differences in D_max to the spinal cord and brain stem between IMRT and VMAT. Conclusions The IMRT and VMAT plans are both robust when the positioning error is small (<3 mm). Compared with IMRT, VAMT is more sensitive to the positioning error, mainly in the target volume. The difference between the two plans becomes larger with the increasing positioning error. An increase in the frequency of image-based guidance is recommended for patients undergoing VMAT.
		2016 Vol. 25 (7): 676-680 [Abstract] ( 2433 ) [HTML 1KB] [ PDF 1426KB] ( 0 )

Thoracic Tumors

	681	Prognosis and it related factors in patients of stage Ⅲ non-smallcell lung cancer after three-dimensional conformal radiotherapy
		Tian Xiuming, Qiu Rong, Wang Yuxiang, Ge Hui, Li Jing, Zhu Shuhai, Qiao Xueying
		Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC). Methods From 2000 to 2010, 474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects. Those patients, consisting of 382 males and 92 females, had a median age of 63 years. In those patients, 211 had stage Ⅲ_A NSCLC and 263 had stage Ⅲ_B NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT, 340 with 3DCRT, and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy (44-77 Gy).The Kaplan-Meier method, log-rank test, and Cox model were used for survival rate calculation, univariate analysis, and multivariate analysis, respectively. Results The follow-up rate was 96.6%.In all patients, the 1-, 3-, and 5-year overall survival rates were 63.0%, 24.9%, and 17.8%, respectively;the median survival time was 18 months. The univariate analysis showed that sex, age, immediate response, radiotherapy method, fractionation scheme, chemotherapy, and radiation pneumonitis (RP) were prognostic factors (P=0.004,0.001,0.000,0.007,0.004,0.009,0.049).The multivariate analysis showed that sex, age, immediate response, radiotherapy method, and RP were independent prognostic factors (P=0.006,0.000,0.000,0.003,0.048).Patients with radiation doses of 60-66 Gy had the best prognosis of all. Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT, female patients, patients at a young age, patients with satisfactory immediate response, patients treated with full-course 3DCRT, and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients. A radiation dose of 60-66 Gy is recommended.
		2016 Vol. 25 (7): 681-685 [Abstract] ( 1999 ) [HTML 1KB] [ PDF 820KB] ( 0 )

	686	Retrospective clinical study of simultaneous reduced dose in clinical target volume of radical intensity-modulated radiotherapy for treatment of stage Ⅲ non-small-cell lung cancer
		Chen Xiuli,Liu Ningbo,Ji Kai,Zhao Lujun,Shi Xiangyu,Wang Daquan,Chen Xi,Wang Ping
		Objective To evaluate the efficacy and adverse effects of radical intensity-modulated radiotherapy (IMRT) with simultaneous reduced dose in clinical target volume (CTV) for inoperable stage Ⅲ non-small cell lung cancer (NSCLC). Methods A retrospective analysis was performed on a total of 70 patients with stage Ⅲ NSCLC who were admitted to our hospital from 2010 to 2014. All patients received simultaneous reduced-dose IMRT with a prescribed dose of 60 Gy in 30 fractions or 60.2 Gy in 28 fractions for primary gross tumor volume (PGTV, expansion of gross tumor volume by 0.5 cm) and a prescribed dose of 54 Gy in 30 fractions or 50.4 Gy in 28 fractions for planning target volume (PTV). In the 70 patients, 40 received neoadjuvant chemotherapy prior to radiotherapy, 50 concurrent chemoradiotherapy, and 25 adjuvant chemotherapy after radiotherapy. Short-term treatment outcomes and adverse reactions were evaluated. The Kaplan-Meier method was used for survival analysis. Results The median follow-up time was 42.8 months (16.9-68.3 months). The short-term response rate (complete response (CR) plus partial response (PR)) was 81.4%. The CR, PR, stable disease, and progressive disease rates were 7%(5/70), 74%(52/70), 13%(9/70), and 6%(4/70), respectively. In all patients, the median survival time was 26.6 months (5.2-68.3 months). The 2-year overall survival, local recurrence-free survival, and progression-free survival rates were 55%, 68%, and 45%, respectively. In all patients, 9%(6/70) had grade ≥3 radiation pneumonitis, 4%(3/70) grade ≥3 oesophagitis, and 7%(5/70) grade ≥3 myelosuppression. Conclusions IMRT with simultaneous reduced dose in CTV is effective for stage Ⅲ NSCLC. It deserves further prospective studies with large sample sizes.
		2016 Vol. 25 (7): 686-689 [Abstract] ( 1938 ) [HTML 1KB] [ PDF 793KB] ( 0 )

	690	Stereotactic body radiotherapy versus surgery for resectable stage Ⅰ non-small cell lung cancer:a systematic evaluation
		Bai Ge,Chu Jianhu,Bao Yongxing,Mnyinuer·Eli,Zheang Chao,Ma Le,Zhang Li
		Objective To systematically evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for resectable stage Ⅰ non-small cell lung cancer (NSCLC). Methods Clinical trials of SBRT or surgery for resectable stage Ⅰ NSCLC were collected by computerized search of Cochrane Library, MEDLINE, EMbase, CBM, CNKI, and VIP. Literature selection, quality evaluation, and data extraction were performed by two inspectors based on the inclusion and exclusion criteria. A meta-analysis was performed on the enrolled studies using RevMan 5.3 software. Results A total of four clinical trials involving 410 patients were included. The results of meta-analysis showed that there was no significant difference in 3-year overall survival rate between SBRT and surgery (RR=1.13, 95%CI=0.66-1.94, P=0.66);there was no significant difference in local control rate between SBRT and surgery (RR=0.71, 95%CI=0.26-1.93, P=0.50);patients treated with SBRT had significantly lower incidence rates of grade 3-4 adverse reactions than those treated with surgery (RR=0.29, 95%CI=0.16-0.53, P=0.000). Conclusions SBRT shows equivalent efficacy to surgery in the treatment of resectable stage Ⅰ NSCLC. However, due to the limitations in this systematic evaluation, the conclusion needs to be further confirmed by large randomized controlled trials.
		2016 Vol. 25 (7): 690-693 [Abstract] ( 2219 ) [HTML 1KB] [ PDF 2306KB] ( 0 )

	694	A study of CT perfusion imaging before and after radiotherapy for solid lung cancer
		Min Xuhong, Song Biao
		Objective To analyze the perfusion status of lung cancer before radiotherapy and the relationship between changes in CT perfusion parameters after radiotherapy and the efficacy of radiotherapy. Methods Twenty-eight patients clinically and pathologically diagnosed with lung cancer were enrolled as subjects. Those patients received CT perfusion imaging scan and perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) were calculated. We use linear correlation analysis for relation between value of CT perfusion imaging and the target volume of lung cancer before radiotherapy,t-test for difference between the remission groups and non-remission groups,compared paired sample t-test for value of CT perfusion imaging before and after radiotherapy. ResultsAccording to the efficacy of radiotherapy, 28 patients with lung cancer were divided into response group (n=16) and non-response group (n=12). The response group had significantly smaller tumor sizes before and after radiotherapy than the non-response group (58.72±22.95 cm³ vs.24.53±13.79 cm³,P=0.000). However, there was no significant correlation of target volume before radiotherapy with any perfusion parameter (P=0.628). The response group had significantly larger BF and BV than the non-response group before radiotherapy (1.23±1.36 vs.6.42±2.57,P=0.024 and 1.23±0.31 vs.0.59±0.18,=0.041), suggesting a low perfusion state of tumor tissue in the non-response group. However, there were no significant differences in MTT and PS between the two groups (0.93±0.58 vs.0.93±0.66,P=0.851 and 1.46±0.83 vs.1.17±0.56,P=0.141).All the 28 patients had significantly smaller BF, BV, MTT, and PS after radiotherapy (9.81±3.56 vs.7.48±3.31,P=0.006;0.96±0.41 vs.0.64±0.38, P=0.003;0.93±0.60 vs.0.53±0.30, P=0.007;1.34±0.73 vs.0.74±0.44,P=0.001). Conclusions CT perfusion imaging can predict the efficacy of radiotherapy for lung cancer, which may guide the planning and implementation of precise radiotherapy for lung cancer.
		2016 Vol. 25 (7): 694-698 [Abstract] ( 1930 ) [HTML 1KB] [ PDF 1856KB] ( 0 )

	699	Treatment modalities for limited-stage small-cell esophageal cancer:an analysis of 121 patients
		Wang Jun,Jiao Wenpeng,Cao Feng,Liu Qing,Wang Yi,Jing Shaowu,Yang Congrong,Cheng Yunjie
		Objective To investigate the treatment modalities and prognostic factors for primary limited-stage small-cell esophageal cancer. Methods A retrospective analysis was performed in 121 patients with limited-stage small-cell esophageal cancer. In 98 patients undergoing surgery,37 received surgery alone,40 received surgery plus chemotherapy,and 21 received surgery plus chemoradiotherapy. In 23 patients receiving nonsurgical treatment,18 received chemoradiotherapy and 5 received chemotherapy alone. Survival rate was caculated with Kaplan-Meier method and log-rank test. Multivariate analysis of prognostic factors in Cox model. Results There were no significant differences in 1-,3-year overall survival (OS) rates between the surgery group and the non-surgery group (88% vs. 78%,37% vs. 43%;P=0.585).In the surgery group,there was no significant difference in LC rate between patients undergoing different treatment modalities (P=0.113);the surgery plus chemotherapy group and the surgery plus chemoradiotherapy group had significantly higher OS rates than the surgery alone group (P=0.002,P=0.028);there were no significant differences in the 1-,3-year OS rates between the surgery plus chemotherapy group and the surgery plus chemoradiotherapy group (88% vs. 83%,44% vs. 50%;P=0.969).Patients undergoing ≥4 cycles of chemotherapy had significantly higher 1-,3-year OS rates than those undergoing<4 cycles of chemotherapy (89% vs. 85%,53% vs. 35%;P=0.036).The multivariate analysis showed that chemotherapy was an independent factor for survival in patients with limited-stage small-cell esophageal cancer (P=0.006). Conclusions Patients undergoing surgery alone for limited-stage small-cell esophageal cancer have a poor prognosis. Compared with radiotherapy,surgery combined with systemic chemotherapy is not able to substantially improve local control and prognosis. Chemotherapy is an independent factor for survival in patients with limited-stage small-cell esophageal cancer. At least 4 cycles of chemotherapy are recommended.
		2016 Vol. 25 (7): 699-702 [Abstract] ( 2010 ) [HTML 1KB] [ PDF 787KB] ( 0 )

	703	Results of a clinical phase Ⅱ trial of whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed after breast-conserving surgery for early breast cancer
		Yang Zhaozhi,Yu Xiaoli,Mei Xin,Ma Jinli,Pan Ziqiang,Chen Xingxing,Zhang Li,Wu Jiong,Shao Zhimein,Chen Jiayi,Guo Xiaomao
		Objective To report the clinical results of whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed after breast-conserving surgery for early breast cancer. Methods From October 2010 to April 2013, 200 patients with early breast cancer who were admitted to our center and treated with breast-conserving surgery were prospectively enrolled as subjects. All patients received inversely intensity-modulated whole breast irradiation with a dose of 45 Gy in 25 fractions and a simultaneous integrated boost to the tumor bed with a dose of 0.6 Gy/Fx (a total dose of 60 Gy in 25 fractions) five times a week. Logistic regression analysis was used to examine the predictive factors for the occurrence of grade 2 radiation skin reactions. Results All patients completed the radiotherapy treatment. The mean planning target volumes (PTVs) of diseased breast and tumor bed were 529.2 cc and 92.9 cc, respectively. The mean V₂₀ of the ipsilateral lung was 17.2%, and the mean dose for the heart was 531 cGy in patients with left breast cancer. According to the Common Terminology Criteria for Adverse Events, version 3.0, the incidence rates of grade 0, 1, and 2 radiation dermatitis in all patients were 8%, 63%, and 29%, respectively. In all patients, 10.5% had moist desquamation. The multivariate analysis revealed that the PTVs of the tumor bed and whole breast were predictive factors for grade 2 dermatitis. In 185 patients who did self-evaluation of breast cosmetic outcome, 50(87.1%) were rated as excellent, 111(60.0%) as good, and 24(12.9%) as fair. The median follow-up time was 38 months (2-56 months), and the 3-year local control rate was 98.7%. Conclusions The whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed achieves satisfactory acute skin toxicity profile and cosmetic outcome. A 3-year follow-up reveals a good local control rate.
		2016 Vol. 25 (7): 703-707 [Abstract] ( 2462 ) [HTML 1KB] [ PDF 1031KB] ( 0 )

	708	A comparative study of distribution of residual cancer cells in the bowel wall after preoperative three-dimensional conformal radiotherapy versus volumetric modulated arc therapy with concurrent chemotherapy in treatment of locally advanced rectum cancer
		Xiao Lin,Zhu Yujia,Qiu Bo,Xiao Weiwei,Yu Xin,Zeng Zhifang,Liu Mengzhong,Gao Yuanhong
		Objective To compare the distribution of residual cancer cells (RCC) in each layer of bowl wall after preoperative three-dimensional conformal radiotherapy (3DCRT) versus volumetric modulated arc therapy (VMAT) combined with concurrent chemotherapy,and to investigate the effect of different radiotherapy techniques on the distribution of RCC. Methods A total of 334 patients with locally advanced rectum cancer (LARC) who were admitted to our hospital from May 2007 to April 2013 were enrolled as subjects. In those patients,172 received preoperative 3DCRT (46 Gy/23 F) with concurrent chemotherapy and 162 received VMAT (50 Gy/25 F) with concurrent chemotherapy. There was no significant difference in the distribution of clinical stage Ⅱ or Ⅲ between the 3DCRT group and VMAT group. All the RCCs in different layers of surgical specimens were evaluated pathologically. Between-group comparison of data was made by Pearson Chi-Square and Fisher′s exact test. Results There were no significant differences in ypT,ypN,or ypTNM staging between the two groups (P values>0.05).In the 226 patients with ypT_2-4 disease,the proportion of RCC in the mucosa,submucosa,muscularis propria,and subserosa/perirectal fat was 34.1%,43.8%,73.5%,and 69.0%,respectively. In patients with ypT_2-4,pN+,cN+,or cT₄ disease,compared with the VMAT group,the 3DCRT group had significantly higher proportion of RCCs in the mucosa (47.9% vs. 18.1%,54.5% vs. 17.2%,39.8% vs. 15.3%,41.3% vs. 14.3%;P=0.000,0.001,0.000,0.000) and submucosa (50.4% vs. 36.2%,56.8% vs. 27.6%,43.0% vs.26.6%,45.3% vs. 27.5%;P=0.032,0.014,0.006,0.017).In patients with pN₀ or cT₃ disease,the 3DCRT group had a significantly higher proportion of RCCs in the mucosa than the VMAT group (28.1% vs. 12.9%,P=0.002;29.5% vs. 13.2%, P=0.015).In patients with ypT_2-4,pN₀/pN+,cT₃/cT₄,or cN₀/cN+ disease,there were no significant differences in the proportion of RCCs in the muscularis propria or subserosa/perirectal fat between the two groups (P values>0.05). Conclusions After neoadjuvant chemoradiotherapy,most RCCs reside in the muscularis propria and subserosa/perirectal fat of the bowl wall. There are no significant differences in the distribution of most RCCs in the bowel wall or postoperative pathological staging between patients undergoing different radiotherapy techniques.
		2016 Vol. 25 (7): 708-712 [Abstract] ( 2031 ) [HTML 1KB] [ PDF 811KB] ( 0 )

	713	Early primary pulmonary mucosa-associated lymphoid tissue lymphoma:a prognostic analysis and literature review
		Wen Ge,Zhang Yujing,Zhang Jinshan,Niu Shaoqing,Li Yiyang,Feng Lingling,Xia Yunfei
		Objective To analyze the clinical features, treatment methods, and prognostic factors for early primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Methods A retrospective analysis was performed on the clinical data, treatment outcomes, and survival of 32 patients with early pulmonary MALT lymphoma from March 2001 to September 2013. The median age of those patients was 56 years. Twenty-three patients had stage Ⅰ_E disease and nine had stage Ⅱ_E disease. According to the marginal zone B-cell lymphoma prognostic index (MZLPI), twenty-three patients were scored as 0 and nine as 1. Nine patients received radiotherapy, eight patients underwent surgery alone, three patients underwent surgery plus chemotherapy, and twelve patients received chemotherapy alone. The Kaplan-Meier method was adapted for calculating the OS,PFS and the log-rank test was used for survival difference analysis and univariate prognostic analysis. Results The 5-year sample size was 22. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 84.5% and 73.2%, respectively. Radiotherapy yielded an overall response rate of 100%, including a complete response rate of 66.7% and a partial response rate of 33.3%. The univariate analysis showed that non-radiotherapy treatment was a prognostic factor for poor PFS. The patients treated with radiotherapy had significantly higher 5-year PFS rates than those treated without radiotherapy (100% vs. 63.0%,P=0.029), while there was no significant difference in 5-year OS rate between these two groups (100% vs. 78.8%,P=0.129). Age older than 60 years, an ECOG score of 2, and an MZLPI score of 1 were prognostic factors for poor PFS (P=0.041, 0.018, and 0.044) and OS (P=0.001, 0.001, and 0.003). Conclusions The prognostic factors for early pulmonary MALT lymphoma include age, ECOG score, and MZLPI score. Low-dose involved-field radiotherapy (24–30 Gy) can improve local control and survival.
		2016 Vol. 25 (7): 713-717 [Abstract] ( 1949 ) [HTML 1KB] [ PDF 806KB] ( 0 )

	718	*Effects of different status of the bladder on dosimetry to normal tissue in brachytherapy of Cervix Cancer:A Meta-analysis*
		Fu Tianxiao,Xu Sheng,Xu Wentao,Zhou Juying,Qin Songbing,Wang Lili,Jiao Yang,Xu Xiaoting
		Objective To assess the effects of bladder filling and emptying state on the dose distribution to normal tissue in intracavitary brachytherapy of cervical cancer. Methods We searched databases including PubMed,EMBASE,Cochrane Library,Ongoing Controlled Trial,Chinese Biomedical Literature Database,Chinese Journal FullText Database and Chinese Scientific Journals FullText Database. Quality assessment and data extract was performed for clinical research that met qualifying criteria,then we performed Meta-analysis by Stat_A12.0 software. Results Six studies were involved and 135 patients were included. The Meta-analysis showed that the median dose D₅₀ to the bladder in filling state was significantly lower than in emptying state (SMD=-2.48,95%CI:-4.37--0.59,P=0.000).D_{1 cm³} and D_{2 cm³} showed no significant difference (P=0.000,0.000).D_{2 cm³} to the rectum in filling state was greater than in emptying state (SMD=0.39,95%CI:0.06-0.72,P=0.257).D₅₀ and D_{1 cm³} showed no significant difference (P=0.105,0.005).D_{2 cm³} to the sigmoid colon in filling state was greater than in emptying state (SMD=0.81,95%CI:0.50-1.12,P=0.648).D₅₀ and D_{1 cm³} showed no significant difference (P=0.039,0.000).D_{1 cm³} and D_{2 cm³} to the small bowel in filling state was lower than in emptying state (SMD=-3.28,95%CI:-5.61--0.95,P=0.000 and SMD=-2.98,95%CI:-4.68--1.28,P=0.000).D₅₀ showed no significant difference (P=0.008).When sensitivity analyses were performed by the sequential dropping of a single study,differences were observed when the study of Patra et al was excluded. Conclusions　In intracavitary brachytherapy of cervical cancer,the dose distribution to the bladder and small bowel in filling bladder state were lower than those in emptying bladder state,the results of sigmoid colon and rectum were just opposite. Confined by article quality and quantity,further evaluations in adequately powered large control trail are needed to confirm these findings.
		2016 Vol. 25 (7): 718-723 [Abstract] ( 2246 ) [HTML 1KB] [ PDF 1647KB] ( 0 )

	724	Preoperative and postoperative radiotherapy for locally advanced colorectal cancer
		Han Yang,Yin Wenming,Jiang Riyue,Ning Zhonghua,Chen Yuan,Xu Guoping,Gu Wendong,Pei Honglei
		Objective To investigate the current situation of comprehensive treatment of rectal cancer in municipal hospitals in China after the release of the Standard Practice in Diagnosis and Treatment of Colorectal Cancer by Department of Medical Administration, Ministry of Health in 2010. Methods A follow-up study was performed by clinic, telephone, and mail investigation of patients with rectal cancer who underwent radical resection in our hospital from January 2010 to December 2013 to assess the implementation of neoadjuvant or postoperative radiotherapy according to the Standard Practice in Diagnosis and Treatment of Colorectal Cancer. Results In a total of 438 patients with rectal cancer, only 9 received preoperative radiotherapy. In 293 patients undergoing postoperative radiotherapy (stage T_3-4N₀M₀ or TxN_1-2M₀), 18(6.1%) received postoperative-radiotherapy alone and 33(11.3%) received postoperative concurrent chemoradiotherapy. In 242 patients (82.6%) treated without postoperative radiotherapy, 173(71.5%) were poorly informed due to misconduct of the medical staff. Conclusions Clinical physicians do not well understand the comprehensive treatment. Particularly, the application of neoadjuvant treatment needs further studies and standardization.
		2016 Vol. 25 (7): 724-727 [Abstract] ( 1817 ) [HTML 1KB] [ PDF 779KB] ( 0 )

Abdominal Tumors

	728	Development and evaluation of whole breast irradiation with volumetric modulated arc therapy-based hybrid intensity-modulated radiotherapy after breast conserving surgery for breast cancer
		Tian Yuan,Ma Pan,Men kuo,Xu Yingjie,Li Minghui,Song Yixin,Dai Jianrong
		Objective To develop whole breast irradiation with volumetric-modulated arc therapy (VMAT)-based hybrid intensity-modulated radiotherapy (IMRT) after breast conserving surgery for breast cancer, and to evaluate its value in clinical application. Methods Ten patients with breast cancer undergoing breast conserving surgery were enrolled. Two radiotherapy plans were designed based on hybrid fixed-beam IMRT/IMRT technique and hybrid VMAT/IMRT technique, respectively. One group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions. The other group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions, as well as simultaneous integrated boost to the tumor bed with 60 Gy in 25 fractions. The dosimetric parameters and delivery efficiency were compared between the two plans using paired t test. Results For patients treated with whole breast irradiation alone, there were no significant differences in conformity index and homogeneity index of target volume between the two plans (P=0.866,0.056);however, compared with the hybrid fixed-beam IMRT/IMRT technique, the hybrid VMAT/IMRT technique significantly increased the doses to organs at risk (OARs) and the number of monitor units (MUs) in the intensity-modulated field (P=0.000-0.050,P=0.002). For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed;however, the hybrid VMAT/IMRT technique significantly reduced the doses to the lung and spinal cord, number of MUs in intensity-modulated field, and delivery time compared with the hybrid fixed-beam IMRT/IMRT technique (P=0.004,0.001,0.000,0.000). Conclusions For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed, the hybrid VMAT/IMRT technique is highly promising for clinical application due to better OAR sparing and higher delivery efficiency.
		2016 Vol. 25 (7): 728-732 [Abstract] ( 1929 ) [HTML 1KB] [ PDF 1242KB] ( 0 )

	733	Acceptance testing of photon beam model in Axesse accelerator in two intensity-modulated treatment planning systems
		Ma Yangguang,Liu lele,Wang fangna,Wang haiyang,Jia fei,Li guowen,Wangtao,Liu shuaipeng,Xu dandan,Guo yuexin
		Objective To investigate the acceptance testing of the photon beam model in Axesse accelerator in Monaco and Oncentra treatment planning systems (TPS), in order to establish an integral method for the acceptance of both systems at the same time. Methods The conflicting parameters of the two TPSs were determined before acceptance, and the corresponding parameters in the accelerator were adjusted to the overlapping values. The acceptance test was performed from the aspects of point dose, surface dose, and characteristic simulation of multi-leaf collimator (MLC). The test case for point dose was designed based on TRS430, TG53, and practical situations. The test case for surface dose included conventional radiation field and intensity-modulated radiotherapy (IMRT) cases. The test of the characteristics of MLC included concave-convex groove, leakage, and values of"offset" and"Gain". Results The error of most point doses were within 4%, and only some measuring points in the penumbra region and outside the radiation field had an error of>4%. The γ pass rate of the surface dose tests and IMRT cases was>90% at a value of 3 mm/3% except three test cases. Oncentra could only simulate the situation with a positive offset value of MLC, but Monaco could simulate the situation with both positive and negative offset values of MLC. Conclusions The results show that this method can accurately validate all the parameters of the two systems and realize the accurate acceptance of Monaco and Oncentra systems with Axesse accelerator. Both Monaco and Oncentra models can meet the needs for clinical calculation.
		2016 Vol. 25 (7): 733-739 [Abstract] ( 2203 ) [HTML 1KB] [ PDF 2314KB] ( 0 )

	740	Influence of sub-field area on dose distribution in intensity-modulated radiotherapy for cervical cancer
		Qiu Rong,Shang Kai,Li Runxiao,Chi Zifeng,Wang Yuxiang
		Objective To investigate the optimization of therapeutic regimen through the adjustment of the minimum sub-field area in intensity-modulated radiotherapy (IMRT) for cervical cancer,under the premise of no influence on the dose to target volume or organs at risk. Methods A total of 12 patients with pathologically confirmed cervical cancer were enrolled,and the prescribed dose to the planning target volume (PTV) was 50 Gy in 25 fractions. The Pinnacle 8.0m treatment planning system was used for all patients,and 16 IMRT plans were developed for each patient,with the application of 9 evenly distributed fixed incidence directions (0°,40°,80°,120°,160°,200°,240°,280°,and 320°),a minimum sub-field number of 80,and a minimum sub-field hop count (MU) of 5 MU.The range of sub-field area was 2-81 cm².Direct machine parameter optimization was used for inverse-planned optimization calculation,and all the plans met the requirements of the clinical prescribed dose. The dose-volume histogram was used to evaluate the dose distribution in target volume and organs at risk. Results With the sub-field area increasing from 2 cm² to 81 cm²,the total hop count of IMRT plan was reduced from (1 405±170) MU to (490±47) MU (P=0.000),and when the sub-field area increased above 6 cm×6 cm,the total hop count was reduced significantly (P=0.000).In the IMRT plan with a minimum sub-field area of 2-49 cm²,there was no significant difference in dose between the target volume and the organs at risk (P>0.05).The dose to the rectum,the bladder,and both femoral heads showed no significant differences across the IMRT plans with different minimum sub-field areas (P>0.05). Conclusions When the Pinnacle 8.0m treatment planning system is used to develop IMRT plans for cervical cancer,the requirements for clinical dose can still be met with a minimum sub-field area reaching 7 cm×7 cm,and there are significant reductions in sub-field hop count and total hop count.
		2016 Vol. 25 (7): 740-744 [Abstract] ( 2097 ) [HTML 1KB] [ PDF 1017KB] ( 0 )

	745	Dosimetry of conformal radiotherapy, field-in-field intensity-modulated radiotherapy, and inverse-planned intensity-modulated radiotherapy after breast-conserving surgery for left-sided breast cancer:a comparative analysis
		Huo Wen,Ning Bo,Hu Jing,Xu Mei,Liu Gang
		Objective To investigate the differences in dosimetry between conformal radiotherapy (CRT), field-in-field intensity-modulated radiotherapy (FIF-IMRT), and intensity-modulated radiotherapy (IMRT) after breast-conserving surgery for left-sided breast cancer. Methods A total of 31 patients who underwent breast-conserving surgery for left-sided breast cancer were randomly selected, and the plans for CRT, FIF-IMRT, and IMRT were developed. The dose-volume histogram (DVH) was used for self-control study, and the non-parametric test was used to compare the differences in target volume and doses to organs at risk (OARs). Results All the three methods met the requirements of the prescribed doses. The CRT group had a higher V₁₀₅ of the target volume and higher heart V₃₀ and D_max(P=0.000,0.000,0.000). The IMRT group had higher V₅ and D_mean(P=0.000,0.000), as well as a higher lung V₅ and a lower lung V₄₀(P=0.000,0.000). The FIF-IMRT group had the lowest D_mean(P=0.000), and the IMRT group had significantly higher D_mean and D_max of the right lung and the spinal cord than the other two groups (P=0.000,0.000,0.000,0.000). The FIF-IMRT group had a significantly lower single hop count than the other two groups (P=0.000). Conclusions CRT has a good dose distribution in the target volume, but greatly injures the surrounding tissues. FIF-IMRT can well protect OARs and cause less damage to the device.
		2016 Vol. 25 (7): 745-747 [Abstract] ( 2214 ) [HTML 1KB] [ PDF 771KB] ( 0 )

	748	Sampling and inspection of dose and mechanical properties of medical linear accelerators in grass-roots radiotherapy units in Sichuan Province, China
		Kang Shengwei,Li Jie,Xiao Mingyong,Liao Xiongfei,Wang Pei,Lang Jinyi
		Objective To investigate the dose and mechanical properties of medical electron linear accelerators in grass-roots radiotherapy units in Sichuan Province, China via sampling and inspection. Methods A total of eight radiotherapy units in Sichuan Province were selected by sampling, and the tests were performed for the dose and mechanical properties of the medical electron linear accelerators in use. Among these accelerators, there were 5 imported accelerators and 3 domestic accelerators. The test items and methods were determined according to the requirements in GB15213-94. Results Among the 14 test items, the items related to the flatness, symmetry, and overlap of radiation field. The other tests of dose accuracy and mechanical precision achieved good results. Conclusions There is a need to strengthen the daily quality control work for dose and mechanical accuracy of medical electron linear accelerators in grass-roots radiotherapy units in Sichuan Province and perfect the allocation of professional equipment and personnel and training of related personnel. With the support of Sichuan Radiotherapy Quality Control Center, quality control supervision and guidance should cover the whole province.
		2016 Vol. 25 (7): 748-750 [Abstract] ( 2172 ) [HTML 1KB] [ PDF 1402KB] ( 0 )

	751


		2016 Vol. 25 (7): 751-752 [Abstract] ( 1633 ) [HTML 1KB] [ PDF 1315KB] ( 0 )

	753	Lentivirus mediated RNAi silence esophageal MDC1 Eca109 cell gene expression of the influence of nude mouse transplantation tumor radiosensitivity
		Liu Zhikun,Zhu Shuchai,Su Jingwei,Li Juan,Shen Wenbin
		Objective To investigate the effects of inhibition of MDC1 protein expression on xenografted tumors in nude mice, and to observe the histopathological and cellular changes in nude mice. Methods Three pairs of effective and control short hairpin RNA targeting MDC1 mRNA were designed and cloned into the pSIH1-H1-copGFP vector. Real-time PCR and Western blot were used to determine the mRNA and protein expression of MDC1. After selection by copGFP reporter gene, cells were divided into negative transfection group (ECA109-N) and MDC1 transfection group (ECA109-M). The transfected cells were injected into nude mice. The mice were divided into ECA109 group, ECA109-N group, and ECA109-M group. Each group was divided into irradiation subgroup and non-irradiation subgroup. The changes in tumor size after irradiation were evaluated in each group. Western blot was used to measure the expression of CHK1, CHK2, and CHK2T68 in xenografted tumors. Flow cytometry was used to analyze the cell cycle distribution and apoptosis of tumor cells in nude mice. The variance analysis was used to compare the mean of multiple groups, and the SNK-q test was used in the two two groups. Results The pMDC1-shRNA plasmid was successfully constructed and used to transfect ECA109 cells. ECA109-M cells were obtained by stable transfection with the recombinant plasmid. All inoculated nude mice survived with visible xenografted tumors at the underside of the paw in about one week. There was no swelling and wound in inoculation sites. There was no significant difference in tumor size between different groups (P>0.05). The tumor growth in the ECA109 group and the ECA109-N group significantly slowed down after irradiation with a dose of 15 Gy (P<0.05). Compared with the other two groups, the ECA109-M group had a significant smaller tumor size, significantly slower relative tumor growth, and significantly higher growth inhibition (all P<0.05). The q value of the ECA109-M group was 1.36. In the ECA109-M group, there were no significant changes in the protein expression of CHK1 and CHK2 after irradiation (P>0.05);however, the phosphorylation of CHK2T68 protein was significantly reduced after irradiation (P<0.05). There were no significant differences in cell cycle distribution or the proportion of apoptotic cells in tumor tissue between the three groups (P>0.05). Conclusions Inhibition of MDC1 protein expression by RNA interference can effectively inhibit the growth of xenografted tumors after irradiation in the nude mice by increasing their radiosensitivity.
		2016 Vol. 25 (7): 753-758 [Abstract] ( 2246 ) [HTML 1KB] [ PDF 1370KB] ( 0 )

	759	miR-206 enhances radiosensitivity of glioma cells by targeting MAPK1 pathway
		Wen Gongling,Zhang Baochao, Wan Lixin, Wen Changming,Wang Yang,Zhang Kai,Rao Shilei,Zhang Jingwei,Liu Yangfan
		Objective To investigate the signaling pathway probably targeted by miR-206 in regulation of the radiosensitivity of glioma cells, and to provide a basis for further understanding of its regulatory mechanism. Methods The miR-206 mimic or miR-206 inhibitor was transfected into U87 glioma cells. The activity of the MAPK pathway was inhibited by PD98059. The cells were exposed to radiation. MTT assay and colony formation assay were used to determine the changes in the radiosensitivity of cells. Quantitative RT-PCR and Western blot were used to determine the expression of miR-206 and MAPK1, respectively. TargetScan prediction and dual luciferase reporter system were used to verify the interaction between miR-206 and MAPK1. Results After exposure to radiation, the glioma cells had downregulated expression of miR-206 and upregulated expression of MAPK1. Overexpression of miR-206 induced by the miR-206 mimic reduced cell proliferation and colony formation ability and enhanced the radiosensitivity;inhibition of miR-206 expression by the miR-206 inhibitor reversed the effects of the miR-206 mimic. MAPK1 was predicted to be the possible target gene of miR-206 by TargetScan software. The dual luciferase reporter assay further confirmed the interaction between miR-206 and MAPK1. The expression of MAPK1 was negatively correlated with that of miR-206. The radiosensitivity of glioma cells was enhanced when the MAPK pathway was blocked by the inhibitor. Conclusions miR-206 probably targets MAPK1. It may regulate the radiosensitivity of glioma cells by inhibiting the activity of the MAPK signaling pathway.
		2016 Vol. 25 (7): 759-763 [Abstract] ( 2119 ) [HTML 1KB] [ PDF 1350KB] ( 0 )

	764	Radiobiological effects of irradiation plus olaparib with different dose rates on CNE-2 cell line
		Zhao Gang,Huang Xiu,Zheng Taihao,Shi Xuejun,Li Meng,Li Ming
		Objective To investigate the radiobiological effects of radiation with different dose rates on human nasopharyngeal carcinoma cell line CNE-2 treated with or without a poly ADP-ribose polymerase (PARP) inhibitor,olaparib. Methods The concentration of olaparib used to treat cells equaled to the inhibition concentration IC₁₀ of olaparib to CNE-2 cells. The CNE-2 cells were divided into acute radiotherapy (RT) group,fractionated radiotherapy (FRT) group,olaparib+RT group,and olaparib+FRT group. All groups were exposed to radiation of 0,1,2,3,5,7,and 10 Gy at a dose rate of 3 Gy/min.The delivery time for each dose point was 4 min in RT and 30 min in FRT.The colony forming assay was used to evaluate the survival of CNE-2 cells at each dose point. The multi-target,single-hit model was used to fit the cell survival curves and the parameters,D₀,D_q,and SF₂,were calculated. At dose points of 0,1,and 2 Gy,western blot was used to determine the expression of PARP-1 in the RT group and the FRT group and γH₂AX in each group. Immunofluorescence was used to evaluate the γH₂AX focus formation. A single factor analysis of variance was used to compare the 4 groups,and two two compared with SNK-q test. Results The IC₁₀ value of olaparib to CNE-2 cells was4.0μmol/L.At dose points of 1 and 2 Gy,the PARP-1 expression was significantly higher in the FRT group than in the RT group (P=0.029,0.022),while the γH₂AX focus number was significantly smaller in the FRT group than in the other three groups (all P<0.05);compared with the RT group,the D₀,D_q,and SF₂ values in the FRT group were increased by 11.67%,15.78%,and 23.61%,respectively;compared with the FRT group,the D₀,D_q,and SF₂ values in the Olaparib+FRT group decreased by 11.19%,6.44%,and 13.26%,respectively;there were no significant differences in above indices between the RT group,the Olaparib+RT group,and the Olaparib+FRT group. Conclusions For the same radiation dose,fractionation reduces the relative dose rate and weakens the radiobiological effects.low-dose olaparib can compromise the single strand break repair induced by the decline of the relative dose rate in a fractionated irradiation mode,which promotes the formation of double-strand break and improves the radiobiological effects.
		2016 Vol. 25 (7): 764-769 [Abstract] ( 2135 ) [HTML 1KB] [ PDF 2708KB] ( 0 )

	770	miR-485-3p regulates radiosensitivity of gastric cancer cells by targeting ATR
		Li Mingjun,Geng Li,Qin Yanru,Gu Hao,Wu Guangyin,Fan Ruitai,Shi Yonggang,Zhang Mingzhi
		Objective To investigate the effect of miR-485-3p on the radiosensitivity of gastric carcinoma MGC803 cells and the possible mechanism of action. Methods The MGC803 cells were transfected with miR-485-3p mimic or ATR siRNA and then treated by radiation. The MTT method, colony-forming assay, and apoptosis test were used to measure the change in radiosensitivity of such cells. RT-PCR and Western blot were used to measure the changes in the expression of miR-485-3p and ATR, and DIANA, TargetScan, and miRanda software and dual-luciferase reporter assay were used to verify the targeted effect of miR-485-3p on ATR. Results After radiation treatment, the expression of miR-485-3p in gastric carcinoma cells was downregulated. The overexpression of miR-485-3p reduced the proliferative capacity and colony-forming ability of cells, increased apoptosis rate, and thus increased radiosensitivity. The software for target gene prediction found that ATR might be the target gene of miR-485-3p, and the dual-luciferase reporter assay further confirmed that ATR was the direct target of miR-485-3p. The miR-485-3p downregulated the expression of ATR, and the inhibition of the ATR signaling pathway by transfection with ATR siRNA increased the radiosensitivity of gastric carcinoma cells. Conclusions The miR-485-3p may target at ATR and regulate the radiosensitivity of gastric carcinoma cells through inhibiting the ATR signaling pathway.
		2016 Vol. 25 (7): 770-774 [Abstract] ( 2149 ) [HTML 1KB] [ PDF 996KB] ( 0 )

	775


		2016 Vol. 25 (7): 775-776 [Abstract] ( 1783 ) [HTML 1KB] [ PDF 1026KB] ( 0 )

Physics·Biology·Technique

	777	Hypofractionated radiotherapy and tumor immunity — new concepts and new combination
		Liu Sihan,Tian Ye,Zhang Daxin
		Modern immunology has established that tumor immune escape is associated with hidden or missing tumor-specific antigens and tumor-associated antigens, as well as immune suppressors that are released from tumor cells to inhibit the immune cytotoxicity and antigen-presenting cells (APCs). The changes in tumor microenvironment have an impact on tumor immunity and treatment outcomes. The immune effects finally depend on activation and inhibition of T cell receptors and other co-regulated receptors (CD₂₈, CD₈₀/CD₈₆, and CTLA-4) in spite of the existence of APCs and cytotoxic T lymphocytes in tumor microenvironment. Recent studies have revealed that radiotherapy induced not only DNA damage but also immunogenesis in tumor cells. Both conventionally fractionated radiotherapy and hypofractionated radiotherapy can induce immunogenesis in tumor cells. Immunogenic regulation makes many tumor antigens expressed in cells exposed to irradiation, which induces immune recognition and cytotoxicity;cell content (DNA, HMGB1, etc.) released from dead immunogenic cells can trigger immune effects and in situ tumor vaccination, which further induce an abscopal effect of radiotherapy. A lot of anti-tumor immunotherapy fails to achieve satisfactory treatment outcomes. Therefore, how to combine radiotherapy, especially stereotactic body radiotherapy, with anti-tumor immunotherapy has recently become a new challenge for researchers.
		2016 Vol. 25 (7): 777-781 [Abstract] ( 2569 ) [HTML 1KB] [ PDF 1227KB] ( 0 )

	782	Research advances in poly (ADP-ribose) polymerase inhibitors in combination with radiotherapy
		Luo Jing,Zhao Lujun,Liu Ningbo,Wang Ping
		As a DNA damage sensor, poly (ADP-ribose) polymerase (PARP) is involved in a wide variety of cellular activities, such as DNA damage repair. PARP inhibitors regulate a series of cellular activities by inhibiting PARP function, which have become a focus of current research. Recently, several in vivo and in vitro studies showed that PARP inhibitors combined with radiotherapy effectively enhanced the efficacy of radiotherapy. This paper reviews the research advances in the mechanisms of action of PARP inhibitors and their combination with radiotherapy.
		2016 Vol. 25 (7): 782-786 [Abstract] ( 2027 ) [HTML 1KB] [ PDF 825KB] ( 0 )

Review Articles

	787


		2016 Vol. 25 (7): 787-791 [Abstract] ( 1335 ) [HTML 1KB] [ PDF 859KB] ( 0 )

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Chinese Medical Association

Cancer Hospital of Chinese
　Academy of Medical
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Chinese Journal of Lung
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