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.9 Published 2016-09-15

	911	Research advances in prevention and treatment of cerebral radiation necrosis
		Wang Xiaoshen,Hu Chaosu
		Cerebral radiation necrosis (CRN) is a serious complication of radiotherapy for intracranial tumors and skull base tumors. Since there lacked effective therapeutic methods in the past, CRN was once considered to be progressive and irreversible. With the development of histopathology and neuroimaging, the development and progression of CRN is gradually clarified, and new therapeutic methods have been developed. In recent years, the scholars at home and abroad have tried to use bevacizumab (a humanized monoclonal antibody targeting vascular endothelial growth factor), nerve growth factor, and ganglioside in the treatment of CRN and have achieved definite therapeutic effects. In some patients, cerebral necrosis was even repaired and reversed. This article reviews the incidence, pathophysiology, treatment, and prognosis of CRN.
		2016 Vol. 25 (9): 911-916 [Abstract] ( 2002 ) [HTML 1KB] [ PDF 1028KB] ( 0 )

	917	Efficacy of intensity-modulated radiotherapy on patients with locally recurrent nasopharyngeal carcinoma
		Yin Li,Guo Wenjie,Xie Peng,Zhu Huanfeng,Yan Pengwei,Wu Jing,Song Dan,Wu Jianfeng,Wang Feijiang,He Xia
		Objective This study retrospectively analyzed the efficacy and toxicity profile of hyperfractionated intensity-modulated radiotherapy (HF-IMRT) for locally recurrent nasopharyngeal carcinoma (NPC). Methods Twenty-eight locally recurrent patients of NPC were enrolled,23 male and 5 female with a median of 51 years (range 25-74 years).All patients had a median recurrent time of 17.5 months and received HF-IMRT with a total dosage of 60-70 Gy,each consisting of 1.2 Gy per fraction,each of the 2 fractions were spaced 6 hours apart and lasting for 5 days. Twenty-five patients received concurrent chemotherapy of nedaplatin or two agent regimen,4 patients received Ad-p53 gene therapy and 6 patients received target therapy of EGFR monoclony antibody. Results The complete response and partial response rates were 89%(25/28) and 11%(3/28) after being treated by HF-IMRT for 3 months. The median follow-up time was 27.5 months. The 1,2,3-year overall survival rates,locoregional recurrence-free survival rates and progression-free survival rates were 100%,91%,80%;100%,80%,55%;88%,65%,55%,respectively. Three patient were observed to develop severe nasopharyngeal necrosis but recover after treatment,no patients experienced hemorrhage of nasopharynx. Multivariate analysis indicated that the poor prognostic factors included tumor stages (T₃-T₄)(P=0.00) and no chemotherapy (P=0.04). Conclusion HF-IMRT is feasible for locally recurrent nasopharyngeal carcinoma with satisfactory local control and controllable adverse reaction,it is worth further clinical studies.
		2016 Vol. 25 (9): 917-922 [Abstract] ( 2301 ) [HTML 1KB] [ PDF 779KB] ( 0 )

	923	Therapeutic effects of extended-field and involved-field irradiation in three-dimensional radiotherapy in patients with esophageal cancer:a meta-analysis
		Bai Wenwen,Zhou Zhiguo,Zhang Ruohui,Song Yuzhi,Zhen Chanjun,Qiao Xueying
		Objective To investigate the therapeutic effects, adverse effects, and patterns of failure of elective irradiation of lymphatic drainage area (extended-field) and involved-field irradiation in three-dimensional radiotherapy (3DRT) in patients with esophageal cancer via a Meta-analysis. Methods The databases Wanfang Data, CNKI, VIP, CBM, PubMed, Embase, and Cochrane Library were searched to collect the controlled clinical trials on extended-field irradiation and involved-field irradiation in 3DRT in patients with esophageal cancer. Stata 11.0 was used for data analysis. The odds ratio (OR) with 95% confidence interval was used to describe the differences between two groups. Results According to the inclusion and exclusion criteria, a total of 12 controlled clinical trials involving 1 095 patients with esophageal cancer were included in this meta-analysis. The results of the meta-analysis showed that compared with the involved-field irradiation group, the extended-field irradiation group had a significantly reduced rate of out-field failure in patients with esophageal cancer who received 3DRT (OR=3.727, P=0.007), but showed significantly higher rates of grade ≥3 acute radiation pneumonitis and radiation esophagitis (acute radiation pneumonitis:OR=0.348, P=0.001;radiation esophagitis:OR=0.385, P=0.000). The two groups had similar 1-, 2-, and 3-year local control rate and overall survival rate (local control rate:OR=0.966/0.946/0.732, P=0.837/0.781/0.098;overall survival rate:OR=0.952/1.149/0.768, P=0.756/0.422/0.120), as well as a similar distant metastasis rate (OR=0.986, P=0.937). Conclusions Compared with involved-field irradiation, extended-field irradiation can reduce the rate of out-field failure in patients with esophageal cancer who receive 3DRT. However, it does not have significant advantages in local control rate and overall survival rate and has an increased incidence rate of adverse effects.
		2016 Vol. 25 (9): 923-928 [Abstract] ( 2010 ) [HTML 1KB] [ PDF 912KB] ( 0 )

	929	A clinical analysis of adverse reactions of postoperative adjuvant radiochemotherapy for esophageal carcinoma
		Shen Wenbin,Gao Hongmei,Cao Yankun,Zhu Shuchai,Li Youmei,Li Shuguang,Li Juan,Liu Zhikun,Su Jingwei
		Objective To investigate the incidence of adverse reactions in patients treated with postoperative adjuvant radiochemotherapy for esophageal carcinoma and its relationship with clinical factors. Methods Logistic regression was used for variate analyses on the incidence of radiation gastritis (RG), radiation pneumonia (RP), and marrow suppression in 49 patients with esophageal cancer who received postoperative adjuvant radiochemotherapy in 2014. Results In all the patients, 19(39%) patients had grade 2 RG, 7(14%) patients grade 2 RP, and 8(16%) patients grade 2 marrow suppression. The univariate analysis showed that the length of stomach was associated with the incidence of grade 2 RG (P=0.016);sex and the volume of stomach were associated with the incidence of grade 2 RP (P=0.026;P=0.047);≥2 cycles of chemotherapy were associated with the incidence of grade 2 marrow suppression (P=0.000). The multivariate analysis showed that the length of stomach was an independent factor for grade 2 RG (P=0.038) and the volume of stomach was an independent factor for grade 2 RP (P=0.013). Conclusions The postoperative state of the intrathoracic stomach affects the incidence of adverse reactions in patients with esophageal carcinoma. A longer stomach may cause higher incidence of grade 2 RG and a larger stomach may cause higher incidence of grade 2 RP.
		2016 Vol. 25 (9): 929-933 [Abstract] ( 2027 ) [HTML 1KB] [ PDF 750KB] ( 0 )

	934	Effect of postoperative adjuvant radiotherapy on treatment outcome of patients with localized soft tissue sarcoma
		Zhao Ruping,Yu Xiaoli,Zhang Zhen,Feng Yan,Yang Zhaozhi,Wang Jian,Guo Xiaomao
		Objective To investigate the treatment outcome of patients with localized soft tissue sarcoma (STS) and related prognostic factors, with a focus of the role of postoperative radiotherapy in the treatment of STS. Methods A retrospective analysis was performed for the clinical data of 203 STS patients who underwent organ preservation surgery in Fudan University Shanghai Cancer Center from July 2000 to July 2010. Of all the patients, 76(37.4%) received adjuvant radiotherapy, which was delivered via anterior-posterior parallel opposed fields at a dose of 45-70 Gy. The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival difference analysis, and the Cox proportional hazards model was used for multivariate analysis. Results The follow-up rate was 100%. The 5-year overall survival (OS) rate, local failure-free survival rate, and distant metastasis-free survival rate were 69.1%, 69.2%, and 68.0%, respectively. The multivariate analysis showed that pathological subtype, tumor size, resection margin status, and postoperative radiotherapy were influencing factors for OS. Among these factors, postoperative radiotherapy was associated with a significantly reduced risk of local recurrence in STS patients (HR=0.327, 95%CI 0.177-0.605, P=0.000) and a significantly increased OS rate (HR=0.489, 95%CI 0.266-0.897, P=0.021). Conclusions Postoperative radiotherapy can reduce local recurrence and improve OS in patients with localized STS, and further studies are needed to clarify its role.
		2016 Vol. 25 (9): 934-938 [Abstract] ( 1830 ) [HTML 1KB] [ PDF 774KB] ( 0 )

	939	A comparative analysis of diffusion-weighted magnetic resonance imaging and contrast-enhanced CT in target volume delineation for pancreatic cancer
		Han Ruobing,Ren Gang,Yu Huiming,Wang Xuan,Liu Chen,Xai Tingyi,Yu Huiming
		Objective To investigate the differences in tumor volume and metastatic tumors of the liver and regional lymph nodes between contrast-enhanced computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWMRI) through a comparative analysis,as well the useful information for target volume delineation,and to guide radiotherapy in clinical practice. Methods A total of 40 patients with pancreatic cancer were enrolled and underwent contrast-enhanced CT and DWMRI in the same position. The target volume was delineated,the major axis of the maximum tumor section was measured,and the numbers of liver metastatic tumors and metastatic tumors of the lymph nodes with a diameter of 5-8 mm or>8 mm were measured based on the CT and DWMRI images. The analysis was performed by using paired t-test or paired Wilcoxon rank sum test. Results The mean gross tumor volume (GTV) delineated by contrast-enhanced CT and DWMRI was 54.95 cm³ and 41.67 cm³(P=0.000),and the mean value-different value was 13.28 cm³.The major axis of the maximum tumor section measured by contrast-enhanced CT and DWMRI were 4.18 cm and 3.94 cm (P=0.000),respectively,and in two patients,d_CT was smaller than d_DWMRI.A total of 83 liver metastatic tumors were identified by contrast-enhanced CT,and 112 were identified by DWMRI;the liver metastatic tumors detected by contrast-enhanced CT accounted for 74% of those detected by DWMRI.As for the metastatic tumors of the lymph nodes with a diameter of 5-8 mm or>8 mm,103 or 46 were detected by contrast-enhanced CT,and 200 or 56 were detected by DWMRI,and the tumors detected contrast-enhanced CT accounted for 52% or 82% of those detected by DWMRI.There were significant differences in all data between contrast-enhanced CT and DWMRI. Conclusions GTV and the major axis of the maximum tumor section measured by DWMRI are lower than those measured by contrast-enhanced CT,and contrast-enhanced CT is sensitive in detecting the metastatic tumors of the liver and lymph nodes. However,it is necessary to conduct further controlled experiments with reference to pathology.
		2016 Vol. 25 (9): 939-943 [Abstract] ( 2255 ) [HTML 1KB] [ PDF 949KB] ( 0 )

	944	A comparative study of positron emission tomography-computed tomography and computed tomography image-guided radiotherapy for cervical cancer with retroperitoneal node metastasis
		An Jusheng,Xu Yingjie,Du Xiaomeng,Zhang Wenjie,Dai Jianrong,Zheng Rong,Huang Manni,Wu Lingying
		Objective To evaluate the feasibility of using positron emission tomography-computed tomography (PET-CT) to guide lesion localization and radiotherapy planning for stage Ⅱ_B-IV_A cervical cancer with retroperitoneal node metastasis. Methods Before treatment, PET-CT was used for staging and lesion localization. Three-dimensional radiotherapy (3DRT) plans with boost doses for metastatic lymph nodes were made based on the fused PET-CT images. The obtained plans were compared with CT image-guided plans within the same period. Comparison was made by paired t test or non-parametric test. Results The PET-CT plans had significantly larger GTV_nd, pGTV_nd, CTV, and PTV than the CT plans (P=0.012, 0.010, 0.018, 0.018). There were no significant differences in V₄₀, V₅₀, or D_{1 cm³} for the small intestine between the two plans (P=0.744, 0.588, 0.423). The PET-CT plans had significantly lower V₂₀, V₃₀, and D_mean for the small intestine than the CT plans (68.1% vs. 74.5%, P=0.020;36.1% vs. 39.6%, P=0.016;2 546.1 vs. 2 761.4 Gy, P=0.036). Moreover, the PET-CT plans had significantly larger V₂₀ and D_mean for the kidney than the CT plans (9.4% vs. 5.7%, P=0.006;877.0 vs. 733.8 Gy, P=0.005). There were no significant differences in V₃₀ and V₄₀ for the kidney or D_mean for the rectum, bladder, colon, pelvic bone, bone marrow, and femoral head between the two plans (P=0.089, 0.341, 0.406, 0.107, 0.178, 0.397, 0.285, 0.743). Conclusions It is feasible to use fused PET-CT images to guide external 3DRT plans, which can accurately localize the metastatic lymph nodes and elevate the radiation dose. However, the protection of the small intestine and kidney should be taken into account.
		2016 Vol. 25 (9): 944-947 [Abstract] ( 2048 ) [HTML 1KB] [ PDF 893KB] ( 0 )

	948


		2016 Vol. 25 (9): 948-949 [Abstract] ( 2119 ) [HTML 1KB] [ PDF 706KB] ( 0 )

	950	The clinical application research of Utrecht applicator in three-dimensional image guided brachytherapy (3D-IGBT) for cervical cancer
		Zhao Zhipeng,Zhang Ning,Cheng Guanghui,He Mingyuan,Shi Dan,Zhao Hongfu
		Objective To investigate the clinical application of Utrecht applicator in three-dimensional image-guided brachytherapy (3D-IGBT) for locally advanced cervical cancer,as well as its application discipline in intracavitary/interstitial (IC/IS) therapy. Methods A retrospective analysis was performed for the clinical data of 45 patients with locally advanced cervical cancer who received radical radiotherapy,and the patients received external beam radiotherapy followed by 3D-IGBT. A total of 130 times (n=45) of IC/IS therapy were performed,and the patients who received such therapy were all enrolled. The patients who met the target dose fractionation defined in the plan were enrolled as group A (n=37,86 times),and the other patients were enrolled as group B (n=22,44 times). Two groups difference was analyzed with Group t-test. Results The frequencies of use of 15-,20-,and 25-mm ovoids by the applicator were 50.0%,20.0%,and 30.0%,respectively,and the 30-mm ovoid was not used. A total of 499 needles were used,and the frequencies of use of 6,7,10,and 11 insertion holes were 23.1%,21.2%,21.2%,and 24.1%,respectively. Group A had a significantly lower mean number of the needles than group B (3.7 vs. 4.2,P=0.008). Compared with group B,group A had a significantly lower mean high-risk clinical target volume (CTV)(40.71±18.43 cm³ vs. 51.81±14.74 cm³,P=0.001),as well significantly lower width and height of high-risk CTV (P=0.011 and 0.006),but the thickness of high-risk CTV was similar between the two groups (P=0.595). The difference between height and insertion depth (DH) was similar between the two groups (P=0.366). Group A had a smaller difference between width and pinhole distance D_{w than group B (P=0.007). Conclusions When IC/IS therapy is performed for locally advanced cervical cancer,the 15-,20-,and 25-mm ovoids of Utrecht applicator and 6,7,10,and 11 insertion holes are frequently used. When the number of needles is no less than 4 and the depth is no less than 3 cm,width is the major factor which affects the planned dose.}
		2016 Vol. 25 (9): 950-954 [Abstract] ( 2076 ) [HTML 1KB] [ PDF 887KB] ( 0 )

	955	Influence of lower limb movements on setup errors in radiotherapy for rectal cancer using kilovoltage cone-beam CT (KV-CBCT)
		Meng Yiran,Xu Qing,Zhang Zhen,Gong Min,Ren Jun
		Objective To investigate the influence of fixation of both lower limbs with negative pressure vacuum cushion and fixation of both ankles with self-made foam mat on setup errors in radiotherapy for rectal cancer. Methods A total of 12 patients with rectal cancer were enrolled in 2014 and randomly divided into group A (using negative pressure vacuum cushion) and group B (using self-made foam mat).An offline registration analysis was performed for the images of 108 times (A,B group of 54 times) of kilovoltage cone-beam CT (CBCT) before and after treatment. Grey scale translation error registration was used, and the results of registration were analyzed. The setup errors in x-axis (left-right direction), y-axis (cranial-caudal direction), and z-axis (anterior-posterior direction) were compared between the two groups. Results There was no significant difference in the absolute setup error in the y-axis between the two groups (2.13±0.64 mm vs.2.61±1.17 mm,P=0.399), while group A showed significantly lower absolute setup errors in the x-axis and z-axis than group B (x-axis:1.51±0.28 mm vs. 2.70±1.05 mm,P=0.039;with an error rate of 7.41% vs. 42.59%;z-axis:1.10±0.29 mm vs. 2.37±0.71 mm,P=0.002;with an error rate of 1.85% vs. 35.19%). Conclusions In the radiotherapy positioning for rectal cancer, fixation of both lower limbs with negative pressure vacuum cushion effectively avoids the translation and rotation of both lower limbs, reduces absolute setup errors, and has higher accuracy than fixation of both ankles with self-made foam mat.
		2016 Vol. 25 (9): 955-957 [Abstract] ( 2249 ) [HTML 1KB] [ PDF 949KB] ( 0 )

	959	Computed tomography image-guided and personalized 3D printed template-assisted 125-iodine seed implantation for recurrent pelvic tumor:a dosimetric study
		Jiang Yuliang,Wang Hao,Ji Zhe,Guo Fuxin,Sun Haitao,Fan Jinghong,Zhang Lujing,Tian Suqing,Wang Junjie
		Objective To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography (CT) image-guided and 3D printed template-assisted 125-iodine (¹²⁵I) seed implantation for recurrent pelvic tumor, and to explore of the accuracy of the technology in treatment planning. Methods A total of 12 patients with recurrent pelvic tumor who received CT image-guided and 3D printed template-assisted ¹²⁵I seed implantation in our hospital from 2015 to 2016 were enrolled as subjects. ¹²⁵I seeds with a prescribed dose of 110-150 Gy were implanted in 15 lesions. Twelve 3D printed templates were designed and produced for 15 treatment areas. Comparison of the dosimetric parameters between postoperative verification and preoperative plans was made by paired t-test. Results The mean D₉₀, mPD, V₁₀₀, V₁₅₀, and V₂₀₀ were 137.4 Gy, 74.4 Gy, 90.1%, 58.7%, and 34.4%, respectively, in postoperative verification and 140.2 Gy, 61.1 Gy, 91.8%, 64.3%, and 36.7%, respectively, in preoperative plans (P=0.153,0.024,0.028,0.003,and 0.302). The conformity index of gross tumor volume was slightly reduced after operation (0.68 vs. 0.69,P=0.437). The external volume index increased after treatment (34.2% vs. 30.5%, P=0.530). Conclusions 3D printed template provides accurate positioning and orientation for treating recurrent pelvic tumor. All main indices of the actual dose distribution in postoperative verification meet the expectation of the preoperative plan, indicating satisfactory treatment accuracy.
		2016 Vol. 25 (9): 959-964 [Abstract] ( 2237 ) [HTML 1KB] [ PDF 824KB] ( 0 )

	965	Application of 3D printing technology in brachytherapy for vaginal stump tumor after CT-guided cervical carcinoma surgery
		Yu Lang,Lian Xin,Yan Junfang,Luo Chunli,He Lei,Zhang Yue,Wang Guanqun,Li Hongming,Yang Bo,Hu Ke,Qiu Jie,Zhang Fuquan
		Objective To investigate the application of 3D printing technology in the manufacture of individualized source applicator for intraluminal brachytherapy. Methods A retrospective analysis was performed for the clinical data of one patient with vaginal stump stenosis and regular solid tumor after cervical carcinoma surgery. The gauze soaked in the developer was used for vaginal packing, and then CT scan was performed to obtain the three-dimensional intraluminal geometric outline of the vagina. A software was used to extract the outline, and 3 lumens were reserved near the lesion. The 3D printer and medical silica gel were used to manufacture the source applicator. The source applicator was placed in the vagina, and CT scan was performed to adjust the position of the source applicator. The final CT image was transferred to the planning system for the delineation of target volume and organs at risk and calculate dose distribution. Results The individualized vaginal source applicator manufactured by 3D printing technology fitted well to the target volume, and the curvature of the catheters was greater than 1 cm, so that the radioactive source could pass successfully. The inserted catheters were cut, and the total operative length of the radioactive source was set to be 1 280 mm, which helped to realize the accurate connection between the individualized source applicator and the afterloader. At the same time when the prescribed dose was reached in the lesion, the bladder and rectal D_{2 cm³} was 320.4 cGy and 331.5 cGy, respectively, which did not exceed the dose limits. Conclusions The individualized source application manufactured by 3D printing technology is applicable to the treatment of patients with vaginal stump stenosis and regular solid tumor after cervical carcinoma surgery, and its clinical effect and adverse effects await further investigation.
		2016 Vol. 25 (9): 965-967 [Abstract] ( 2200 ) [HTML 1KB] [ PDF 846KB] ( 0 )

	968	Advantages of tracking no less than three gold markers in radiotherapy with CyberKnife
		Jing Shenghua,Yang Xiaowei,Xu Nuo,Peng Jiahua,Zhu Xixu,Li Bing
		Objective To analyze the differences between CyberKnife radiotherapy with different numbers of gold markers. Methods A total of 424 patients undergoing CyberKnife with gold markers from 2013 to 2014 were enrolled and analyzed. In these patients, 330 patients with no less than 3 gold markers were assigned to observation group and 94 patients with less than 3 gold markers were assigned to control group. The setup error and treatment error were recorded and analyzed for each patient. Results The mean setup error and mean treatment error were 0.031 mm and 0.314 mm in the observation group and 0.057 mm and 1.122 mm in the control group, respectively. Conclusion Tracking no less than 3 gold markers can substantially improve the accuracy and quality of treatment.
		2016 Vol. 25 (9): 968-970 [Abstract] ( 2270 ) [HTML 1KB] [ PDF 933KB] ( 0 )

	971	Volumetric modulated arc therapy for nasopharyngeal carcinoma patients with poor compliance:setup error and expansion margin of target volume
		Chen Jie,Zhang Wenxue,Wang Keqiang,Guo Zhichao,Wu Jun,Cao Yongzhen,Lyu Zhonghong
		Objective To investigate the setup error for nasopharyngeal carcinoma (NPC) patients with poor compliance using kV cone-beam computed tomography, and to calculate the expansion margin from the clinical target volume (CTV) to planning target volume (PTV). Methods In 45 NPC patients from 2013 to 2015, the setup error, 95% confidence interval (CI)-1 for random error, and PTV-1 value were calculated. Moreover, in 16 NPC patients with poor compliance based on five verifications (random error not within 95%CI-1), the setup error, 95%CI-2 for random error, and PTV-2 value were calculated. For the 16 special patients, PTV-1 and PTV-1 combined with PTV-2 were used to develop the plan-1 and plan-2, respectively. The dosimetric difference between plan-1 and plan-2 was evaluated. Results Both PTV-1 and PTV-2 had the largest expansion margin in the y direction. The CTV of plan-1 could not meet the requirement of the prescription dose after the setup error was introduced. Compared with plan-1, the V_95% and D₉₅ values for the CTV of plan-2 were increased by 6.26% and 4.43%, respectively. The D₀₁ value was significantlylarger in plan-2 than in plan-1(P=0.005), which, however, met the clinical requirement. Conclusions In patients with poor compliance, the dose to target volume can be effectively elevated and the normal tissue can be spared from damage when PTV-1 combined with PTV-2 is selected as expansion margin.
		2016 Vol. 25 (9): 971-974 [Abstract] ( 2330 ) [HTML 1KB] [ PDF 791KB] ( 0 )

	975	Dosimetric effects of target volume delineation with metal clip and seroma, alone or in combination, on external-beam partial breast irradiation:a study based on four-dimensional computed tomography
		Guo Bing,Li Jianbin,Wang Wei,Li Fengxiang,GuoYanluan,Li Yankang,Liu Tonghai
		Objective To evaluate the dosimetric effects of target volume delineation with metal clip and seroma, alone or in combination, on external-beam partial breast irradiation (EB-PBI) based on four-dimensional computed tomography (4DCT). Methods Twenty female patients undergoing EB-PBI from 2009 to 2013 were enrolled as subjects. The gross tumor volumes (GTV_S), GTV_C, GTV_S, and GTV_C+S, were delineated on 4DCT images at 10 phases using metal clip, seroma, and both of them, respectively. The GTV_S on 4DCT images at 10 phases were fused to generate the internal gross tumor volumes (IGTV_S), IGTV_C, IGTV_S, and IGTV_C+S. The planning target volumes (PTV_S), PTV_C, PTV_S, and PTV_C+S, were obtained via expansion of margin by 15 mm. The three-dimensional conformal radiotherapy plans were made by one physician based on PTV_C, PTV_S, and PTV_C+S on end-inhalation images. The target volume, homogeneity index (HI), conformity index (CI), and doses to organs at risk were compared between the three groups. Results The _C+S group had the largest IGTV, PTV, and the ratio of PTV to diseased breast volume, which was followed by the C group and the S group (all P<0.05). The S group had significantly lower doses to the ipsilateral normal breast and lung than the C group and the _C+S group (all P<0.05). There were no significant differences in HI or CI between the three groups (all P>0.05). Conclusions The volume variation caused by target volume delineation on 4DCT images based on different references has little impact on dose distribution in target volume. However, it has substantial impact on radiation doses to the ipsilateral normal breast and lung.
		2016 Vol. 25 (9): 975-979 [Abstract] ( 2224 ) [HTML 1KB] [ PDF 755KB] ( 0 )

	980	Application of a self-made positioning device in laryngeal CT-MRI image fusion
		Zheng Xuliang,Xing Xiaofen,Cui Tong,Wang Dandan,Chu Xuegang
		Objective To investigate the application of a self-made positioning device in CT-MRI image fusion in patients with laryngeal tumor, as well as the precision of image fusion and the changes in target volume delineation after fusion. Methods A total of 10 patients with laryngeal cancer were enrolled, and a self-made positioning device was used to collect CT and MRI images in a fixed position. These images were fused by mutual information combined with manual fusion. The precision of image fusion was assessed by the positional deviation of internal and external markers and degree of gross tumor volume (GTV) overlap (P_CT-MRI) between CT and MRI images. GTV was contoured based on CT images (V_CT), MRI images (V_MRI), and fused images (V_CT+MRI). The overlapped volume of V_CT and V_MRI(V_CT-MRI) was calculated, and the target volume was analyzed and compared. Results The positional deviations of three external markers in the three directions were 0.996±0.222 mm, 1.146±0.291 mm, and 1.368±0.298 mm (P=0.000), respectively, while those of the internal markers were 0.476±0.151 mm, 0.561±0.083 mm, and 0.724±0.125 mm (P=0.000), respectively. V_CT, V_MRI, V_CT+MRI, and V_CT-MRI were 26.355±7.876 cm³, 33.556±7.407 cm³, 40.036±7.627 cm³, 19.875±8.588 cm³(P=0.000), respectively. P_CT-MRI was 73.7%±9.8%. Conclusions The self-made positioning device can improve the consistency of position during the collection of CT and MRI images, and fused CT-MRI images can provide more information and improve the precision of target volume delineation.
		2016 Vol. 25 (9): 980-983 [Abstract] ( 2185 ) [HTML 1KB] [ PDF 772KB] ( 0 )

	984	Dose evaluation method for adaptive radiotherapy plans based on script functions
		Zhu Jian,Bai Tong,Hou Zhen,Lu Jie,Wang Ruozheng,Yin Yong,Li Baosheng,Shu Huazhong,Luo Limin
		Objective To investigate the dose evaluation method for adaptive radiotherapy plans based on script functions, so that the function of radiotherapy plan transfer in the Dynamic Planning module can be completed by all versions of Pinnacle treatment planning system (TPS). Methods The first step was to write and embed the scripts, and then the isocenter of irradiation was set up in the late-course image space. The scripts were executed to export and import the radiation field and set up the weight, so as to realize the transfer of radiotherapy plan between different image spaces. This method and the Dynamic Planning module of Pinnacle TPS were used to evaluate the adaptive radiotherapy plan of one patient with nasopharyngeal carcinoma, and these two methods were compared in terms of plan parameters and dosimetry. Results Compared with the Dynamic Planning module, this method maintained the consistency in the fore-and late-course plan parameters of the radiotherapy plan. The two methods had different positions of the isocenter, which caused the difference in dose distribution;however, if the two methods transferredthe adaptive radiotherapy plan at the same isocenter, the dose distribution was exactly the same. Conclusions This method for the evaluation of adaptive radiotherapy plans is accurate, simple, convenient, and applicable to all versions of Pinnacle TPS, and it does not take up additional image storage space. This method increases the flexibility and precision of radiotherapy dose evaluation and provides a technical support for clinical practice and research.
		2016 Vol. 25 (9): 984-987 [Abstract] ( 1918 ) [HTML 1KB] [ PDF 1044KB] ( 0 )

	989	Measurement of leaf position accuracy of dynamic multi-leaf collimator using electronic portal imaging device and EBT3 film dosimeter
		Li Yinghui,Chen Lixin,Zhuang Yongdong,Wang Bin,Zhu Jinhan,Liu Xiaowei
		Objective To establish a fast and accurate method for measurement of leaf position accuracy of dynamic multi-leaf collimator (MLC) using electronic portal imaging device (EPID) and EBT3 film dosimeter. Methods A Varian 6 MV accelerator was used with the gantry angle and the collimator angle fixed at zero degree. A total of 11 sliding window MLC fields were designed. Each field contained a group of strip fields with the same width. The width of a strip field ranged from 1 mm to 10 mm and the distance between two adjacent strip fields was 20 mm. The relationship between the width of the strip field (band width) and the full width at half maximum (FWHM) was calibrated using EPID and EBT3 as measurement tools. A field with a band width of 5 mm was designed in the same way and several MLC leaf deviations were made in different positions. EPID and EBT3 film dosimeter were used to analyze the leaf position accuracy. Results A good linear relationship between band width and FWHM was achieved when the band width was larger than 4 mm. The accuracy of band width, distance between peaks, and MLC leaf position were determined as ±0.2 mm, ±0.1 mm, and ±0.1 mm by EPID and ±0.3 mm, ±0.2 mm, and ±0.2 mm by EBT3 film dosimeter, respectively. Conclusions This study provides a fast and accurate method for the measurement of MLC leaf position accuracy using EPID or EBT3 film dosimeter, which is helpful for quality assurance of MLC.
		2016 Vol. 25 (9): 989-993 [Abstract] ( 2518 ) [HTML 1KB] [ PDF 910KB] ( 0 )

	994	Impact of movement frequency on gross tumor volume of moving tumors based on three-and four-dimensional CT scans
		Shang Dongping,Xing Jianhong,Zhang Qiang,Yin Yong
		Objective To investigate the impact of movement frequency on gross tumor volume (GTV) of moving tumors and coordinate position of the central point based on three-and four-dimensional CT scans. Methods The respiratory motion platform from Modus and 8 phantoms with different shapes and volumes were used to simulate the movement of lung tumors. Three-and four-dimensional CT scans were performed at movement frequencies of 10, 15, and 20 times/min. GTV (GTV₁₀, GTV₁₅, and GTV₂₀) and IGTV (IGTV₁₀, IGTV₁₅, and IGTV₂₀) were delineated, and the coordinate position of the central point was obtained. The Friedman test was performed for GTV₁₀, GTV₁₅, GTV₂₀, IGTV₁₀, IGTV₁₅, IGTV₂₀, and the coordinate position of the central point. Results GTV₁₀, GTV₁₅, and GTV₂₀ at the three movement frequencies were 12.41±14.26 cm³, 10.38±11.18 cm³, and 12.50±15.23 cm³, respectively (P=0.687), and the positional values were -8.2±96.2 mm, -8.6±96.1 mm, and -8.6±95.7 mm in x-axis (P=0.968), 108.2±25.0 mm, 110.4±22.5 mm, and 109.0±24.2 mm in y-axis (P=0.028), and 65.2±13.7 mm, 65.4±13.4 mm, and 65.4±13.2 mm in z-axis (P=0.902). IGTV₁₀, IGTV₁₅, and IGTV₂₀ at the three movement frequencies were 17.78±19.42 cm³, 17.43±19.56 cm³, and 17.44±18.80 cm³, respectively (P=0.417), and the positional values were -7.7±95.9 mm, -7.9±95.6 mm,and -7.9±95.1 mm in x-axis (P=0.325), 109.4±24.5 mm, 109.6±24.1 mm, and 109.2±24.3 mm in y-axis (P=0.525), and 65.5±13.3 mm, 65.6±13.4 mm, and 65.5±13.3 mm in z-axis (P=0.093). Conclusions During simulated positioning of thoracic tumors, respiratory movement frequency has no significant impact on target volume established by four-dimensional CT scan. There are no significant differences in three-dimensional target volume established at different respiratory frequencies, but respiratory frequency has a significant impact on the position of the central point of the target volume in y-axis.
		2016 Vol. 25 (9): 994-998 [Abstract] ( 2066 ) [HTML 1KB] [ PDF 831KB] ( 0 )

	999	Simulation and application of 3D printed compensator in electron radiation therapy for Merkel cell carcinoma
		Wang Junfeng,Li Dingyu,Huang Zhangling,Yuan Xianglin,Hu Guoqing,Qiu Hong
		Objective To investigate the design and manufacture of 3D printed compensator in electron radiation therapy for Merkel cell carcinoma, and to verify the feasibility of this technique in electron radiation therapy. Methods Computed tomography was used to collect images of a human head phantom. The delineation of target volume of Merkel cell carcinoma was simulated in the planning system and a radiotherapy plan was formulated after adding the compensator. The compensator was printed out by a 3D printer and fixed on the head phantom. A second CT scan was performed to make a new treatment plan. For the two plans, several planes parallel to the beam were selected to calculate gamma passing rates. The actual dose distribution was measured using disposable films. The gamma passing rate was compared between the film system and the planning system. The conformity index (CI) and the heterogeneity index (HI) of target volume were compared between the plans using the printed compensator and the conventional compensator of the same thickness. Comparison between the two plans was made by paired t test. Results Using the dose distribution of the plan with simulated compensator, the gamma passing rate was 94.7±2.3% in the plan with 3D printed compensator. Using the dose distribution measured by the film, the gamma passing rate was 96.6% in the plan with 3D printed compensator. Compared with the conventional compensator, the 3D printed compensator achieved a significantly elevated CI (0.85 vs. 0.69, P=0.004) and a slightly improved HI (1.30 vs. 1.26, P=0.001). Conclusions The conformal dose distribution provided by 3D printed compensator for tumors at different depths meets the clinical need.
		2016 Vol. 25 (9): 999-1002 [Abstract] ( 1973 ) [HTML 1KB] [ PDF 839KB] ( 0 )

	1003	Radiosensitizing effect of mesoporous silica-encapsulated gold nanorods on human triple-negative breast cancer cells
		Zhao Ning,Li Bingxin,Shi Zeliang,Yang Zhangru,Meng Jin,Li Ping,Zhang Qing,Fu Shen
		Objective To investigate the radiosensitizing effect of mesoporous silica-encapsulated gold nanorods (GNRs@mSiO₂) combined with 6 MV X-ray on human triple-negative breast cancer MDA-MB-231 cells and its possible mechanism. Methods A transmission electron microscope was used to analyze the morphology and intracellular distribution of GNRs@mSiO₂. An atomic absorption spectrophotometer was used to evaluate the uptake of GNRs@mSiO₂ by cells. The CCK-8 assay was used to measure the cytotoxicity of different concentrations of GNRs@mSiO₂. The colony formation assay was used to determine the effect of GNRs@mSiO₂ on the radiosensitivity of cells. Flow cytometry was used to measure the cell cycle, apoptosis, and the level of reactive oxygen species. Between-group comparison was made by paired t test. Results The uptake of GNRs@mSiO₂ by MDA-MB-231 cells reached a peak value at 24 h, which was (7.09±0.26)-fold higher than that in the control group and significantly higher than those in other groups (P=0.002-0.014). After exposure to 12.5-50.0μg/ml GNRs@mSiO₂ for 24 h, more than 90% of the cells remained alive. The D₀, D_q, and SF₂ values in the GNRs@mSiO₂+irradiation group were lower than those in the irradiation alone group, yielding a sensitization enhancement radio of 1.27(radio of SF₂ values). The apoptosis rate was (30.4±0.68)% in the GNRs@mSiO₂+irradiation group. The proportion of cells in G₂/M phase was (31.25±0.75)% in the GNRs@mSiO₂+irradiation group, which was significantly higher than those in other groups (P=0.003-0.033). Conclusions Mesoporous silica-encapsulated gold nanorods can effectively enhance the radiosensitivity of human triple-negative breast cancer MDA-MB-231 cells to 6 MV X-ray.
		2016 Vol. 25 (9): 1003-1007 [Abstract] ( 1974 ) [HTML 1KB] [ PDF 818KB] ( 0 )

	1008	Effects of Ku86 knockdown on the radiosensitivity of Hela cells
		He Ke,Qu Hu,Xu Linan,Niu Gang,Fei hui,Jiang Hongye,Liang Yanchun,Li Tingting,Yao Bing
		Objective To study the effects of siRNA-mediated Ku86 knockdown on the radiosensitivity of human cervical carcinoma Hela cells. Methods Quantitative real-time PCR and Western blot were used to determine the expression of Ku86 gene in Hela cells exposed to X-ray radiation. siRNA was used for Ku86 knockdown. After transfection with si-NC or si-KU86, Hela cells were exposed to 0, 2, 4, 6, 8, and 10 Gy of X-ray. The CCK-8 kit, flow cytometry, and colony formation assay were used to evaluate cell proliferation, apoptosis, and changes in radiosensitivity after transfection, respectively. The expression of p53 and caspase-8 was evaluated to analyze the effect of Ku86 knockdown on radiation-induced apoptosis. Results After X-ray irradiation, both mRNA and protein expression of Ku86 was upregulated. Ku86 knockdown reduced cell proliferation and colony formation ability. The radiation sensitization enhancement ratio was 1.57. Ku86 knockdown also elevated the expression of p53 and caspase-8 and enhanced apoptosis. Conclusions siRNA-mediated Ku86 knockdown enhances the radiosensitivity of human cervical carcinoma Hela cells.
		2016 Vol. 25 (9): 1008-1012 [Abstract] ( 2255 ) [HTML 1KB] [ PDF 839KB] ( 0 )

	1013


		2016 Vol. 25 (9): 1013-1014 [Abstract] ( 2122 ) [HTML 1KB] [ PDF 698KB] ( 0 )

	1015	Current status of clinical application of stereotactic body radiation therapy
		Xiao Guangli
		Stereotactic body radiation therapy has become more and more popular in clinical practice due to its satisfactory efficacy and relatively low incidence of side effects. Different fractionation schemes are adopted based on the characteristics, location, and size of tumor. However, the optimal fractionation scheme and dose limits for organs at risk are still not clear. Therefore, further studies and observation of long-term adverse reactions are required.
		2016 Vol. 25 (9): 1015-1019 [Abstract] ( 2171 ) [HTML 1KB] [ PDF 994KB] ( 0 )

	1020	Progress in diagnosis and treatment of local recurrence after radical radiotherapy for esophageal cancer
		Li Ruiqing,Cao Liang,Zhao Kuaile
		The diagnosis of local recurrence after radiochemotherapy for esophageal cancer requires the combination of multiple imaging methods (esophageal X-ray, computed tomography, endoscopic ultrasonography, and positron emission tomography-computed tomography), dynamic changes in esophagoscopy, and biopsy. The main treatment of recurrence includes salvage surgery, radiochemotherapy, endoscopic mucosal resection, and chemotherapy. The overall survival rate after the above treatment is improved compared with palliative care but still unsatisfactory. Early diagnosis of recurrence is fundamental for improved treatment outcomes.
		2016 Vol. 25 (9): 1020-1024 [Abstract] ( 2126 ) [HTML 1KB] [ PDF 783KB] ( 0 )

	1025


		2016 Vol. 25 (9): 1025-1026 [Abstract] ( 1674 ) [HTML 1KB] [ PDF 773KB] ( 0 )

	1027


		2016 Vol. 25 (9): 1027-1028 [Abstract] ( 1834 ) [HTML 1KB] [ PDF 787KB] ( 0 )

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