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.8 Published 2016-08-15

	Head and Neck Tumors Abdominal Tumors Thoracic Tumors Investigation Report Physics·Biology·Tchnique Review Article

Investigation Report

	791	Investigation on the current situation of radiotherapy in sichuan province
		Qi Guohai,Wang Pei,Li Jie,Wang Xianliang,Tang Bin,Wu Fan,Kang Shengwei
		Objective To understand the status of the radiation therapy in sichuan province,analysis the development level of radiotherapy in the past five years in sichuan province,provide reference for the rational allocation of radiotherapy resources in the province,promote the healthy development of radiotherapy. Methods With reference to the surveys carried out by other provinces and the survey of sichuan province in 2009,to determine the survey schemes,survey projects. The survey covers all medical units of radiation therapy in the province,adopt the way of combination of questionnaire and on-the-spot visiting. Results There is a big progress in basic condition,treatment equipment,auxiliary equipment,verification equipment,personnel and application of new technologies. Compared with 2009 survey,multiple projects achieve a 50% or even more than 100% growth. Conclusions The rapid development of radiation oncology in sichuan province will ultimately benefit a large number of tumor patients in sichuan province. Patients will be treated with better environment,treatment technology and quality. At the same time,higher requirement of quality control for the entire province is put forward to us.
		2016 Vol. 25 (8): 791-794 [Abstract] ( 1884 ) [HTML 1KB] [ PDF 729KB] ( 0 )

Head and Neck Tumors

	795	HLA-B alleles and nasopharyngeal carcinoma in Xinjiang, China:relationship and clinical significance
		Hu Yunhui,Liu Kai,Geng Xiaotao,Wang Ruozheng
		Objective To explore the relationship between HLA-B allele polymorphisms and nasopharyngeal carcinoma (NPC) in Xinjiang, China and its clinical significance. Methods A total of 226 patients were assigned to NPC group, while 207 healthy volunteers were assigned to control group. PCR amplification with sequence-specific primers was used to determine HLA-B alleles. Comparison of HLA-B allele frequency between the above two groups, between Han and Uygur populations, and between patients with various clinical characteristics of NPC was made by chi-square test. The Kaplan-Meier method was used to calculate the survival rates and the log-rank univariate analysis was used to explore the relationship between survival rates and HLA-B allele frequency. Results In all the subjects or Han population alone, the allele frequency of HLA-B46 in the NPC group was significantly higher than that in the control group (P=0.000;P=0.000). In Uygur population, however, there was no significant difference in the allele frequency of HLA-B46 between the NPC group and the control group (P>0.05). In the patients with NPC, those less than 30 years old had a significantly higher allele frequency of HLA-B44 than those no less than 30 years old (P=0.029);those with differentiated non-keratinizing carcinoma had a significantly higher allele frequency of HLA-B48 than those with undifferentiated non-keratinizing carcinoma (P=0.029);those with stage T₁+T₂ disease had a significantly higher allele frequency of HLA-B48 than those with stage T₃+T₄ disease (P=0.029). The 5-year overall survival, disease-free survival, distant metastasis-free survival, and local relapse-free survival rates had no relationship with the expression of HLA-B46, HLA-B44, or HLA-B48 in NPC patients (all P>0.05). Conclusions HLA-B46 allele is probably a NPC susceptibility gene in Han population in Xinjiang. HLA-B44 is probably associated with early age of onset, while HLA-B*48 is probably associated with the pathological type and T stage of NPC. Therefore, HLA-B alleles are probably associated with the development and progression of NPC.
		2016 Vol. 25 (8): 795-801 [Abstract] ( 1876 ) [HTML 1KB] [ PDF 1059KB] ( 0 )

	802	A dosimetric study of helical tomotherapy for nasopharyngeal carcinoma
		Cao Xinge,Wang Yadi,Zhang Yongqian,Zhang Fuli,Gao Junmao
		Objective To use helical tomotherapy (HT) for determining the difference between actual doses and planning doses to the target volume and organs at risk (OARs) in patients with nasopharyngeal carcinoma receiving radiotherapy, and to provide guidance for the clinical treatment. Methods Localization and delineation of the target volume and OARs were performed by computed tomography (CT) in 21 patients with nasopharyngeal carcinoma receiving radical radiotherapy using HT. All patients underwent megavoltage CT (MVCT) scan prior to treatment. The obtained MVCT images were used for dose reconstruction in the adaptive module of HT, in which the actual dose was obtained and the non-image-guided dose was simulated. Each single dose distribution and the corresponding CT image were sent to software MIM6.0 for superimposition, and the overall dose was obtained. The initial plan, image-guided plan, and non-image-guided plan were named Plan-1, 2, and 3, respectively. The dose distribution in thetarget volume and OARs was compared between the three plans with t-test or wilcoxon test. Results Compared with those in Plan-1, the D₉₈ values for the planning gross tumor volume (PGTV) and planning target volume (PTV) in Plan-2 were significantly reduced by 1.16% and 2.3%, respectively (P=0.025;P=0.043);the volumes of the left and right parotids in Plan-2 were significantly reduced by 46.0% and 46.5% on average, respectively (P=0.000);the distances between the midline and the center-of-mass for left and right parotids were significantly reduced by 6.9% and 6.5%, respectively (P=0.000);the V₂₆ and D_mean for both parotid glands were significantly elevated by 32.8% and 25.2%, respectively (P=0.000). Compared with those in Plan-1, the D₉₈ values for PGTV, PTV-1, and PTV-2 in Plan-3 were significantly reduced by 2.0%, 1.9%, and 2.4%, respectively (P=0.001;P=0.007;P=0.036);the V₂₆ and D_mean for both parotid glands in Plan-3 were significantly elevated by 33.6% and 25.3%, respectively (P=0.000);D_max to the spinal cord was significantly increased by 6.9%(P=0.005). There was no significant difference in D₂ to the spinal cord between Plan-2 and Plan-1(P=0.392). Conclusions The doses to both parotid glands increase during HT for nasopharyngeal carcinoma, which is closely associated with the shift of the parotid glands toward the midline. Image-guided radiotherapy does not enhance the dose to the target volume, but reduces the dose to the spinal cord.
		2016 Vol. 25 (8): 802-806 [Abstract] ( 2130 ) [HTML 1KB] [ PDF 775KB] ( 0 )

Thoracic Tumors

	807	Prospective non-randomized clinical study of biomarker-guided concurrent chemoradiotherapy for unrescetable esophageal squamous cell carcinoma
		Yang Zhe,Dai Honghai,Feng Alei,Li Qiang,Lyu Dongxiao,Han Junqing
		Objective To evaluated the efficacy of biomarker-guided concurrent chemoradiotherapy in unrescetable esophageal squamous cell carcinoma patients. Methods 54 cases of unrescetable esophageal squamous cell carcinoma were enrolled in the prospective non-randomized clinical study and divided into study group and control group. All cases were treated with concurrent chemoraditherapy. Intensity-modulated radiation therapy was used with a dose of 60-66 Gy. Chemotherapy was perfromed on day 1 and d29.In the study group the selection of the chemotherapy drug was based on the excision repair cross-complementation 1(ERCC1),thymidylate synthetase (TYMS),ribonucleotide reductase M1(RRM1),and the β-tubulin isotype Ⅲ(TUBB3) mRNA expression levels. In the control group,the regiment for chemotherapy was Cisplatin plus Fluorouracil. TheObjective response rate and overall survival (OS) were calculated using Kaplan-meier method and log-rank test was used for between-group comparison. The survival rate was calculated using Kaplan-Meier method and analyzed using log-rank method,other comparison was performed by χ² test. Results The follow-up rate was 100% in the study group and 96% in the controll group. The Objective response rate of the study group and the control group were 85% and 86(P=0.483),respectively. The median survival time (MST) in the study group was 35.5 months and that in the control group was 25.8 months. The 1-,2-,and 3-year OS rates of the study group and the control group were 84%,68%,46% and 71%,59%,28% respectively (P=0.047).No significant differences were observed in the incidence of side-effects in the two groups. Conclusions Selecting the chemotherapy drug according to biomarker,combined with radiation therapy,could improve survival.in unrescetable esophageal squamous cell carcinoma. The value needs further investigation.
		2016 Vol. 25 (8): 807-812 [Abstract] ( 2249 ) [HTML 1KB] [ PDF 942KB] ( 0 )

	813	A clinical study of salvage radiotherapy for supraclavicular lymph node metastasis in patients with esophageal cancer
		Zhou Zhiguo,Zhen Chanjun,Zhang Ping,Liang Junli,Qiao Xueying,Bai Wenwen,Liu Xin,Wang Shuoshuo,Gao Xianshu
		Objective To evaluate the efficacy of salvage radiotherapy for supraclavicular lymph node metastasis (SLNM) after initial treatment in patients with esophageal cancer. Methods A total of 117 patients with SLNM after radical resection for esophageal cancer were enrolled as subjects from 2006 to 2012. All patients received three-dimensional radiotherapy with 1.8-2.0 Gy per cycle, 5 cycles a week. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The Cox model was used for multivariate analysis. Results The follow-up rate was 100%. In all the patients, the 1-and 3-year overall survival (OS) rates were 38.5% and 14.1%, respectively. The 1-and 3-year OS rates were significantly higher in patients treated with salvage radiotherapy or radiochemotherapy (n=100) than in patients without any salvage treatment (n=17)(42% vs. 18%,P=0.008;17% vs. 0%, P=0.008). The patients treated with radiochemotherapy (n=32) had significantly higher 1-and 3-year OS rates than those treated with radiotherapy alone (n=68)(59% vs. 34%, 36% vs. 11%, P=0.002) or without any salvage treatment (n=17)(59% vs. 18%, 36% vs. 0%, P=0.002). Patients without visceral metastasis (n=80) had significantly higher 1-and 3-year OS rates than those with visceral metastasis (n=37)(44% vs. 27%,P=0.002;22% vs. 0%,P=0.002). Patients with supraclavicular doses of ≥60 Gy in salvage radiotherapy (n=75) had significantly higher 1-and 3-year OS rates than those with supraclavicular doses of<60 Gy in salvage radiotherapy (n=25)(75% vs. 25%,P=0.000;24% vs. 8%,P=0.000). The multivariate analysis using the Cox model showed that supraclavicular doses of ≥60 Gy, mediastinal metastasis, visceral metastasis, and salvage treatment method were independent factors for survival (P=0.001,0.015,0.009,0.025). Conclusions Salvage radiotherapy can improve the survival of patients with SLNM in esophageal cancer. Salvage radiotherapy or radiochemotherapy is highly recommended for patients with SLNM alone. A radiation dose of ≥60 Gy in salvage radiotherapy improves survival in patients.
		2016 Vol. 25 (8): 813-817 [Abstract] ( 2178 ) [HTML 1KB] [ PDF 970KB] ( 0 )

	818	The dose study of radiation gastritis caused by esophageal cancer radical postoperative prophylactic irradiation
		Shen Wenbin,Gao Hongmei,Zhu Shuchai,Li Youmei,Cao Yankun,Li Shuguang,Wen Shiwang,Zhu Hui
		Objective To study the relationship between radiation gastritis (RG) caused by esophageal cancer radical postoperative prophylactic IMRT and the dose of gastric. Methods A total of 49 esophageal cancer patients received postoperative adjuvant radiatherapy after esophagectomy,we analysised the dose-volume histogram of treatment plan and the the occurrence of RG,To analysis those physical indicators may be related to the occurrence of RG. The of ROC curve to analysis the physical index of the occurrence of acute radiation gastritis, Chi square test is compared between groups, Logistic method was used to multivariate analysis. Results The whole group,a total of 19 cases (39%) patients with symptoms of acute RG level 2 or higher. The Results of ROC curve analysis showed that the physical variables associated with the occurrence of RG include stomach Max,stomach Mean,LSTT₅-LSTT₄₀ and V₅-V₅₀.According to the ROC curve,the cutoff values of the physical parameters of the patients were grouped. The incidence of acute ≥2RG in the group of above boundary value patients significantly higher than below boundary value group,the physical index of the differences between groups were significant (P=0.000-0.022),except V₅.The Results of Logistic multivariate analysis showed that LSTT₅ and V₄₀ were independent predictor of≥2 RG (P=0.026,0.001). Conclusions According to the Results of this study,We should pay attention to the protection of the stomach in develop a treatment plan for the prevention of postoperative patients with esophageal cancer,dose-volume histogram can well predict the occurrence of RG.Stomach LSTT₅ and V₄₀ were independent predictor of≥2 RG.The Results of this study need to be further studied.
		2016 Vol. 25 (8): 818-822 [Abstract] ( 1953 ) [HTML 1KB] [ PDF 771KB] ( 0 )

	823	The necessity of EGFR-targeted therapy combined with synchronized whole brain radiotherapy for non-small-cell lung cancer with mutated EGFR and brain metastasis
		Su Pengcheng,Cao Jianzhong,Li Hongwei
		Objective To explore the necessity of EGFR-targeted therapy combined with synchronized whole brain radiotherapy (WBRT) for non-small-cell lung cancer (NSCLC) with mutated EGFR and brain metastasis by comparing the effects on prognosis between WBRT combined with tyrosine kinase inhibitor (TKI) and TKI alone. Methods A retrospective analysis was performed in 43 patients with EGFR mutation-positive NSCLC and brain metastasis. In those patients, 24 patients received WBRT plus TKI and 19 patients TKI alone. Results The overall response rate (RR) and 6-month intracranial disease control rate (CR) were significantly higher in the WBRT+TKI group than in the TKI group (79% vs. 37%, P=0.002;79% vs. 63%, P=0.008). The median intracranial progression-free survival (IPFS) time was significantly longer in the WBRT+TKI group than in the TKI group (23.7 vs. 8.3 months, P=0.025). The multivariate analysis indicated that the control of lung cancer, WBRT+TKI, and single brain metastasis were favorable factors for substantially longer IPFS time (P=0.033,0.019,0.019). In 23 patients with exon 19 deletion, 12 patients received WBRT+TKI and 11 patients TKI alone;compared with the TKI group, the WBRT+TKI group had significantly higher RR and 6-month CR as well as significantly longer IPFS (100% vs. 35%, P=0.000;100% vs. 55%, P=0.008;23.7 vs. 8.4 months, P=0.003). In 20 patients without exon 19 deletion, however, there were no significant differences in RR or 6-month CR between the WBRT+TKI group (n=12) and the TKI group (n=8)(64% vs. 50%, P=1.000;58% vs. 75%, P=0.642).The median IPFS was 14.4 and 8.4 months (P=0.864). Conclusions WBRT combined with TKI is superior to TKI alone in the treatment of NSCLC with brain metastasis. Patients with exon 19 deletion have substantially better treatment outcomes.
		2016 Vol. 25 (8): 823-828 [Abstract] ( 2074 ) [HTML 1KB] [ PDF 822KB] ( 0 )

	829	Comparison of clinical features and prognosis between thymoma alone and thymoma with myasthenia gravis
		Wang Lihuan,Meng Shaolin,Wu Yong,Zhang Yuhai,Wang Wei,Song Lele,Li Yuemin
		Objective To investigate the clinicopathological features and prognosis in patients with thymoma and patients with thymoma and myasthenia gravis (MG). Methods A retrospective analysis was performed on the clinicopathological data of 161 patients pathologically diagnosed with thymoma alone or thymoma and MG from 2008 to 2014. In those patients, 128 had thymoma with MG and 33 had thymoma alone. The survival rates were calculated using the Kaplan-Meier method and analyzed using χ² test or Fisher′s exact probability test. Results The mean age of onset was 45.2 years for patients with thymoma and MG and 48.5 years for patients with thymoma alone. In patients with thymoma and MG, 74.2% had a tumor diameter of ≤5 cm, while 75.8% of patients with thymoma alone had a tumor diameter of ≥5 cm. According to the Masaoka staging system, 78.1% of patients with thymoma and MG had stage Ⅰ+Ⅱ disease, while 51.1% of patients with thymoma alone had stage Ⅲ+Ⅳ disease. There was no significant difference in the 3-year overall survival (OS) rate between the two groups (98.1% vs. 81.8%, P=1.000). The 5-year OS rate was significantly higher in patients with thymoma and MG than in patients with thymoma alone (91.1% vs. 42.9%, P=0.000). In all patients, 140 patients with complete resection had significantly higher 3-and 5-year OS rates than 21 patients with incomplete resection (97.2% vs. 58.8%, P=0.000;92.7% vs. 25.0%, P=0.000). In patients with stage Ⅱ disease, there were no significant differences in the 3-or 5-year OS rates between patients with complete resection alone (n=25) and patients with complete resection and postoperative radiotherapy (n=25)(95% vs. 100%, P=1.000;86% vs. 100%, P=0.467). Conclusions Compared with patients with thymoma alone, patients with thymoma and MG have an earlier age of onset, substantially smaller tumor diameters, and earlier Masaoka stages. MG and complete resection are positive prognostic factors for patients with thymoma. Radiotherapy after complete resection can reduce the recurrence rate in patients with stage Ⅱ disease.
		2016 Vol. 25 (8): 829-833 [Abstract] ( 2064 ) [HTML 1KB] [ PDF 1177KB] ( 0 )

Abdominal tumors

	834	Phase Ⅰ study of weekly PTX+DDP,and postoperative radiotherapy for early cervical cancer in Chinese women
		Zhu Lihong,Tian Suqing,Qu Ang,Wang Hao,Wang Junjie,Guo Hongyan
		Objective To determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of weekly PTX and DDP concurrent postoperative radiotherapy in Chinese women with high-and intermediate-risk early cervical cancer. Methods Women with high risks postoperative cervical carcinoma,ECOG≤2 were eligible. Pelvis RT (6/10 MV X-ray,3DCRT 40 Gy/20f,para-metrial boost 10-20 Gy/5-10f) was followed by 2-4f brachytherapy applications (¹⁹²Ir,5 Gy/f).Concurrent weekly chemotherapy was started at DDP 20 mg/m² and PTX 10 mg/m² weekly,and escalated in three-patient cohorts according to 3+3 Methods . Results 25 patients were enrolled and treated over seven doses levels until dose-limiting toxicity (DLT) was reached. Median age was 48 years (range,34-66).All of patients finished RT in 7 weeks. Grade 3,4 non-hematologic toxicities were diarrhea and observed in two patients (4 cycles,DLT) at level 7.Grade 3,4 hematologic,principally leukopenia and neutropenia,and occurs late cycles. One grade 4 leukopenia and neutropenia was observed at dose level 6 but not seen in three additional patients. No one was delayed treatment time by concurrent chemotherapy.22 patients finished 6 cycles. Median follow-up is 59.5 months. Three patients have died of cancer metastasis and recurrence. One patient has died of respiratory failure. Conclusions Combination PTX and DDP administered concurrently with pelvic EBRT can be safely administered at the MTD of DDP 35 mg/m² and PTX 30 mg/m² weekly for six cycles in Chinese women with postoperative cervical cancer.
		2016 Vol. 25 (8): 834-838 [Abstract] ( 2120 ) [HTML 1KB] [ PDF 769KB] ( 0 )

	839	Predictive value of dose-volume histograms of organs at risk in volumetric modulated arc therapy plans for cervical cancer
		Wang Qiang,Li Guangjun,Song Ying,Bai Sen
		Objective To investigate the predictive value of dose-volume histograms (DVHs) of organs at risk (OARs) including the bladder, rectum, and small intestine in volumetric modulated arc therapy (VMAT) plans for cervical cancer. Methods A total of 100 VMAT plans for cervical cancer were assigned into the learning group. The correlation of the anatomical information with the V₃₀, V₄₀, and V₅₀ values of the bladder, rectum, and small intestine was evaluated in the group. The support vector regression (SVR) algorithm was used to establish the correspondence between the anatomical information and the DVHs of OARs. The DVHs of OARs in the verification group containing 20 VMAT plans were predicted based on the anatomical information. Results The DVHs of the bladder, rectum, and small intestine were likely to be influenced mainly by the spatial relationship between these OARs and target volume. In the verification group, the prediction errors of V₃₀,V₄₀ and V₅₀ by SVR algorithm were-2.4%±3.5%,-2.5%±3.8%, and-1.5%±4.9% for the bladder, 0.5%±2.6%,-1.5%±5.1%, and-2.0%±7.4% for the rectum, and-2.9%±5.3%, 2.7%±7.7%, and 5.3%±11.1% for the small intestine, respectively. Conclusions After learning the correlation between the anatomical information and the DVHs of OARs from prior VMAT plans for cervical cancer, SVR algorithm can precisely predict the DVHs of the bladder, rectum, and small intestine based on the anatomical information.
		2016 Vol. 25 (8): 839-842 [Abstract] ( 2171 ) [HTML 1KB] [ PDF 1409KB] ( 0 )

	843	Prognosis and staging of primary bone lymphoma:an analysis of 40 patients
		Zeng Jing,Pang Qingsong,Zhang Huilai,Wang Peiguo,Zhang Wencheng,Wang Fengmin,Qu Pengpeng
		Objective To retrospectively analyze the treatment outcomes and prognostic factors for primary bone lymphomas (PBL). Methods Forty patients with PBL who were admitted to our center from 1964 to 2014 were enrolled as subjects. In those patients, 10 were treated with chemotherapy alone, 10 with radiochemotherapy, 10 with postoperative chemotherapy, 9 with postoperative radiochemotherapy, and 1 with surgery alone. The median radiation dose was 36 Gy. The Kaplan-Meier method was used to calculate survivalrates. The log-rank test was used for survival difference analysis and univariate prognostic analysis. Results The follow-up rate was 100%. The 3-year sample size was 36. In all patients, the 1-and 3-year overall survival rates were 60% and 42%, respectively, while the 1-and 3-year disease-free survival rates were 45% and 34%, respectively. The univariate analysis showed that no pathological fracture at diagnosis, normal lactate dehydrogenase level, an International Prognostic Index score of ≤1, early clinical stage (stage Ⅰ_E), complete response after initial treatment, no less than 6 cycles of chemotherapy, a radiation dose of ≥40 Gy, no progression outside radiation field after radiotherapy, and grade<3 bone marrow suppression during the treatment were prognostic factors for survival (P=0.027, 0.037, 0.000, 0.016, 0.000, 0.000, 0.022, 0.014, and 0.030). Conclusions The incidence of PBL is low. Comprehensive treatment can achieve satisfactory outcomes. As a PBL staging system, Ann Arbor has limitations. The staging of PBL should be based on local bone destruction and metastasis.
		2016 Vol. 25 (8): 843-846 [Abstract] ( 2096 ) [HTML 1KB] [ PDF 741KB] ( 0 )

	884


		2016 Vol. 25 (8): 884-885 [Abstract] ( 1784 ) [HTML 1KB] [ PDF 703KB] ( 0 )

Physics·Biology·Tchnique

	847	A Monte Carlo simulation method for reconstruction of accelerator based on verified 6 MV X-ray phase-space and energy spectrum information
		Wang Yun,Yao Hui,Wang Jiehua,Gu Peihua
		Objective To establish a novel Monte Carlo simulation method for reconstruction of medical accelerator model and X-ray energy spectrum based on IAEA Varian 6 MV X-ray phase-space file and photon energy spectrum of the target accelerator. Methods The verified 6 MV X-ray phase-space files were preprocessed to elevate the energy of each particle. Particles were saved in different Phase-Space-Let (PSL) files according to their position and energy, yielding an initial photon energy spectrum for Monte Carlo simulation of accelerator under an initial target energy. The initial photon energy spectrum was fit to a photon energy spectrum of an accelerator (Elekta Precise 10 MV X-ray accelerator) under an unknown target energy to yield a fitting coefficient, which was the weight of each PSL. Finally, an accelerator model under an unknown target energy was reconstructed using the initial PSL files and the weight information. The percentage depth dose (PDD) distribution was calculated in different square open fields. The effectiveness of this method was verified using one dimensional gamma passing rate. Results The peak position and overall distribution of the reconstructed 10 MV photon energy spectrum were in accordance with those of the verified 10 MV photon energy spectrum. The PDD calculated from the reconstructed 10 MV accelerator model agreed well with the measured PDD. The one-dimensional gamma passing rate was above 96%(1%/1 mm, threshold=0%). Conclusions The Monte Carlo reconstruction method proposed in this study is reliable, accurate, and effective.
		2016 Vol. 25 (8): 847-850 [Abstract] ( 1895 ) [HTML 1KB] [ PDF 937KB] ( 0 )

	851	Computed tomography images with different resolutions in Sentinel system:a setup error analysis
		Li Jie,Chen Chuandong,Kang Shengwei,Liao Xiongfei,Ying Gang,Wang Shoulong,Wang Pei
		Objective To study the impact of setup error caused by computed tomography (CT) images with different resolutions in the Sentinel system on clinical treatment. Methods A phantom was scanned by large-aperture positioning CT with two different resolutions (CT₁:0.5 mm×0.5 mm×1.0 mm, FOV 256 mm, Matrix 512, thickness 1 mm;CT₃:1.0 mm×1.0 mm×3.0 mm, FOV 500 mm, Matrix 512, thickness 3 mm). The CT images were transferred to the planning system. The radiation fields were designed and transferred to MOSAIQ and Sentinel systems. Ten fixed setup errors were applied to a six degree of freedom couch. The Sentinel system was used to position the two groups of CT images and generate the setup errors. The comparison of two datasets was made by paired t-test. Cone-beam CT was used for independent verification. Results The setup errors in x-, y-, and z-directions were significantly smaller on CT₁ than on CT₃(0.19±0.11 vs. 0.33±0.16 mm, P=0.061;0.59±0.79 vs. 1.07±1.09 mm, P=0.008;0.67±0.75 vs. 1.16±1.30 mm, P=0.043). There were no significant differences in rotational errors in x-, y-, or z-directions between the two datasets (P=0.494;P=0.182;P=0.298). Conclusions The Sentinel system has a higher setup accuracy in the 0.5 mm×0.5 mm×1.0 mm mode than in the 1.0 mm×1.0 mm×3.0 mm mode. However, the later mode is still an acceptable choice in clinical treatment.
		2016 Vol. 25 (8): 851-854 [Abstract] ( 2283 ) [HTML 1KB] [ PDF 1037KB] ( 0 )

	855	Effects of variance reduction techniques on the efficiency and accuracy of Monte Carlo simulation for the single source channel of Gamma Knife
		Tian Yuan,Xu Yingjie,Ren Xinxin,Ma Pan,Men Kuo,Dai Jianrong
		Objective To evaluate the effects of four types of variance reduction techniques (ring counter grid, high electron cutoff energy, termination of electron tracking in some structures, and emission direction-biased sampling of source) on the efficiency and accuracy of Monte Carlo simulation for the single source channel of the Leksell Gamma Knife. Methods The single source channel of the Leksell Gamma Knife was modeled using Monte Carlo software MCNP. Four types of variance reduction techniques were used to simulate the dose distribution in the water-like phantom. The computation efficiency and simulation result were compared between the four techniques. Results All techniques substantially improved the computation efficiency and had little effect on the accuracy of the simulation (relative error less than 2.5%). However, if the electron cutoff energy was above 50 keV, the simulation became quite inaccurate due to neglect of the scattering of high-energy electrons and their dosimetric contribution to the penumbra. When the scattering of high-energy electrons and their dosimetric contribution to the penumbra were ignored, the dose to the Profile platform was overestimated and the dose to the penumbra was underestimated. Conclusions Rational use of variance reduction techniques can substantially improve the efficiency of Monte Carlo simulation for the single source channel of the Leksell Gamma Knife. However, the impact of variance reduction techniques on the accuracy of the simulation should be carefully evaluated.
		2016 Vol. 25 (8): 855-860 [Abstract] ( 1861 ) [HTML 1KB] [ PDF 907KB] ( 0 )

	860


		2016 Vol. 25 (8): 860-861 [Abstract] ( 1681 ) [HTML 1KB] [ PDF 1125KB] ( 0 )

	862	A study of parameters of a volumetric modulated arc therapy plan for cervical and upper esophageal cancer
		Liu Dan,Zhang Ruohui,Jing Zhonghao,Miao Mingchang,Chi Zifeng
		Objective To figure out the optimal parameters of a volumetric modulated arc therapy (VMAT) plan for cervical and upper esophageal cancer by quality evaluation of VMAT plans with different parameters, and to provide a reference for the design of clinical VMAT treatment plan. Methods Ten patients with cervical esophageal cancer and ten patients with upper esophageal cancer were enrolled as subjects. The Nucletron Oncentra 4.3 treatment planning system was used to generate plans for Elekta Synergy VMAT accelerator. Six VMAT plans were made with variation in the gantry angle (2°, 3°, and 4°), the maximum delivery time (80 s, 110 s, and 150 s), and the collimator angle (0° and 45°). The doses to the planning target volume and organs at risk were analyzed by paired t test. Results For cervical and upper esophageal cancer, the quality of VMAT plans with a collimator angle of 45° was better than those with a collimator angle of 0°(P=0.003-0.007). For cervical esophageal cancer, there was no significant difference in quality between VMAT plans with a maximum delivery time of 110 s or 150 s and those with a maximum delivery time of 80 s (P>0.05);for upper esophageal cancer,there was also no significant difference in quality between VMAT plans with three different maximum delivery times (P>0.05). For cervical esophageal cancer, the VMAT plans with a gantry angle of 3° had a better quality than those with a gantry angle of 2° or 4°(P=0.010-0.048). For upper esophageal cancer, the VMAT plans with a gantry angle of 3°had a better quality than those with a gantry angle of 4°(P=0.010-0.048). Compared with those with a gantry angle of 2°, the VMAT plans with a gantry angle of 3°had a slightly better dose distribution in the target volume (P=0.046), but a slightly higher dose to lung tissue (V₂₅ and V₃₀,P=0.007 and 0.026). Conclusions The optimal initial parameters of a VMAT plan for cervical and upper esophageal cancer are a collimator angle of 45°, a maximum delivery time of 80 s, and a gantry angle of 3°.
		2016 Vol. 25 (8): 862-866 [Abstract] ( 1954 ) [HTML 1KB] [ PDF 753KB] ( 0 )

	867	Intraoperative radiotherapy using low-energy X rays:dosimetric characteristics and potential limitations in clinical application
		Ouyang Bin,Xiao Zhenhua,Wang Zhenyu,Huang Botian,Wen Bixiu
		Objective To test intraoperative radiotherapy with mobile photon beam using the INTRABEAM system (Germany), and to analyze the dosimetric characteristics of low-energy photon beam using X-ray source and spherical applicators and explore its potential limitations in clinical application. Methods A special water phantom, a parallel-plate ionization chamber, and an electrometer were used to measure the depth dose rates and isotropy of dose distribution in x/y plane of X-ray source and different spherical applicators in the INTRABEAM system. Those data were then compared with the system data. Results For the X-ray source, the deviation of observed depth dose rate and isotropy in the x/y plane from the system data were-2.16%±1.36% and-1.9%~2.1%, respectively. For applicators with different diameters, the deviation of observed depth dose rate, transfer coefficient, and isotropy in x/y plane from the system data were-10.0%~2.3%,-8.9%~4.2%, and-1.6%~2.6%, respectively. Surface dose rate and dose gradient became larger with the decrease in the diameter of the spherical applicator. The measurement of depth dose rate and isotropy of X-ray source and spherical applicators showed good repeatability. The influencing factors for measurement accuracy included the positioning error of ionization chamber, energy response, noise current, and correction factor f’(R). Conclusions This study reveals the dosimetric characteristics of the INTRABEAM system, verifies the accuracy of the system data, and obtains the data for clinical application and routine quality assurance. However, large dose gradient and small therapeutic range may limit its wide clinical application.
		2016 Vol. 25 (8): 867-871 [Abstract] ( 2153 ) [HTML 1KB] [ PDF 1858KB] ( 0 )

	872	A preliminary study of the role of miR-193a-3p in radioresistance of esophageal cancer cells
		Meng Fang,Qian Liting,Ding Bojin,Zhou Jieping
		Objective To investigate the role of miR-193a-3p in the radioresistance of esophageal squamous cell carcinoma (ESCC). Methods MTT assay was used to identify the cell lines with the highest radiosensitivity and radioresistance in four esophageal cancer cell lines exposed to irradiation of 6 MV X-ray. Stem-loop quantitative real-time PCR was used to measure the expression levels of miR-193a-3p, miR-155, and miR-22-3P in the two cell lines. Further studies were performed on miR-193a-3p because of the substantial difference in its expression between the two cell lines. The mimic (3PM) and antagomiR (3PA) of miR-193a-3p as well as siRNA (si-LOXL4) were synthesized and transfected into cells to elevate and inhibit miR-193a-3p expression. MTT assay and flow cytometry were used to evaluate the effects of miR-193a-3p and its downstream gene LOXL4 on radiosensitivity. Results KYSE510 and KYSE410 were characterized as cell lines with the highest radiosensitivity and radioresistance, respectively. miR-193a-3p had a substantially larger difference in expression between the two cell lines than miR-155 or miR-22-3P (1.00∶21.00). Transfection of 3PM resulted in elevated expression of miR-193a-3p in KYSE510, which had a significantly lower radiosensitivity and a significantly reduced apoptosis ratio by 11.01% compared with the control group (P<0.05). KYSE410 transfected with 3PA had a significantly higher radiosensitivity (P<0.05). The expression of LOXL4, a downstream gene of miR-193a-3p, was negatively correlated with miR-193a-3p expression. Transfection with si-LOXL4 inhibited the expression of LOXL4, which resulted in a significantly lower radiosensitivity and a significantly reduced apoptosis ratio by 7.07% compared with the control group (P<0.05). Conclusions miR-193a-3p promotes the radioresistance of esophageal cancer cells probably by regulation of LOXL4.
		2016 Vol. 25 (8): 872-878 [Abstract] ( 2031 ) [HTML 1KB] [ PDF 6645KB] ( 0 )

	879	miR-485-3p regulates radiosensitivity of gastric cancer cells by targeting TLR1/NF-κB signaling pathway
		Li Mingjun,Wu Guangyin,Fan Huijie,Gu Hao,Fan Ruitai,Shi Yonggang,Zhang Mingzhi
		Objective To investigate whether miR-485-3p plays a role in regulation of radiosensitivity of gastric cancer cells by targeting TLR1. Methods Quantitative real-time PCR and Western blot were used to determine the expression of miR-485-3p and TLR1, respectively. The interaction between miR-485-3p and TLR1 was verified by target prediction software (DIANA, TargetScan, and miRanda) and dual luciferase reporter assay. Gastric cancer MGC803 cells transfected with miR-485-3p mimic or TLR1 siRNA were exposed to irradiation. Apoptosis assay, colony formation assay, and MTT assay were used to evaluate the changes in radiosensitivity of gastric cancer cells. Dual luciferase reporter assay was used to determine the effects of miR-485-3p overexpression and TLR1 silencing on the activity of NF-κB. Western blot was used to study the effects of miR-485-3p overexpression and TLR1 silencing on NF-κB target genes. Results In gastric cancer cells exposed to radiation, the expression of miR-485-3p was downregulated and the expression of TLR1 was upregulated. TLR1 was predicted to be the target of miR-485-3p by target prediction software. Dual luciferase reporter assay further confirmed TLR1 as the direct target of miR-485-3p. miR-485-3p negatively regulated the expression of TLR1. The overexpression of miR-485-3p, as well as TLR1 silencing, increased the apoptosis rate of cells, reduced colony formation and cell proliferation, and enhanced the radiosensitivity of the cells. Both miR-485-3p overexpression and TLR1 silencing reduced the activity of NF-κB and downregulated the expression of multiple NF-κB target genes. Conclusions miR-485-3p enhances the radiosensitivity of gastric cancer cells probably by targeting TLR1 and regulating the NF-κB signaling pathway.
		2016 Vol. 25 (8): 879-884 [Abstract] ( 2185 ) [HTML 1KB] [ PDF 1334KB] ( 0 )

	886	Curcumin enhances the radiosensitivity of thyroid cancer cells TPC-1
		Zhao Yongqiang, Tian Dezeng,Wei Xiaohua,Bao Qide,Wu Guanyin,Cui Yuelong
		Objective To study the effect of curcumin on the radiosensitivity of the human papillary thyroid cancer cell line TPC-1, to investigate the signaling pathway probably targeted by curcumin, and to provide new insights for the development of radiosensitizers for thyroid cancer. Methods The human papillary thyroid cancer cell line TPC-1 was treated with curcumin and radioactive iodine. CCK-8 assay, colony formation assay, and flow cytometry were used to evaluate cell proliferation, colony formation ability, and cell apoptosis, respectively. Western blot was used to measure the expression of p50, p65, and apoptosis-related proteins, Bcl-2 and Bax. Cell proliferation, colony formation ability, and cell apoptosis were determined again after the activity of the NF-κB signaling pathway was blocked by a NF-κB signaling pathway inhibitor PDTC. Results After treatment with curcumin and radioactive iodine, the human papillary thyroid cancer TPC-1 cells had reduced cell proliferation and colony formation, an elevated apoptosis rate, downregulated expression of anti-apoptotic Bcl-2, and upregulated expression of pro-apoptotic Bax in a dose-dependent manner. These Results indicated that curcumin enhanced the radiosensitivity of TPC-1 cells. Curcumin inhibited the activation of the NF-κB signaling pathway in the TPC-1 cells treated with radioactive iodine. When the activity of the NF-κB pathway was blocked by PDTC, cell proliferation and colony formation were reduced and the apoptosis rate was increased, indicating an enhanced radiosensitivity of TPC-1 cells. Conclusions Curcumin is likely to target the NF-κB signaling pathway. It regulates the radiosensitivity of thyroid cancer cells by inhibiting the activity of the NF-κB signaling pathway.
		2016 Vol. 25 (8): 886-890 [Abstract] ( 2610 ) [HTML 1KB] [ PDF 1387KB] ( 0 )

Review Article

	891	Research advances in postoperative radiotherapy for esophageal squamous cell carcinoma
		Luo Yijun,Li Minghuan,Zhu Yingming,Yu Jinming
		Surgery remains an important therapeutic method for localized esophageal cancer, but the 5-year survival rate of patients undergoing surgical resection alone is only 20%-25%. Early studies show that postoperative radiotherapy reduced regional recurrence rate, but did not increase the survival rate. Most recent studies show that stage Ⅲ or lymph node-positive patients can obtain survival benefit from postoperative radiotherapy, and patients in pT_2-3N₀M₀ stage may also benefit from postoperative radiotherapy. The recommended radiotherapy target volumes include bilateral supraclavicular areas, superior mediastinum, subcarinal area, and tumor bed. It is recommended in most studies that regional lymph nodes in the upper abdomen should be included in patients with lower-segment lesions. The locally advanced patients may benefit more from postoperative radiotherapy combined with chemotherapy. The significance of postoperative radiotherapy for esophageal squamous cell carcinoma, target volume design, and combined chemotherapy need individualized consideration and more clinical evidence.
		2016 Vol. 25 (8): 891-894 [Abstract] ( 2108 ) [HTML 1KB] [ PDF 772KB] ( 0 )

	895	Recent advances of intracavitary/interstitial brachytherapy in cervical cancer
		Zhang Ning,Cheng Guanghui
		To illustrate the kinds of applicator, indication, side effects, long term follow-up results, clinical experience and the latest developments of intracavitary/interstitial brachytherapy (IC/IS-BT),more than 50 research articles concerning IC/IS-BT about cervical cancer were reviewed.
		2016 Vol. 25 (8): 895-901 [Abstract] ( 2289 ) [HTML 1KB] [ PDF 1662KB] ( 0 )

	902	Research advances in multi-modality medical image registration and fusion methods and their clinical application
		Gu Heng,Nie Shengdong
		Multi-modality medical image processing has become a hot topic for research in the field of image processing and plays an important role in clinical diagnosis and treatment. Images with different modalities provide different information on patients. Anatomical images (such as computed tomography and magnetic resonance imaging) provide information on anatomical morphology and the structure of human body, and functional images (such as single-photon emission computed tomography and positron emission tomography) provide the functional information on the distribution of radioactive concentration within human body. Such information needs to be fused to obtain comprehensive fusion images, and the images with different modalities need to be registered to obtain useful fusion images. This article reviews several image registration and fusion techniques used in the medical field, points out their advantages and shortcomings, and introduces the application of various processing techniques in clinical practice.
		2016 Vol. 25 (8): 902-906 [Abstract] ( 2116 ) [HTML 1KB] [ PDF 789KB] ( 0 )

	907	Research advances in gold nanoparticle radiosensitization in radiotherapy for cancer
		Nie Fangfang,Zhang Chunfu,Fu Jie
		Gold nanoparticles (AuNPs) have been widely used in biomedicine due to their unique physical and chemical properties as well as good biocompatibility. Current research in this field has been focused on AuNP radiosensitization in radiotherapy for cancer. Extensive studies in vivo and in vitro have showed the radiosensitization effect of AuNPs. However, the mechanism of radiosensitization by AuNPs still requires further studies. Right now, the radiation-insensitive phase (G₀+G₁ phase) to radiation-sensitive phase (G₂+M phase) transition of tumor cells by AuNPs is widely considered as the main cause of radiosensitization. There are many influencing factors for AuNP radiosensitization such as particle size, surface modification, microscopic distribution, radiation energy, radiation dose, and type of tumor cells. Moreover, safety should also be taken into account in AuNP radiosensitization. Clinical trials of AuNPs have been carried out right now. More studies on AuNP radiosensitization are needed to achieve real clinical transformation.
		2016 Vol. 25 (8): 907-910 [Abstract] ( 2173 ) [HTML 1KB] [ PDF 759KB] ( 0 )

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