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.8 Published 2017-07-26

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

Guideline

	845	Modern radiation therapy for nodal non-Hodgkin lymphom-target definition and dose guidelines from the international lymphoma radiation oncology group
		Tim Illidge,MD,PhD¹, Lena Specht,MD², Joachim Yahalom,MD³,Berthe Aleman,MD,PhD⁴, Anne Kiil Berthelsen,MD⁵,Louis Constine,MD⁶,Bouthaina Dabaja,MD³, Kavita Dharmarajan,MD⁷,Andrea Ng,MD⁸,Umberto Ricardi,MD⁹, Andrew Wirth,MD¹⁰
		The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed,integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era,combined-modality treatment with systemic therapy is appropriate. A new concept,involved-site RT,defines the clinical target volume. For indolent NHL,often treated with RT alone,larger fields should be considered. Newer treatment techniques,including intensity modulated RT,breath holding,image guided RT,and 4-dimensional imaging,should be implemented,and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.
		2017 Vol. 26 (8): 845-852 [Abstract] ( 1461 ) [HTML 1KB] [ PDF 2536KB] ( 0 )

Special Featyre

	853	Clinical application of brachytherapy for malignant tumor (3):other malignant tumors
		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 soft tissue sarcomas,skin tumors,pediatric malignancies,isolated lymph node metastasis.
		2017 Vol. 26 (8): 853-856 [Abstract] ( 1376 ) [HTML 1KB] [ PDF 940KB] ( 0 )

Head and Neck Tumors

	857	Clinical values of ¹⁸FDG PET-CT and MRI in precise radiotherapy after surgery in patients with oropharyngeal squamous cell carcinoma
		Huang Rong,Wu Hui,Xu Jing,Lu Xiaoxu,Sun Xueming,Wang Shujuan
		Objective To investigate the clinical values of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸FDG PET-CT) and magnetic resonance imaging (MRI) in precise radiotherapy after surgery in patients with oropharyngeal squamous cell carcinoma. Methods A total of 53 patients with oropharyngeal squamous cell carcinoma were enrolled and underwent PET-CT and MRI imaging within two weeks after surgery. The detection rates of residual lesions and lymph node metastases after surgery by PET-CT and MRI were compared on the basis of the pathological results of biopsy. The gross tumor volume (GTV) and clinical target volume (CTV) determined by PET-CT and MRI were compared;the normally distributed data were analyzed using the t test, and the skewed distribution data by the Wilcoxon rank sum test. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value in predicting precise radiotherapy after surgery, as determined by PET-CT and MRI, were compared with the chi-square test. Results Fourteen patients had residual lesions after surgery. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET-CT in detecting residual lesions after surgery were significantly higher than those of MRI (92.86%, 94.87%, 86.67%, 97.37%, and 94.34% vs. 57.14%, 76.92%, 47.06%, 83.34%, and 71.70%, all P<0.05);the specificity, positive predictive value, and accuracy of PET-CT in detecting lymph node metastases were also significantly higher than those of MRI (all P<0.05), except for the sensitivity and negative predictive value (P>0.05). For the 14 patients with residual lesions, GTV_PET/CT was significantly smaller than GTV_MRI(45.62±22.13 cm³ vs. 60.61±23.12 cm³, P=0.034), so did CTV (125.54±17.53 cm³ vs. 142.18±21.22 cm³, P=0.011). There was no significant difference between CTV_PET-CT and CTV_MRI in 39 patients without residual lesions after surgery (117.87±17.66 cm³ vs. 128.05±20.65, P=0.099). Conclusions PET-CT is superior to MRI in detecting the residual lesions and lymph node metastases after surgery in patients with oropharyngeal squamous cell carcinoma, which provides valuable information for radiotherapy planning.
		2017 Vol. 26 (8): 857-861 [Abstract] ( 1360 ) [HTML 1KB] [ PDF 1605KB] ( 0 )

	862	Dosimetric effects of air cavity on target volume and organs at risk during intensity-modulated radiation therapy for nasopharyngeal carcinoma
		Liu Zhiping,Tian Yuan,Wang Hongzhi,Luo Jingwei,Gao Li,Xu Guozhen
		Objective To evaluate the dosimetric effects of air cavity on primary tumor and organs at risk (OARs) during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma patients. Methods Nine patients with nasopharyngeal carcinoma had CT simulation before treatment and on the 25 fraction of radiotherapy. Radiotherapy plan1 was first created by delineating the target volumes and OARs on the first CT image, which was then copied and merged with the second CT image. Air cavity that was formed following tumor volume regression was delineated on the first CT image, and the density of air cavity was set to zero. A new gross target volume (GTV) was formed by subtracting the air cavity from the original GTV, and the new CT image was named CT_Air. Plan2 was then created by calculating the dose distribution on CT_Air using the same portals and parameters as Plan1. Assuming that Plan1 and Plan2 were both used throughout the course of radiotherapy, the dosimetric parameters of nasopharyngeal tumor and OARs in the absence and presence of air cavity were then compared using the paired t-test. Results D_mean, D₉₅, D₉₀, D₁₀, and D₅ of tumor were significantly higher in plan2 than in plan1(P=0.000, 0.001, 0.001, 0.001, and 0.005, respectively), with a<0.5 Gy increase in dose. A dose build-up effect was observed within the tumor region posterior to the air cavity, where the highest dose was 1.4 cm posterior to the air cavity, resulting in a dose difference of 0.36 Gy. In addition, D_2cc and D_1cc of the brain stem were significantly higher in plan2 than in plan1(P=0.036 and 0.044, respectively). D_max of the optical chiasm, left optical nerve, and right optical nerve were also increased in the presence of air cavity (P=0.438, 0.434, and 0.477, respectively), but the change in dose was<0.12 Gy. Conclusions Air cavity induces a small but negligible increase in the tumor and OARs dose in patients with nasopharyngeal carcinoma during IMRT. However, closer monitoring should be conducted for patients with OARs that is close to or has surpassed tolerance prior to radiotherapy.
		2017 Vol. 26 (8): 862-866 [Abstract] ( 1562 ) [HTML 1KB] [ PDF 1819KB] ( 0 )

Thoracic Tumors

	867	Effect of postoperative adjuvant therapy on the prognosis of patients with stage pT₃N₀M₀ thoracic esophageal squamous cell carcinoma:a preliminary analysis
		Shen Wenbin,Gao Hongmei,Zhu Shuchai,Li Teng,Li Shuguang,Li Youmei,Liu Zhikun,Li Juan,Su Jingwei
		Objective To determine the prognostic factors in patients with stage pT₃N₀M₀ thoracic esophageal squamous cell carcinoma (TSCC) after esophagectomy, and to compare the effects of different treatment modalities on the prognosis of patients. Methods A retrospective analysis was conducted on 480 patients with stage pT₃N₀M₀ TSCC from 2007 to 2010 to determine the prognostic factors in the patients, and to compare the effects of different treatment modalities on their prognosis. Survival rate was calculated using the Kaplan-Meier estimator, and multivariate analysis of prognostic factors was performed using the Cox model. Results Of the 439, 333, and 278 patients who completed the 1-, 3-, and 5-year follow-up, respectively, the 1-, 3-, and 5-year overall survival (OS) rates were 90.0%, 68.7%, and 57.9%(median 87 months, 95% confidence interval (CI=74.7-99.4), respectively, and the 1-, 3-, and 5-year disease-free survival (DFS) rates were 82.3%, 60.4%, and 52.3%(median 71.3 months, 95%CI=55.1-87.5), respectively. In order to account for the different constituent ratios of some clinical and pathological data between the three groups of patients, 55 patients in each group were matched using propensity score matching (PSM)(all P>0.05). It was found that the post-PSM 1-,3-, and 5-year OS and DFS were significantly different between patients who received surgery only, postoperative chemotherapy (POCT), and postoperative chemoradiotherapy/radiotherapy (POCRT/RT)(P=0.000 and 0.006,respectively). Multivariate Cox analysis showed that age, lesion location, and treatment modality were independent prognostic factors for OS and DFS (P=0.029,0.004,0.000 and P=0.009,0.003,0.002), and the length of lesion was also an independent prognostic factor for DFS (P=0.003). Conclusions Although the rate of post-operative treatment failure is still high among patients with stage pT₃N₀M₀ TSCC, POCRT/PORT can improve the prognosis and the 5-year OS and DFS of these patients. However, further large-sample prospective studies will be required to confirm these findings.
		2017 Vol. 26 (8): 867-873 [Abstract] ( 1484 ) [HTML 1KB] [ PDF 844KB] ( 0 )

	874	Clinical effect of preoperative neoadjuvant chemoradiotherapy plus esophagectomy in treatment of locally advanced esophageal cancer
		Ran Gang,Zhou Lizhen,Zhou Chao,Kong Min,Zhu Chengchu,Yang Haihua
		Objective To evaluate the tolerance of preoperative neoadjuvant chemoradiotherapy (neoCRT) plus esophagectomy, as well as the short-term outcome, tumor resection rate, incidence of postoperative complications, and perioperative mortality, in patients with locally advanced esophageal cancer. Methods This study included 74 patients with thoracic esophageal cancer who were admitted to our hospital from May 2011 to June 2015. Chemotherapy and radiotherapy were performed concurrently. The chemotherapy consisted of vinorelbine (25 mg/m² on days 1, 8, 22, and 29) and cisplatin (25 mg/m² on days 1-4 and 22-25). The radiotherapy was conventionally fractionated with a total dose of 40 Gy (2.0 Gy/d). At 4-8 weeks after chemoradiotherapy, esophagectomy was performed (neoCRT+surgery group);definitive chemoradiotherapy (DCRT) was performed in the patients who refused surgery (DCRT group);follow-up was performed in the patients who refused any anti-cancer therapies after neoCRT (neoCRT group). Results Forty-four patients underwent neoCRT+surgery, with a radical resection (R₀) rate of 100% and a pathological complete response (pCR) rate of 43%;17 patients received DCRT;13 patients received neoCRT alone. For the neoCRT+surgery group, DCRT group, and neoCRT group, the 2-year overall survival (OS) rates were 79%, 75%, and 17%, respectively, and the 2-year disease-free survival (DSF) rates were 75%, 55%, and 17%, respectively. There were significant differences in OS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.001), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.415). There were significant differences in DFS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.002), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.416). The rate of clinical response to preoperative neoCRT was 87% for all patients. Fifty-six patients (76%) developed grade ≥3 myelosuppression due to preoperative neoCRT. The incidence rates of postoperative pulmonary infection, anastomotic leakage, and anastomotic stenosis were 21%, 12%, and 7%, respectively, and the perioperative mortality rate was 2%. Conclusions For patients with locally advanced esophageal cancer, preoperative neoCRT plus surgery can increase the clinical response rate and pCR rate, reduce the tumor stage, and improve the survival, but chemoradiotherapy toxicities and perioperative complications cannot be ignored.
		2017 Vol. 26 (8): 874-879 [Abstract] ( 1712 ) [HTML 1KB] [ PDF 1031KB] ( 0 )

	880	Efficacy and safety of stereotactic radiotherapy combined with bevacizumab for brain metastases of lung adenocarcinoma
		Pan Mianshun,Li Yong,Qiu Shujun,Guo Yutian,Chen Lei,Shao Xianjun,Zhang Li,Zhang Guoyu,Zhuge Fenghua
		Objective To evaluate the clinical efficacy and safety of stereotactic radiotherapy(SRT) combined with bevacizumab for brain metastases in patients with lung adenocarcinoma. Methods The clinical data of 95 patients with brain metastases of lung adenocarcinoma were retrospectively analyzed, including 36 patients treated with SRT and bevacizumab (bevacizumab group) and 59 patients treated with SRT, corticosteroids, and mannitol (traditional drug group). The tumor response rate, peritumoral edema control rate, improvement in Karnofsky Performance Scale (KPS) score, and adverse reactions were analyzed. Results Compared with the traditional drug group, the bevacizumab group had significantly higher tumor response rate (P=0.033) and peritumoral edema control rate (P=0.000) at 1-4 weeks after treatment, as well as an obvious improvement in KPS score and reduced doses of corticosteroids and mannitol. In addition, the adverse reactions in the bevacizumab group were mild and controllable. Conclusions SRT combined with bevacizumab for brain metastases in patients with lung adenocarcinoma can achieve higher short-term tumor response rate and peritumoral edema control rate and improve patients’ quality of life.
		2017 Vol. 26 (8): 880-883 [Abstract] ( 1560 ) [HTML 1KB] [ PDF 1508KB] ( 0 )

Abdominal Tumors

	884	Value of postmastectomy radiotherapy in locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy
		Rong Qinglin,Wang Shulian,Tang Yu,Jin Jing,Song Yongwen,Wang Weihu,Liu Yueping,Fang Hui,Ren Hua,Liu Xinfan,Yu Zihao,Li Yexiong
		Objective To evaluate the value of postmastectomy radiotherapy (PMRT) in locally advanced breast cancer patients treated with neoadjuvant chemotherapy (neoCT) and modified radical mastectomy, and to investigate the possibility of individualized radiotherapy according to the response to neoCT. Methods We analyzed 523 patients with stage Ⅲ_A and Ⅲ_B breast cancer who received neoCT and modified radical mastectomy in our hospital from 1999 to 2013. Of all patients, 404 received PMRT, and 119 did not. The locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method, survival difference analysis and univariate prognostic analysis were performed using the log-rank test, and multivariate prognostic analysis was performed using the Cox regression model. Results Compared with those not treated with PMRT, the patients treated with PMRT had a significantly lower 5-year LRR rate (13.9% vs. 24.8%, P=0.013), a significantly higher DFS rate (64.1% vs. 53.9%, P=0.048), and an insignificantly higher OS rate (83.2% vs. 78.2%, P=0.389). In the patients with ypT₃-T₄, ypN₂-N₃, or pathologic stage Ⅲ disease, those treated with PMRT had a significantly reduced 5-year LRR rate (P<0.05) and a significantly increased 5-year OS rate (P<0.05), as compared with those not treated with PMRT. Among the 158 patients with ypN₀ disease, the 5-year LRR rate was significantly lower in those treated with PMRT than in those not treated with PMRT (P=0.004). Of 41 patients who achieved a pathologic complete response, 2 patients, who did not receive PMRT, developed LRR. The multivariate prognostic analysis indicated that PMRT was an independent prognostic factor associated with reduced LRR in all patients and ypN₀ patients. Conclusions In patients with stage Ⅲ_A and Ⅲ_B breast cancer treated with neoCT and modified radical mastectomy, PMRT can significantly reduce LRR for all patients and can reduce both recurrence and mortality for those with ypT₃-T₄, ypN₂-N₃, or pathologic stage Ⅲ disease. There is no sufficient evidence that PMRT can be omitted safely for ypN₀ or pCR patients according to their response to neoCT.
		2017 Vol. 26 (8): 884-891 [Abstract] ( 1602 ) [HTML 1KB] [ PDF 1349KB] ( 0 )

	892	Efficacy of extended-field intensity-modulated radiotherapy for early-stage NK/T cell lymphoma
		Wu Tao,Liu Qiulim,Hu Yunfei,Mei Fan,Zhang Yi,Zuo Kai,Luo Wen,Huang Yunhong,Lu Bing
		Objective To evaluate the efficacy of extended-field intensity-modulated radiotherapy (IMRT) in the treatment of patients with early-stage NK/T cell lymphoma (NKTCL),and to examine the clinical characteristics and the effect of treatment factors on the prognosis of these patients. Methods The clinical data of 165 patients with early-stage NKTCL who underwent extended-field IMRT with (n=158,95.8%) or without chemotherapy (n=7,4.2%) were reviewed. Of these 165 patients,140(84.8%) received a radiation dose of ≥50 Gy to the primary lesion,and 25 patients (15.2%) received a radiation dose of<50 Gy. Most patients (n=147,89.1%) were treated with L-asparaginase-based chemotherapy regimens,whereas only 11 patients (6.7%) were treated with doxorubicin-based CHOP/CHOP-like regimens. In addition,109 patients (66.1%) received ≥4 cycles of chemotherapy. Locoregional control (LRC),overall survival (OS),and progression-free survival (PFS) rates were calculated using the Kaplan-Meier method,and the log-rank test was used for survival comparison and univariate prognostic analysis. A multivariate prognostic analysis was performed using the Cox model. Results The 5-year sample size 55.The 5-year OS,PFS,and LRC rates of all patients were 74.2%,72.5%,84.4%,respectively. The patients who received a dose of ≥50 Gy had a significantly higher 5-year LRC rate than those with<50 Gy (91.8% vs. 39.7%,P=0.000).The 5-year OS was significantly higher in the low-risk early-stage group than in the high-risk early-stage group (P=0.002).For the high-risk early-stage NKTCL group,patients who received ≥4 cycles of chemotherapy had significantly higher 5-year OS and PFS than those who received<4 cycles of chemotherapy (5-year OS:71.3% vs. 59.5%,P=0.032;5-year PFS:70.4% vs. 54.4%,P=0.009).In addition,multivariate analysis showed that ECOG≥2,primary tumor invasion (PTI),and Ann Arbor stage Ⅱ were associated with poor OS (P=0.006,0.002,0.014),and ECOG≥2 and PTI were associated with reduced LRC (P=0.004,0.016).Furthermore,ECOG≥2,PTI,Ann Arbor stage Ⅱ,and extranasal primary site were associated with lower PFS (P=0.045,0.003,0.030,0.032). Conclusions Extended-field IMRT at a dose of ≥50 Gy can lead to favorable LRC,OS,and PFS in patients with early-stage NKTCL.However,it is less effective against distant early-stage NKTCL in patients with poor prognosis. Nevertheless,≥4 cycles of chemotherapy can significantly improve the OS and PFS of patients with early-stage NKTCL.
		2017 Vol. 26 (8): 892-898 [Abstract] ( 1411 ) [HTML 1KB] [ PDF 863KB] ( 0 )

	899	Prognostic value of pretreatment serum hemoglobin level in early-stage extranodal nasal-type NK/T-cell lymphoma
		Li Xue,Lan Shengmin,Cao Jianzhong,Zhang Ning,Yuan Qiang,Guo Ruyuan,Li Hongwei
		Objective To investigate the effect of pretreatment serum hemoglobin (Hb) level on the prognosis of early-stage extranodal nasal-type NK/T-cell lymphoma. Methods A retrospective analysis was performed on the clinical data of 175 patients with stage Ⅰ or Ⅱ extranodal nasal-type NK/T-cell lymphoma who were admitted to The Tumor Hospital Affiliated to Shanxi Medical University from 2000 to 2015. The inclusion criteria included Ann Arbor Ⅰ/Ⅱ stage, the primary tumor located in the upper aerodigestive tract, without other malignant diseases, and complete clinical information and follow-up data. Of the 175 patients, 67 received chemotherapy alone, 8 received radiotherapy alone,100 received radiotherapy and chemotherapyed. The survival rate was calculated using the Kaplan-Meier method. The log-rank test was used for univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results The univariate analysis showed that pretreatment serum Hb level (≥120 g/L), lactate dehydrogenase (LDH) level (normal), Eastern Cooperative Oncology Group (ECOG) score (0-1), Ann Arbor stage (I_E), and radiotherapy were associated with significantly improved progression-free survival (PFS) and overall survival (OS)(P=0.000-0.046). The multivariate analysis showed that pretreatment serum Hb level, LDH level, ECOG score, and Ann Arbor stage were independent prognostic factors for PFS and OS (P=0.000-0.040). Conclusion Patients with a high pretreatment serum Hb level (≥120 g/L) have a better prognosis than those with a low pretreatment serum Hb level (<120 g/L).
		2017 Vol. 26 (8): 899-903 [Abstract] ( 1357 ) [HTML 1KB] [ PDF 840KB] ( 0 )

	904	Long-term follow-up of patients with early-stage diffuse large B-cell lymphoma of Waldeyer’s ring treated with intensity-modulated radiotherapy
		Song Xue,Wu Lirong,Chen Zhenzhang,Jiang Ning,Wang Dejun,Zhao Lijun,Bian Xiuhua,He Xia
		Objective To evaluate the treatment outcome, prognostic factors, radiation dose, and toxicities in patients with early-stage primary diffuse large B-cell lymphoma of Waldeyer’s ring (WR-DLBCL) treated with intensity-modulated radiotherapy (IMRT). Methods This study included 80 patients with a confirmed diagnosis of stage Ⅰ—Ⅱ primary WR-DLBCL who were admitted to our hospital from 2008 to 2015. Only 3 patients received radiotherapy alone, and the other patients received radiotherapy and chemotherapy. After chemotherapy, 24 patients achieved complete remission (CR), and 53 patients achieved partial remission (PR). IMRT was given to the primary lesion and cervical lymphatic drainage region. Survival analysis was performed using the Kaplan-Meier method and log-rank test. The Cox model was used for analysis of prognostic factors. The toxicities were scored using the RTOG criteria. Results The median follow-up was 64 months. The 5-year locoregional control (LRC), overall survival (OS), and progression-free survival (PFS) rates were 94%, 88%, and 84%, respectively. The dose-volume histogram showed that the maximum, mean, and minimum doses to primary gross tumor volume were 54.47 Gy, 52.27 Gy, and 38.83 Gy, respectively. Prognostic analysis showed that age>60 years and increased lactate dehydrogenase (LDH) were influencing factors for OS (P=0.009 and 0.002), and that aged>60 years, IPI ≥2, and increased LDH were influencing factors for PFS (P=0.001, 0.035, and 0.007). Among all patients, 12, 53, and 8 experienced grade 1-3 radiation-induced acute oral mucositis, respectively, and 16 and 13 experienced grade 1 and 2 xerostomia as the late toxicity, respectively. Conclusions For patients with early-stage primary WR-DLBCL, IMRT results in satisfactory OS, PFS, and LRC and has tolerable early or late radiation-induced toxicities.
		2017 Vol. 26 (8): 904-908 [Abstract] ( 1505 ) [HTML 1KB] [ PDF 769KB] ( 0 )

	909	Prognostic analysis of 71 patients with primary central nervous system diffuse large B-cell lymphoma
		Meng Fanjun,Guo Jiangui,Lin Youen,Zhang Yujing
		Objective To investigate prognostic factors in patients with primary central nervous system diffuse large B-cell lymphoma (PCNS-DLCBL). Methods The clinical data of 71 patients with PCNS-DLCBL confirmed by pathology and clinical tests, who were admitted to our hospital from 1991 to 2015, were retrospectively analyzed. All patients received chemotherapy, mainly with high-dose methotrexate (HD-MTX, 66/71), and 59 patients received radiotherapy, mainly with whole brain radiotherapy (WBRT)±local boost. The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival comparison and univariate prognostic analysis, and the Cox model was used for multivariate prognostic analysis. Results Fifty-eight patients achieved a complete response (CR), ten achieved a partial response (PR), and three had progressive disease (PD). The 5-year overall survival (OS) rate was 43%, and the 5-year progression-free survival (PFS) rate was 34%. The univariate analysis showed that the factors associated with OS included the following:age of onset, Karnofsky Performance Scale (KPS) score, single or multiple lesions, whether to receive radiotherapy, evaluation results after radiotherapy and chemotherapy, and the presence or absence of recurrence (P=0.000-0.047);the multivariate analysis showed that the three factors that affected OS were age of onset, KPS score, and the presence or absence of recurrence (P=0.000-0.022). The univariate analysis revealed that chemotherapy regimen, whether to receive radiotherapy, total radiotherapy dose, WBRT dose, evaluation results after radiotherapy and chemotherapy, and the presence or absence of recurrence were the factors associated with PFS (P=0.000-0.028);the multivariate analysis revealed that KPS score and the presence or absence of recurrence were associated with PFS (P=0.000-0.011). Conclusions Among patients with PCNS-DLCBL, younger age, higher KPS score, and no recurrence are associated with better OS, and single lesion, radiotherapy, and better evaluation results after radiotherapy and chemotherapy may be associated with better OS;higher KPS score, better evaluation results after radiotherapy and chemotherapy, and no recurrence are the factors associated with better PFS, and HD-MTX chemotherapy, radiotherapy, higher total radiotherapy dose, and higher WBRT dose may be associated with better PFS. Whether to receive radiotherapy after achieving a CR with chemotherapy and the target area and dose of radiotherapy need to be further studied.
		2017 Vol. 26 (8): 909-913 [Abstract] ( 1426 ) [HTML 1KB] [ PDF 778KB] ( 0 )

	914	Primary breast lymphoma:a prognostic analysis and literature review
		Zhang Na,Liu Peng,Lu Ke,Sun Quanquan,Zhu Yuan
		Objective To summarize the clinical characteristics and evaluate the feasible treatments of primary breast lymphoma (PBL). Methods The clinical data of 34 PBL patients (age 24-79 years) who were treated in our hospital between April 2006 and December 2013 were reviewed. Of these 34 patients, 18 had stage ⅠE PBL and 16 had stage Ⅱ_E PBL. Pathological types included diffuse large B cell lymphoma (29 patients), anaplastic large cell lymphoma (2 patients), marginal zone lymphoma (2 patients), and mantle cell lymphoma (1 patient). Two patients underwent surgery, four patients received chemotherapy alone, five patients received chemoradiotherapy, fourteen patients underwent surgery plus chemotherapy, and nine patients underwent surgery plus chemoradiotherapy. The 5-year overall survival (OS) and progression-free survival (PFS) rates were determined by the Kaplan-Meier estimator. Results During follow-up, 26 patients were alive without lymphoma and 8 patients had died by the end of follow-up (7 died from lymphoma and 1 died from chemotherapy-related hepatic failure). Among the 6 patients who relapsed, 5(83.3%) had recurrence within the first 2 years of treatment. In particular, 1 patient who had bilateral breast involvement developed left breast relapse after bilateral mastectomy and chemotherapy, 2 patients had bone marrow metastasis, 1 patient had lung and mediastinal lymph node metastases, and 2 had skin relapse. The 5-year OS and PFS rates of all patients were 75% and 75%, respectively. Conclusions Since PBL is a rare malignancy, its overall prognosis is fair and the incidence of local relapse is low with chemotherapy alone or in combination with other treatments. However, further studies on the development of more effective treatments will be required for patients who have failed the existing treatments.
		2017 Vol. 26 (8): 914-917 [Abstract] ( 1023 ) [HTML 1KB] [ PDF 747KB] ( 0 )

Physics·Biology·Technique

	918	Development and application of MOSAIQ integration platform based on radiotherapy workflow
		Yang Xin,He Zhenyu,Jiang Xiaobo,Lin Maosheng,Zhong Ningshan,Hu Jiang,Qi Zhenyu,Bao Yong,Li Qiaoqiao,Li Baoyue,Hu Lianying,Lin Chengguang,Gao Yuanhong,Liu Hui,Huang Xiaoyan,Deng Xiaowu,Xia Yunfei,Liu Mengzhong,Sun Ying
		Objective To develop a MOSAIQ Integration Platform^CHN (MIP) based on the workflow of radiotherapy (RT) and to meet the actual requirements in China and the special needs for the radiotherapy department. Methods MIP used C/S (client-server) structure mode running on the local network in the hospital and its database was based on the Treatment Planning System (TPS) and MOSAIQ database. Five network servers,as the core hardware,supplied data storage and network service based on “cloud services”. The core software was developed based on Microsoft Visual Studio Platform using C# network programming language. The MIP server could simultaneously offer network service for about 200 workstations,including entry,query,statistics,and print of data. Results MIP had 15 core function modules,such as Notice,Appointment,Billing,Document Management (application/execution),and System Management,which almost covered the whole workflow of radiotherapy. Up to June 2016,the recorded data in the MIP were as follows:13546 patients,13533 plan application forms,15475 RT records,14656 RT summaries,567048 billing records,and 506612 workload records. Conclusions The MIP based on the RT workflow has been successfully developed and used in clinical practice. It is an important part of radiotherapy information system construction with the advantages of intuitive operation,real-time performance,data security,and stable operation. It is digital,paperless,user-friendly,and convenient for the retrieval and statistics of data as well as information sharing and department management,and can significantly improve the efficiency of the department. More functions can be added or modified to enhance its potentials in research and clinical practice.
		2017 Vol. 26 (8): 918-923 [Abstract] ( 1447 ) [HTML 1KB] [ PDF 1234KB] ( 0 )

	924	Dosimetric evaluation of RapidPlan model on different Radiotherapy devices
		Ren Jiangping,Tao Qingsong,Zhou Yingying,Lou Pengrong,Guo Jianxin
		Objective To evaluate the dosimetric differences of one RapidPlan Model on different Radiotherapy devices. Methods A RapidPlan Model was built based on 30 reoptimization IMRT plans of cervical cancer patients on type"A" LA.Dosimetric differences of automatic optimized IMRT plans using this model on 4 different type LAs,named respectively"A","B","C" and"D",were compared with 12 test cervical cancer cases. These four LAs were well commissioned in the treatment planning system (TPS).Student t test was applied for statistical analysis on dosimetric differences. Results Dosimetric differences between A vs. B,C and D were observed on D_mean,HI,CI of PTV₅₀ and PTV₄₅,as well as on V₅₀,V₄₀,V₃₀ of rectum and bladder. Significant dosimetric differences were observed between A and D (P<0.05). Conclusions Automatic planning with RapidPlan model may result in dosimetric differences on different Radiotherapy devices. These differences should be aware of with caution in its clinical application.
		2017 Vol. 26 (8): 924-928 [Abstract] ( 971 ) [HTML 1KB] [ PDF 1989KB] ( 0 )

	929	Analysis of VMAT dosimetric verifications with different techniques
		Niu Zhenyang,Fei Zhenle,Duan Zongjin,Li Zhijie, Wang Lei
		Objective To investigate the gamma (γ) passing rates for volumetric-modulated arc therapy (VMAT) dosimetric verification with different techniques. Methods A total of 12 VMAT plans for the treatment of different anatomical sites in cancer patients were chosen. The Octavius 4D system was used to measure the dose distributions in two different settings:the gantry was rotating (three-dimensional (3D) and 2D γ-analysis) and the gantry was fixed at 0°(2D γ-analysis). The γ passing rates were analyzed with 3%/3 mm and 2%/2 mm criteria, using the paired t test or Wilcoxon signed-rank test. The 2D γ passing rates for different irradiation methods were calculated. Results For the 3D and 2D dose distributions obtained at a rotating gantry angle as well as the 2D dose distribution obtained at zero gantry angle, the average γ passing rates were 96.03%, 96.98%, and 98.90% for 3%/3 mm (P= 0.227, P= 0.000, P= 0.003);82.08%, 84.04%, and 90.90% for 2%/2 mm (P= 0.379, P= 0.000, P= 0.000). For the 2D dose distributions obtained with different irradiation methods, the average γ passing rate was 98.99% for 3%/3 mm and 93.68% for 2%/2 mm. Conclusions The VMAT dosimetric verification based on a 3D volumetric dosimeter at a rotating gantry position can be clinically useful for delivery quality assurance (QA), and can achieve the most reliable dose calculation for VMAT, which has more referential values.
		2017 Vol. 26 (8): 929-933 [Abstract] ( 1571 ) [HTML 1KB] [ PDF 1095KB] ( 0 )

	934	Clinical value of negative pressure vacuum cushion combined with thermoplastic body membrane in radiotherapy for Wilms tumor in children
		Qu Chao, Han Chen
		Objective To investigate the clinical value of negative pressure vacuum cushion combined with thermoplastic body membrane in radiotherapy for Wilms tumor in children. Methods A total of 42 pediatric patients with Wilms tumor who received radiotherapy after surgery were enrolled in the study and were randomly divided into two groups according to the fixation positions:group A and group B. During radiotherapy, the patients in group A were fixed with negative pressure vacuum cushion, and those in group B were fixed by negative pressure vacuum cushion combined with thermoplastic body membrane. The setup errors, short-term effects, adverse reactions, and prognosis were compared between the two groups. Results Group B showed significantly lower translational errors and rotational errors, as well as significantly higher rates of ≤3 mm and ≤5 mm errors, compared with the group A (P=0.04,0.04,0.04,0.03,0.00,0.04,0.04,0.00,0.04). Group B also showed significantly higher complete remission rates and response rates than group A (P=0.02,0.04). There were no significant differences in the adverse reaction rates (P=0.75) and the overall survival (OS) rates at 2 and 3 years (P=0.68,0.74) between the two groups. Group A had the M_PTV values in left-right (LR) direction (x-axis), superior-inferior (SI) direction (y-axis), and anterior-posterior (AP) direction (z-axis) being 5.74 mm, 5.93 mm, and 5.94 mm, respectively, and group B had the M_PTV values at LR, SI, and AP directions being 4.21 mm, 5.71 mm, and 4.61 mm, respectively. Conclusions In the radiotherapy positioning for Wilms tumor in children, fixation limbs with negative pressure vacuum cushion combined with thermoplastic body membrane effectively reduces the setup errors and improves the effect of radiotherapy, so it holds promise for clinical application.
		2017 Vol. 26 (8): 934-937 [Abstract] ( 1393 ) [HTML 1KB] [ PDF 1093KB] ( 0 )

	938	Effect of STAT-3-mediated non-dependent VEGFR-2 pathway on radiosensitivity of non-small cell lung cancer cells
		Liu Bin,Hu Chenxi,Liu Liang,Liu Qingjing,Tang Jingjiao,Jiang Xiaodong
		Objective To investigate the effect of signal transducer and activator of transcription-3(STAT-3)-mediated non-dependent vascular endothelial growth factor receptor-2(VEGFR-2) pathway on the radiosensitivity of non-small cell lung cancer (NSCLC) cells and its possible mechanism. Methods NSCLC cells were divided into control group, apatinib (VEGFR-2 inhibitor) group, apatinib+S3I-201(STAT-3 inhibitor) group, radiation (RT) group, RT+apatinib group, and RT+apatinib+S3I-201 group. Q-PCR and Western blot were used to measure the mRNA and protein expression of VEGFR-2, STAT-3, other proteins involved in the signaling pathway, hypoxia-inducible factor 1α(HIF-1α), and cyclin D₁. The cellular radiosensitivity was determined by colony-forming assay and cell apoptosis and cell cycle distribution were evaluated by flow cytometry. Results For Calu-1 cells, there was no significant difference in the expression of VEGFR-2 mRNA and STAT-3 mRNA between the apatinib group and the control group (P>0.05);the apatinib group had significantly lower expression of HIF-1α mRNA and cyclin D₁ mRNA than the control group (P<0.05);the apatinib+S3I-201 group had significantly lower mRNA and phosphorylated protein expression of VEGFR-2, STAT-3, and related downstream target proteins than the control group (F=304.54, P<0.01;F=118.99, P<0.01, F=144.34, P<0.01;F=529.66, P<0.01);compared with the control group, the apatinib+S3I-201 group and the apatinib group showed increases in apoptosis rate and proportion of cells in G₂+M phase, and the apatinib+S3I-201 group had significantly greater increases than the apatinib group (F=72.37, P<0.01). Compared with Calu-1 cells, the radiosensitizing effect of apatinib on A549 cells was limited (SER[sensitizer enhancement ratio]=1.39). The radiosensitizing effect of apatinib+S3I-201 on A549 cells was significantly higher than that of apatinib (SER:1.72 vs. 1.39, P=0.000). Conclusions The inhibition of STAT-3 can enhance the radiosensitivity of NSCLC cells. When VEGFR-2 is inhibited by apatinib, activated STAT-3 regulates the expression of cyclin D₁ directly or indirectly to affect the radiosensitivity of NSCLC cells. The inhibition of VEGFR-2 and STAT-3 has a good radiosensitizing effect on NSCLC cells.
		2017 Vol. 26 (8): 938-944 [Abstract] ( 1510 ) [HTML 1KB] [ PDF 1572KB] ( 0 )

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		2017 Vol. 26 (8): 945-946 [Abstract] ( 924 ) [HTML 1KB] [ PDF 686KB] ( 0 )

Review Articles

	947	Progress in three-dimensional MRI-guided brachytherapy for cervical cancer
		Xiao Yao,Ouyang Yi,Chen Kai,Cao Xinping
		Cervical cancer is one of the leading causes of death in women with malignancies worldwide. Brachytherapy plays an essential role in the radiation therapy for cervical cancer, and its combination with external beam radiation is indicated for previously untreated or recurrent cervical cancer at various stages without distant metastasis. Magnetic resonance imaging (MRI) has superior resolution of soft tissue, which allows for accurate delineation of target volume, protects organs at risk (OARs), and thus improves treatment outcomes. In recent years, many studies have demonstrated the feasibility and superiority of three-dimensional MRI-guided brachytherapy for cervical cancer. This article aims to elaborate on relevant MRI techniques, selection of applicators, delineation of target volume and OARs, evaluation of treatment plans, and the clinical effect of three-dimensional MRI-guided brachytherapy.
		2017 Vol. 26 (8): 947-950 [Abstract] ( 1737 ) [HTML 1KB] [ PDF 763KB] ( 0 )

	951	Progress in charged particle therapy
		Xia Wenlong,Hu Weigang,Dai Jianrong,Wang Luhua
		Charged particle therapy offers a better effect and obvious dosimetric and biological advantages over conventional radiotherapy in tumor control. Charged particles form Bragg peak in the dose distribution in tissue, enable most of energy to be deposited in the target region, and thus enhance tumor control and reduce the damage to normal tissues surrounding the tumor. With the increasing demand for charged particle therapy and the advances in particle accelerator, particle therapy technology is developing rapidly. The core apparatus of particle therapy facility is particle accelerator, and the accelerator type, particle type, and implementation technique determine the performance and therapeutic effect of the facility. This article provides a detailed comparative analysis of various particle therapies. Statistical data show that proton therapy is dominant in particle therapy, and high construction difficulty, large facility size, and extremely high cost have limited the development of heavy ion therapy. Nowadays, there are still some technical problems regarding charged particle therapy, and more clinical trials are required.
		2017 Vol. 26 (8): 951-955 [Abstract] ( 1010 ) [HTML 1KB] [ PDF 2611KB] ( 0 )

	956	Advances in clinical treatment of MALT lymphoma
		Liu Ke,Zhu Suyu
		Mucosa-associated lymphoid tissue (MALT) lymphoma often occurs in the stomach as well as the head and neck. This disease has characteristics of multi-site dissemination and indolent development,and about 80% of MALT lymphoma patients are in early stage. Helicobacter pylori (Hp) eradication is the main method for treating early-stage Hp-positive gastric MALT lymphoma. For patients with other types of early-stage MALT lymphoma and those with gastric MALT lymphoma who failed Hp eradication therapy,radiotherapy has a good clinical effect. In recent years,radiotherapy target volume has changed from the involved field to the involved site,and the dose has been decreased. This article provides a review of the above aspects.
		2017 Vol. 26 (8): 956-960 [Abstract] ( 1331 ) [HTML 1KB] [ PDF 786KB] ( 0 )

	961	Application of FDG PET-CT in chemoradiotherapy for esophageal cancer
		Gu Feiying,Jiang Chenxue,Xu Yaping
		Esophageal cancer is one of the most common gastrointestinal cancers, and chemoradiotherapy is an important part of the multidisciplinary treatment for this disease. In recent years, ¹⁸Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) is widely used in esophageal cancer for delineation of gross tumor volume, local boost irradiation in the late stage of radiotherapy, and assessment of the pathologic remission rate after neoadjuvant chemoradiotherapy, response to definitive chemoradiotherapy, and prognosis. In this article, we review the application of FDG PET-CT in the chemoradiotherapy for esophageal cancer.
		2017 Vol. 26 (8): 961-964 [Abstract] ( 1505 ) [HTML 1KB] [ PDF 773KB] ( 0 )

	965	Theory and practice of involved-field radiotherapy for esophageal squamous cell carcinoma
		Luo Yijun,Wang Xiaoli,Yu Jinming,Li Minghuan
		Chemoradiotherapy is a major treatment for inoperable esophageal carcinoma (EC). However, there is still controversy over the target volume for radiation, particularly nodal target volume. EC is characterized by a high rate of lymph node metastasis, and its metastatic pattern is not always predictable. Elective nodal irradiation (ENI) will increase the radiation field, which may increase the incidence of adverse events. Some investigators used involved-field irradiation (IFI) to reduce treatment-related toxicities without compromising survival. Studies have demonstrated that regional and distant micrometastases can be controlled, to some extent, by chemotherapy, incidental irradiation, and the abscopal effects of radiation. With either ENI or IFI, EC recurrence is usually found in the primary tumor and at distant sites, without survival difference. These data suggest that IFI is feasible in EC patients.
		2017 Vol. 26 (8): 965-969 [Abstract] ( 1417 ) [HTML 1KB] [ PDF 993KB] ( 0 )

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