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.12 Published 2016-12-15

	Head and Neck Tumors Thoracic Tumors Review Articles Physics·Biology·Technology Symposium Experience exchange

Head and Neck Tumors

	1277	Comparison of efficacy and adverse reactions between radiotherapy combined with cisplatin and radiotherapy combined with nimotuzumab in treatment of locally advanced nasopharyngeal carcinoma
		Liao Xiyi,Kong Lin,Zheng Hua,Dai Mingming,Wang Lichen,Lu Jiade,Lin Qin
		Objective To evaluate the efficacy and adverse reactions of radiotherapy combined with cisplatin or nimotuzumab after induction chemotherapy with docetaxel,cisplatin,and 5-fluorouracil (TPF) for locally advanced nasopharyngeal carcinoma. Methods Sixty patients with stage Ⅲ-Ⅳ_b nasopharyngeal carcinoma were randomly divided into experimental group (n=28) and control group (n=32). The two groups received radiotherapy after three cycles of induction chemotherapy with TPF. The control group received cisplatin during radiotherapy at a dose of 40 mg/m²,once a week,for 7 weeks,while the experimental group received nimotuzumab one week before radiotherapy at a dose of 200 mg,once a week,for 7 weeks. Survival analysis was used with the Kaplan-Meier method and log-rank test,efficacy and adverse reactions comparing were used with χ² test. Results The short-term treatment outcomes were evaluated at three months after treatment. There were no significant differences in the complete or partial response rates between the control group and the experimental group (97% vs. 96% or 3% vs. 4%,P=0.923). There were no significant differences in 3-year progression-free survival or overall survival rate between the control group and the experimental group (88% vs. 79%,P=0.352;97% vs. 89%,P=0.268) The experimental group had significantly lower incidence rates of marrow suppression,severe fatigue,nausea,and vomiting than the control group (P=0.002,0.008,0.001). Conclusions There is no significant difference in clinical efficacy between radiotherapy combined with cisplatin and radiotherapy combined with nimotuzumab in the treatment of locally advanced nasopharyngeal carcinoma. However,radiotherapy combined with targeted therapy achieves significantly fewer adverse reactions.
		2016 Vol. 25 (12): 1277-1280 [Abstract] ( 2123 ) [HTML 1KB] [ PDF 840KB] ( 0 )

	1281	Assessment of consistency of multiple magnetic resonance imaging modalities in measurement of gross tumor volume for nasopharyngeal carcinoma
		Gu Donglian,Liu Shuying,Zhu Xiaodong,Lai Shaolyu,Jin Guanqiao,Su Danke
		Objective To investigate the consistency of multiple magnetic resonance imaging (MRI) modalities in measurement of gross tumor volume (GTV) for nasopharyngeal carcinoma. Methods A retrospective analysis was performed among 45 patients who were newly diagnosed and pathologically confirmed with nasopharyngeal carcinoma. All patients underwent plain, enhanced, and diffusion-weighted MRI scans. Primary tumor was manually delineated on enhanced axial T₁WI, axial T₂WI, and apparent diffusion coefficient (ADC) maps. GTV was calculated by the sum of areas. The obtained GTV was divided into T₁+C group, T₂WI group, and ADC group. One-way analysis of variance was used to evaluate the differences between the mean values from the three groups. The Bland-Altman method was used to evaluate the consistency of different imaging modalities in GTV measurement using the mean difference between the two groups and 95% distribution of the difference. Results There was no significant difference in mean GTV between the T₁+C group, the T₂WI group, and the ADC group (20.8±18.1) vs. (21.5±17.2) vs. (24.4±20.8) cm³(P=0.617). The mean differences and 95% limits of agreement between the T₂WI group and the T₁+C group, between the ADC group and the T₂WI group, and between the ADC group and the T₁+C group were 0.74, 2.94, and 3.68 cm³ and (-5.97-7.44),(-8.25-13.69), and (-3.34-10.70) cm³, respectively. Conclusions The multiple MRI modalities have poor consistency in measurement of GTV for nasopharyngeal carcinoma. Therefore, they cannot replace each other. Enhanced T₁WI combined with T₂WI and DWMRI can determine a relatively accurate range of target volume for nasopharyngeal carcinoma.
		2016 Vol. 25 (12): 1281-1284 [Abstract] ( 1781 ) [HTML 1KB] [ PDF 836KB] ( 0 )

	1285	Prognostic value of pretreatment primary tumor and regional lymph node necrosis in nasopharyngeal carcinoma with 3DRT
		Zhang Xiangguo,Liang Sixian,Han Fei,Xu Xiaonan,Cheng Ying,Huang Juhong,Kou Mengying
		Objective To investigate the clinical features and prognostic value of primary tumor and regional lymph node necrosis in nasopharyngeal carcinoma (NPC). Methods Clinical data were collected from 477 patients newly diagnosed with NPC in our hospital from 2009 to 2013. Pretreatment MRI and CT scans of primary tumor and regional lymph nodes were performed to analyze the clinical features and prognostic value of primary tumor and regional lymph node necrosis after 3DRT. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. Univariate and multivariate prognostic analyses were made by the log-rank test and the Cox model. Results In the 477 patients, 219(45.9%) had tumor necrosis and 258(54.1%) had not. The patients without tumor necrosis had significantly longer median survival time and significantly higher 3-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates than those with tumor necrosis (40 vs. 37 months, 93.7% vs. 78.2%, 86.7% vs. 63.8%, 96.3% vs. 87.0%, 93.4% vs. 79.7%, all P=0.000). The univariate analysis showed that tumor necrosis was an important influencing factor for OS, PFS, LRFS, and DMFS rates in patients. T stage, N stage, and clinical stage were correlated with OS, PFS, and DMFS rates in patients (P=0.000-0.004). The multivariate analysis showed that pretreatment tumor necrosis were predictive factors for all survival in patients with NPC (P=0.001-0.022),with T stage for LRFS,DMFS (P=0.016,0.006) and N stage for PFS (P=0.000). Conclusions Patients with pretreatment tumor necrosis are likely to have recurrence or metastasis as well as shorter survival time than those without tumor necrosis. On the basis of T/N stage, identification of the state of tumor necrosis helps clinical physicians to make more reasonable treatment plans and improve the prognosis.
		2016 Vol. 25 (12): 1285-1289 [Abstract] ( 1798 ) [HTML 1KB] [ PDF 809KB] ( 0 )

Thoracic Tumors

	1290	A prospective study of effects of whole brain radiotherapy on cognitive function and quality of life in patients with brain metastases from lung cancer
		Lian Yixin,Zhou Mengyun,Zou Li,Chen Qingqing,Tian Ye
		Objective To evaluate the effects of whole brain radiotherapy (WBRT) on cognitive function and quality of life (QOL) in patients with brain metastases from lung cancer. Methods A total of 41 patients with brain metastases from lung cancer who were admitted to our hospital and treated with WBRT in 2015 were enrolled as subjects. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used for cognitive evaluation. The Alzheimer′s Disease Cooperative Study Activity of Daily Living (ADCS-ADL) scale was used for evaluation of QOL. Comparison of cognitive function and QOL before and after WBRT was made by the independent sample t-test. Results The incidence rates of cognitive dysfunction based on MoCA and MMSE were 96.55% and 48.28% before WBRT, and 94.29% and 31.43% after WBRT, respectively. There were no significant changes in MoCA score, MMSE score, or ADCS-ADL score after WBRT (18.24±0.95 vs. 19.37±0.70,P=0.341;23.51±0.88 vs. 24.54±0.71,P=0.375;57.44±2.59 vs. 59.37±2.27,P=0.583). Conclusions WBRT has no significant impacts on cognitive function and QOL in patients with brain metastases from lung cancer. MoCA is more sensitive than MMSE in detection of cognitive dysfunction in patients with brain metastases.
		2016 Vol. 25 (12): 1290-1294 [Abstract] ( 1810 ) [HTML 1KB] [ PDF 856KB] ( 0 )

	1295	Extracapsular extension in prediction of the efficacy of postoperative radiotherapy in the treatment of stage Ⅲ_A—N₂ non-small cell lung cancer
		Zhang Baozhong,Yuan Zhiyong,Zhao Lujun,Pang Qingsong,Wang Ping
		Objective To investigate the value of extracapsular extension (ECE) in prediction of the efficacy of postoperative radiotherapy (PORT) in the treatment of stage Ⅲ_A—N₂ non-small cell lung cancer (NSCLC). Methods From 2008 to 2009, 220 patients with stage Ⅲ_A—N₂ NSCLC who received surgical treatment were enrolled as subjects. All patients received postoperative chemotherapy and 43 out of them received PORT. Those patients were divided into ECE (+) group and ECE (-) group, which were further divided into subgroups according to whether PORT was applied or not. Progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method and analyzed using log-rank test. Univariate and multivariate prognostic analyses were conducted using the log-rank test and the Cox model, respectively. Results The univariate analysis showed that the ECE (-) group had significantly improved PFS and OS rates than the ECE (+) group (P=0.000, 0.000). In the ECE (+) group, there were no significant differences in PFS or OS rate between the PORT subgroup and the non-PORT subgroup (P=0.584, 0.723). In the ECE (-) group, the PORT subgroup had a significantly improved PFS rate than the non-PORT subgroup (P=0.039), while there was no significant difference in OS rate between the two subgroups (P=0.125). The multivariate analysis indicated that ECE was an independent prognostic factor for PFS and OS rates in patients with stage Ⅲ_A—N₂ NSCLC (P=0.001, 0.020). Conclusions ECE is an independent prognostic factor for stage Ⅲ_A—N₂ NSCLC and promises to provide a basis for the use of PORT in the treatment of stage Ⅲ_A—N₂ NSCLC.
		2016 Vol. 25 (12): 1295-1300 [Abstract] ( 1634 ) [HTML 1KB] [ PDF 838KB] ( 0 )

	1301	Relationship between acute radiation pneumonitis and dosimetric factors in intensity-modulated radiotherapy for lung caner:a study based on different lesion locations
		Huang Rui,Zhu Xiaodong,Fu Qingguo,Huang Jiangqiong,Yang Liuting,Chen Long
		Objective To explore the dosimetric factors for acute radiation pneumonitis (ARP) after restricted field intensity-modulated radiotherapy (IMRT) for lung caner based on different lesion locations. Methods A retrospective study of ARP was performed among 113 patients with lung cancer undergoing restricted field IMRT from 2013 to 2015. The Radiation Therapy Oncology Group criteria were used to grade ARP. Comparison was made by χ² test and independent sample t-test. The logistic regression model was used for multivariate analysis. The receiver operating characteristic curve was used to predict the optimal cut-off value. Results The statistical analysis showed that the incidence of ARP was not related to clinical factors. The V₅ of the diseased lung was an independent predictor of the incidence of grade>2 ARP (P=0.016). The optimal cut-off value of V₅ was 71.6%. According to the lesion locations in patients, the rV₅ was an independent predictor of the incidence rates of ARP in the right lung, upper right lung, and right middle/lower lung (P=0.020, 0.020, 0.049) with optimal cut-off values of 66.2%, 74.7%, and 87.5%, respectively. The aV₅ was an independent predictor of the incidence of ARP in mediastinal lung cancer (P=0.009) with an optimal cut-off value of 66.73%. Conclusions The V₅ of the diseased lung is an independent predictor of the incidence of grade>2 ARP. In terms of the different lesion locations, the rV₅ is an independent predictor of the incidence rates of grade>2 ARP in the right lung, upper right lung, and right middle/lower lung. The aV₅ is an independent predictor of the incidence of ARP in mediastinal lung cancer.
		2016 Vol. 25 (12): 1301-1304 [Abstract] ( 1852 ) [HTML 1KB] [ PDF 892KB] ( 0 )

	1305	Efficacy of intracavitary brachytherapy for recurrent esophageal cancer after radiotherapy
		Sun Yunchuan,Tian Dandan,Bi Jianqiang,Yuan Xiangkun,Shi Fumin,Hu Zhiwei,HuJianwei,Wang Junjie
		Objective To discuss the preliminary efficacy and adverse reactions of intracavitary brachytherapy in the treatment of loco-regional recurrent (LR) esophageal cancer after radiotherapy. Methods Iridium-192 brachytherapy was used to carry out intracavitary radiotherapy for 18 patients with LR esophageal cancer after initial radiotherapy from 2009 to 2013. A total irradiation dose of 16-30 Gy was given in 4-6 fractions (4-5 Gy per fraction). Intracavitary irradiation covered the lesion plus 1.0 cm upper and lower margins. The zero reference point was 10 mm far from the axis. Short-term efficacy, local control (LC) rate, overall survival (OS) rate, and adverse reactions were evaluated. Results In the 18 patients, the follow-up rate was 100%;the overall response rate was 94%,with a complete response rate of 3/18, a partial response rate of 14/18, and a no response rate of 1/18. In 16 patients with clinical symptoms on admission, 13 showed remission (6 had symptoms disappearing and 7 had symptoms alleviated), 2 remained the same, and 1 got worse after treatment, yielding an overall clinical remission rate of 81%. In all the 18 patients, 6 patients had grade ≥2 radiation esophagitis (RE), consisting of 4 with grade 2 RE and 2 with grade 3 RE.One patient with esophageal stricture at 5 months after radiotherapy received gastric fistula surgery. The median time to LC was 14 months (3-38 months). The 1-, 2-, and 3-year LC rates were 72%, 44%, and 33%, respectively. The 1-, 2-, and 3-year OS rates were 61%, 22%, and 17%, respectively. The median OS time was 12 months (5.5-45.0 months). Fourteen deaths occurred in those patients, consisting of 12 cancer-related deaths and 2 non-cancer-related deaths. Conclusions Intracavitary brachytherapy achieves satisfactory efficacy and significantly improves the symptoms in the treatment of LR after radiotherapy for esophageal cancer.
		2016 Vol. 25 (12): 1305-1309 [Abstract] ( 1912 ) [HTML 1KB] [ PDF 936KB] ( 0 )

	1310	Ⅱ and Ⅲ rectal cancer neoadjuvant treatment evaluation
		Palida·Apiziaji,Ayiguli·Hare,Yisikada·Abulimiti,Zhang Jinrong
		Objective To evaluate the efficacy of neoadjuvant therapy plus surgery and surgery plus postoperative adjuvant therapy for phase Ⅱ and Ⅲ low rectal cancer. Methods A retrospective analysis was performed on the clinical data of patients with phase Ⅱ and Ⅲ(T₃, T₄ and/or N₁, N₂) low rectal cancer who were admitted to our hospital from 2009 to 2013.Those patients were divided into group A (n=98) and group B (n=93) according to the treatment method. Group A received neoadjuvant therapy followed by radical resection. Group B was treated with radical resection and postoperative adjuvant therapy. Between-group comparison was made by χ² test or Fisher′s exact probability test. The Kaplan-Meier method was used to analyze the survival rates. Results The follow-up rate was 92.1%.The 3-year local recurrence (LR) and distant metastasis (DM) rates were significantly lower in group A than in group B (12.9% vs. 32.2%,P=0.002;13.5% vs. 37.8%,P=0.001).The 3-year overall survival and disease-free survival rates were significantly improved in group A than in group B (84.7% vs. 69.9%,P=0.022;77.6% vs. 50.3%,P=0.004). Conclusions Neoadjuvant therapy is a safe and reliable treatment approach for phase Ⅱ and Ⅲ low rectal cancer, which can significantly reduce LR and DM rates and prolong the survival time.
		2016 Vol. 25 (12): 1310-1313 [Abstract] ( 1846 ) [HTML 1KB] [ PDF 895KB] ( 0 )

	1314	Gross tumor volume delineation in patients undergoing breast – conserving surgery:a comparative study of preoperative magnetic resonance imaging, postoperative specimen, and lumpectomy cavity based on surgical clips
		Zhang Aiping,Li Jianbin,Wang Wei,Wang Yongsheng,Chen Zhaoqiu,Mu Dianbin,Shao Qian
		Objective To explore the gross tumor volume (GTV) difference and correlation between preoperative magnetic resonance imaging (MRI), postoperative specimen, and lumpectomy cavity based on surgical clips. Methods Fifty patients with breast cancer undergoing breast-conserving surgery were enrolled as subjects from 2014 to 2015. GTV_MRI was defined as tumor volume based on preoperative MRI scans, while GTV_MRI+1 was defined as GTV_MRI plus a 1.0-cm margin. GTV_ES was defined as the volume of excised specimen, while GTV_PAT was defined as the pathological volume of the specimen. GTV_TB was defined as tumor volume based on lumpectomy cavity localized by surgical clips on computed tomography images. Comparison between any two GTVs was made by Friedman test and Wilcoxon test. A correlation analysis was made by Spearman rank correlation. Results The median values of GTV_MRI, GTV_MRI+1, GTV_PAT, GTV_ES, and GTV_TB were 0.97(0.01-6.88), 12.58(3.90-34.13), 0.97(0.01-2.36), 15.46(1.15-70.69), and 19.24(4.72-54.33) cm³, respectively. There were no significant differences between GTV_MRI and GTV_PAT, between GTV_MRI+1 and GTV_ES, and between GTV_ES and GTV_TB (P=0.188, 0.07, 0.264). Neither GTV_ES nor GTV_TB was correlated with GTV_MRI(P=0.071, 0.378) or GTV_MRI+1(P=0.068, 0.375). GTV_TB was positively correlated with GTV_ES (r=0.488, P=0.004). Conclusions For patients undergoing breast-conserving therapy, during lumpectomy guided by palpation rather than imaging, neither the volume of excised specimen nor lumpectomy cavity based on surgical clips are correlated with tumor volume based on preoperative MRI.
		2016 Vol. 25 (12): 1314-1318 [Abstract] ( 1759 ) [HTML 1KB] [ PDF 839KB] ( 0 )

Physics·Biology·Technology

	1319	A dosimetric study of multileaf collimator interdigitation in volumetric modulated arc therapy plans for multiple brain metastases
		Duan Jinghao,Li Chengqiang,Wang Ruozheng,Gong Guanzhong,Tao Cheng,Liu Xiao,Zhu,Jian,Yin Yong
		Objective To evaluate the dosimetric difference between volumetric modulated arc therapy (VMAT) plans with and without an interdigitating multileaf collimator (MLC) in the treatment of multiple brain metastases, and to investigate the advantages of MLC interdigitation in VMAT plans for multiple brain metastasis. Methods A retrospective study was performed on clinical data from 15 patients with multiple brain metastases in our hospital. A dual arc VMAT plan with an interdigitating MLC (VMAT-1) was designed on computed tomography (CT) images. Then, keeping all parameters unchanged, another VMAT plan with a non-interdigitating MLC (VMAT-2) was made after re-optimization. The conformity index (CI) and homogeneity index (HI) of the planning target volume (PTV), doses to organs at risk (OARs), monitor units (MUs), control points, delivery time, and planning time were compared between the two treatment plans using the Wilcoxon signed rank test. Results VMAT-1 achieved a better HI than VMAT-2(P=0.04), while there was no significant difference in CI between the two plans (P=0.33). VMAT-1 had a significantly higher D_98% for PTV than VMAT-2(P=0.04). Compared with VMAT-2, the D_mean to the brain stem in VMAT-1 was significantly reduced by 4%(P=0.04). The doses to other OARs in VMAT-1 were similar to those in VMAT-2. In some patients, compared with VMAT-2, VMAT-1 had a lower dose to normal tissue at the junction of neighboring CT planes of tumor. Compared with VMAT-2, the MUs of VMAT-1 were significantly increased by 4%(P=0.01), while there were no significant differences in control points or delivery time between the two plans (P=0.81, 0.73). VMAT-1 had the planning time significantly reduced by 26% compared with VMAT-2(P=0.00). Conclusions In VMAT plans for multiple brain metastases, MLC interdigitation could save the VMAT planning time and improve the planning efficiency.
		2016 Vol. 25 (12): 1319-1322 [Abstract] ( 1712 ) [HTML 1KB] [ PDF 849KB] ( 0 )

	1323	Variation in target volume and position in concurrent chemoradiotherapy for pancreatic cancer
		Sun Jingui,Li Jianbin,Wei Hua,Wang Xiaofang,Yang Wenchao,Wang Jinzhi,Wang Yue,Liu Tonghai
		Objective To investigate the variation in target volume and position in radiotherapy for pancreatic cancer based on contrast-enhanced three-dimensional computed tomography (3DCT) images,and to investigate the influence of radiotherapy re-planning during the treatment on doses to organs at risk. Methods Thirty-one patients with pancreatic cancer received contrast-enhanced 3DCT scans before radiotherapy and at the 15^th-18^th fraction. gross tumor volume (GTV) was delineated on the two sets of images. The coordinates and volume of GTV were acquired after automatic registration in the treatment planning system. Radiotherapy plan-1 and plan-2 were made based on the initial target volume (CT-1) and the target volume after 15^th-18^th fraction (CT-2),respectively. Plan-3 was defined by copying plan-1 to the CT-2. The results were analyzed using one-way analysis of variance and Pearson correlation analysis. Results During the treatment,the center of GTV had a significant larger displacement in the superior-inferior direction than in the right-left or anterior-posterior direction ((0.7±0.2) vs. (0.4±0.1) cm,(0.7±0.2) vs. (0.4±0.1) cm,P=0.048);the volume of GTV was significantly reduced by (27.1±17.1)%(P=0.000).The degrees of inclusion (DI) of the two GTVs were 0.6±0.2 and 0.8±0.2(P=0.000).The matching index (MI) was 0.5±0.1.The three-dimensional vector of GTV was negatively correlated with DI and MI (P=0.000,0.000,0.000).Compared with plan-3,the D_mean values for the liver and right kidney in plan-2 were significantly reduced by 21.9% and 14.4%,respectively (P=0.025,0.040). Conclusions The position and volume of GTV have significant changes during conventional fractionation radiotherapy combined with concurrent chemotherapy for pancreatic cancer. Re-planning during the treatment can significantly reduce doses to the liver and right kidney. Therefore,it is necessary to perform target correction and re-planning at an appropriate time during treatment.
		2016 Vol. 25 (12): 1323-1326 [Abstract] ( 1560 ) [HTML 1KB] [ PDF 835KB] ( 0 )

	1327	Sensitivity of passing rates of intensity-modulated radiotherapy plans in dose verification against gantry angle errors
		Wang Ning,Wang Bin,Chen Along,Huang Xiaoyan
		Objective To analyze the sensitivity of passing rates of intensity modulated radiation therapy (IMRT) plans in dose verification against gantry angle errors. Methods Gantry angle errors (±2.0°, ±1.0°, and ±0.5°) were introduced into the clinical IMRT plans of 9 patients. There were 7 IMRT plans for each patient, containing 1 original IMRT plan and 6 IMRT plans with gantry angle errors. The dose distribution of the original and modified plans for each patient was measured by ArcCHECK array. Based on the dose distribution of the original plan, the passing rate of each plan was calculated using absolute distance to agreement (DTA) analysis and Gamma analysis with the criteria of 3%/3 mm and 2%/2 mm. The obtained passing rates were analyzed by non-parametric Wilcoxon rank test. Results Under the criteria of 3%/3 mm, the mean passing rate in 9 original IMRT plans was 95.2% using DTA analysis and 96.5% using Gamma analysis. According to Gamma analysis, the plans with gantry angle errors of-2.0°,2.0°,1.0°,-0.5°, and 0.5°had the mean passing rates decreased by 12.2%, 23.5%, 6.3%, 0.9%, and 2.9%, respectively (P=0.008,0.008,0.008,0.036,0.012). According to DTA analysis, the above plans had the mean passing rates decreased by 16.2%, 23.8%, 1.7%, 6.8%, and 3%, respectively (all P=0.008). The passing rates calculated by DTA method were more sensitive to the gantry angle errors than those by Gamma method, while the passing rates under the criterion of 2%/2 mm were more sensitive than those under the criterion of 3%/3 mm. Conclusions The greater the gantry angle errors, the larger the decrease in the mean passing rate. IMRT dose verification is even sensitive enough to detect the gantry angle errors within 0.5°. Enhanced quality control and assurance of gantry angle is needed to guarantee the accuracy of IMRT delivery.
		2016 Vol. 25 (12): 1327-1330 [Abstract] ( 1857 ) [HTML 1KB] [ PDF 935KB] ( 0 )

	1331	Effects of setup error on brainstem dose distribution in patients with nasopharyngeal carcinoma and weight loss
		Jing Di,Yang Zhen,Shen Liangfang
		Objective To investigate the effects of setup error acquired by cone-beam computed tomography (CBCT) on the dose to the brainstem. Methods Setup errors were collected from 4 patients with locally advanced nasopharyngeal carcinoma (NPC) undergoing three-dimensional radiotherapy. In the 33 radiotherapy plans, the upper limit of the dose to the brainstem was 54 Gy in total radiation and 163.3 cGy in a single radiation. Treatment was re-planed using a corrected center based on setup error. For each patient, areas exposed to radiation higher than 163.64 cGy were recorded in each layer of the brainstem after single treatment. The CorelDraw software was used to superpose all overdose areas in each layer of the brainstem. The Photoshop software was used to calculate the volume of the overdose areas. The changes in weight after radiotherapy were recorded and analyzed using paired t test. Results In 116 CBCT scans without correction, the setup errors were (0.90±0.85),(0.98±0.6), and (0.98±1.05) mm in x, y, and z directions, and (0.25±0.49)° in rotation. According to the images of a total of 2 502 layers of the brainstem acquired by 116 CBCT scans, 2 040 layers of the brainstem had doses over the upper limit to different degrees. The patient with the highest frequency of overdose in the brainstem had a total overdose volume up to 3.83% in 20 scans. Another patient had the overdose volume only 0.13% of the total volume. There was no significant relationship between weight loss and setup error (P>0.05). Conclusions Setup error acquired by CBCT has a substantial impact on the dose to the brainstem. It is an effective approach for verification of target volume delineation.
		2016 Vol. 25 (12): 1331-1334 [Abstract] ( 1595 ) [HTML 1KB] [ PDF 805KB] ( 0 )

	1335	A preliminary study of test and clinical application of a physical model based on the three-dimensional dose verification system using electronic portal imaging device
		Huang Miaoyun,Chen Mingqiu,Li xiaobo,Chen Yuangui,Xu Benhua,Chen Lixin
		Objective To establish a physical model and optimize its physical parameters using the electronic portable imaging device (EPID) three-dimensional dose verification system, and to prepare it for clinical application. Methods EPID was used to acquire images of 3, 5, 10, 15, 20, and 25 cm square fields for construction of a physical model. The parameters of the physical model were optimized based on the percentage depth dose, total scatter factor, and off-axis ratio at a depth of 10 cm in a homogeneous water phantom. A thimble ionization chamber and radiochromic films were used to measure the point and planar doses for single fields, combined fields, and IMRT plans in a homogenous phantom and a human phantom. The results were compared with those in the three-dimensional reconstruction. In the human phantom and 10 intensity-modulated radiotherapy (IMRT) plans for tumors in different sites, the passing rates under the criteria of 5%/3 mm and 3%/3 mm were compared between three-dimensional reconstruction and treatment planning system (TPS) calculation. The dose and volume analyses were performed on target volume and organs at risk (OARs) in patients. Results For the single fields, combined fields, and IMRT plans, the mean deviations of point dose were less than 0.5% between three-dimensional reconstruction and ionization chamber measurement, and less than 2.0% between three-dimensional reconstruction and TPS calculation. In the homogenous phantom, the human phantom, and patients, the mean passing rates of both two-and three-dimensional doses were higher than 95% under the criteria of 5%/3 mm and 3%/3 mm. In patients, however, OARs with small volume had relatively large dose deviations. Conclusions A series of pre-clinical tests show that the three-dimensional dose verification system is an effective approach for clinical dose verification and holds promise for clinical application.
		2016 Vol. 25 (12): 1335-1340 [Abstract] ( 1978 ) [HTML 1KB] [ PDF 871KB] ( 0 )

	1341	Experience in statistical analysis of failure of a 23EX linear accelerator within 7 years
		Tan Tingqiang,Li Li,Huang Renbing
		Objective To study the application of statistical analysis of failure in the maintenance of a 23EX linear accelerator. Methods The failure data of a 23EX linear accelerator were collected from 2008 to 2015. The relationship between failure frequency and running time of the 23EX linear accelerator was analyzed. The Pareto diagram was used to analyze the main subsystems and components that had impacts on the stability of the 23EX linear accelerator. Results The 23EX linear accelerator had a total of 318 failures and 358 components replaced in 7 years. Within the first 1.5 years of use, the failure frequency gradually increased and the highest frequency was up to 38 failures per 6 months. Afterwards, the failure frequency declined and remained relatively stable. The third quarter had the highest failure frequency in a year. Multileaf collimator (MLC) and mechanical system, responsible for 66.4% and 11.9% of failures, respectively, were the main subsystems that had impacts on the stability of the 23EX linear accelerator. MLC nut and motor, taking 38.8% and 28.5% of replaced components, respectively, were the main components that had impacts on the stability of the 23EX linear accelerator. Conclusions The statistical analysis of accelerator failure helps maintenance personnel figure out the distribution of failures and identify the main factors for the accelerator stability. Moreover, it provides a basis for improving maintenance strategy.
		2016 Vol. 25 (12): 1341-1344 [Abstract] ( 1670 ) [HTML 1KB] [ PDF 956KB] ( 0 )

	1345	Immediate early response gene 5 in cervical cancer tissues:radiosensitivity and clinical significance
		Liu Yang,Wu Yumei,Tian Ming,Zhao Hui,Yu Xinping,Zhou Pingkun
		Objective To investigate the expression features of immediate early response gene 5(IER5) in patients with cervical cancer before and after radiotherapy,and to study the relationship of IER5 with radiosensitivity and clinical outcomes. Methods From 2014 to 2015,39 patients with stage Ⅱ_b-Ⅲ_b cervical cancer undergoing concurrent chemoradiotherapy were enrolled as subjects. Cervical cancer tissues were collected before and after radiotherapy with doses of 2-6,10,20,and 30 Gy. Western blotting was used to determine the relative expression of IER5 protein. Results The expression of IER5 protein in cervical cancer tissues was significantly higher after exposure to 10,20,and 30 Gy of radiation (t=3.06,4.01,6.99,P<0.01).The expression of IER5 protein was correlated with the radiation dose (r=0.511,P<0.01).There was a significant interaction between the expression of IER5 protein under different doses of irradiation and the tumor size before radiotherapy (F=3.212,P<0.05).When the tumor diameter was<4 or 4-5 cm before treatment,the expression of IER5 had significant radiation dose-dependent variation (F=10.493,P<0.01;F=9.977,P<0.01).However,there was no significant dose-dependent variation in the expression of IER5 protein when the tumor diameter was>5 cm. Conclusions The expression of IER5 protein in patients with cervical cancer is significantly higher after radiotherapy. Moreover,IER5 expression gets higher with the increase in radiation dose,indicating that IER5 is related to the radiosensitivity of patients with cervical cancer. The smaller the tumor,the more radiation dose-dependent the IER5 expression.
		2016 Vol. 25 (12): 1345-1349 [Abstract] ( 1717 ) [HTML 1KB] [ PDF 804KB] ( 0 )

	1350	Expression of OCT-4 in cervical cancer patients with different radiosensitivity and effect of OCT-4 knockdown on radiosensitivity of cervical cancer cells
		Guo Meng,Wang Yang,Zhang Chenghui,Wan Lixin
		Objective To study the expression of OCT-4 in tumor tissues of cervical cancer patients with different radiosensitivity, and to explore the effect of OCT-4 knockdown on radiosensitivity of human cervical squamous carcinoma Siha cells and its mechanism. Methods Real-time PCR and Western-blot were used to determine the mRNA and protein expression of OCT-4, respectively, in tumor tissues of cervical cancer patients with different radiosensitivity. The Siha cells were transfected with OCT-4-SiRNA to construct the OCT-4 knockdown cell line (OCT-4 SiRNA group). The control group and NC transfection group were also set up. The Siha cells in each group were exposed to different doses of X-ray. The MTT assay and colony formation assay were used to evaluate cell proliferation and colony formation ability in each group, respectively. Flow cytometry was used to assess apoptosis and cell cycle in each group. Western blot was used to measure the expression of cleaved caspase-3 and p-Akt in each group. Results With the decrease in radiosensitivity of patients with cervical cancer, the mRNA and protein expression of OCT-4 in tumor tissues were significantly increased (P<0.05). Compared with the control group and the NC group, the OCT-4 SiRNA group had a significantly increased cell proliferation inhibition rate, significantly weaker colony formation ability, significantly enhanced apoptosis and cell cycle inhibition, significantly higher expression of cleaved caspase-3, and significantly lower expression of p-Akt after exposure to different doses of X-ray (all P<0.05). Conclusions OCT-4 expression is negatively correlated with the radiosensitivity of patients with cervical cancer. OCT-4 knockdown enhances the radiosensitivity of human cervical squamous carcinoma Siha cells by promoting the expression of cleaved caspase-3 and inhibiting the expression of p-Akt.
		2016 Vol. 25 (12): 1350-1355 [Abstract] ( 1654 ) [HTML 1KB] [ PDF 878KB] ( 0 )

	1356	Effects of microRNA-34a overexpression on radiosensitivity of four human cervical cancer cell lines
		Song Lili,Liu Shikai,Zeng Saitian,Zhang Liang
		Objective To investigate the effects of miRNA-34a overexpression on the radiosensitivity of four human cervical cancer cell lines. Methods Cervical cancer lines, C33A, HeLa, SiHa, and CaSki, were transfected with pGenesil-1-miRNA-34a plasmid using the liposome 2000 kit. Cervical cancer lines overexpressing miRNA-34a (miRNA-34a/C33A, miRNA-34a/HeLa, miRNA-34a/SiHa, and miRNA-34a/CaSki) were constructed by G418 selection. These cells were exposed to different doses of ⁶⁰Coγ-ray. The expression of miRNA-34a was determined using TaqMan real-time PCR and Western blot. The cell growth inhibition rate and colony formation ability were measured by MTT assay and colony formation assay, respectively. Apoptosis and expression of apoptosis-related proteins were evaluated using flow cytometry and Western blot, respectively. Results The expression of miRNA-34a was significantly higher in positive cervical cancer cell lines than in the negative control groups (P<0.05). The cervical cancer cell lines overexpressing miRNA-34a had significantly elevated growth inhibition rates and significantly weaker colony formation ability than the negative control groups (both P<0.05). The results of flow cytometry showed that cervical cancer cell lines overexpressing miRNA-34a had significantly higher apoptosis rates than the negative control groups (P<0.05). The results of Western blot indicated that cervical cancer lines overexpressing miRNA-34a had increased expression of cleaved caspase 9 and cleaved PARP proteins after exposure to 4 Gy+ radiation. Conclusions Cervical cancer lines overexpressing miRNA-34a are successfully constructed in this study. Overexpression of miRNA-34a enhances the radiosensitivity of cervical cancer cells. The mechanism is related to the activation of apoptosis pathway.
		2016 Vol. 25 (12): 1356-1361 [Abstract] ( 1835 ) [HTML 1KB] [ PDF 929KB] ( 0 )

	1362	Effect of specific knockdown of BMI-1 on radiosensitivity enhancement in esophageal carcinoma cells
		Yang Xingxiao,Ma Ming,Zhang Weili,Wang Xuan,Liu Zhikun,Zhu Shuchai
		Objective To inhibit the expression of B-cell-specificmiv integration site-1(BMI-1) in esophageal cancer ECA109 cells by siRNA interference, and to observe the effects of BMI-1 knockdown on cell proliferation, migration, cell cycle, and apoptosis after exposure to radiation. Methods Effective BMI-1 siRNA was designed and synthesized based on the sequence of the BMI-1 mRNA. ECA109 cells transfected with BMI-1 siRNA and negative control (NC) siRNA were assigned to BMI-1 siRNA group and NC group, while ECA109 cells without transfection were set as a control. Real-time PCR and Western blot were used to determine the mRNA and protein expression of BMI-1 in ECA109 cells, respectively. The Transwell chamber assay was used to evaluate the migration ability of BMI-1-knockdown ECA109 cells. The MTT assay, flow cytometry, and colony formation assay were used to evaluate the effects of BMI-1 knockdown on the radiosensitivity of ECA109 cells. Results Compared with the NC group and the control group, the BMI-1 siRNA group had significantly lower mRNA and protein expression of BMI-1 and significantly reduced cell proliferation and migration after exposure (P=0.024,P=0.000). According to the results of the colony formation assay, there was no significant difference in radiosensitivity between the control group and the NC group (P=0.025,P=0.031), while the BMI-1 siRNA group had significantly higher radiosensitivity than the control group and the NC group (P=0.000). According to the results of flow cytometry, the BMI-1 siRNA group had a significantly lower percentage of G₂/M cells and significantly increased apoptosis after exposure than the control group and the NC group (P=0.000,0.000);however, there was no significant difference in apoptosis between the three groups before radiation (P=0.350). Conclusions SiRNA-mediated BMI-1 knockdown and X-ray radiation effectively reduce the expression of BMI-1, inhibit sublethal damage repair, and increase the radiation lethality in esophageal cancer ECA109 cells.
		2016 Vol. 25 (12): 1362-1367 [Abstract] ( 1681 ) [HTML 1KB] [ PDF 1016KB] ( 0 )

Experience exchange

	1368


		2016 Vol. 25 (12): 1368-1368 [Abstract] ( 1455 ) [HTML 1KB] [ PDF 734KB] ( 0 )

Review Articles

	1369	Research advances in radiotherapy combined with targeted molecular therapy for locally advanced non-small cell lung cancer
		Fu Zhixue,Liang Jun
		Radiotherapy alone and chemoradiotherapy are main approaches for treating unresectable locally advanced non-small cell lung cancer (NSCLC). However, the overall efficacy of these treatment approaches is far from satisfactory. Recently, targeted molecular therapy has become a milestone in the treatment of locally advanced lung cancer. Particularly, inhibitors of epidermal endothelial growth factor and vascular endothelial growth factor have been widely used. Right now, more and more studies focus on radiotherapy combined with targeted molecular therapy for treating locally advanced NSCLC. According to the reported phaseⅠ-Ⅲ clinical trials, whether radiotherapy combined with targeted molecular therapy has better efficacy than concurrent chemoradiotherapy, sequential chemoradiotherapy, or radiotherapy alone still needs further studies. This paper provides a systematic analysis of radiotherapy combined with targeted molecular therapy for locally advanced NSCLC.
		2016 Vol. 25 (12): 1369-1374 [Abstract] ( 2155 ) [HTML 1KB] [ PDF 913KB] ( 0 )

	1375	Research progress in PD-1/PD-L1 monoclonal antibody combined with radiotherapy in treatment of solid tumors
		Wang Qianrong,Li Baosheng
		D-1/PD-L1 monoclonal antibody combined with radiotherapy enhances anti-tumor immune response and achieves substantial treatment outcomes in preclinical studies of some solid tumors. Therefore, the combination therapy is a promising clinical treatment mode for solid tumors. Extensive studies have focused on the mechanism, timing, fractionation mode, and radiation dose of the combination therapy. This paper reviews the research progress in PD-1/PD-L1 monoclonal antibody combined with radiotherapy for treating solid tumors.
		2016 Vol. 25 (12): 1375-1378 [Abstract] ( 2277 ) [HTML 1KB] [ PDF 856KB] ( 0 )

	1379	Advances of radiobiology in stereotactic body radiation therapy
		Yi Peiqiang,Fu Jie
		RT can not only give the tumor a high dose of irradiation,but also protect the surrounding normal tissue as much as possible. SBRT is consistent with the general law of the dose-effect of tumor radiation biology,which the high dose radiation will increase the damage to the tumor. Compared to conventional radiation therapy,SBRT has less fractions (1-5),and higher single dose (8-30 Gy).The LQ (Linear-Quadratic) model which applied in the multi-fractions conventional radiation therapy may not evaluate the biological effect accurately in large dose radiation. Some scholars proposed USC (universal survival curve),LQL (linear-quadratic-linear),gLQ (generalized-linear-quadratic) modified models to intent to predict the radiobiology better in SBRT.SBRT has become one of the important methods to treat the tumor in Lung,Live,Spine and other organs. Advances in radiation biology can further explore the clinical application of SBRT,which contributes to improve the therapeutic effect of tumor radiotherapy
		2016 Vol. 25 (12): 1379-1383 [Abstract] ( 1778 ) [HTML 1KB] [ PDF 902KB] ( 0 )

	1384	Research advances in protection against radiation-induced lung injury by drugs
		Gao Zhen,Wang Gaoren,Ju Yongjian
		Radiation-induced lung injury is the most common complication after radiotherapy for chest tumor. It is mainly characterized by early radiation-induced pneumonia and late radiation-induced pulmonary fibrosis. Radiation-induced lung injury is closely related not only to irradiation volume and dose, but also to the expression of many cytokines and signal transduction. This paper reviews the research advances in protection against radiation-induced lung injury by various drugs.
		2016 Vol. 25 (12): 1384-1387 [Abstract] ( 1958 ) [HTML 1KB] [ PDF 843KB] ( 0 )

Symposium

	1388	Interpretation of the clinical practice guidelines by MASCC/ ISOO in 2014 for the management of mucositis secondary to cancer therapy
		Li Meng,Deng Aiping,Wang Yi
		For finding the standard treatment of oral mucositis and gastrointestinal mucositis secondary to cancer therapy. To search CNKI and pubmed data base for the keywords of mucositis and guidelines. No corresponding guidelines were found in CNKI;the first guidelines were published by the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) in 2004 and updated in 2014.The interpretation of the new guidelines can provide a reference for domestic counterparts.
		2016 Vol. 25 (12): 1388-1391 [Abstract] ( 1702 ) [HTML 1KB] [ PDF 922KB] ( 0 )

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Cancer Hospital of Chinese
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