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.7 Published 2017-07-10

	Head and Neck Tumors Abdominal Tumors Thoracic Tumors Physics·Biology·Technique Review Articles Special Featyre

Special Featyre

	723	The study of re-irradiation for head and neck cancer
		Lu Xuegua,Hu Chaosu
		Nearly 50% patients with head and neck cancer after radiotherapy will recurrence in the previous radiation fields. Salvage surgery is the first choice of treatment. Clinical studies have shown that a small number of patients with recurrent head and neck cancer can benefit from salvage surgery plus postoperative re-irradiation or re-irradiation with or without chemotherapy or targeted therapy,and these patients can achieved tumor control and long-term survival. However, the overall efficacy is not satisfactory, and often accompanied by severe acute and late, and even fatal treatment-related toxicity. Therefore, it is necessary to give full consideration to the condition of recurrent tumor, the first radiotherapy related factors and the patient′s related status before implementation of re-irradiation. The development of radiotherapy technology and comprehensive treatment, including the clinical application of proton and heavy ion and immune therapy, provides the possibility of improving the prognosis and reducing treatment-related toxicity for these patients.
		2017 Vol. 26 (7): 723-727 [Abstract] ( 960 ) [HTML 1KB] [ PDF 927KB] ( 0 )

Head and Neck Tumors

	728	A clinical analysis of 30 patients with synchronous head and neck and esophageal cancer
		Li Sihan,Chen Zhiqin,Li Guang
		Objective To examine the clinical characteristics,treatment,and prognosis of patients with synchronous head and neck and esophageal cancer (SHNEC). Methods The clinical data of 30 SHNEC patients treated in the Department of Radiotherapy of the First Affiliated Hospital of China Medical University from 2010 to 2014 were retrospectively reviewed. The patients were followed up and survival was calculated using the Kaplan-Meier method. Differences between survival curves were analyzed by the log-rank test,and prognostic analysis was performed using the Cox regression model. At the same and different time,the comprehensive diagnosis were 24 cases and 6 cases.21 patients were treated with radiochemotherapy, 9 patients were treated by surgery and radiotherapy±chemotherapy. Results SHNEC was frequently found in elderly men with heavy drinking and smoking habits. Hypopharyngeal cancer with middle esophageal cancer was most common among the patients;of the 30 patients,23(77%) had hypopharyngeal cancer,and 12(40%) had hypopharyngeal cancer with middle esophageal cancer. The median survival time of the patients was 20 months,and the 1-and 2-year overall survival (OS) rates were 83% and 37%,respectively. Univariate analysis showed that the stage of esophageal cancer,heavy smoking and drinking habits,and a family history of cancer were significantly associated with patient prognosis (P=0.009,0.044,0.012). In addition,the Cox analysis also demonstrated that the stage of esophageal cancer (HR=3.53,P=0.008),heavy smoking and drinking habits (HR=2.33,P=0.049),and a family history of cancer (HR=2.78,P=0.026) were independent prognostic factors. Conclusions Hypopharyngeal and middle esophageal cancer is the most common type of SHNEC,and the stage of esophageal cancer and heavy smoking and drinking habits are significantly associated with the prognosis of SHNEC patients. In addition,patients with stage Ⅰ and Ⅱ esophageal cancer can also achieve acceptable survival after receiving radiotherapy-based comprehensive treatment.
		2017 Vol. 26 (7): 728-731 [Abstract] ( 971 ) [HTML 1KB] [ PDF 744KB] ( 0 )

	732	Correlation between characteristics of intracranial lesions and level of cognitive function in patients with an initial diagnosis of brain metastases
		Chen Yanfang,Lian Yixin,Zhou mengyun,Zou Li,Tian Ye
		Objective To investigate the correlation between the characteristics of intracraniallesions and the level of cognitive function in patients with an initial diagnosis of brain metastases. Methods A retrospective analysis was performed in 51 patients with an initial diagnosis of brain metastases who were admitted to The Second Hospital Affiliated to Suzhou University from January 2015 to April 2016.CT and (or) MRI were used to determine the characteristics of intracranial lesions and the Montreal Cognitive Assessment was used to evaluate the cognitive function of patients. Comparison between groups was made by Mann-Whitney U test. The correlation between ranked data was analyzed by Spearman rank correlation test. Results Of the 51 patients with an initial diagnosis of brain metastases,47(92%) had cognitive impairment,including mild cognitive impairment in 31(61%) and dementia in 16(31%).There was no significant difference in level of cognitive function between the patients with involvement of the left hemisphere alone and those with involvement of the right hemisphere alone (P=0.425).The patients with involvement of both hemispheres had a significantly lower level of cognitive function than those with involvement of the left hemisphere alone (P=0.042).The patients with involvement of three or more brain lobes had a significantly lower level of cognitive function than those with involvement of one or two brain lobes (P=0.015,0.024).The intracranial lesion volume and edema volume had no significant effect on the overall cognitive function of patients (P=0.077,0.178).The patients with>3 intracranial lesions had a significantly lower level of cognitive function than those with 1-3 intracranial lesions (P=0.010). Conclusions More than 90% of patients with an initial diagnosis of brain metastases have cognitive impairment. Cognitive impairment is mainly associated with lesion site,involvement of brain lobes,and number of lesions,but not with lesion volume and edema volume.
		2017 Vol. 26 (7): 732-736 [Abstract] ( 1004 ) [HTML 1KB] [ PDF 912KB] ( 0 )

Thoracic Tumors

	737	Therapeutic efficacy of different adjuvant modalities in thoracic esophageal squamous cell carcinoma
		Shen Wenbin,Gao Hongmei,Zhu Shuchai,Li Teng,Li Shuguang,Li Youmei,Liu Zhikun,Su Jingwei,Li Juan
		Objective To evaluation and comparison the curative effect of different adjuvant therapy and prognostic factors with thoracic esophageal squamous cell carcinoma (ESCC) after surgery,and to find the best treatment for them. Methods A total of 863 patients with thoracic ESCC underwent surgery in the fourth hospital of Hebei Medical University,From January 2007 to December 2010,To analyze the influence factors of the patient′s independent prognosis and the effect of postoperative adjuvant therapy on the prognosis of patients. The 1:1, after the tendency of a total of 261 cases were used PSM method (87 cases/group).The Kaplan-Meier method was used to calculate OS,DFS and log-rank test and monovariable analysis,Cox model was used to multivariable analysis. Results The sample size in 1,3,5 was 123,589,863 cases. The 1-,3-,and 5-year overall survival (OS) and disease-free survival (DFS) of all patients were 89.7%,62.1%,51.7% and 76.8%,52.1%,44.2%,respectively. The 1,3,5-years of OS and DFS were 956%,73.3%,61.1% and 85.6%,61.1%,54.4%,78.9%,38.9%,31.3% and 67.8%,27.8%,20.0%,92.2%,55.6%,44.4% and 67.8%,44.4%,36.7%(all P=0.000) among postoperation chemoradiotherapy (POCRT),postoperation chemotherapy (POCT) and postoperation radiotherapy (PORT) after pairing with PSM.The result of COX analysis showed that the degree of inflammatory adhesion,pTNM stage and the number of positive lymph nodes were the independent prognostic factors in patients with OS (P=0.002,0.000,0.007).The history of drinking,pTNM stage and treatment model were the independent prognostic factors of DFS (P=0.009,0.000,0.012). Conclusions Patients with thoracic esophageal squamous cell carcinoma after surgery to receive adjuvant therapy has a good effect,compared with PORT and POCT,POCRT can significantly improve the OS and DFS,and POCRT was the independent prognostic factors of DFS.
		2017 Vol. 26 (7): 737-743 [Abstract] ( 1236 ) [HTML 1KB] [ PDF 1012KB] ( 0 )

	744	Efficacy evaluation of rescue treatment for 218 patients with recurrent esophageal cancer after radical resection
		Ni Wenjie,Yang Jin-song,Yu Shufei,Zhang Wencheng,Xiao Zefen,Zhou Zongmei,Zhong Hongxing,Chen Dongfu,Feng Qinfu, Lu Jima,Liang Jun,Wang Xiaozhen,Wang Lyuhua,Yin Weibo
		Objective To evaluate the efficacy of rescue treatment for recurrent esophageal cancer after radical esophagectomy, and to provide insights into the development of comprehensive treatment for esophageal cancer. Methods The clinical data of 218 patients who were confirmed with recurrent metastatic esophageal cancer after R₀ resection and received rescue treatment in our hospital from 2004 to 2014 were retrospectively reviewed. The survival rate was determined by the Kaplan-Meier method. Univariate and multivariate prognostic analyses were performed using the log-rank test and Cox proportional hazards model, respectively. Results The median post-recurrence follow-up time was 53 months. The 1-and 3-year overall survival (OS) rates after recurrence were 57.2% and 24.4%, respectively. Among the 163 patients with local recurrence, the 1-and 3-year OS rates were 70% and 42% for patients treated with chemoradiotherapy (n=40), 55% and 24% for those with radiotherapy alone (n=106), and 23% and 8% for those with supportive therapy (n=13)(chemoradiotherapy vs. radiotherapy alone P=0.045, radiotherapy alone vs. supportive therapy P=0.004;none of the patients who were treated with chemotherapy alone survived for one year or more). Univariate analysis showed that N staging, TNM staging, and post-recurrence rescue treatment regimen were independent prognostic factors for esophageal cancer (all P=0.001). On the other hand, multivariate analysis indicated that only rescue treatment regimen was the independent prognostic factor for esophageal cancer (P=0.013). Conclusions Rescue chemoradiotherapy or radiotherapy alone can bring significant survival benefits for patients with recurrent and metastatic, especially locally recurrent, esophageal cancer following radical esophagectomy.
		2017 Vol. 26 (7): 744-748 [Abstract] ( 1055 ) [HTML 1KB] [ PDF 982KB] ( 0 )

	749	Clinical value of lung equivalent uniform dose in predicting VMAT-induced radiation pneumonitis
		Wang Cheng,Gu Jiale,Deng Qinghua,Ma Shenglin,Tang Rongjun,Shen Lijuan,Ren Yao,Li Xiadong
		Objective To investigate the clinical effect of lung equivalent uniform dose (LEUD)-based predictive model for radiation pneumonitis (RP) induced by volumetric modulated arc therapy (VMAT) and to determine the optimal a value. Methods A total of 65 patients with primary lung cancer who received VMAT from July 2015 to February 2016 were divided into RP group and non-RP group according to the presence or absence of RP after radiotherapy. Their dose-volume histogram (DVH) data and other data were obtained and analyzed by the self-compiled numerical analysis program. The LEUD values in the two groups were calculated at a=[-50, 50], and then the a value was identified when the relative difference of LEUD between the two groups was maximal. The paired t test was used for analyzing the differences in V₅, V₂₀, V₃₀, minimum lethal dose (MLD), and LEUD (a_optimal) between the two groups. A Pearson correlation analysis was used to determine the correlation of V_dose and LEUD (a_optimal) with RP. The logistic regression method was used to establish the predictive model of RP. Results The maximum relative difference in LEUD between RP group and non-RP group was obtained at a=0.3(627.94 cGy vs. 510.23 cGy, relative difference[R]=23.07%). R decreased slowly at t=[-50,-5], increased sharply at t=[-5, 0], and reached the maximum value at a=0.3. After a rapid decrease at a=[0.3, 4], R decreased slowly at a=[4, 50]. The correlation analysis of the traditional physical volume dose threshold also showed thatthe LEUD (at a=0.3) was correlated with V₅, V₁₀, V₂₀, and MLD (r=0.929, P<0.05). Conclusions For patients receiving VMAT for thoracic cancer, LEUD (at a=0.3) can distinguish between patients with and without RP. Therefore, LEUD is recommended to be<510 cGy. A combination of LEUD and conventional physical dose has a good clinical predictive value for RP under non-uniform irradiation.
		2017 Vol. 26 (7): 749-753 [Abstract] ( 1074 ) [HTML 1KB] [ PDF 874KB] ( 0 )

	754	Dosimetric assessment of CT-guided radioactive seed implantation assisted by 3D printing non-coplanar template in treatment of chest malignant tumor
		Ji Zhe,Jiang Yuliang,Guo Fuxin,Peng Ran,Sun Haitao,Fan Jinghong,Wang Junjie
		Objective To compare the preoperative and postoperative dosimetric results of radioactive seed implantation assisted by 3D printing template in the treatment of chest malignant tumor, and to examine the effect this technique on the precision of radioactive seed implantation. Methods A total of 21 patients who received 3D printing template-assisted CT-guided ¹²⁵I seed implantation for chest tumors in 2016 were included in the study. The prescribed dose of the treatment was 110-180 Gy. Preoperative planning, individual template production, and puncture and seed implantation were performed in all patients, and the postoperative dosimetric results were then compared with the preoperative plan by assessing various dosimetric parameters including D₉₀, MPD, V₁₀₀, V₁₅₀, CI, EI, and HI of gross tumor volume (GTV), D_2cc of the spinal cord and aorta, and D_mean and V₂₀ of the affected side of the lung. Statistical analysis was performed using the Wilcoxon non-parametric test. Results A total of 21 3D printing templates were designed and produced. The mean GTV volume (preoperative) of all patients was 77.1 cm³, and the mean number of implanted seeds was 68. In addition, the mean D₉₀ of the postoperative GTV was 147.3 Gy. There were slight changes in the dosimetric parameters after treatment (P>0.05). Conclusions 3D printing template allows for accurate positioning and implantation of radioactive seeds during the treatment of chest tumor. Postoperative dosimetric parameters were consistent with those in the preoperative planning, indicating that the 3D printing template provides high precision for the treatment of chest tumor.
		2017 Vol. 26 (7): 754-758 [Abstract] ( 1233 ) [HTML 1KB] [ PDF 1328KB] ( 0 )

Abdominal Tumors

	759	Mid-term outcomes of a prospective phase Ⅱ trial of preoperative sandwich-like neoadjuvant chemoradiotherapy for locally advanced rectal cancer
		Wei Jiawang,Zhang Rong,Xiao Weiwei,Yu Xin,Guo Suping,Zeng Zhifan,Chen Gong,Pan Zhizhong,Wan Desen,Ding Peirong,Gao Yuanhong
		Objective To evaluate the mid-to long-term survival benefits of preoperative sandwich-like neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Methods A total of 45 LARC patients who underwent neoadjuvant sandwich CRT in the form of XELOX regimen prior to,concurrently with,and following volumetric modulated arc radiotherapy (VMAT) in 2012 were enrolled in this study. VMAT was given at a gross tumor volume dose of 50 Gy in 25 fractions,and a clinical target volume dose of 45-46 Gy in 25 fractions. Total mesorectal excision was performed 6 to 8 weeks after completion of VMAT.The overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method,and survival comparison and univariate prognostic analysis were performed using the log-rank test. Results The median follow-up time was 46.7 months. There was no local recurrence detected among the patients. The 3-year distant metastasis (DM) rate was 18%,and the 3-year OS and DFS were 96% and 84%,respectively. Univariate analysis indicated that perineural invasion,N₁-N₂ pathology (pathological stage Ⅲ),and Ca-199>35 U/ml before treatment were risk factors for DM (P=0.000,0.000,and 0.013,respectively). Conclusions The significant short-term efficacy of preoperative sandwich-like neoadjuvant CRT can be extended to a positive mid-term survival in LARC patients. However,further phase Ⅲ clinical studies will be needed to confirm this finding.
		2017 Vol. 26 (7): 759-762 [Abstract] ( 891 ) [HTML 1KB] [ PDF 943KB] ( 0 )

	763	Effect of tumor volume and radiation dose on the prognosis of hepatocellular carcinoma patients treated with whole body gamma knife
		Duan Ying,Lyu Jin,Li Xiao,Yan Cunqing,Zhang Jian,Guo Xingdong,Chen Huiru,Chen Liang,Zou Yue
		Objective To examine the effects of gross tumor volume (GTV) and radiation dose onthe prognosis of hepatocellular carcinoma (HCC) patients treated with whole body gamma knife. Methods The clinical data of 69 HCC patients who underwent body gamma knife treatment from January 2012 to June 2015 in the Radiotherapy Center of the PLA General Hospital were retrospectively reviewed. Based on a 50% or 60% isodose coverage of the planning target volume (PTV), patients were treated with a radiation dose of 4-5 Gy per fraction, and a total marginal dose of 36-50 Gy (median dose 45 Gy). Short-term efficacy, overall survival (OS), and the adverse effect of the treatment were evaluated. The optimal cut-off tumor volume was identified using the receiver operating characteristic curve, and survival was determined by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and Cox proportional hazards regression model, respectively. Results The overall short-term response rate of the 69 patients was 67%. The 1-and 2-year OS rates were 62% and 40%, respectively, with a median survival of 18.6 months. The multivariate analysis showed that gross tumor volume (GTV)<93 cm³(P=0.013) and short-term efficacy of radiotherapy (P=0.000) were significant independent prognostic factors for survival. When GTV was<93 cm³, prognosis was significantly better in patients treated with a dose of ≥45 Gy than in those with<45 Gy (P=0.019). In contrast, radiation dose had no significant effect on survival among patients with GTV>93cm³(P=0.665). Conclusions GTV is an independent prognostic factor for overall survival of HCC patients. Although high-dose radiotherapy provides survival benefits to patients with small GTV, it is not necessarily suitable for patients with large GTV.
		2017 Vol. 26 (7): 763-767 [Abstract] ( 991 ) [HTML 1KB] [ PDF 788KB] ( 0 )

	768	CBCT analysis of displacement of titanium clips for tumor bed localization after breast-conserving surgery for breast cancer
		Zhong Renming,Xiao Qing,Zhao Jianling,Li Yan,Ye Chengwei,Li Shuai,Bai Sen,Li Guangjun
		Objective To analyze the displacement of titanium clips for tumor bed localization after breast-conserving surgery for breast cancer and its influential factors. Methods A retrospective analysis was performed on the cone-beam computed tomography (CT) images of 14 patients with breast cancer who received radiotherapy after breast-conserving surgery from April to October,2016.The relative position of the chest wall and the errors of the titanium clips in radiotherapy were measured. A Pearson correlation analysis was used to analyze the correlation of the displacement of titanium clips with the relative position of titanium clips,the breast volume,the vertical distance between the titanium clips and the tangential line of the chest wall,and the maximum thickness of the breast. Results The system errors of the chest wall in left-right,superior-inferior,and anterior-posterior directions were 4.42,3.44,and 5.13 mm,respectively,and the random errors were 3.55,3.07,and 4.54 mm,respectively. The titanium clips had a large displacement relative to the chest wall,mainly in the left-right direction. The maximum system error was 4.39 mm and the random error was 2.42 mm. The displacement of titanium clips was not significantly correlated with the breast volume and the maximum thickness of the breast (P>0.05).However,the relative position of titanium clips in superior-inferior direction was significantly correlated with the displacement of the lowest,the most lateral,the most anterior,and the most posterior titanium clips (P<0.05).As to the uppermost clips,there was a significant difference in displacement between the clips close to the chest wall and the clips far from the chest wall (P=0.02). Conclusions Due to large setup error and displacement of titanium clips during radiotherapy,simultaneous integrated boost is not suitable for patients with breast cancer who are immobilized by vacuum cushion and received radiotherapy. The unstable immobilization may be the major influential factor for the displacement of titanium clips.
		2017 Vol. 26 (7): 768-773 [Abstract] ( 1183 ) [HTML 1KB] [ PDF 1681KB] ( 0 )

Physics·Biology·Technique

	774	Dosimetric comparison between three radiotherapy regimens involving supraclavicular and infraclavicular regions in breast cancer patients after breast-conserving surgery
		Chen Huiru,Wang shi,Wu Zhaoxia,Li Xiao,Chen Liang,Zhang Jian,Guo Xingdong,Duan Yin,Gan Lin,Yan Cunqing,Zou Yue
		Objective To evaluate the dosimetric difference between fixed-field static intensity-modulated radiotherapy (IMRT), fixed-field dynamic multileaf collimator (DMLC), and volumetric modulated arc therapy (VMAT), all of which involve supraclavicular and infraclavicular regions, in breast cancer patients after breast-conserving surgery. Methods This study included 14 female patients with breast cancer who received radiotherapy after breast-conserving surgery in our hospital from October 2012 to April 2016. The radiation field included the chest wall and supraclavicular and infraclavicular regions. IMRT, DMLC, and VMAT plans were generated for each patient while using identical optimization conditions. The doses to planning target volume (PTV) and organs at risk (OARs) were compared based on dose-volume histogram (DVH);one-way analysis of variance or nonparametric Wilcoxon rank test was used for comparison. Results For the dose distribution of PTV, VMAT achieved the best V₉₅, V₉₈, CI, and HI (P<0.009). Concerning the doses to OARs, VMAT achieved the best V₅, V₂₀, and D_mean of the ipsilateral lung and the best V₅ and D_mean of the contralateral lung (P<0.022). D_mean of the spinal cord was significantly lower in VMAT than in IMRT and DMLC (P=0.004). Conclusions VMAT is preferred for the patients with breast cancer to be treated with radiotherapy involving supraclavicular and infraclavicular regions after breast-conserving surgery. It can improve the dose distribution of target and reduce the doses to organs at risk and radiotherapy toxicities.
		2017 Vol. 26 (7): 774-777 [Abstract] ( 1245 ) [HTML 1KB] [ PDF 741KB] ( 0 )

	778	Dosimetric comparison between two brachytherapy applicators in cervical cancer treatment
		Feng Xi,Wang Xianliang,Yuan Ke,Tan Yankee,Zhang Dekang
		Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer. Methods The records of 40 cervical cancer (Ⅱ_B-Ⅳ_A) patients treated with 3D-image-guided HDR-BT were reviewed. Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator. The D_100% and V_150% of the clinical target volume (CTV) and the D_{2 cc} of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test. Results Overall metrics:CTV volume:66.04±13.86 cm³(TR) vs. 65.67±15.08 cm³(TO)(P=0.052);CTV D₁₀₀:3.71±0.34 Gy (TR) vs. 3.37±0.49 Gy (TO)(P=0.016);CTV V_150%:0.54±0.02(TR) vs. 0.56±0.04(TO)(P=0.034);rectum D_{2 cc}:3.38±0.30 Gy (TR) vs. 2.95±0.80 Gy (TO)(P=0.037);bladder D_{2 cc}:4.33±0.39 Gy (TR) vs. 2.93±1.27 Gy (TO)(P=0.00);and small intestine D_{2 cc}:3.04±1.02 Gy (TR) vs. 3.41±0.57 Gy (TO)(P=0.171). Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer. In addition, D_{2 cc} of the rectum and bladder were both higher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators. Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable applicator for the treatment of cervical cancer.
		2017 Vol. 26 (7): 778-780 [Abstract] ( 1239 ) [HTML 1KB] [ PDF 719KB] ( 0 )

	781	A study of PET-CT SUV range for dose verification in carbon ion radiation therapy
		Sun Lining,Hu Weigang,Lai Songtao,Shi Leijun,Chen Junchao
		Objective The positron generated at the dose deposition site by using high-energy carbon ions to hit the material annihilate with the negative electron in the material to release the gamma photon. The positron-emitting isotope (PEI) distributions in the target volume are activated significantly by carbon ions. Therefore, the mean values of positron emission tomography (PET) activity could be related to the delivered doses to the clinical target volume from carbon ion. This specialty can be used for the image registration fusion of the carbon ion treatment planning computed tomography (CT) and treatment verification PET-CT. After radiation in the almost same decay period, the relationship between the different target volume and the PET-CT SUV of different every single fraction dose can be found, then the range of SUV for the radiation target could be decided. So this PET-CT standardized uptake value (SUV) range can also provide a reference for the correlation and consistency in planning target dose verification and evaluation for the clinical trial. Methods The head phantom was used as a simulation of the real human body, the 1 cc, 4 cc, and 10 cc cube volume target contouring were done in the TPS, the 90 degree fixed carbon ion beams were delivered in different single fraction effective dose of 2.5 GyE, 5 GyE, and 8 GyE. After the beam delivery, later the PET-CT scanning was performed and parameters of scanning followed the trial regulation. The MIM Maestro software was used for the image processing and fusion to determine the maximum, minimum, average, and total values of SUV in the virtual clinical target volumes for the different single fraction dose. Results The results showed that for the same target volume, the SUV range of target had an approximate linear correlation with effective dose of target (P=0.000). The same effective dose for the different target volumes got the same SUV range (P>0.05). Conclusions For the carbon ion treatment plan, the SUV range from image registration and fusion of planning CT and PET-CT after treatment can be used to make an evaluation for accuracy of the dose distribution. And this method also could be used in the hyper-fraction treatment plan. In the SUV range research of different decay periods, the similar method can be performed for the exploration.
		2017 Vol. 26 (7): 781-785 [Abstract] ( 1131 ) [HTML 1KB] [ PDF 743KB] ( 0 )

	786	Effect of ion chamber sensitive volume on absolute dose verification in CyberKnife plan
		Liang Zhiwen,Yang Jing,Yang Zhiyong,Hu Bin,Cheng Junping,Li Qin,Wu Gang
		Objective To evaluate the effect of ion chamber sensitive volume on absolute dose verification in CyberKnife plan. Methods Solid water phantoms were scanned by a CT scanner, single-field plan, multi-field isocentric plan and sequential optimized plan were designed by the treatment planning system. Absolute doses were measured at the specified point in each plan using the ion chambers with sensitive volumes of 0.007 cm³(A16), 0.24 cm³(A12 s), and 0.6 cm³(PTW30013) and compared with calculated values. Results For the single-field plan, the relative error increased as the aperture size of collimator decreased;with relative errors within ±2%, the smallest aperture sizes of collimator were 12.5 mm (A16), 25 mm (A12 s), and 30 mm (PTW30013).For the multi-filed isocentric plan, the relative errors were 0.26%±3.90%(A16),-6.28%±14.33%(A12 s), and-9.41%±14.10%(PTW30013). For the sequential plan optimized with 15 mm cone, the relative error was 0.79%±1.43%;for the sequential plan optimized with 7.5 mm cone, the relative error was 2.01%±8.39%. In absolute dose verification for clinical plans, there was no significant difference between the results measured by these ion chambers (P=0.985). Conclusions There is no significant effect of ion chamber sensitive volume on absolute dose verification in CyberKnife plan under the following two situations:(1) the collimator with a relatively large aperture is used;(2) the sensitive volume of ion chamber is totally covered by the prescription isodose line.
		2017 Vol. 26 (7): 786-789 [Abstract] ( 994 ) [HTML 1KB] [ PDF 2090KB] ( 0 )

	790	Simulation of the discrepancy in 4DCT-based cumulative dose using digital phantoms
		Liu Gang,Yang Zhiyong,Liang Zhiwen,Yang Jing, Nie Xin,Cao Ting,Quan Hong,Zhang Jun,Li Qin
		Objective To conduct a computer simulation to evaluate the discrepancy between the cumulative doses calculated by four-dimensional computed tomography (4DCT) images and 4DCT scans (for real-time respiratory motions) due to the patient’s irregular breathing. Methods A series of digital phantoms were generated from a patient’s 4DCT images to simulate 4DCT images and 4DCT scans (for real-time respiratory motions) resulting from various irregular breathing curves. A six-field intensity-modulated radiotherapy plan was generated. Two cumulative doses in the target were calculated. The first one, named D^all, was calculated by tracking the point displacements in the target manifested on the 4DCT images;the second one, named D^4D, was calculated based on the point displacements along the whole breathing motion during 4DCT scanning. Dose discrepancy betweenD^4D and D^allwas calculated to evaluate the correlation between breathing pattern and dose discrepancy in the target. Results The dose discrepancy in the target was correlated with mean motion excursion and the standard deviation of motion excursion.ΔD_min(ΔD₉₉)in the target increased from 2.39%(2.04%) to 11.91%(5.24%) as the mean motion excursion increased from 5 mm to 15 mm, and increased from 5.93%(2.15%) to 14.65%(5.01%) as the standard deviation of motion excursion increased from 15% to 45% of the mean motion excursion. When the mean period increased from 3 s to 5 s or the standard deviation of period increased from 10% to 40% of the mean period,ΔD_min(ΔD₉₉)in the target was greater than 6.0%(2.0%), but less than 9.0%(3.0%). When the target diameter was 2 cm, 3 cm, and 4 cm,ΔD_min(ΔD₉₉)in the target was 11.88%(5.50%), 6.91%(2.42%), and 7.53%(3.62%), respectively. Conclusions There is a large discrepancy between the cumulative doses calculated using 4DCT images and 4DCT scans (for real-time respiratory motions) when the patient has irregular breathing. This dose discrepancy depends on mean motion excursion and the standard deviation of motion excursion, but has little relationship with mean period, the standard deviation of period, and tumor volume.
		2017 Vol. 26 (7): 790-794 [Abstract] ( 1015 ) [HTML 1KB] [ PDF 1859KB] ( 0 )

	795	Independent 3D dose calculation for IMRT based on simplification of beam model and collapsed-cone convolution/superposition algorithm
		Zhu Jinhan,Wang Bin,Liang Jian,Liu Xiaowei,Chen Lixin
		Objective To realize independent 3D dose calculation for intensity-modulated radiotherapy (IMRT) by building a two-source beam model of medical linear accelerator combined with a collapsed-cone convolution/superposition (CCCS) algorithm. Methods Two-source beam models of medical linear accelerators (Varian and Elekta) were built to calculate the 3D dose distributions using the CCCS algorithm. Scp,percent depth dose,and off-axis dose distribution were compared with the scanning data of ion chamber to confirm the calculation model. Twelve intensity-modulated treatment plans from each accelerator (a total of 24 plans) were selected for comparison. The calculation results of treatment planning system (TPS) were independently validated,and further compared with the measurement results of detector matrix. Results The dose deviations at the center of rectangle fields were lower than 1%,the deviation between doses at the same position in the field was not higher than 1%,and the positional deviation in the penumbra region was not higher than 1 mm. Gamma analysis based on 3%/3 mm standard was used tocompare the results calculated by detectors and TPS.The pass rates were higher than 90%. Conclusions The independent 3D dose calculation for IMRT based on two-source beam model combined with CCCS algorithm has been successfully set up. The comparison between regular field and IMRT plan indicates that this method and calculation model can be used for independent 3D dose calculation of clinical plan.
		2017 Vol. 26 (7): 795-799 [Abstract] ( 1116 ) [HTML 1KB] [ PDF 1001KB] ( 0 )

	800	The feasibility research of checking treatment plan by using Linatech treatment planning system
		Tang Huimin,Lu Miao zhen
		Objective To assess the feasibility of “secondary check” by LinaTech TiGRT treatment planning systems. Methods Choosing the Linatech TiGRT treatment planning system,researched and developed by Linatech company,as the third-party check tools. First,using Linatech TPS for recomputing treatment plans for geometrical phantoms designed in TG-119 and patients.after computation,compared the point dose with the measured data of phantoms (Using chameber No.2571 to measure point dose) and original plans. Using PTW verisoft with a criteria of 3% dose difference and 5 mm distance to agreement to assess the dose distribution on center level. After then,you can assess the accuracy of treatment plans. Results Tiny volume changes were found in ROI,especially in small size phantoms orcuspidal regions. For comparing measured data with recomputed plans and original plans,the dose data were found basically identical in TG-119 phantoms. And for patients,the differences between recomputed plans and AAA original plans or AXB original plans were smaller in breast cancer,but they were even bigger innasopharynx cancer,all patient cases showed a gamma passing rate more than 90%.The gamma passing rate of AAA original plans and AXB original plans were 95.6% and 97.53% for breast cancer,and 94.67% and 96.83% for nasopharynx cancer. Conclusions The method of utilizing the LinaTech TiGRT treatment planning system as a third-party check tools to assess the accuracy of plans is feasible,and the validation process is convenient,but some functions still need to improve and the scope of differences still need more patient cases to determine.
		2017 Vol. 26 (7): 800-805 [Abstract] ( 1068 ) [HTML 1KB] [ PDF 764KB] ( 0 )

	806	Application of detector array in treatment planning system modeling adjustment
		Niu Zhenyang,Fei Zhenle,Duan Zongjin,Li Zhijie,Wang Lei
		Objective To investigate the feasibility of detector array in Monaco modeling for MLC parameters adjustment. Methods One parameter was fixed, and then the other parameter was changed. The γ pass rates of the test beams, namely 3ABUT, 7SegA, and FOUR L, were assessed to determine the values of leaf transmission and leaf offset. A total of 12 tumor cases from different anatomical sites were randomly selected. Two-dimensional dose verification (rack angle zero) of Step& Shot and dMLC plans as well as three-dimensional dose validation of VMAT plan were performed using Octavius 4D system. The γ pass rates were analyzed at a standard of 3%/3 mm. Meanwhile, the point dose verification for these three plans was analyzed to obtain the dose deviations. Results The values of leaf transmission and leaf offset were 0.0105 and-0.08 mm, respectively. The average γ pass rates (%) of Step& Shot, dMLC, and VMAT plans were 88.59±2.94, 87.81±3.28, and 87.45±2.24 before adjustment and 98.45±1.23, 98.9±1.01, and 96.03±1.66 after adjustment. In addition, the average dose deviations (%) according to the point dose verification were 0.85±0.75, 0.95±0.39, and 0.98±0.40 before adjustment and 0.97±0.57, 1.08±0.76, and 0.86±0.45 after adjustment. Conclusions Octavius detector 729 ionization chamber array is a feasible and reliable device in Monaco modeling for MLC parameters adjustment.
		2017 Vol. 26 (7): 806-809 [Abstract] ( 960 ) [HTML 1KB] [ PDF 1056KB] ( 0 )

	810	Effect of lentivirus-mediated expression of RNF₂ gene on the proliferation and migration of esophageal carcinoma cells following X-ray radiotherapy
		Liu Zhikun,Wang Xuan,Zhang Weili,Yang Xingxiao,Su Jingwei,Zhu Shuchai
		Objective To examine the effect of X-ray radiotherapy on cell proliferation, migration, apoptosis, and cell cycle of human esophageal carcinoma ECA-109 cells following RNA interference (RNAi)-mediated downregulation of RNF₂ gene expression. Methods The level of RNF₂ mRNA expression in the human esophageal carcinoma cell line ECA-109 was determined using RT-PCR. Cell proliferation of ECA-109 was measured by MTT assay, and the changes in RNF₂ protein expression in ECA-109-R cells were determined using Western blot. The changes in cell cycle and cell apoptosis at different time points following radiation were analyzed by flow cytometry, and the effect of transduction on cell migration was examined using Transwell migration assay. Data were subjected to an analysis of variance with repeated measurement design. Results The mean mRNA and protein levels of RNF₂ in ECA-109 cells were significantly increased in a dose-dependent manner in the radiation group than in the control group (P<0.01).MTT results demonstrated that ECA-109 cell proliferation was significantly decreased at each time point following radiation compared to those without radiation (P<0.01).The levels of BMI₁ and RNF₂ protein expression were significantly reduced in the ECA-109-R group than in the ECA-109 and ECA-109-N groups (P<0.01),and no significant difference in protein levels was observed between the ECA-109 group and ECA-109-N group (P>0.05).The Transwell migration assay showed that the number of migrating cells following 3.5 h of radiation was significantly lower in the ECA-109-R group than in the ECA-109 and ECA-109-N groups (P<0.01). The percentage of G₂/M phase cells in each group was significantly lower following 6 Gy radiation compared to that in the corresponding untreated group (P<0.01), and the percentage of G₂/M phase cells was significantly lower in the ECA-109-R group than in the ECA-109 and ECA-109-N groups (P<0.05).Furthermore,cell apoptosis following radiation was also significantly higher in the ECA-109-R group than in the ECA-109 and ECA-109-N groups (P<0.01). Conclusions RNAi-mediated downregulation of RNF₂ expression in esophageal carcinoma cells can reduce cell proliferation and cell migration, rescue post-radiation G₂/M cell cycle arrest, promote cell apoptosis,and increase radiosensitivity.
		2017 Vol. 26 (7): 810-815 [Abstract] ( 1044 ) [HTML 1KB] [ PDF 2453KB] ( 0 )

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		2017 Vol. 26 (7): 816-818 [Abstract] ( 980 ) [HTML 1KB] [ PDF 922KB] ( 0 )

Review Articles

	819	Advances in magnetic resonance imaging-guided adaptive radiotherapy
		Huang Wei,Li X.Allen,Li Baosheng
		Cone-beam computed tomography (CBCT)-guided radiotherapy has been widely used in radiotherapy, but it still has many limitations. Using magnetic resonance imaging (MRI) instead of CBCT for imaging-guided radiotherapy can not only make use of the advantages of MRI, but it also allows for online and real-time tracking of tumor motion and biological changes. This technique truly realizes the real-time MRI-guided adaptive radiotherapy (ART) in anatomy and biology, and sets another milestone in the advancement of radiotherapy. This review summarizes the technical advantages of MRI-guided radiotherapy, the basic structure and type of MR-Linac, and the technical difficulties and solutions of MRIgART.
		2017 Vol. 26 (7): 819-822 [Abstract] ( 1207 ) [HTML 1KB] [ PDF 749KB] ( 0 )

	823	Translational study and clinical application of precision medicine in nasopharyngeal carcinoma
		Yin Jun,Xu Peng,Qin Yuan,Lang Jinyi
		The application of precision medicine in cancer treatment is becoming increasingly common as a result of the continuous advancement in basic research and physical techniques. The revolution of radiotherapy techniques, development of multimodal imaging technology, application of biological target dose carving and adaptive radiotherapy, availability of big data-based radiotherapy planning systems, and selection of chemotherapy regimen have all made the treatment of nasopharyngeal carcinoma increasingly precise. The growing interaction between laboratory research and clinical practice not only underscores the importance of translational medicine, but also prompts the development of biological immunotherapy and screening of prognostic factors. As a result, these changes mark the beginning of a new era for the diagnosis and treatment of nasopharyngeal carcinoma. This review provides a summary from 61 articles on the current progress in translational study and clinical application of precision medicine in nasopharyngeal carcinoma.
		2017 Vol. 26 (7): 823-827 [Abstract] ( 1122 ) [HTML 1KB] [ PDF 810KB] ( 0 )

	828	Radiomics:clinical application and progress
		Li Zhenjiang,Mao Yu,Li Baosheng,Li Hongsheng
		Radiomics is an emerging tumor diagnosis and auxiliary detection technique that has undergone rapid development in the past few decades. The availability of new imaging equipment and reagents, as well as the use of standardized imaging protocol, has made quantitative and standardized imaging analysis possible. Radiomics is a field of study that involves the extraction of a large number of quantitative features from areas of interest in medical images using data-characterization algorithms, and transformation of these data into first-order or high-order data. The accuracy of clinical diagnosis and prognostic value of radiomics can be further improved by analyzing the relationship between data layers. Although radiomics has many advantages and has made great progress, its standardization, reliability, and application in large data and multicenter studies will need to be further optimized.
		2017 Vol. 26 (7): 828-832 [Abstract] ( 1050 ) [HTML 1KB] [ PDF 775KB] ( 0 )

	833	*Research progress in electronic portal imaging device-based in vivo* dosimetry verification**
		Li Liqin,Li Guangjun,Shen Jiuling,Bai Sen
		In vivo dosimetry (IVD) is currently the most direct and effective means of quality assurance. The electronic portal imaging device (EPID) has been widely used for IVD verification owing to its favorable dosimetric properties. In recent years,an increasing number of EPID-based IVD studies have emerged around the world. The purpose of this paper is to give an overview of the present progress in EPID-based IVD studies,and to provide a reference for the subsequent application of EPID in IVD.
		2017 Vol. 26 (7): 833-837 [Abstract] ( 1804 ) [HTML 1KB] [ PDF 784KB] ( 0 )

	838	Research advances in gold nanoparticle-mediated tumor radiosensitization
		Zhao Ning,Fu Shen
		Nanotechnology has been extensively applied in the diagnosis and treatment of cancer, and is currently a major focus of research worldwide. Among the various nanomaterials, gold nanoparticles (GNPs) are of particular interest to many researchers due to their superior properties of low cytotoxicity, good biocompatibility, and preferential accumulation in tumors (the “enhanced permeability and retention” effect), which in turn gives GNPs a potential application in cancer diagnostics, imaging, photothermal therapy, and radiotherapy. Many published studies have shown that GNPs can be used as a new ideal radiosensitizer, and therefore understanding the radiosensitizing effects of GNPs both in vitro and in vivo will be of great significance in the clinical translation of nanomedicine.
		2017 Vol. 26 (7): 838-841 [Abstract] ( 1018 ) [HTML 1KB] [ PDF 760KB] ( 0 )

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