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.6 Published 2017-06-01

	Orignal Article

Orignal Article

	607	Clinical application of brachytherapy for malignant tumor (2):abdomen and pelvic cavity
		Cheng Guanghui
		This article analyzes recent clinical data on brachytherapy around the world, as well as the clinical experience from the author and her research team. The author summarizes the indications, contraindications, target volume, dosage, efficacy, and side effects to form a mature brachytherapy regimen. The work may provide a reliable reference for counterparts in China and be helpful for improving brachytherapy. This article mainly discusses brachytherapy for abdominal and pelvic malignant tumors.
		2017 Vol. 26 (6): 607-613 [Abstract] ( 1473 ) [HTML 1KB] [ PDF 1033KB] ( 0 )

	614	New suggestion for clinical downstaging of nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy
		Gao Jin,Chen Chen,Tao Yalan,Wang Xiaohui,Chang Hui,Li Xiaohui,Han Fei,Su Yong,Xia Yunfei
		Objective To propose a new suggestion for the clinical downstaging of nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT) without changing the current T,N,and M staging system. Methods We reviewed the records of 536 NPC patients treated in Sun Yat-Sen University Cancer Center from January 2002 to December 2006.The Kaplan-Meier method was used to calculate the disease-specific survival (DSS) rate,and the log-rank test was used for survival differenceanalysis. The Cox regression model was used to calculate the hazard ratio (HR) of each subset. ResultsAccording to the 7^th edition of UICC/AJCC staging system,the 5-year DSS rates of stage Ⅰ-Ⅲ patients (except T₃N₂M₀) were all more than 85%(P>0.05),those of stage Ⅳ_A and Ⅳ_B patients were 71.8% and 46.2%,respectively (P=0.171),and that of stage ⅠVC patients was only 24.0%.In stage Ⅲ,the 5-year DSS rate of non-T₃N₂M₀ patients (91.5%) was significantly higher than that of T₃N₂M₀ patients (78.6%)(P=0.042),but there was no significant difference in DSS between T₃N₂M₀ patients and stage Ⅳ_A and Ⅳ_B patients. Based on the above results,new stage Ⅰ included T_1-3N_0-1M₀ and T_1-2N₂M₀,new stage Ⅱ included T₃N₂M₀,T₄N_0-2M₀,and TxN₃M₀,and new stage Ⅲ included TxNxM₁.The 5-year DSS rates of new stage Ⅰ,Ⅱ,and Ⅲ patients were 93.3%,72.7%,and 24.0%,respectively (P=0.000).Compared with new stage Ⅰ patients,new stage Ⅱ and Ⅲ patients had HRs of 4.01 and 16.76,respectively,for 5-year DSS. Conclusions In the era of IMRT,the new clinical staging system (stages Ⅰ,Ⅱ,and Ⅲ) helps with prognostic evaluation and clinical treatment.
		2017 Vol. 26 (6): 614-620 [Abstract] ( 1650 ) [HTML 1KB] [ PDF 1147KB] ( 0 )

	621	Prognostic value of extracapsular spread of regional lymph nodes in nasopharyngeal carcinoma with 3DCRT based on magnetic resonance imaging
		Zhang Xiangguo, Liang Sixian, Pan Suming, Xu Xiaonan, Cheng Ying, Huang Juhong, Wang Jiaocheng, Ma Hongxia
		Objective To evaluate the prognostic value of the extracapsular spread (ECS) of regional lymph nodes in nasopharyngeal carcinoma (NPC) based on magnetic resonance imaging. MethodsA retrospective review was performed for 477 previously untreated patients with NPC who were treated in Yuebei People′s Hospital from January 2009 to December 2013.Univariate and multivariate survival analyses were performed to identify the prognostic value of ECS in NPC. Results There were 216 patients with ECS and 261 patients without ECS, and the median survival of the two groups of patients was 38.5 months and 39.0 months, respectively. The 3-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates of the patients with ECS versus those without ECS were 81.9% versus 90.7%, 65.8% versus 85.0%, 87.8% versus 95.8%, and 80.3% versus 92.9%, respectively (all P=0.000).The univariate analysis showed that N stage and ECS were important prognostic factors for OS, PFS, LRFS, and DMFS in NPC patients (P=0.000-0.004), and T stage and TNM stage were associated with OS, PFS, and DMFS (all P=0.000).The multivariate analysis using the Cox regression model showed that T stage was an independent prognostic factor for the survival of NPC patients, and ECS was an important prognostic factor for PFS, LRFS, and DMFS. Conclusion ECS of regional lymph nodes is a risk factor for local recurrence or distant metastasis in patients with NPC.
		2017 Vol. 26 (6): 621-626 [Abstract] ( 1523 ) [HTML 1KB] [ PDF 1161KB] ( 0 )

	627	Experience and efficacy of SBRT for lung cancer:an analysis of 200 patients
		Dong Baiqiang,Xu Yujin,Sun Xiaojiang,Zheng Xiao,Du Xianghui,Di Xiaoyun,Shan Guoping,Chen Weijun,Li Pu,Li Jianlong,Shao Kainan,Xu Yaping,Chen Ming
		Objective To evaluate the safety and clinical efficacy of stereotactic body radiation therapy (SBRT) for lung cancer. Methods A retrospective analysis was performed on 200 patients with primary non-small cell lung cancer (NSCLC)(118 patients) or solitary pulmonary metastasis (82 patients) who underwent SBRT in Zhejiang Cancer Hospital from January 2012 to September 2015. The 80% isodose line covered 95% of the planning target volume, and the 100% isodose line covered 100% of the internal gross tumor volume. The fractional dose was 4.0-18.0 Gy daily or every other day, and the biologically equivalent dose ranged from 40.0 to 151.2 Gy (median 100 Gy). Results All patients completed treatment. The follow-up rate was 96.0%. The complete response and partial response rates were 14.8%(17/115) and 65.2%(75/115) for the primary tumor group, versus 25%(19/77) and 38%(29/77) for the metastasis group. The incidence rates of grade Ⅱ and Ⅲ acute radiation pneumonitis were 4.7% and 3.1%, respectively. The median follow-up was 14.9 months. The 1-and 2-year local control rates were 95.7% and 84.3% for the primary tumor group, versus 92% and 73% for the metastasis group. The 1-and 2-year overall survival rates were 94.5% and 92.0% for the primary tumor group, versus 85% and 62% for the metastasis group. Conclusions SBRT is a safe and effective treatment for early primary NSCLC and solitary pulmonary metastasis, resulting in high 1-and 2-year local control and overall survival rates and low rate of complications.
		2017 Vol. 26 (6): 627-630 [Abstract] ( 1766 ) [HTML 1KB] [ PDF 771KB] ( 0 )

	631	Motion of gastroesophageal junction adenocarcinoma during preoperative radiotherapy
		Tang Yuan,Cui Weijie,Wang Xin,Jin Jing,Li Shuai,Li Ning,Liu Wenyang,Ren Hua,Fang Hui,Wang Weihu,Song Yongwen,Liu Yueping,Wang Shulian,Li Yexiong,Chen Bo,Tang Yu,Qi Shunan,Lu Ningning
		Objective To evaluate the range of motion of gastroesophageal junction (GEJ) adenocarcinoma during preoperative radiotherapy. Methods Fourteen consecutive patients who received preoperative chemoradiotherapy for GEJ adenocarcinoma were included in this study. Fiducial markers were placed on the upper and lower edges of and around the primary tumor under a gastroscope. Eight patients underwent four-dimensional computed tomography to obtain 98 intrafractional images containing 8 fiducial markers at the GEJ. Twelve patients underwent cone-beam computed tomography at the 1 st to 5th, 7th, 12th, 17th, and 22nd courses of radiotherapy to obtain 90 interfractional images. The paired t test was used for difference analysis. Results The intrafractional tumor displacements in left-right (LR), ventro-dorsal (VD), and cranio-caudal (CC) directions were 0.92±0.95 mm, 2.27±2.73 mm, and 9.95±5.48 mm, respectively;the motion in CC direction was larger than that in LR or VD direction (P=0.000 or P=0.000);the motion in VD direction was larger than that in LR direction (P=0.000). The interfractional tumor displacements in LR, VD, and CC were 6.56±4.19 mm, 5.69±3.29 mm, and 6.49±4.37 mm, respectively;the motion in LR or CC direction was larger than that in VD direction (P=0.031 or P=0.044);there was no significant difference between the motions in LR and CC directions (P=0.956). In order to ensure 95% of prescribed dose to at least 90% of the tumor volume, the margins from GEJ lesion in LR, VD, and CC directions were 19.4 mm, 14.6 mm, and 27.2 mm, respectively, which could cover both intrafractional and interfractional tumor displacements during preoperative radiotherapy. Conclusions GEJ tumor has a wide range of movement in preoperative intra-and inter-fractional radiotherapy. This should be considered for precise radiotherapy, and a new method should be selected to limit tumor movement.
		2017 Vol. 26 (6): 631-635 [Abstract] ( 1357 ) [HTML 1KB] [ PDF 962KB] ( 0 )

	636	The prognostic role of level of involved regional lymph node in patients with stage Ⅱ extranodal nasal-type NK/T-cell lymphoma of the upper aerodigestive tract
		Wu Runye,Qi Shunang,Chen Bo,Liu Kang,Jin Jing,Wang Shulian,Liu Yueping,Song Yongwen,Tang Yuan,Tang Yu,Li Ning,Lu Ningning,Ren Hua,Fang Hui,Yang Yong,Wang Weihu,Ouyang Han,Li Yexiong
		Objective This study aimed to evaluate the prognostic value of regional lymph node spread in patients with stage Ⅱ nasal-type NK/T-cell lymphoma of the upper aerodigestive tract (UADT-NKTCL). Methods From 1987 to 2013,a total of 97 patients with newly-diagnosed stage Ⅱ UADT-NKTCL were retrospectively reviewed. Primary tumors were located in the nasal cavity (n=52) or extranasal UADT sites (n=45).The majority of patients were treated with primary radiotherapy. Sixty-five patients were treated with combined modality therapy (CMT),and 32 patients were treated with radiotherapy alone (n=27) or chemotherapy alone (n=5).The Kaplan-Meier method was used to calculate the survival rate, and the log-rank test was used for survival difference analysis and monovariate prognostic analysis. The Cox regression model was used to multivariate prognostic analysis. Results The 5-year overall survival (OS) and progression-free survival (PFS) rates for all stage Ⅱ patients were 57% and 49%,respectively. The presence of a lower neck lymph node (defined as extension below the caudal border of the cricoid cartilage) was significantly associated with poor outcomes on univariate analysis and maintained significance on multivariate analysis. The median survival for patients with lower neck lymph node was 19.3 months and the 2-,5-years OS rates were 28% and 11%(P=0.000).For stage Ⅱ patients,CMT significantly improved survival. The 5-year OS and PFS rates were 64% and 52% for CMT,compared with 40.4%(P=0.006) and 42% for single modality therapy (P=0.088). Conclusion The level of regional lymph node is a powerful prognostic factor for stage Ⅱ UADT-NKTCL.The involvement of low neck lymph node is significantly associated with poorer survival outcomes.
		2017 Vol. 26 (6): 636-640 [Abstract] ( 1407 ) [HTML 1KB] [ PDF 863KB] ( 0 )

	641	Effect of deep inspiration breath-hold technique on dosimetry of target volume and organs at risk in mediastinal lymphoma irradiation
		Qi Shunan,Liu Zhiqiang,Cao Ying,Liu Shoufu,Fang Hui,Ren Hua,Chen Bo,Tang Yu,Lu Ningning,Li Ning,Tang Yuan,Song Yongwen,Liu Yueping,Wang Shulian,Jin Jing,Li Yexiong
		Objective Objective To evaluate the effect of deep inspiration breath-hold technique (DIBH) on the dosimetry of target volume and organs at risk (OARs) in mediastinal lymphoma irradiation. Methods This was a prospectively study and five patients with stage Ⅰ and Ⅱ mediastinal lymphomas were included continuously. The absolute target volume, the absolute OAR doses, and the relative doses to volume were compared between DIBH and free-breathing (FB) scans, based on the principles of the affected site irradiation and the “butterfly” field. The differences were analyzed using paired t test. Results The median age of these five patients was 30 years. Compared with FB scan, DIBH scan led to significant decreases in the gross tumor volume (GTV)(Δ=29.4 cm³, P=0.006) and the planning target volume (PTV)(Δ=322 cm³, P=0.005) before chemotherapy, while no significant difference in clinical target volume (CTV) was found. Meanwhile, the lung volume of DIBH scan was significantly increased (mean Δ=1456 cm³, P=0.001), while the heart width of DIBH scan was significantly reduced (Δ=1.3 cm, P=0.012), as compared with those of FB scan. The mean doses to the lung and heart were significantly lower in DIBH scan than in FB scan (heart:8.5±4.7 Gy vs. 11.6±4.7 Gy, P=0.022;lung:7.6±1.1 Gy vs. 11.6±1.4 Gy, P=0.000). The absolute target volume of the heart was significantly reduced at V₁₅ and above in DIBH scan than in FB scan (all P<0.05). Relative doses to volume of the lung and heart were significantly reduced at each dose level (from V₅ to V₃₅) in DIBH scan than in FB scan (all P<0.05). Conclusions DIBH technique can significantly reduce PTV, enlarge lung volume, and reduce the mean dose and relative doses to volume of the lung and heart at each level (from V₅ to V₃₅) compared with FB scan in mediastinal lymphoma radiation.
		2017 Vol. 26 (6): 641-645 [Abstract] ( 1323 ) [HTML 1KB] [ PDF 1832KB] ( 0 )

	646	Clinical features and treatment outcome of inflammatory myofibroblastic tumor:a retrospective study of 58 patients
		Zhang Jianghu,Gao Li,Yi Junlin,Yang Lin,Xu Guozhen,Luo Jingwei,Xiao Jianping,Wang Kai,Qu Yuan,Zhang Shiping,Huang Xiaodong
		Objective To evaluate the risk of locoregional recurrence (LRR) and the influencing factors for long-term survival in patients with inflammatory myofibroblastic tumor (IMT). Methods A retrospective analysis was performed for 58 IMT patients who completed initial therapy or initial adjuvant therapy in our hospital from January 2002 to January 2017 to evaluate their failure patterns and survival. The LRR and survival rates were compared between groups. 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 median follow-up time was 34 months. Among the 58 patients,50 underwent surgery alone,and 8 underwent surgery and adjuvant therapy. Seventeen patients experienced treatment failure,16 patients developed LRR,3 patients developed distant metastasis,including 2 patients with local failure,and 5 patients died of tumor recurrence or metastasis. The 5-year LRRFS was 75%,and the 5-year OS rate was 90%.The univariate analysis showed that resection margin and local staging were influencing factors for LRRFS (P=0.018,0). Conclusions Radical resection combined with adjuvant therapy is the key to improving the treatment outcome of IMT.
		2017 Vol. 26 (6): 646-649 [Abstract] ( 1609 ) [HTML 1KB] [ PDF 766KB] ( 0 )

	650	Correlation between weight loss and setup errors in intensity-modulated radiotherapy for rectal cancer
		Ye Zhixiong,Xu Qing,Peng Jiayuan,Zhang Yanjun,Xia Weiyi,Liu Xunchi,Hu Weigang,Zhang Zhen
		Objective To investigate the change in body weight over time in rectal cancer patients receiving radiotherapy and the correlation between setup errors and weight loss, and to establish the image-guided radiotherapy regimens in different periods of treatment. Methods A total of 24 postoperative patients with rectal cancer admitted to our hospital in 2016 were selected. Before each fraction of radiotherapy, the body weight was recorded, and the patients underwent cone-beam computed tomography (CBCT) with different frequencies in every week. The planning CT was matched with CBCT to obtain setup errors. The paired t test was used for difference analysis;the Pearson method was used to analyze the correlation between setup errors and weight loss. Results Body weight was measured 456 times in the 24 patients, and these patients underwent CBCT scans and image registration 456 times. Two patients were excluded because of treatment discontinuance. In the first and second weeks, there was no significant change in body weight. In the third week, the mean weight loss was 1.53 kg. In the fourth week, the mean weight loss was 2.48 kg. In the fifth week, the mean weight loss was 3.24 kg. The setup errors obtained by CBCT image registration in the superior-inferior (SI), anterior-posterior (AP), and left-right (LR) directions were 0.19 cm, 0.20 cm, and 0.18 cm, respectively, in the first week, 0.18 cm, 0.17 cm, and 0.15 cm, respectively, in the second week, 0.20 cm, 0.22 cm, and 0.21 cm, respectively, in the third week, 0.19 cm, 0.25 cm, 0.24 cm, respectively, in the fourth week, and 0.34 cm, 0.33 cm, and 0.31 cm, respectively, in the fifth week. The Pearson correlation analysis showed that weight loss increased the setup errors, with P values of 0.140, 0.046, and 0.044 in the SI, AP, and LR directions, respectively. Conclusions For rectal cancer patients receiving radiotherapy, the body weight decreases significantly in the late period (especially in the fifth week), which influences the setup errors. Therefore, in the fourth and fifth weeks of radiotherapy for rectal cancer, the weight loss should be closely monitored, and the number of CBCT scans can be increased before the treatment fraction to ensure the accuracy and optimization of treatment.
		2017 Vol. 26 (6): 650-652 [Abstract] ( 1436 ) [HTML 1KB] [ PDF 748KB] ( 0 )

	653	Delineation of target volume in intensity-modulated radiotherapy for para-aortic lymph node metastases in patients with gynecological malignancies
		Ma Yan,Ge Ying,Chen Zhishen,Yu Lei,Jia Xiaojing
		Objective To preliminarily explore the delineation of clinical target volume in intensity-modulated radiotherapy for para-aortic lymph node metastases in patients with gynecological malignancies. Methods A retrospective analysis was performed on 56 gynecological tumor patients with para-aortic lymph node metastases who were admitted to our department from January 2010 to September 2016.The number and distribution of metastatic para-aortic lymph nodes were determined by imaging method. Results A total of 108 positive para-aortic lymph nodes were found in the 56 patients, with 1-4(mean, 2) positive para-aortic lymph nodes per patient. The mean diameter of positive para-aortic lymph nodes was 2.3 cm (1.2-4.0 cm).A total of 20 metastatic lymph nodes (19%) were located at the L₄ level, 38(35%) at the L₃ level, 44(41%) at the L₂ level, and 6(5%) at the L₁ level. There were 71 metastatic lymph nodes (66%) at the left side of the para-aortic region, 20 metastatic lymph nodes (19%) between the abdominal aorta and the vena cava, and 17 metastatic lymph nodes (15%) at the right side of the inferior vena cava. Conclusions For patients with gynecological malignancies, nodal contouring for the para-aortic region should not be defined by a fixed circumferential margin around the vessels. The left side of the para-aortic region should be covered adequately;the upper target should be extended up to the renal artery, and needs to be further extended for patients who have nodal involvement near the renal arteries and veins.
		2017 Vol. 26 (6): 653-656 [Abstract] ( 1521 ) [HTML 1KB] [ PDF 1503KB] ( 0 )

	657	A comparative analysis of Matrixx and EPID for dosimetric verification of intensity-modulated radiotherapy
		Guo yuexin,Pei yuntong, Ma yangguang, Jia fei, Wang haiyang
		Objective To compare the dosimetric verification results of Varian Portal Dosimetry and Matrixx, and to assess the reliability of the clinical application of electronic portal imaging device (EPID) verification. Methods Varian TrueBeam linear accelerator, which was equipped with a 120-leaf multileaf collimator and an amorphous silicon EPID, as well as portal dose prediction software. IBA I′mRT Matrixx ion chamber array was used. EPID algorithm configuration, dose calibration, and testing before use were performed. The sliding-window protocol was used. There were 77 patients with tumors involving the head and neck (mainly nasopharyngeal carcinoma), mediastinum, abdomen, and pelvic cavity were selected. The verification plan of the portal dose was created with a source-detector distance of 100 cm, and the gantry angle was kept the same as the treatment plan. The verification plan was carried out in the TrueBeam machine, and the data were collected at the same time by EPID. Comparison between the measured and calculated dose images was performed, and the evaluation standard was gamma index (3%/3 mm). The paired t-test was used for difference analysis. Results For the 77 patients,the Gamma passing rates of both methods were above 97%. Except for head and neck carcinoma were a significant difference between the results of dosimetric results using EPID and Matrixx in intensity-modulated radiotherapy (P=0.018) other remaining all P> 0.05. Conclusions The dosimetric verification results of EPID are consistent with those of Matrixx. EPID can be used for dosimetric verification, and Matrixx ion chamber array can be used only in case of a low Gamma passing rate.
		2017 Vol. 26 (6): 657-660 [Abstract] ( 1436 ) [HTML 1KB] [ PDF 1595KB] ( 0 )

	661	A study of automatic treatment planning based on kernel density estimation
		Fan Jiawei,Wang Jiazhou,Hu Weigang
		Objective To develop an automatic algorithm to predict the dose-volume histogram (DVH) and implement it in clinical practice. Methods Based on the prior information in the existing plan, such as dosimetric results of organs at risk (OARs) and OAR-target spatial relationship, a two-dimensional kernel density estimation was implemented to predict the DVH of OARs. The predicted DVH curves were converted into objective functions that would be implemented in the Pinnacle treatment planning system. Comparisons between predicted and actual values and between Auto-plan and manual planning were made by paired t test. Results We applied this algorithm to 10 rectal cancer patients, 10 breast cancer patients, and 10 nasopharyngeal carcinoma patients. The predicted DVH of OARs showed that the deviation between the actual and predicted values at important clinical dose points were within 5%(P>0.05). The re-planning for the 10 breast cancer patients using Auto-plan showed that the heart dose was significantly reduced and the target coverage was increased, which was consistent with the predicted results. Conclusions The method proposed in this study allows for accurat DVH prediction, and, combined with Auto-plan, can be used to generate clinically accepted treatment plans.
		2017 Vol. 26 (6): 661-666 [Abstract] ( 1477 ) [HTML 1KB] [ PDF 2058KB] ( 0 )

	667	Comparison of whole-body equivalent doses from volumetric modulated arc therapy and static intensity-modulated radiotherapy for cervical cancer
		Dong Xiaoqi,Feng Ge,Yin Ce,Li Na,Jia Mingxuan
		Objective To compare the whole-body equivalent doses from volumetric modulated arc therapy (VMAT) and static intensity-modulated radiotherapy (IMRT) for patients with cervical cancer. Methods Nine patients with cervical cancer admitted to our hospital in 2014 were included in this study. Both VMAT and IMRT were planned for each patient. Each patient’s personal dose equivalent (Hp (10)) was measured using thermoluminescent dosimeters placed at the xiphoid process and glabella during IMRT and VMAT. The whole-body equivalent doses were estimated based on the results measured at the xiphoid process and compared between the VMAT and IMRT techniques. The paired t test was used for difference analysis. Results The Hp (10) values measured at the xiphoid process and glabella of every patient were lower for VMAT than for IMRT. At a prescribed dose of 50 Gy, if the mean Hp (10) values measured at the xiphoid process were considered to represent the whole-body equivalent doses, the whole-body equivalent doses for VMAT and IMRT were 364 mSv and 538 mSv, respectively. Conclusions VMAT results in a lower whole-body equivalent dose to patients compared with IMRT. The decreased whole-body equivalent dose delivered by VMAT may reduce the likelihood of a radiation-induced secondary malignancy.
		2017 Vol. 26 (6): 667-670 [Abstract] ( 1363 ) [HTML 1KB] [ PDF 789KB] ( 0 )

	671	Effect of BMI-1 on radiosensitization of esophageal carcino-ma cells after silencing of BMI-1 gene
		Yang Xingxiao,Ma Ming,Song Heng,Liu Zhikun,Zhu Shuchai
		Objective To investigate the effects of BMI-1 expression inhibition by RNA interference on the radiosensitivity of esophageal cancer TE-13 cells and its mechanism. Methods The siRNA based on the sequence of BMI-1 mRNA was synthesized to transfect cultured TE-13 cells as BMI-1 siRNA group, a negative one was synthesized to transfect cultured TE-13 cells as negative control group (NC group), and untransfected TE-13 cells were named as control group. The expression of the BMI-1 mRNA and protein in TE-13 cells was measured by quantitative real-time PCR and Western blot, respectively. The cell proliferation and the radiosensitivity of TE-13 cells were measured by MTS and colony-forming assay, respectively. Flow cytometry was used to analyze cell cycle and apoptosis. The expression of BCL-2 and BAX in TE-13 cells was measured by Western blot. Comparison between groups was made by analysis of variance. Results The BMI-1 siRNA group had significantly lower expression of BMI-1 mRNA and protein than the control group and the NC group (P=0.000,0.000). The proliferation of TE-13 cells in the BMI-1 siRNA group decreased significantly after irradiation (P=0.031). The colony-forming assay showed that the BMI-1 siRNA group had a significantly higher radiosensitivity than the control group and the NC group (P=0.000). After irradiation, the BMI-1 siRNA group had a significantly lower percentage of cells in G₂/M phase than the control group and the NC group (P=0.000,0.000). The BMI-1 siRNA group had a significantly increased apoptosis rate (P=0.000,0.000),significantly reduced expression of BCL-2(P=0.000,0.000), and significantly increased expression of BAX after irradiation (P=0.000,0.000). Conclusions BMI-1 siRNA can inhibit the expression of BMI-1 gene in esophageal cancer TE-13 cells, eliminate the cell cycle arrest in G₂/M phase, induce cell apoptosis after ionizing irradiation in vitro, and increase the radiosensitivity, which may be related to the regulation of the expression of BCL-2 and BAX.
		2017 Vol. 26 (6): 671-676 [Abstract] ( 1429 ) [HTML 1KB] [ PDF 1861KB] ( 0 )

	677	Effect of 17AAG-cypate polymer micelle on radio-sensitivityof A549 cells
		Wu Chenjie,Xue Lian,Chen Chenglong,Peng Yiru,Luo Huanhuan,Chen Huabing,Yu Dong
		Objective To investigate the radiosensitizing effect of 17AAG-cypate micelles on human non-small cell lung cancer A549 cells and its possible mechanism. Methods (1) A single-hit multi-target model formula was used to analyze the radiosensitizing effects of 17AAG-M and 17AAG-cypate-M.(2) The effects of 17AAG-cypate-M on the viability of A549 cells under laser and X-ray irradiation were analyzed by MTT assay.(3) The effect of the drugs on the cell senescence was observed by β-galactosidase staining assay.(4) The effects of different treatment conditions on DNA damage repair were analyzed by γ-H₂AX immunofluorescence staining assay.(5) The expression of p-Erk1/2 and p-Akt was measured by Western blot. The paired t test was used for analyzing the differences between groups. Results Compared with the X-ray irradiation group, the X-ray+17AAG-cypate-M group had a lower mean lethal dose and a sensitization enhancement ratio greater than 1, indicating that 17AAG-cypate-M had a radiosensitizing effect. Compared with the 17AAG-M group, the 17AAG-cypate-M group showed significantly lower cell viability (P<0.01), a significantly higher percentage of aging cells (P<0.01), and significantly further delayed DNA damage repair (P<0.01). And the 17AAG-cypate-M group had lower expression of p-Erk1/2 and p-Akt than the 17AAG-M group. Conclusions Compared with 17AAG-M, 17AAG-cypate-M has a higher radiosensitizing effect on A549 cells. The mechanism might be inducing the cell senescence, delaying DNA damage repair, and inhibiting the expression of p-Erk1/2 and p-Akt.
		2017 Vol. 26 (6): 677-681 [Abstract] ( 1273 ) [HTML 1KB] [ PDF 1360KB] ( 0 )

	682	The effects of Celecoxib on human brain microvascular endothelial cells release 6-keto-PGF_1α and TXB₂ and apoptosis after radiation
		Sun Jiaxing,Xu Xiaoting,Tu Yu
		Objective To investigate the effect of Celecoxib on human brain microvascular endothelial cells release6-keto-PGF_1α,TXB₂ and apotosis after irradiation. Methods The logarithmic growth phase cells were divided into control groups (Con),simple irradiation (IR) groups and combination groups (IR+C).CCK-8 and clone formation experiment were used to evaluate the effects of radiosensitivity and toxicity of celecoxib. The results were observed atthe time point of 6 h,12 h,24 h,48 h after irradiation. ELISA was used to test the contents of 6-keto-PGF_1α and TXB₂,which metabolized by PGI₂ and TXA₂ from culture medium after irradiation at different time points in different groups. TXB2/6-keto-PGF_1αratios were calculated. Annexin V-FITC/PI double staining method was used to measure the apoptosis rates at different time points in different groups. Western blot was used to measure the protein expression. Paired t test difference. Results Compared with simple irradiation group,there were no significant radiosensitivity (SER=0.96) in combination groups incubated with30 μmol/L of celecoxib. Compared with the control group,the ratio of TXB2/6-keto-PGF_1αincreased at each time point in IR and IR+C (P<0.05),and the apoptosis rates increased (P<0.05).Cox-2,P-JNK and Cleaved caspase-3 increased. Compared with IR,the ratio of TXB2/6-keto-PGF_1αdecreased at each time point in IR+C (P<0.05),and the apoptosis rates decreased (t=3.34~6.38,P< 0.05).The protein expression of Cox-2,P-JNK and Cleaved caspase-3 decreased. Conclusions Celecoxib may help to protect HBMECs from releasing TXA₂ and decreasing the ratio of TXB2/6-keto-PGF_1α,and inhibitting apoptosis after irradiation. The mechanisms of apoptosis inhibition may be related to the inhibition of Cox-2 and P-JNK,caspase-3 Cleaved proteinexpressions.
		2017 Vol. 26 (6): 682-686 [Abstract] ( 1352 ) [HTML 1KB] [ PDF 1009KB] ( 0 )

	687	Effect of SIRT1 gene silencing on radiosensitivity of diffuse large B-cell lymphoma cells
		Kang Yixin,Gao Shegan,Guo Yanzhen,Yao Jun,Zhang Zhiye,Gao Xiaohui,Zhang Dianbao,Guo Shuangshuang,Zhang Lulin
		Objective To explore the effect of SIRT1 gene silencing on the radiosensitivity of diffuse large B-cell lymphoma (DLBCL) cells. Methods Immunohistochemistry was used to measure the protein expression of SIRT1 in DLBCL tissues. Western blot was used to measure the expression of SIRT1 in DLBCL cell lines (OCI-Ly3, SU-DHL-2, and SU-DHL-4) and the immortalized B cell line HMy2.CIR. After SU-DHL-4 cells were transfected with si-SIRT1 and si-NC using Lipofectamine 2000, the expression of SIRT1 was determined by Western blot. MTT assay and colony-forming assay were used to assess the cell growth and colony formation ability of SU-DHL-4 cells treated with radiation. The group t-test or univariate analysis of variance was used for comparison between groups. Results The expression rate of SIRT1 in DLBCL tissues was 72.6%(103/140), which was significantly higher than that in reactive lymphoid hyperplasia (RLH) tissues (26.5%, 8/25)(P=0.001). The SIRT1 expression was significantly higher in DLBCL cells than in HMy2.CIR cells (P=0.020). After SIRT1 gene silencing by si-SIRT1, the expression of SIRT1 was significantly reduced in SU-DHL-4 cells (P=0.008). Besides, SIRT1 gene silencing significantly reduced the growth rate and colony formation ability of SU-DHL-4 cells treated with radiation (P=0.030). Conclusions SIRT1 gene silencing enhances the radiosensitivity of DLBCL cells, providing a novel target for the radiotherapy of DLBCL.
		2017 Vol. 26 (6): 687-690 [Abstract] ( 1481 ) [HTML 1KB] [ PDF 892KB] ( 0 )

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		2017 Vol. 26 (6): 691-692 [Abstract] ( 1156 ) [HTML 1KB] [ PDF 989KB] ( 0 )

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		2017 Vol. 26 (6): 693-695 [Abstract] ( 1365 ) [HTML 1KB] [ PDF 1043KB] ( 0 )

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		2017 Vol. 26 (6): 696-697 [Abstract] ( 1352 ) [HTML 1KB] [ PDF 701KB] ( 0 )

	698	Research advances in proton therapy for pediatric cancer
		Wen Xiaoxiao,Shi Haiou,An Zheng
		Pediatric cancer is one of the leading causes of death in children around the world. Although radiotherapy is an important means of treatment for pediatric cancer, it causes acute or chronic adverse events that may affect patients’ survival time and quality of life. As a novel and advanced radiation technique, proton therapy allows for precise dose delivery in target volume, significantly reducing the irradiation to surrounding tissues and organs. Studies have shown that proton therapy is well tolerated in the treatment of pediatric cancer, and it achieves good tumor control;proton therapy is superior to traditional radiotherapy in improving quality of life, protecting intelligence, and reducing the risk of secondary cancer. This article reviews the research advances in the application of proton therapy in the treatment of pediatric cancer.
		2017 Vol. 26 (6): 698-701 [Abstract] ( 1521 ) [HTML 1KB] [ PDF 799KB] ( 0 )

	702	Research advances in subventricular zone irradiation in glioblastoma
		Wang Chengang,Luo Yijun,Li Minghuan,Yu Jinming
		Glioblastoma multiforme (GBM, WHO grade IV) contains some glioma stem cells which have unique self-renewal capacity and multilineage potency. There are numerous neural stem cells in the subventricular zone (SVZ) of adult human brain;it may also act as a storehouse of glioma stem cells that can promote the development and recurrence of a tumor. GBM involving SVZ is prone to early recurrence and intracranial metastasis after resection, so irradiation of the SVZ potentially influences the survival of GBM patients. This review provides a summary of related experimental and clinical studies, and discusses the value of irradiation of the SVZ in GBM patients and the direction of future research.
		2017 Vol. 26 (6): 702-705 [Abstract] ( 1488 ) [HTML 1KB] [ PDF 791KB] ( 0 )

	706	Research advances in radiation-induced lung injury and Th₁/Th₂ imbalance
		Cheng Jing,Yao Ye,Xie Conghua
		Normal lung tissues are inevitably exposed to X-ray in thoracic radiotherapy, causing radiation-induced lung injury (RILI). The main pathological manifestations include the accumulation of inflammatory cells, release of cytokines, accumulation and proliferation of fibroblasts, and excessive deposition of alveolar interstitial collagen in the irradiated region. RILI severely affects the treatment compliance and quality of life and even threatens the life in the patients receiving radiotherapy. In recent years, numerous studies have found that Th₁/Th₂ imbalance is closely associated with the development and progression of RILI, and the cytokine network plays an executive role in the progression of RILI. Therefore, restoring the Th₁/Th₂ balance in vivo may provide a new way to prevent and treat RILI.
		2017 Vol. 26 (6): 706-710 [Abstract] ( 1322 ) [HTML 1KB] [ PDF 821KB] ( 0 )

	711	Current status of research on prediction of radiotherapy induced adverse reactions by radiation genomics
		Liu Lipin,Bi Nan,Wang Lyuhua
		The occurrence and severity of radiotherapy-induced adverse events cannot be accounted for or predicted by therapeutic and clinical factors alone. Evidence suggests that genetic variants are associated with adverse effects following radiotherapy. Radiation genomics is the study of genetic variants associated with radiotherapy toxicity. Radiation genomics aims to develop a risk prediction model and uncover the biological mechanisms responsible for radiotherapy toxicity. With the advances in genomics and bioinformatics in the past two decades, radiation genomics has evolved from candidate gene studies to genome-wide association studies, with a series of progress. In this review, we will discuss the study background, design, approaches, challenges, and future directions for radiation genomics.
		2017 Vol. 26 (6): 711-714 [Abstract] ( 1443 ) [HTML 1KB] [ PDF 796KB] ( 0 )

	715	Implementation and development of independent check in radiotherapy
		Shen Jiuling,Li Guangjun,Li Liqin,Liu Fubo,Bai Sen
		Independent check is one of the key measures of quality control (QC) in radiotherapy and is essential for the assurance of radiotherapy accuracy. In recent years, with the application of computer-aided system, the automaticity of independent check, as well as its accuracy and efficiency, increases. Meanwhile, QC has evolved from a device-centered to a process-centered program. Therefore, independent check has been increasingly systematic and specific. This review gives a brief summary of the implementation and development of independent check.
		2017 Vol. 26 (6): 715-718 [Abstract] ( 1495 ) [HTML 1KB] [ PDF 788KB] ( 0 )

	719	Experience and efficacy of SBRT for lung cancer:an analysis of 200 patients
		Dong Baiqiang,Xu Yujin,Sun Xiaojiang,Zheng Xiao,Du Xianghui,Di Xiaoyun,Shan Guoping,Chen Weijun,Li Pu,Li Jianlong,Shao Kainan,Xu Yaping,Chen Ming
		Objective To evaluate the safety and clinical efficacy of stereotactic body radiation therapy (SBRT) for lung cancer. Methods A retrospective analysis was performed on 200 patients with primary non-small cell lung cancer (NSCLC)(118 patients) or solitary pulmonary metastasis (82 patients) who underwent SBRT in Zhejiang Cancer Hospital from January 2012 to September 2015. The 80% isodose line covered 95% of the planning target volume, and the 100% isodose line covered 100% of the internal gross tumor volume. The fractional dose was 4.0-18.0 Gy daily or every other day, and the biologically equivalent dose ranged from 40.0 to 151.2 Gy (median 100 Gy). Results All patients completed treatment. The follow-up rate was 96.0%. The complete response and partial response rates were 14.8%(17/115) and 65.2%(75/115) for the primary tumor group, versus 25%(19/77) and 38%(29/77) for the metastasis group. The incidence rates of grade Ⅱ and Ⅲ acute radiation pneumonitis were 4.7% and 3.1%, respectively. The median follow-up was 14.9 months. The 1-and 2-year local control rates were 95.7% and 84.3% for the primary tumor group, versus 92% and 73% for the metastasis group. The 1-and 2-year overall survival rates were 94.5% and 92.0% for the primary tumor group, versus 85% and 62% for the metastasis group. Conclusions SBRT is a safe and effective treatment for early primary NSCLC and solitary pulmonary metastasis, resulting in high 1-and 2-year local control and overall survival rates and low rate of complications.
		2017 Vol. 26 (6): 719-720 [Abstract] ( 1222 ) [HTML 1KB] [ PDF 776KB] ( 0 )

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		2017 Vol. 26 (6): 720-720 [Abstract] ( 1252 ) [HTML 1KB] [ PDF 779KB] ( 0 )

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China Association for
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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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