Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2017 Vol.26 Issue.5 Published 2017-04-21

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

Special Feature

	489	Clinical application of brachytherapy for malignant tumors (1):head and neck and thoracic tumors Cheng Guanghui
		Cheng Guanghui
		In this article, recent clinical data of brachytherapy around the world are analyzed and combined with the clinical experience from the author and her research team. The author summarizes the indications, contraindications, target range, dosage, efficacy, and side effects to form a mature brachytherapy regimen. The systematic work may provide a reliable reference for domestic counterparts and be helpful for improving brachytherapy. This article mainly discusses head and neck and thoracic tumors.
		2017 Vol. 26 (5): 489-494 [Abstract] ( 1590 ) [HTML 1KB] [ PDF 1020KB] ( 0 )

Consensus

	495	Expert consensus on work flow and quality control of CT-guided ¹²⁵I seed permanent interstitial brachytherapy assisted by 3D-printing non-coplanar templates
		Radiation Oncology Branch of Chinese Medical Association,Radiotherapy Specialized of China Physicians Committee,Radiotherapy Specialized of China Research Hospital Committee,Minimally Invasive Treatment Branch of China Elderly Cancer Society,Chinese North Multi Center Cooperative Group of Particles Radiotherapy Specialized of Beijing Medical Association
		Permanent radioactive seed implantation belongs to the interstitial brachytherapy which delivers a high dose to the target volume and low doses to the surrounding normal tissues. Seed implantations are under puncture guidance which leads to minimal injury and rapid recovery, thus becoming the standard therapy for early-stage prostate carcinoma. Radioactive seed implantations require the guidance by ultrasound, CT, and MRI assisted by the navigator system to ensure accurate seed distribution in the target volume and a high degree of consistency with preoperative planning. To realize a conformal and precise dose distribution in the target volume, image guidance with template assistance is the key. ¹²⁵I seed implantation under ultrasound guidance with transperineal template assistance has become a very successful therapy for prostate carcinoma, but no criteria are available for its use in other carcinomas. Here we review the consensus on the ¹²⁵I seed implantation therapy under CT-guidance assisted by 3D-printing non co-planar template (3D-PNCT), including radiation physics and dosimetry, indications, and 3D-PNCT work flow. Despite the effectiveness of ¹²⁵I seed implantation as a local therapy for solid tumors, there is still a compelling need for prospective, randomized, multi-center clinical trials to get high-level evidence to confirm the role of ¹²⁵I seed implantation in the comprehensive treatment of cancer.
		2017 Vol. 26 (5): 495-500 [Abstract] ( 1802 ) [HTML 1KB] [ PDF 870KB] ( 0 )

Head and Neck Tumors

	501	Study on N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy and RTOG guidelines for cervical lymph node levels
		Kang Min,Zhao Tingting,Zhou Pingting,Liao Xueyin,Wei Tingting,Wang Rensheng
		Objective To propose a new N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy (IMRT) and Radiation Therapy Oncology Group (RTOG) guidelines for cervical lymph node levels.Methods A retrospective analysis was performed in 324 patients with newly diagnosed nasopharyngeal carcinoma who had no distant metastasis confirmed by pathology and received IMRT in the Department of Radiation Oncology in The First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2011.They were restaged according to the 7^th edition of UICC/AJCC staging system for nasopharyngeal carcinoma. The survival rates were estimated using the Kaplan-Meier method and the log-rank test was used for univariate prognostic analysis. The Cox proportional hazards model was used for multivariate prognostic analysis. Results Of 324 patients,269(83.0%) had lymph node metastasis. The median follow-up was 58 months (6-77 months).The 5-year overall survival,disease-free survival,relapse-free survival,and distant metastasis-free survival rates were 84.8%,77.1%,92.7%,and 80.5%,respectively. Univariate and multivariate analyses of patients with positive cervical lymph nodes revealed that retropharyngeal lymph node status,cervical lymph node level,and laterality were evaluated as independent prognostic factors for nasopharyngeal carcinoma. According to the hazard ratio calculated,the N staging system was revised as follows:N₀:no regional lymph node metastasis;N₁:VⅡ_a or/and unilateral levels (I,Ⅱ,Ⅲ,V_a) involvement;N₂:bilateral levels (I,Ⅱ,Ⅲ,V_a) involvement;N₃:levels IV_a,V_b,and IV_b+V_c involvement. Conclusions The proposed N staging system is based on IMRT and RTOG guidelines for lymph node levels and more practical,and can provide highly Objective prediction of outcome and guide treatment in nasopharyngeal carcinoma.
		2017 Vol. 26 (5): 501-507 [Abstract] ( 1603 ) [HTML 1KB] [ PDF 1406KB] ( 0 )

	508	A meta-analysis of diffusion tensor imaging for diagnosis of early radiation-induced brain injury
		Li Junchen,Li Guohua,Hu Chunhong
		Objective To analyze the diagnostic value of diffusion tensor imaging (DTI) for early radiation-induced brain injury.Methods We searched CNKI and PubMed and included articles according to the PRISMA statement. FA value, λ_\|\|, and λ_丄 were pooled, and Forest plot generation, cumulative analysis, sensitivity analysis, and regression analysis were performed. We also used the funnel plot to analyze publication bias. Results A total 11 studies were included for meta-analysis. The results of FA value heterogeneity test were as follows:P=0.000, I²=93.6% in China;P=0.004, I²=82.2% in other countries and regions;P=0.000, I²=91.5% in all regions. The regression analysis of time-dose dependence and study design showed significant and non-significant associations, respectively, with the heterogeneity of these studies (adjusted P=0.026, P=0.005;adjusted P=0.859, P=0.908). The results of λ_\|\| and λ_丄 heterogeneity tests were as follows:P=0.908, I²=0.0%;P=0.100, I²=56.6%. There was a sign of publication bias by Egger’s test (coefficient:-6.26, 95% CI:-9.31 to -3.20, P=0.001) and Begg’s test (P=0.004). Conclusions DTI-derived metrics are sensitive and reliable in the diagnosis of early radiation-induced brain injury.
		2017 Vol. 26 (5): 508-512 [Abstract] ( 1367 ) [HTML 1KB] [ PDF 976KB] ( 0 )

	513	A retrospective study of the treatment for epithelial-myoepithelial carcinoma
		Zhang Jianghu, Huang Xiaodong,Gao Li,Yi Junlin,YangLin,Ma Peiqing,Xu Guozhen,Luo Jingwei,Xiao Jiangping,Wang Kai,Qu Yuan,Zhang Shiping
		Objective To evaluate the risk of locoregional recurrence (LRR) and the influencing factors for long-term survival in patients with epithelial-myoepithelial carcinoma (EMCa).Methods A retrospective analysis was performed for 18 EMCa patients, who received initial therapy or initial adjuvant therapy in our hospital from 1999 to 2015, to investigate their survival. Among these patients, 8(44%) underwent surgery alone, 9(50%) received adjuvant radiotherapy, and 1(6%) received radical concurrent chemoradiotherapy. Locoregional recurrence-free survival (LRFS) and overall survival (OS) rates were compared between these groups. The Kaplan-Meier mtthod was used to calculated survival rates and log-rank test was used to compare the LRFS.Results With a median follow-up time of 46 months, 5 patients developed LRR, and the 5-year LRFS and OS rates were 69% and 93%, respectively. The patients treated with radiotherapy had a significantly higher 5-year LRRFS rate than those not treated with radiotherapy (71% vs. 57%, P=0.569). Conclusions LRR is the main failure mode of EMCa treatment, and further improving local control is the key to improved survival.
		2017 Vol. 26 (5): 513-516 [Abstract] ( 1391 ) [HTML 1KB] [ PDF 2267KB] ( 0 )

Thoracic Tumors

	517	Clinical effect of three-dimensional radiotherapy combined with chemotherapy for esophageal squamous cell carcinoma:a study of 1257 patients
		Zhand Andu,Han Jing,Han Chun,Kong Jie,Wang Lan,Zhang Jun,Hao Kaikai
		Objective To compare the efficacy between three-dimensional radiotherapy (3DRT) combined with chemotherapy and radiotherapy alone for patients with esophageal squamous cell carcinoma.Methods A retrospective analysis was performed for 1257 patients with esophageal squamous cell carcinoma who were admitted to our hospital from July 2003 to June 2012 and met the inclusion criteria;362 patients were treated with 3DRT combined with chemotherapy (chemoradiotherapy group) and 895 patients were treated with radiotherapy alone (radiotherapy group). The short-term outcome, overall survival (OS) rate, and causes of death were analyzed. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis. Results The response rate was 99.1%(346/349) in the chemoradiotherapy group and 99.0%(813/821) in the radiotherapy group (P=0.397). The 1-, 3-, and 5-year OS rates were 74.0%,42.0%,and 32.9% in the chemoradiotherapy group and 65.9%,33.0%,and 23.3% in the radiotherapy group (P=0.000), and were 75.6%,43.5%,and 33.2% in the concurrent chemoradiotherapy group and 65.9%,33.0%,and 23.3% in the radiotherapy group (P=0.000). There were no significant differences in 1-, 3-, and 5-year OS rates between the concurrent chemoradiotherapy group and the sequential chemoradiotherapy group (P=0.583). The sequential chemoradiotherapy group had an insignificant increase in 1-, 3-, and 5-year OS rates compared with the radiotherapy group (P=0.065). Tumor recurrence and local control failure were the main causes of death, followed by distant metastasis. The chemoradiotherapy group had a significantly lower proportion of patients who died of local control failure than the radiotherapy group (7.4% vs. 14.7%, P=0.003). Conclusions For patients with esophageal squamous cell carcinoma, chemoradiotherapy leads to significantly improved overall survival compared with radiotherapy alone;compared with radiotherapy alone, sequential chemoradiotherapy results in an increasing trend in OS rates, while concurrent chemoradiotherapy results in significantly increased OS rates. Chemoradiotherapy can reduce the deaths due to local control failure compared with radiotherapy alone.
		2017 Vol. 26 (5): 517-521 [Abstract] ( 1438 ) [HTML 1KB] [ PDF 1077KB] ( 0 )

	522	Influence of microextension on clinical target volume delineation in adenocarcinoma and squamous cell carcinoma among patients with non-small cell lung cancer
		Zhang Weike,Xie Limei,Wang Zhongshan,Pang Dequan
		Objective To better understand the relationship between the maximum tumor diameter and the most distant micrometastases in different types of non-small cell lung cancer (NSCLC) and to provide histological evidence for the delineation of clinical target volume (CTV) from gross tumor volume.Methods We retrospectively studied the pathological specimens from 113 surgically treated NSCLC patients (44 squamous cell carcinoma patients and 69 adenocarcinoma patients) who were admitted to our hospital from 2014 to 2015. The maximum tumor diameter was determined by a combination of gross and microscopic measurements. Micrometastases were microscopically determined. The distances between the tumor edges and micrometastases outside the tumor boundaries were measured by an ocular micrometer followed by a calculation. Quantitative data were analyzed by t test, and qualitative data were analyzed by logistic regression. Results The regression relationship between the maximum tumor diameter and micrometastases was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group (P=0.151). The association between the presence or absence of lymph node metastasis and the most distant micrometastasis was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group (P=0.597). No association between the degree of tumor differentiation and the most distant micrometastasis was observed in either group (P=0.113). The average measurement of the most distant micrometastases was 2.94 mm in the adenocarcinoma group, with 7.5 mm as the distance to cover 95% of the most distant micrometastases. To reach the same coverage, 4 mm was needed for tumor size smaller than 3 cm, 6 mm for those between 3 cm and 5 cm, and 7.5 mm for those larger than 5 cm. The average measurement of the most distant micrometastases was 2.69 mm in the squamous cell carcinoma group, with 6 mm as the distance to cover 95% of the most distant micrometastases. Conclusions For NSCLC, the most distant micrometastasis of adenocarcinoma is associated with the maximum tumor diameter and presence or absence of lymph node metastasis, and the CTV should thus be adjusted accordingly;no relevance between the most distant micrometastasis and maximum tumor diameter is observed in squamous cell carcinoma;there is no relationship between the most distant micrometastasis and the degree of tumor differentiation in adenocarcinoma and squamous cell carcinoma.
		2017 Vol. 26 (5): 522-526 [Abstract] ( 1386 ) [HTML 1KB] [ PDF 1840KB] ( 0 )

	527	Clinical effect of whole brain radiotherapy for brain metastases from lung adenocarcinoma in patients with or without EGFR mutations
		Zhang Xiaqin,Li Hongwei,Wang Weili,Jia Sufang,Bai Wei,Cao Jianzhong,Song Xin
		Objective To compare the clinical effect of whole brain radiotherapy (WBRT) for brain metastases from lung adenocarcinoma between patients with and without epithelial growth factor receptor (EGFR) mutations.Methods A retrospective analysis was performed for 89 patients with brain metastases from lung adenocarcinoma who were treated in our hospital from August 2010 to May 2015. EGFR testing was performed in all patients. WBRT (6-MV external X-ray beam) was performed at 30 Gy in 10 fractions or 40 Gy in 20 fractions;for patients with ≤3 brain metastases, simultaneous integrated boost intensity-modulated radiotherapy was performed at 40-45 Gy in 10 fractions or 50-60 Gy in 20 fractions. The response rate, intracranial progression-free survival (IPFS), and overall survival (OS) were compared between patients with EGFR mutations and patients with wild-type EGFR. The Kaplan-Meier method was used to calculate IPFS and OS, the log-rank test was used for survival difference analysis and univariate prognostic analysis, and the Cox model was used for multivariate prognostic analysis. Results For these 89 patients, the overall response rate was 62%, the median IPFS was 7.0 months (95%CI:6.060-7.940), and the median OS was 12.0 months (95%CI:9.539-14.465). The univariate and multivariate analyses showed that the response rate was associated with Karnofsky Performance Scale (KPS) score and EGFR mutation status (P=0.009 and 0.035);KPS score and EGFR mutation status were significant prognostic factors for IPFS (P=0.048 and 0.000);KPS score and primary tumor control were significant prognostic factors for OS (P=0.000 and 0.031). Conclusions After WBRT for brain metastases from lung adenocarcinoma, the patients with EGFR mutations have a higher response rate and a longer IPFS compared with those with wild-type EGFR, but there is no significant in OS between the two groups of patients.
		2017 Vol. 26 (5): 527-531 [Abstract] ( 1405 ) [HTML 1KB] [ PDF 846KB] ( 0 )

	532	Prognostic role of primary tumor burden in extranodal nasal-type NK/T-cell lymphoma
		Qi Shunan,Xu Liming,Yuan Zhiyong,Cao Jianzhong,Lan Shengmin,Wu Junxin,Wu Tao,Zhu Suyu,Qian Liting,Hou Xiaorong,Zhang Fuquan,Zhang Yujing,Zhu Yuan,Yang Yong,Li Yexiong
		Objective There is still a lack of effective clinical prognostic factors for predicting outcomes and guiding treatments in extranodal nasal-type NK/T-cell lymphoma (NKTCL). This study was aimed to investigate the clinical features and prognostic role of primary tumor burden (PTB).Methods A total of 1383 patients were recruited from ten hospitals, including 947 stage Ⅰ patients (68.5%), 326 stage Ⅱ patients (23.6%), and 110 stage Ⅲ-IV patients (8.0%). There were 751 patients (54.3%) presenting with high PTB (H-PTB). The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was conducted for survival difference analysis. Meanwhile, a multivariate analysis was performed using the Cox regression model. Results H-PTB was associated with high invasive potential, high frequency of B symptoms, advanced stage, regional lymph node involvement, lactate dehydrogenase elevation, and poor performance status. The patients with H-PTB had significantly lower 5-year overall survival (OS) and progression-free survival (PFS) rates than those with low PTB (L-PTB)(OS:50.2% vs. 72.1%, P=0.000;PFS:41.8% vs. 62.5, P=0.000). PTB was an independent prognostic factor for both OS (HR=1.851) and PFS (HR=1.755) according to the Cox multivariate analysis. Moreover, H-PTB was associated with significantly lower locoregional control (LRC) in early-stage NKTCL, and the 5-year LRC rate was 71.6% in patients with H-PTB and 84.3% in those with L-PTB (P=0.000). Conclusions H-PTB is associated with multiple adverse clinical features in NKTCL, and it is an independent indicator for poor outcomes and LRC. H-PTB can be used as a reliable indicator for risk stratification and treatment decision.
		2017 Vol. 26 (5): 532-537 [Abstract] ( 1409 ) [HTML 1KB] [ PDF 1966KB] ( 0 )

	538	Clinical efficacy of preoperative neoadjuvant chemoradiotherapy for unresectable locally advanced adherent colon cancer in 40 patients
		Yu Xin,Li Liren,Xiao Weiwei,Wang Qiaoxuan,Ding Peirong,Zeng Zhi-fan,Chen Gong,Pan Zhizhong,Wan Deseng,Gao Yuanhong
		Objective To investigate the efficacy and toxicities of neoadjuvant chemoradiotherapy (neoCRT) in the management of unresectable locally advanced adherent colon cancer (LAACC).Methods A retrospective analysis was performed on the clinical records of 40 patients with initially diagnosed unresectable LAACC who received preoperative neoCRT in our center from October 2010 to December 2015. Results Thirty-nine patients completed the preoperative neoCRT.Thirty-four patients underwent radical resection after neoCRT, and the R₀ resection rate, pathological complete response rate (pCR), tumor downstaging rate, nodal downstaging rate, and clinical downstaging rate were 91%, 24%(8/34 patients), 76%(26/34 patients),100%(32/32 patients), and 94%(32/34 patients), respectively. Among the 21 patients with bladder invasion, the full bladder was preserved in 7 patients (33%) and partial cystectomy was performed in 11 patients (52%).During the course of neoCRT, the grade 3-4 hematologic toxicity rate, grade 3 hand-foot syndrome rate, grade 3 radiodermatitis, and incomplete intestinal obstruction rate were 23%, 3%, 3%, and 5%, respectively. The 3-year sample size was 25 patients. For all the patients, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 75% and 80%, respectively. Of the 34 patients who received surgical radical resection, the 3-year OS and disease-free survival (DFS) rates were 87% and 81%, respectively. In addition, local tumor recurrence was identified in 3 patients, and distant metastasis was identified in 6 patients. Conclusions NeoCRT is an effective treatment for unresectable LAACC that results in significant tumor downstaging and enhanced R₀ resection rate without an increase in surgical complications. The patients treated with radical surgical resection after neoCRT show a satisfactory short-term outcome. Further studies will be required to determine the clinical value of neoCRT in treating LAACC.
		2017 Vol. 26 (5): 538-541 [Abstract] ( 1380 ) [HTML 1KB] [ PDF 786KB] ( 0 )

	542	Efficacy and adverse effects of hypofractionated radiotherapy versus conventionally fractionated radiotherapy in patients with intermediate-to high-risk localized prostate cancer:a meta-analysis
		Guo Wei,Gu Xiaobin,Qi Xin,Gao Xianshu,Ma Mingwei,Cui Ming,Xie Mu,Bai Yun,Peng Chuan
		Objective To compare the efficacy and adverse effects of hypofractionated radiotherapy versus conventionally fractionated radiotherapy for intermediate-to high-risk localized prostate cancer .Methods A literature search was performed in PubMed, Embase, Web of Science, CNKI, VIP database, and Wanfang Data to collect the controlled clinical trials of hypofractionated radiotherapy versus conventionally fractionated radiotherapy in patients with intermediate-to high-risk localized PCa published up to August 31, 2016. Stata 12.0 was used for meta-analysis. The difference between two groups was estimatedby calculating the hazard ratio (HR) or risk ratio (RR) with 95% confidence interval (CI). Results According to the inclusion and exclusion criteria, a total of 5 controlled clinical trials involving 1621 patients with PCa were included in this meta-analysis. The meta-analysis showed that overall survival (HR=1.00, 95%CI:0.85-1.17, P=0.980) and biochemical failure (RR=0.87, 95%CI:0.68-1.12, P=0.274) were comparable between the two groups. Compared with the conventionally fractionated radiotherapy, the incidence of acute gastrointestinal adverse events (grade≥2) was significantly higher in the hypofractionated radiotherapy (RR=1.94, 95%CI:1.23-3.06, P=0.004). However, there were no significant differences in the incidence of acute genitourinary adverse events (grade≥2)(RR=1.03, 95%CI:0.92-1.14,P=0.626), late gastrointestinal adverse events (grade≥2)(RR=1.17,95%CI:0.90-1.51, P=0.238), and late genitourinary adverse events (grade≥2)(RR=1.11, 95%CI:0.94-1.30, P=0.228) between the two groups. Conclusions Conventionally fractionated radiotherapy and hypofractionated radiotherapy have comparable therapeutic effects in patients with intermediate-to high-risk localized PCa. Although the patients treated with hypofractionated radiotherapy have a higher incidence of acute gastrointestinal adverse events than those treated with conventionally fractionated radiotherapy, the incidence of late gastrointestinal and genitourinary adverse events is comparable between the two groups of patients and the adverse effects are tolerable.
		2017 Vol. 26 (5): 542-545 [Abstract] ( 1355 ) [HTML 1KB] [ PDF 865KB] ( 0 )

	546	Clinical efficacy and safety of recombinant adenovirus-p53 combined with concurrent radiotherapy and hyperthermia in treatment of advanced soft tissue sarcoma:a study of 76 patients
		Xiao Shaowen,Xu Yizhi,Zhang Shanwen,Liu Changqing,Fang Zhiwei,Bai Chujie,Li Dongming,Li Yongheng,Cai Yong,Sun Yan,Zheng Baomin,Su Xing,Xu Gang
		Objective To evaluate the efficacy and safety of recombinant adenovirus-p53(rAdp53) injection combined with radiotherapy and hyperthermia in the treatment of unresectable advanced soft tissue sarcoma.Methods In this retrospective study, we evaluated 76 patients with unresectable advanced primary or recurrent soft tissue sarcoma treated in our hospital from November 2005 to November 2012. These patients received radiotherapy and hyperthermia with rAdp53(p53 group, n=41) or without rAdp53(control group, n=35). rAdp53((1-2)×10¹² viral particles each time, once a week, 8 times on average) was injected into the tumor or infused into the pelvic cavity. Radiotherapy (2 Gy each time, 5 times a week) was performed for the planning target volume at 56.3±5.3 Gy in the p53 group and 58.1±4.2 Gy in the control group, with no significant difference between the two groups (P>0.05). Superficial or deep thermotherapy was employed 8 times on average (twice a week). Clinical features, response rate, time to progression (TTP), overall survival (OS), and adverse events were compared between the two groups (P>0.05). The Kaplan-Meier method was used to calculate OS;the log-rank test was used for survival difference analysis and univariate prognostic analysis;the chi-square test was used for comparison of categorical data. Results At 2 months after treatment, the p53 group had significantly increased response rate (partial response+ complete response+ stable disease)(85% vs. 54%, P=0.003) and local control rate (49% vs. 23%, P=0.020) as well as prolonged TTP (12 months vs. 5 months, P=0.010) and OS (48 months vs. 31 months, P=0.049), as compared with the control group. No adverse events caused by radiotherapy and hyperthermia except transient fever were seen in the two groups. Conclusions Concurrent radiotherapy and hyperthermia combined with rAdp53 injection is effective and safe for patients with advanced soft tissue sarcoma.
		2017 Vol. 26 (5): 546-549 [Abstract] ( 1276 ) [HTML 1KB] [ PDF 763KB] ( 0 )

	550	CT-guided interstitial brachytherapy for locally advanced cervical cancer:introduction of the technique and report of dosimetry
		Liu Zhongshan,Zhao Yangzhi,Guo Jie,Lin Xia,Lu Shuangchen,Wang Hongyong,Qiu Ling,Ren Xiaojun,Zhang Bingya,Wang Tiejun
		Objective To examine the dosimetric advantages of three-dimensional (3D) computed tomography (CT)-guided interstitial brachytherapy (BT) for target volume and surrounding normal tissue in patients with locally advanced cervical cancer,and to provide a simple and effective clinical treatment approach.Methods A total of 52 patients who had poor tumor response to external beam radiotherapy (EBRT) with a residual tumor greater than 5 cm at the time of BT were included. The patients were treated by 3D CT-guided interstitial BT using a “hybrid” applicator comprised of uterine tandem and free metal needles. The high-risk clinical target volume (HR-CTV),intermediate-risk clinical target volume (IR-CTV),and organs at risk (OAR) were contoured. The total dose,including external beam radiotherapy and high dose-rate BT,was biologically normalized to conventional 2 Gy fractions (EQD₂).D₉₀ and D₁₀₀ for both HR-CTV and IR-CTV,and D_{2 cc} for the bladder,rectum,and sigmoid were analyzed. Results The mean D₉₀ value for HR-CTV was 88.4±3.5 Gy. The D_{2 cc} for the bladder,rectum,and sigmoid were 81.1±5.6,65.7±5.1,and 63.1±5.4 Gy,respectively.D_{2 cc} ≤90 Gy for the bladder and D_{2 cc} ≤70 Gy for the sigmoid wereobserved in all the patients.D_{2 cc} ≤70 Gy for the rectum was observed in 89% of patients. Conclusions 3DCT-guided interstitial BT has a significant dosimetric advantage for target volume accompanied by few minor complications,and thereby may be clinically feasible for treating locally advanced cervical cancer. However,its long-term efficacy and possible toxicities will require further clinical observation.
		2017 Vol. 26 (5): 550-554 [Abstract] ( 1557 ) [HTML 1KB] [ PDF 1691KB] ( 0 )

Physics·Biology·Technology

	555	Application of 4DCT and MRI image deformation registration in the determination of primary liver cancer radiotherapy target
		Huang Fujing,Ma Changsheng,Wang Ruozheng,Gong Guanzhong,Shang Dongping,Yin Yong
		Objective To investigate the feasibility of defining the radiotherapy target of primary liver cancer using four-dimensional computed tomography (4DCT) and T₂-weighted magnetic resonance (MR-T₂) deformable image registration.Methods Ten patients with hepatocellular carcinoma (HCC) who first received radiotherapy were included in this study. The 4DCT in free breathing and MR-T₂ in deep breathing were acquired sequentially. 4DCT were sorted into ten series of CT images according to the respiratory phase. MIM software was used for deformable image registration. The accuracy of deformable image registration was assessed by the maximal displacements in three-dimensional directions of the portal vein and the celiac trunk and the degree of liver overlapping (P-LIVER). Gross tumorvolume (GTV) was delineated on different series of CT images and the internal GTV (IGTV) was merged by ten GTVs on 4DCT images in each phase. The MR-T₂ image was deformably registered to 4DCT images in each phase to acquire ten GTV_DR. The IGTV_DR was obtained by merging the ten GTV_DR. The differences between different target volumes were compared by paired t-test. Results The maximal displacements in three-dimensional directions of the portal vein were 0.3±0.8 mm along the x-axis, 0.8±1.8 mm along the y-axis, and 0.5±1.5 mm along the z-axis. The maximal displacements in three-dimensional directions of the celiac trunk were 0.1±1.0 mm along the x-axis, 0.7±1.2 mm along the y-axis, and 0.6±2.0 mm along the z-axis. Overlapping degree was 115.4±13.8%. The volumes of GTVs obtained from 4DCT images in each phase after DR increased by an average of 8.18%(P<0.05), and were consistent with those delineated on MR-T₂ images. The IGTV after DR increased by an average of 9.67%(P<0.05). Conclusions MRI image can show more information and have a higher contrast than CT image. MRI images should be combined with 4DCT images for delineating the GTV. It can better determine the scope and trajectory of the target and improve the delineation accuracy of HCC target.
		2017 Vol. 26 (5): 555-559 [Abstract] ( 1558 ) [HTML 1KB] [ PDF 2344KB] ( 0 )

	560	Dosimetric evaluation of four adaptive IMRT strategies for head-neck cancer
		Tan Shuhui,Li Yufeng,Huang Pu,Lou Jingjiao,Li Hongsheng,Yin Yong,Li Dengwang
		Objective To investigate the effects of numerous re-planning strategies on the anatomic and dosimetric outcomes of target volume and organs at risk (OARs) in patients with head and neck cancer receiving fractionated radiotherapy.Methods From 2015 to 2016,28 patients with head and neck cancer were enrolled in this study with Shandong Cancer Hospital,consisting of 19 patients with nasopharyngeal carcinoma, 4 patients with laryngocarcinoma, and 5 patients with carcinoma of the maxillary sinus. All of them received conventionally fractionated radiotherapy. Each patient had six weekly cone-beam CT (CBCT) scans, which were performed on the first day of every week, to obtain reference images. A virtual CT image was generated by registration of planning CT and each weekly CBCT image. The four re-planning strategies were used for the reconstruction of re-planned dose, while the initial planning was used as a reference. The weekly doses calculated using virtual CT were summed together to obtain the actual dose. The actual and initial planned doses were evaluated. The nonparametric Friedman test was used to evaluate the differences between multiple groups, and the differences between any two groups were analyzed by paired t test. Results The sizes of planning target volume, clinical target volume, and left/right parotid glands (PGs) changed significantly within the six weeks (P=0.041, 0.046, 0.024, and 0.017, respectively).For these four re-planning strategies, there were significant differences between the actual dose and the initial planned dose to the PGs (all P<0.05), with average values decreased by 5.02%, 11.17%, 12.08%, and 13.19%, respectively, compared with that in the reference strategy. Conclusions Re-planning during treatment course could ensure the sparing of OARs and allow for sufficient dose to the target volume. The higher the number of re-planning strategies, the more the actual dose is close to the initial planed dose;the efficiency of two re-planning strategies is the highest.
		2017 Vol. 26 (5): 560-564 [Abstract] ( 1985 ) [HTML 1KB] [ PDF 1157KB] ( 0 )

	565	Efficacy and safety of ¹²⁵I seed implantation for treating neuroblastoma in nude mice
		Zhang Wang,Yang Yan,Lyu Linya, Wang Shan,Kong Xiangru,Zhang Jun,Yang Jiao,Wang Yuchan
		Objective To examine the efficacy and safety of ¹²⁵I seed implantation for treating neuroblastoma (NB) in animal models.Methods A total of 45 nude mice models of neuroblastoma were constructed and divided into the ¹²⁵I group.control group.and blank group at 15 mice per group. The long and short diameters of the tumor were measured every 3 days.and the tumor inhibition rate was calculated every 9 days. Apoptotic and proliferative protein expression levels in tumor tissue and peritumoral tissue.as well as endocrine markers and bone marrow of the nude mice.were analyzed. The independent sample t test was used to compare the mean scores.and ANOVA was used for comparison between multiple groups. Results Tumor volume inhibition rate was significantly higher in the ¹²⁵I group than in the control group and blank group on days 9.18.and 27(all P<0.05).Caspase-3 expression in tumor tissues was significantly higher in the ¹²⁵I group than in the control group and blank group (all P<0.05).whereas proliferating cell nuclear antigen (PCNA) expression was significantly lower in the ¹²⁵I group than in the control group and blank group (all P<0.05).There was no significant difference in Caspase-3 and PCNA expression between the control group and blank group (all P>0.05).In addition.no significant difference in the expression of Caspase-3 and PCNA in peritumoral tissue was observed between the ¹²⁵I group.control group.and blank group (all P>0.05).Cell apoptosis in tumor tissue was significantly lower in the blank group and control group than in the ¹²⁵I group (all P<0.05).while there was no significant difference between the blank group and the control group (P>0.05).There was no significant difference in endocrine markers between the three groups (P>0.05).There was no significant bone marrow suppression in the ¹²⁵I group.and this observation was similar to those in the control group and blank group (all P>0.05).Conclusions ¹²⁵I seeds have significant toxicity to NB.¹²⁵I seed implantation is safe in nude mice with NB within the therapeutic doses.
		2017 Vol. 26 (5): 565-571 [Abstract] ( 1276 ) [HTML 1KB] [ PDF 1465KB] ( 0 )

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		2017 Vol. 26 (5): 572-574 [Abstract] ( 1347 ) [HTML 1KB] [ PDF 1408KB] ( 0 )

	575


		2017 Vol. 26 (5): 575-576 [Abstract] ( 1066 ) [HTML 1KB] [ PDF 726KB] ( 0 )

Experience exchange

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		2017 Vol. 26 (5): 577-577 [Abstract] ( 1167 ) [HTML 1KB] [ PDF 751KB] ( 0 )

Review Articles

	578	Advances in treatment of early-stage classical Hodgkin′s lymphoma
		Shen Jinwen,Zhu Yuan
		Much progress has been made in the diagnosis and treatment of Hodgkin′s lymphoma, which has become a highly curable malignancy. However, prolonged survival makes clinicians pay more attention to long-term toxicities of treatment. Consequently, individualized treatment based on disease stage and risk factors is a research hotspot at present. This article reviews recent advances in the individualized treatment of early-stage classical Hodgkin′s lymphoma.
		2017 Vol. 26 (5): 578-581 [Abstract] ( 1560 ) [HTML 1KB] [ PDF 783KB] ( 0 )

	582	Progress in the application of rituximab in treating primary mediastinal B-cell lymphoma
		Xu Liming,Yuan Yajing,Wang Peiguo,Wu Gang
		Primary mediastinal large B-cell lymphoma (PMBCL) is morphologically similar to diffuse large B-cell lymphoma (DLBCL) and nodular sclerosis Hodgkin lymphoma. For most PMBCL patients, chemotherapy plus consolidation radiotherapy showed that the latter could improve PMBCL responsiveness and progression-free survival (PFS), and its combined use with chemotherapy demonstrated higher therapeutic efficacy. Recent clinical studies suggested that rituximab and anthracycline chemotherapy regimens could increase PMBCL treatment efficacy, reduce early treatment failure, enhance PFS and overall survival, and improve prognosis. Although rituximab combined with some high-intensity chemotherapy without radiotherapy have achieved good results, many studies still support the use of post-immunochemotherapy consolidation mediastinal radiotherapy. Based on the results of a few studies with a small sample size, patients who were assessed as complete metabolic remission by PET following high-intensity immunochemotherapy may omit consolidation radiotherapy. However, these results will need to be further confirmed by large-sample multicenter clinical trials. Consolidation radiotherapy is recommended for patients with poor prognostic factors or PET score>3.
		2017 Vol. 26 (5): 582-587 [Abstract] ( 1568 ) [HTML 1KB] [ PDF 863KB] ( 0 )

	588	Advances in therapeutic options for peripheral T-cell lymphomas
		Wu Zheng,Zhu Suyu
		Peripheral T-cell lymphoma (PTCL) is a highly specific and invasive non-Hodgkin’s lymphoma derived from mature T-cells that leave the thymus. At present, the clinical progress in PTCLs is behind that in B-cell lymphomas, and the current treatments for PTCLs have low efficacy and poor overall prognosis. Therefore, there is currently still no standard treatment for PTCL. The efficacy of the conventional CHOP chemotherapy regimen is poor, and the value of radiotherapy in early-stage PTLC patients remains to be determined. Autologous hematopoietic stem cell transplantation is the top choice for consolidation treatment for high-risk patients, but the efficacy of novel drugs for PTCLs needs to be further confirmed. In addition, PET/CT plays a more important role in predicting the prognosis of PTCLs.
		2017 Vol. 26 (5): 588-592 [Abstract] ( 1285 ) [HTML 1KB] [ PDF 822KB] ( 0 )

	593	Significance of p53 in cervical cancer and its influence on radiosensitivity
		Li Ping,Chen Minbin
		Radiotherapy is a major local treatment for cervical cancer. However, local uncontrollability due to radioresistance is still common. Therefore, the prediction of radiosensitivity is quite beneficial to develop an optimal treatment strategy for individual patients. Multiple factors could influence the radiosensitivity of cells, and p53 status is one of them. The upstream or downstream molecules of p53 could also be regulated to affect the radiosensitivity of cervical cancer. The aim of the review is to analyze the difference in p53 status between different types of cervical cancer and to discuss how p53 regulates the response to radiotherapy.
		2017 Vol. 26 (5): 593-597 [Abstract] ( 1379 ) [HTML 1KB] [ PDF 830KB] ( 0 )

	598	Research progress in pathogenesis of myocardial fibrosis in radiation-induced heart damage
		Yao Ye,Zhong Yahua,Xie Conghua
		Myocardial fibrosis is a predominant pathological change of radiation-induced heart disease (RIHD) in late stage. It often occurs several or more than ten years after radiotherapy and can lead to myocardial remodeling, impaired cardiac function, and heart failure. At present there is no effective method to prevent or reverse the development of radiation-induced myocardial fibrosis. Many cells, cytokines, and other factors are involved in the development and progression of myocardial fibrosis in RIHD and some of them have been validated. But most investigators focused on the pathological changes and related mechanisms in early stage, and myocardial fibrosis was just regarded as an endpoint event. The definitive mechanisms of myocardial fibrosis in late stage remain unclear. This paper reveiws the studies about general mechanisms of myocardial fibrosis in RIHD and summarizes the roles of microcirculation dysfunction, mast cells, several cytokines, hypoxia, oxidative stress, and renin-angiotensin system, and points out the future research direction of the pathogenesis of myocardial fibrosis in RIHD. It provides new ideas for discovering the potential targets for clinical intervention of myocardial fibrosis in RIHD.
		2017 Vol. 26 (5): 598-602 [Abstract] ( 1384 ) [HTML 1KB] [ PDF 1015KB] ( 0 )

Symposium

	603	Selection, installation, and acceptance test of MRI simulator
		Chen Xinyuan,Han Wei,Song Yixin,Men Kuo,Niu Chuanmeng,Zuo Lijing,Ren Wenting,Dai Jianrong
		Magnetic resonance imaging (MRI) simulator (MRI-Sim) can provide superior images for radiotherapy. Due to the complexity of MRI technology and the safety problem caused by strong magnetic field, the acquisition and implementation of MRI simulation is more complicated than CT simulation. In order to ensure the introduction of MRI-Sim, this paper reviews the selection, installation, and acceptance test of MRI-Sim, including the selection of host and auxiliary equipment, installation site preparation, and safety precautions,as well as MRI-Sim acceptance test and commissioning.
		2017 Vol. 26 (5): 603-606 [Abstract] ( 1689 ) [HTML 1KB] [ PDF 1061KB] ( 0 )

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Chinese Medical Association

Cancer Hospital of Chinese
　Academy of Medical
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Chinese Anti-Cancer
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Chinese Journal of Lung
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