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.9 Published 2017-09-10

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

Guideline

	971	Modern radiation therapy for extranodal lymphomas:field and dose guidelines from international lymphomaradiation oncology group
		Joachim Yahalom,MD,Tim Illidge,MD,PhD,Lena Specht,MD,PhD,Richard T.Hoppe,MD,Ye-Xiong Li,MD,Richard Tsang,MD,and Andrew Wirth,MD,on behalf of International Lymphoma Radiation Oncology Group
		Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL).Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL),consolidation after systemic therapy,salvage treatment,or palliation. The wide range of presentations of ENL,involving any organ in the body and the spectrum of histological sub-types,poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL.This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL,and to address the technical challenges of simulation,volume definition and treatment planning for the most frequently involved organs. Specifically,detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL.We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU),as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype,anatomy,the treatment intent,and other treatment modalities that may be have been used before RT.
		2017 Vol. 26 (9): 971-984 [Abstract] ( 2280 ) [HTML 1KB] [ PDF 1775KB] ( 0 )

Consensus

	985	Consensus and controversies on delineation of radiotherapy target volume for a patient with locally advanced non-small cell lung cancer
		Zhao Dan,Fu Xiaolong,Wang Lyuhua,Qu Baolin,Li Baosheng,Zhao Lujun,Xu Xiangying,Wang Jianhua,Qu Yaqin,Zhu Shuchai,Yu Zhilong,Li Guang,Yu Hong,Yang Yongjing,Li Jie,Xu Bo,Yin Weibo,Zhu Guangying
		Objective To investigate the consensus and controversies on the delineation of radiotherapy target volume for patients with locally advanced non-small cell lung cancer (LA-NSCLC). Methods Questionnaires including 15 questions on the delineation of radiotherapy target volume of NSCLC were sent to 12 radiation departments in China in November 2015. A patient with LA-NSCLC was selected by Fudan University Shanghai Cancer Center, and simulation CT images and medical history data were sent to the 12 radiation departments. Twelve radiation oncologists from the 12 radiation departments showed and explained the delineation of radiotherapy target volume of their own, and the patient was discussed by all experts in the sixth multidisciplinary summit forum of precise radiotherapy and chemotherapy for tumor and lung cancer. Results All receivers of the questionnaire answered the questions. The standard lung window width/level for the delineation of lung cancer was 800-1600/-600 to -750 HU, and the mediastinum window was 350-400/20-40 HU. Respiratory movement was measured by stimulator, 4D-CT, and stimulator+4D-CT with 2-5 mm expansion based on experience. The primary clinical target volume (CTV) was defined as gross target volume (GTV) plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma. The metastatic lesion of mediastinal lymph nodes was delineated as 5 mm plus primary lesion in 6 departments and as primary lesion in another 6 departments. Of the 12 departments, 10 applied 5 mm of set-up error, 1 applied 3 mm, and 1 applied 4-6 mm. For V₂₀ of the lungs, 10 departments defined it as<30%, 1 as<35%, and 1 as 28%. Nine departments defined the radiation dose of concurrent chemoradiotherapy (CCRT) for LA-NSCLC as 60 Gy in 30 fractions, 62.7 Gy in 33 fractions in 1 department, 50-60 Gy in 25-30 fractions in 1 department, and 60-70 Gy in 25-30 fractions in 1 department. For the delineation of target volume for the LA-NSCLC patient treated with CCRT, the primary planning target volume (PTV) was defined as GTV plus organ movement (IGTV) and set-up error (GTV→IGTV→PTV) in 3 departments, as CTV plus organ movement (ITV) and set-up error (GTV→CTV→ITV→PTV) in 8 departments, and as CTV plus set-up error/IGTV plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma (CTV) and set-up error (GTV→CTV→PTV/GTV→IGTV→CTV→PTV) in 1 department. For the delineation of PTV in the mediastinal lymph node, GTV→IGTV→PTV was performed in 3 departments, GTV→CTV→ITV→PTV in 8 departments, and GTV→CTV→PTV in 1 department. For 10%-100% patients with LA-NSCLC, the radiation field needed to be replanned when 38-50 Gy was completed. There was no unified standard for the optimal standardized uptake value (SUV) of positron emission tomography (PET)-computed tomography (CT) simulation and delineation. Seven departments had applied magnetic resonance imaging (MRI) simulation and 10 departments had applied stereotactic body radiation therapy (SBRT) for the treatment of early-stage NSCLC. For the delineation of PTV for early-stage NSCLC (T_1-2N₀M₀), GTV→IGTV→PTV was performed in 5 departments, IGTV→PTV in 3 departments, and GTV→CTV→ITV→PTV in 2 departments. In all the 12 departments, peripheral early-stage NSCLC was given 6.0-12.5 Gy/fraction, 3-12 fractions and central early-stage NSCLC was given 4.6-10.0 Gy/fraction, 5-10 fractions. The results of discussion on the delineation of target volume for the patient were as follows:respiratory movements should be measured by 4D-CT or simulator;the lung window width/level is 1600/-600 HU and the mediastinal window width/level is 400/20 HU;the primary controversy is whether the involved-field irradiation or elective nodal irradiation should be used for the delineation of CTV_nd in the mediastinal lymph node. Conclusions Basic consensus is reached for the delineation of target volume in LANSCLC in these aspects:lung window width/level, respiratory movements and set-up error, primary lesion delineation, the radiation dose in CCRT, and the optimal time for replanning the radiation field. There are controversies on the optimal SUV in the delineation of target volume based on PET-CT simulation, the optimal dose fractionation in SBRT for early-stage NSCLC, and the delineation of CTV_nd.
		2017 Vol. 26 (9): 985-991 [Abstract] ( 1651 ) [HTML 1KB] [ PDF 866KB] ( 0 )

Head and Neck Tumors

	992	Application of OBI system in intensity-modulated radiotherapy for nasopharyngeal carcinoma
		Zhong Jiajian,Wang Chentao,Deng Yongjin,Qiu Minmin,Lin Zehuang,Min Mengzhen,Xiao Zhenhua,Wang Zhenyu,Wen Bixiu
		Objective To examine the application of On-Board Imaging (OBI) system-based image-guided radiotherapy (IGRT) in the improvement of the precision of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma. Methods Ten patients with nasopharyngeal carcinoma were treatedwith IMRT using the OBI system. The IGRT images after positioning, position adjustment, and treatmentwere observed and recorded to investigate the image difference between CT simulation and IGRT. ResultsThe deviations in the x (lateral), y (cranial-caudal), and z (ventral-dorsal) directions between CT simulation and IGRT images were 0.22±1.00 mm,-0.37±1.28 mm, and 0.04±1.36 mm, respectively, after positioning, 0.29±0.76 mm,-0.04±0.78 mm, and -0.01±0.92 mm, respectively, after position adjustment, and 0.20±0.78 mm, 0.16±0.80 mm, and 0.05±0.92 mm, respectively, after treatment. The probabilities of a ≤1 mm deviation in the x, y, and z directions were 81.0%, 77.6%, and 88.2%, respectively, after positioning, 92.5%, 96.4%, and 96.4%, respectively, after position adjustment, and 91.7%, 94.9%, and 96.8%, respectively, after treatment. Conclusions The application of OBI system-based IGRT is very important in the improvement of the precision of fractionated IMRT for patients with nasopharyngeal carcinoma. The position of the patient should be adjusted based on the IGRT image after positioning in order to correct set-up error and effectively increase the precision of fractionated IMRT.
		2017 Vol. 26 (9): 992-996 [Abstract] ( 1640 ) [HTML 1KB] [ PDF 957KB] ( 0 )

	997


		2017 Vol. 26 (9): 997-999 [Abstract] ( 1930 ) [HTML 1KB] [ PDF 845KB] ( 0 )

Thoracic Tumors

	1000	Effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on prognosis of limited-stage small-cell lung cancer
		Hu Xiao,Xia Bing,Bao Yong,Xu Yujin,Wang Jin,Ma Honglian,Jin Ying,Fang Min,Tang Huarong,Chen Mengyuan,Dong Baiqiang,Fu Xiaolong,Chen Ming
		Objective To investigate the effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on the prognosis of limited-stage small-cell lung cancer (SCLC). Methods A total of 188 patients with limited-stage SCLC were enrolled in this study and divided into hyperfractionated group (n=92) and hypofractionated group (n=96). The hyperfractionated group received thoracic radiotherapy at 45 Gy in 30 fractions twice a day, while the hypofractionated group received 55 Gy in 22 fractions once a day. The Kaplan-Meier method was used to calculate survival rates, and the Cox model was used for multivariate prognostic analysis. Results There were not significant differences in 1-, 2-, and 5-year progression-free survival (PFS) rates and 1-, 2-, and 5-year overall survival (OS) rates between the hyperfractionated group and the hypofractionated group (82% vs. 85%, 61% vs. 69%, 59% vs. 69%, P=0.27;85% vs. 77%, 41% vs. 34%, 27% vs. 27%, P=0.37). The multivariate analysis showed that the time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days was favorable prognostic factor for PFS (P=0.005). The time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days and prophylactic cranial irradiation were favorable prognostic factors for OS (P=0.044;P=0.000). There were significant differences in incidence rates of grade 2 and 3 acute radiation esophagitis between the two groups (28% vs. 16%, 9% vs. 2%, P=0.009). Conclusions Both hyperfractionated radiotherapy and hypofractionated radiotherapy combined with chemotherapy can improve the PFS and OS of patients with limited-stage SCLC. The time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days and the time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days are favorable prognostic factors for PFS and OS, respectively. However, the hyperfractionated group has significantly higher incidence rates of grade 2 and 3 acute radiation esophagitis than the hypofractionated group.
		2017 Vol. 26 (9): 1000-1005 [Abstract] ( 1603 ) [HTML 1KB] [ PDF 869KB] ( 0 )

	1006	Long-term efficacy of concurrent chemoradiotherapy at different radiotherapy doses in treatment of esophageal carcinoma
		Ren Xuejiao,Wang Lan,Han Chun,Ding Boyue,Han Jing,You Yang
		Objective To compare the local control (LC), long-term overall survival (OS), and clinical adverse reactions in esophageal carcinoma patients receiving concurrent chemoradiotherapy at different radiotherapy doses. Methods A total of 373 esophageal carcinoma patients who received concurrent chemoradiotherapy in our hospital during 2004-2013 were included in this retrospective study. These patients were divided into<60 Gy group (n=99), 60 Gy group (n=155), and>60 Gy group (n=119) based on the dose of radiation. The Kaplan-Meier method was used to calculate LC and OS rates;the log-rank test was used for survival comparison and univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The 3-, 5-, 7-, and 10-year sample sizes were 97,96,56, and 38 in the<60 Gy group, 146,141,72, and 17 in the 60 Gy group, and 118,115,56, and 20 in the>60 Gy group. The 3-, 5-, 7-, and 10-year LC rates were 55.3%, 51.4%, 48.9%, and 48.9% in the<60 Gy group, 65.1%, 60.1%, 55.1%, and 55.1% in the 60 Gy group, and 49.4%, 45.1%, 37.7%, and 37.7%(8-year) in the>60 Gy group (P=0.020). The 3-, 5-, 7-, and 10-year OS rates were 35.4%, 26.1%, 22.0%, and 22.0% in the<60 Gy group, 49.0%, 41.3%, 32.1%, and 28.9% in the 60 Gy group, and 31.1%, 25.2%, 14.5%, and 12.9%(8-year) in the>60 Gy group (P=0.000). The univariate analysis showed that for stage Ⅱ esophageal carcinoma patients with gross tumor volume (GTV) ≤44 cm³, the LC rate was higher in the 60 Gy group than in the<60 Gy group (P=0.040,0.035), and the OS rate was higher in the 60 Gy group than in the other two groups (P=0.001,0.003 and P=0.045,0.006). Similarly, for stage Ⅲ esophageal carcinoma patients with GTV>44 cm³, the LC rate was higher in the 60 Gy than in the>60 Gy group (P=0.011,0.015), and the OS rate was higher in the 60 Gy group than in the other two groups (P=0.045,0.006 and P=0.033,0.002). The incidence rates of acute radiation esophagitis and radiation pneumonia were significantly higher in the>60 Gy group than in the other two group (P=0.007,0.033). Furthermore, the multivariate analysis indicated that radiotherapy dose, T stage, and N stage were independent prognostic factors for esophageal carcinoma (P=0.004,0.008,0.037). Conclusions Concurrent chemoradiotherapy at 60 Gy is most efficacious for patients with esophageal carcinoma, and the radiotherapy dose of>60 Gy significantly increases the incidence of adverse reactions.
		2017 Vol. 26 (9): 1006-1011 [Abstract] ( 1540 ) [HTML 1KB] [ PDF 864KB] ( 0 )

	1012	Effect of nutritional status and inflammatory markers on acute adverse reactions during concurrent chemoradiotherapy for esophageal carcinoma
		Wang Qian,Wang Jun,Wang Yi,Jing Shaowu,Liu Qing,Cao Feng,Jiao Wenpeng,Yang Congrong,Cheng Yunjie,Wu Yajing
		Objective To examine the effects of different pre-treatment nutritional status and inflammatory markers on acute adverse reactions in esophageal cancer patients during concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy. Methods The acute adverse reactions of 338 eligible esophageal cancer patients who received concurrent IMRT and chemotherapy in our hospital from 2006 to 2014 were reviewed. The effects of different pre-treatment nutritional status, such as body mass index level (BMI), albumin level (ALB), total lymphocyte count (TLC), the presence or absence of anemia, and inflammatory indicators including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), on acute adverse reactions in the patients were examined. Data were analyzed using the chi-square test with continuity correction and logistic regression analysis. Results The incidence rate of malnutrition in the patients based on their nutritional status was 5.62%-54.14%. The incidence rate of grade≥2 acute radiation esophagitis (RE) was significantly higher in the low ALB group than in the normal ALB group (P=0.000). The incidence rate of adverse reactions in the hematologic system increased as TLC decreased (P=0.006), but the incidence rate of acute radiation pneumonitis (RP) was reduced as TLC decreased (P=0.001). In addition, the incidence rate of grade ≥2 acute RE was significantly higher in the anemia group than in the non-anemia group. Inflammatory marker analysis demonstrated that the incidence rate of acute RE was significantly higher in the high NLR group and high PLR group than in the low NLR group and low PLR group (P=0.000 and P=0.024, respectively). Logistic regression analysis of nutritional status and inflammatory markers showed that TLC was an independent risk factor for acute adverse reactions in the hematologic system (P=0.001), and ALB and PLR were independent risk factors for acute RE (P=0.017 and P=0.011,respectively). Conclusions Nutritional status and inflammatory markers are associated with concurrent chemoradiotherapy-induced acute adverse reactions in esophageal carcinoma patients, and hence may be valuable indicators of acute adverse reactions during treatment. In addition, nutritional treatment and support care should be actively provided to the patients to prevent the development of acute adverse reactions during treatment.
		2017 Vol. 26 (9): 1012-1018 [Abstract] ( 1552 ) [HTML 1KB] [ PDF 859KB] ( 0 )

	1019	Effect of three-dimensional radiotherapy on the survival of patients with stage Ⅳ squamous cell lung cancer
		Hu Cheng,Hu Yinxiang,Ma Zhu,Ouyang Weiwei,Su Shengfa,Li Qingsong,Wang Yu,Li Huiqin,He Zhixu,Lu Bing
		Objective To retrospectively analyze the effect of three-dimensional radiotherapy on the survival of patients with stage Ⅳ squamous cell lung cancer. Methods Of the 101 patients collected from two prospective phase Ⅱ studies, 88 were part of the per-protocol set. All patients received platinum-doublet chemotherapy with concurrent radiation to the primary tumor. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Survival was calculated using the Kaplan-Meier estimator, and univariate and multivariate analyses were performed using the log-rank test and Cox model, respectively. Results The 1-, 2-, 3-, and 5-year OS rates of the 88 patients were 42.2%, 13.6%, 8.7%, and 3.1%, respectively, and the median survival time (MST) was 10 months. The 1-, 2-, 3-, and 5-year OS and MST at PTV dose ≥63 Gy were 45.7%, 25.7%, 17.1%, 7.1%, and 11 months, respectively, whereas the 1-, 2-, 3-, and 5-year OS and MST at PTV dose<63 Gy were 39.6%, 4.5%, 2.8%, 0%, and 10 months, respectively (P=0.007). The median PFS at ≥63 Gy and<63 Gy were 9 months and 7 months, respectively (P=0.032). The 1-, 2-, 3-, and 5-year OS and PFS of patients who received 4 cycles of chemotherapy at a PTV dose of ≥63 Gy were 51.9%, 29.6%, 18.5%, 9.9%, and 9 months, respectively (P=0.001 and P=0.012), which were significantly prolonged compared with other treatment modalities. Multivariate analysis showed that PTV ≥63 Gy may be influence the OS of patients (P=0.080). Conclusions Three-dimensional radiotherapy can prolong the survival of patients with stage ⅠV squamous cell lung cancer, as demonstrated by the gradual improvement in OS and PFS following the increase in the intensity of concurrent chemotherapy and radiation therapy. A PTV dose of ≥63 Gy may be influence the OS.
		2017 Vol. 26 (9): 1019-1023 [Abstract] ( 1442 ) [HTML 1KB] [ PDF 838KB] ( 0 )

Abdominal Tumors

	1024	Application of MRDWI combined with CEA and SCC in evaluation of the efficacy of concurrent chemoradiotherapy for cervical squamous cell carcinoma
		Jiang Xin,Zhu Wei,Yu Dedong,Wu Yun
		Objective To determine the value of the apparent diffusion coefficient (ADC) of magnetic resonance diffusion-weighted imaging (MRDWI) combined with squamous cell carcinoma antigen (SCC) and carcinoembryonic antigen (CEA) in the evaluation of the efficacy and prognosis of concurrent chemoradiotherapy for cervical carcinoma. Methods A total of 80 patients with cervical squamous cell carcinoma confirmed by histology or cytology in our hospital from 2013 to 2016 were included in this study. Of the 80 patients, 39 were FIGO stage Ⅱ_B, 7 were stage Ⅲ_A, 26 were stage Ⅲ_B, and 8 were stage ⅠVA. MRDWI examination and SCC and CEA measurements were first performed for the patients following group assignment, and the patients were then given extrapelvic radiotherapy (45-50 Gy)+platinum-based chemotherapy plus brachytherapy (20-25 Gy) based on their conditions. MRDWI, SCC, and CEA examinations were performed again after treatment to determine the changes in ADC, SCC, and CEA. In addition, ADC, SCC, and CEA were examined in the middle stage of treatment for 40 patients. Data were analyzed using the paired t-test or ANOVA. Results The overall response rate of the 80 patients after concurrent chemoradiotherapy was 100%. No disease progression was identified in any of the patients until the end of treatment, and the overall survival time of the patients was all above 6 months. Serum SCC and CEA were reduced after treatment (P=0.000,0.000), whereas the ADC value was increased after treatment (P=0.000). The increase in ACD following the decreases in SCC and CEA after treatment (P=0.000, 0.000) was indicative of increased efficacy of the concurrent chemotherapy and radiotherapy. Conclusions MRDWI combined with SCC and CEA is highly reliable for the evaluation of efficacy and prognosis of concurrent chemoradiotherapy for cervical cancer.
		2017 Vol. 26 (9): 1024-1027 [Abstract] ( 1121 ) [HTML 1KB] [ PDF 883KB] ( 0 )

	1028	Clinical efficacy of radiotherapy in treatment of recurrent lesions at vaginal cuff after hysterectomy for cervical cancer
		Li Huiling,Lin Xian,Chen Wenjuan,Chen Guilin
		Objective To analyze the long-term efficacy and adverse effects of radiotherapy in the treatment of recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, and to investigate prognostic factors. Methods A total of 105 patients who were admitted to our hospital due to recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer from January 2005 to July 2011 were enrolled in this study and divided into group A (6-12 months), group B (12-24 months), and group C (≥24 months) according to the time to recurrence. All patients received radiotherapy and only 96 patients also received concurrent chemotherapy. The long-term outcomes and adverse events were compared between the three groups, and the prognostic factors were analyzed. Survival curves were analyzed by the Kaplan-Meier method. Results The follow-up rate was 98.1%. The response rates of group A, B, and C were 60%, 82%, and 86%, respectively. The 3-and 5-year survival rates for all patients were 58.1% and 31.4%, respectively. The median survival time for all patients was 42 months. Group C had a significantly longer median survival time than group A (P=0.010). The patients with a maximum tumor diameter of<4 cm had a significantly better treatment outcome than those with a maximum tumor diameter of ≥4 cm (P=0.000). There was a significant difference in median survival time between the patients with recurrent lesions limited to the vaginal cuff and those with recurrent lesions beyond the vaginal cuff (47 months vs. 32 months, P=0.005). Conclusions For patients with recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, radiotherapy is a salvage treatment and has significant clinical efficacy. The treatment outcome and prognosis are related to time to recurrence, tumor size, and the extent of recurrent lesions.
		2017 Vol. 26 (9): 1028-1032 [Abstract] ( 1174 ) [HTML 1KB] [ PDF 819KB] ( 0 )

	1033	Expression of ERCC-1 protein and its clinical implication in locally advanced cervical cancer
		Zhang Zhongxin,Li Wei,Sun Hong
		Objective To examine the protein expression of the nucleotide excision repair gene (ERCC-1) in patients with locally advanced cervical cancer and its relationship with the efficacy of radiotherapy and chemotherapy. Methods The expression of ERCC-1 protein in 88 patients with locally advanced cervical cancer treated in our hospital between 2007-2011 was measured using immunohistochemistry (IHC). The patients were divided into high-expression group (n=48) and low-expression group (n=40) based on the fluorescence intensity on the IHC staining. All patients received cisplatin (40 mg/m² per week) during radiotherapy. The relationship between ERCC-1 protein expression and the clinicopathological factors of cervical cancer was analyzed using the chi-square test. Survival was calculated using the Kaplan-Meier method and compared by the log-rank test. Multivariate prognostic analysis was performed using the Cox model. Results The overall response rate (CR+PR) was 81%(39/48) in the high-ERCC-1 expression group and 85%(34/40) in the low-ERCC-1 expression group (P=0.641). ERCC-1 protein expression was associated with recurrence and metastasis (P=0.043,0.043). The 5-year survival rate was significantly higher in the low-ERCC-1 expression group than in the high-ERCC-1 expression group (65% vs. 42%, P=0.029). Conclusions Patients with high ERCC-1 protein expression are more likely to have local recurrence and distant metastasis than those with low ERCC-1 protein expression. ERCC-1 protein expression may be a clinically significant biomarker for predicting the prognosis of cervical cancer patients.
		2017 Vol. 26 (9): 1033-1037 [Abstract] ( 1025 ) [HTML 1KB] [ PDF 923KB] ( 0 )

	1038	Risk factors for lower extremity lymphedema following treatment of gynecologic cancers:a meta-analysis
		Chang Xin,Shen Jiaofeng,Peng Qiliang,Zhuang Zhixiang,Tian Ye
		Objective To investigate the multiple risk factors for lower extremity lymphedema in patients following treatment of common gynecologic cancers by meta-analysis for systematic analysis and comprehensive quantitative study. Methods Clinical trials published up until August 2016 were retrieved from PubMed, Embase, and the Cochrane Library. The quality of the included studies was assessed by the Newcastle-Ottawa Scale, and data analysis was performed using Stata 14.0 and RevMan 5.3. The strength of the associations between risk factors and gynecologic cancer-related lower extremity lymphedema was described as odds ratio (OR) and 95% confidence intervals (CI). Results Eighteen studies were included in the meta-analysis, and 8 relevant factors were identified. The risk factors for lower extremity lymphedema after treatment of gynecologic cancer mainly included radiotherapy (OR=2.45, 95%CI:2.05-2.95, P=0.000), FIGO stage (OR=2.29, 95%CI:1.66-3.14, P=0.000), and pelvic lymph node dissection (OR=2.00, 95%CI:1.02-3.91, P=0.040). Conclusions Radiotherapy, FIGO stage, and pelvic lymph node dissection are the main risk factors for lower extremity lymphedema after treatment of gynecologic cancers.
		2017 Vol. 26 (9): 1038-1044 [Abstract] ( 949 ) [HTML 1KB] [ PDF 1186KB] ( 0 )

	1045	Interfractional dosimetric study of target volume and organs at risk following intracavitary brachytherapy for cervical cancer
		Yan Junfang,Yu Lang,Hu Ke,Hou Xiaorong,Shen Jie,Lian Xin,Liu Zhikai,Zhang Fuquan
		Objective To examine the interfractional dosimetric variations among inverse three-dimensional (3D) plan, forward 3D plan, and two-dimensional (2D) plan of intracavitary brachytherapy for cervical cancer, and to discuss the risk of implementing the interval plan on different implantation applicators at short time intervals. Methods Twenty-five groups of CT-guided intracavitary brachytherapy (two consecutive radiations at ≤4 d apart) plans from 11 cervical cancer patients who received radical radiation therapy in our hospital were reviewed and compared. The dwelling location and time of the first intracavitary brachytherapy plan (Plan-1) were simulated on the CT image of the second intracavitary brachytherapy to form Plan-1-S. The target coverage indices and D_{2 cc} of organs at risk (OARs) of Plan-1-S and Plan 2(actual plan of the second intracavitary brachytherapy) under the three planning modes were recorded and compared using the paired t-test, Wilcoxon signed rank test, and ANOVA. Results The D₉₀, D₁₀₀, and V₁₀₀ of high-risk CTV were significantly lower in Plan-1-S created under the inverse mode in the actual plan (-9.11±13.46%,-13.16±18.79%, and -7.80±13.34%, P=0.002, 0.002, and 0.005, respectively). D₉₀, D₁₀₀, and V₁₀₀ of the interval plan had the greatest reduction under the inverse mode (76%, 80%, and 76%, respectively). The maximum reductions in D₉₀, D₁₀₀, and V₁₀₀ were 332.14 cGy (2D), 244.12 cGy (forward), and 41.76%(inverse). OAR overdose occurred most frequently under the forward mode;the rates of D₉₀, D₁₀₀, and V₁₀₀ reductions accompanied by one OAR overdose were 29.41%, 37.50%, and 25.00%, and the rates of D₉₀, D₁₀₀, and V₁₀₀ reductions by two OAR overdoses were 5.88%, 12.50%, and 6.25%,respectively. Overdose occurred most frequently in the small intestine (36%). Comparison of the three planning modes showed that the inverse plan had a greater reduction in each target coverage index than the 2D plan. Conclusions The simulated interval plan can significantly reduce target coverage and increase the risk of OAR overdose regardless of the planning mode and the short time intervals, and is therefore not recommended for clinical application.
		2017 Vol. 26 (9): 1045-1049 [Abstract] ( 1086 ) [HTML 1KB] [ PDF 962KB] ( 0 )

	1050	Efficacy of three-dimensional conformal radiotherapy in treatment of prostate cancer:a meta-analysis
		Zhang Lijin,Wu Bin,Yu Bo,Sha Sha,Wang Caiping,Yuan Jun,Zha Zhenlei,Zhao Hu
		Objective To systematically compare the efficacy of three-dimensional conformal radiotherapy (3D-CRT) versus intensity-modulated radiotherapy (IMRT) in the treatment of prostate cancer (PCa). Methods Clinical comparative studies of IMRT and 3D-CRT in the treatment of PCa were collected from PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Wanfang Data after two independent researchers developed the strategy and inclusion and exclusion criteria for the literature search. Articles published up to February 2017 were searched for, and the languages of publications were restricted to English and Chinese. Clinical meta-analysis of the data from the relevant studies was performed using the RevMan5.3 software. Results A total of 15 relevant retrospective cohort studies were collected from the databases in strict accordance to the search strategy and inclusion and excluding criteria. There were 4608 PCa patients, including 2229 in the IMRT group and 2379 in the 3D-CRT group. IMRT and 3D-CRT had similar adverse effects in terms of early-stage (odds ratio[OR]=0.77, 95% confidence interval[CI]:0.43-1.40, P=0.390) and late-stage (OR=0.75, 95%CI:0.55-1.04, P=0.080) urinary tract injury. However, IMRT led to reduced early-stage (OR=0.47, 95%CI:0.27-0.82, P=0.008) and late-stage (OR=0.52, 95%CI:0.35-0.78, P=0.001) intestinal injury compared with 3D-CRT. Meanwhile, the biochemical recurrence-free survival rate was also significantly higher in the IMRT group than in the 3D-CRT group (OR=1.87, 95%CI:1.51-2.32, P=0.000). Conclusions IMRT is more protective against intestinal injury with a higher biochemical recurrence-free survival rate compared with 3D-CRT during the treatment of PCa.
		2017 Vol. 26 (9): 1050-1054 [Abstract] ( 1081 ) [HTML 1KB] [ PDF 921KB] ( 0 )

Physics·Biology·Technique

	1055	Dosimetric comparison between volumetric-modulated arc therapy and intensity-modulated radiotherapy for esophageal cancer:a meta-analysis
		Gao Han,Jia Pengfei,Chen Bingsen,Tang Lemin
		Objective To investigate the dosimetric comparison of target volumes and organs at risk (OAR) between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for esophageal cancer by a meta-analysis. Methods A literature search was performed to collect the clinical studies on dosimetric comparison between VMAT and IMRT. The primary endpoints of interest were dosimetric parameters of target volumes and OAR, number of monitor units (MUs), and treatment time (TT). Results A total of 17 studies involving 323 patients were included in this meta-analysis. When the total dose was>50.4 Gy, VMAT showed significantly lower mean dose (D_mean) of gross tumor volume (GTV) and maximum dose (D_max) of planning target volume (PTV) than IMRT (P=0.009;P=0.039). There were no significant differences in D_mean, V₃₀, and V₄₀ of the heart, D_max of the spinal cord, and V₅, V₁₀, and D_mean of the lung between VMAT and IMRT (P>0.05). VMAT showed significantly lower V₁₅, V₂₀, and V₃₀ of the lung than IMRT (P=0.001;P=0.000;P=0.023). When the single dose was 1.8 Gy and 2.0 Gy, VMAT showed significantly lower TT (reduced by 323.5 s and 193.7 s) and number of MUs (reduced by 275.4 MU and 134.2 MU) than IMRT (P=0.000 and 0.009;P=0.000 and 0.022). Conclusions VMAT can significantly reduce TT, MUs, irradiation dose to the lung, and the risk of radiation pneumonitis, and improve the utilization rate of equipment. Compared with IMRT, VMAT has no significant advantages in protection of the spinal cord and the heart and dosimetric parameters of target volumes except D_mean of PTV and D_mean and D_max of GTV when the total dose was ≤50.4 Gy.
		2017 Vol. 26 (9): 1055-1061 [Abstract] ( 1533 ) [HTML 1KB] [ PDF 946KB] ( 0 )

	1062	Dosimetric analysis of 3D-printed coplanar template-assisted and CT-guided ¹²⁵I seed implantation for the treatment of malignant tumors
		Peng Ran,Jiang Yuliang,Ji Zhe,Guo Fuxin,Sun Haitao,Fan Jinghong,Li Xu,Wang Junjie
		Objective To compare the pre-and post-operative tumor target volume and to examine the consistency in physical dosimetric parameters of organs at risk (OAR) following 3D-printed coplanar template (3D-PCT)-assisted and CT-guided radioactive seed implantation. Methods The 3D-printed coplanar template was designed using a computer software, and the coordinate system was established where the center was used as the basis for setting the x axis and y axis. Crosses defining the center of treatment were drawn on the patient’s body and matched with the corresponding central point, x axis, and y axis of the coplanar template. 3D-PCT-assisted and CT-guided radioactive seed implantation was performed based on the pre-operative plan, and the pre-operative, operative, and post-operative plans were designed to evaluate the target tumor volume and the normal dose received by the tissues. In addition, dosimetric parameters, including D₉₀(minimum dose received by 90% of the gross target volume), V₁₀₀, V₁₅₀, V₂₀₀(percentage of GTV that received 100%, 150%, and 200% of the prescribed dose, respectively), minimum peripheral dose (MPD), conformal index (CI), external index (EI), and homogeneity index (HI) in the pre-operative and post-operative plans were also assessed and compared using the Wilcoxon test. Results Fourteen patients treated in our institution from August to October, 2016 were included in this study. The median age of the patients was 61.5 years, and the median Karnofsky Performance Scale score was 80. A total of 14 lesions from the 14 patients were treated by seed implantation in the neck (n=4), chest (n=3), abdomen (n=5), and pelvis (n=2). Of the 14 patients that underwent implantation, 8 had previously received radiation therapy, and 6 had not received radiation therapy. Dosage optimization was performed for all patients during the operation. The median activity of the implanted seeds was 0.625 mCi (0.55-0.75 mCi,1 Ci=3.7×10¹⁰ Bq), and the preoperatively planned median number of needling and implanted seeds were 9(4-34) and 45.5(10-162), respectively. However, the actual median number of needling and implanted seeds were 9.5(4-34) and 45.5(10-162), respectively. Dosimetric analysis showed that there were no significant changes in tumor volume (P=0.135), D₉₀(P=0.208), MPD (P=0.104), V₁₀₀(P=0.542), V₁₅₀(P=0.754), V₂₀₀(P=0.583), CI (P=0.426), EI (P=0.326), and HI (P=0.952) after implantation. Conclusions 3D-PCT guidance and dosage optimization can result in good consistency between pre-and post-operative plans for radioactive seed implantation. 3D-PCT is a convenient and cheap technique suitable for large-scale clinical application.
		2017 Vol. 26 (9): 1062-1066 [Abstract] ( 1226 ) [HTML 1KB] [ PDF 853KB] ( 0 )

	1067	Influence of CT value division on dose calculation in treatment planning
		Zhang Jun,Zhou Dingyi,Xie Conghua,Liu Hui,Zhou Fuxiang,Zhong Yahua,Dai Jingl,Zhou Yunfeng
		Objective To divide computed tomography (CT) values into different ranges and investigate the influence of CT value division on dose calculation, and to propose a method to combine magnetic resonance imaging (MRI) with assigned CT values. Methods Ten CT images each were collected from patients with head and neck, chest, and pelvic tumors. Random sampling was performed for the CT values of main tissues or organs at the three parts, and then the mean CT value of each tissue or organ was calculated to divide the CT values into different ranges. A virtual phantom was built in the Varian Eclipse treatment planning system, and for the prescribed dose of 100 cGy, the machine output was recorded at different CT values. The influence of different CT value ranges on dose calculation was analyzed. The treatment plans of intensity-modulated radiotherapy were selected from 5 cervical cancer patients, and new CT values were assigned to the planning target volume (PTV) and organs at risk to obtain new CT images. The plans were transferred to the new CT images and compared with the results on the original CT images in terms of dosimetric parameters. Results After dividing the CT values into different ranges and verifying the results in dose calculation, the CT values corresponding to different human tissues or organs were -100 to 100 HU. The influence of CT value variation on dose calculation was within 3%. In the same treatment plan, there were small differences in dosimetric parameters between new CT images and original CT images. D_max, D_mean, D_98%, D_95%, D_5%, and D_2% of PTV were all below 3%, and D_max and D_mean of the bladder, rectum, small intestine, femoral head, and bone marrow were below 2%. Conclusions The influence of CT value division on dose calculation in the treatment planning for pelvic tumors is acceptable, so it can be used in combination with MRI.
		2017 Vol. 26 (9): 1067-1071 [Abstract] ( 1268 ) [HTML 1KB] [ PDF 1068KB] ( 0 )

	1072	Influence of changing the parameters on energy and profiles of helical tomotherapy
		Xiao Bin,Yue Qi,Zhang Li,Wang Zhiwei,Yang Xiumei,Gu Dan,Duan Jimei,Zhang Yong
		Objective To investigate the impact of injection current (IC), injection voltage (IV), and pulse forming network (PFN) on energy (depth ratio D₂₀/D₁₀) and profiles of helical tomotherapy, and to improve the quality control for the stability of beam characteristics. Methods The energy and profiles were measured by ion chamber and TomoDose at different values of IC, IV, and PFN, the relationship between the energy and various parameters was evaluated by Pearson correlation analysis, and the changes in profiles were evaluated by comparative analysis. Results The energy had no correlation with IV and PFN values (P>0.05), but had a strong correlation with IC value (P=0.007), which showed a downward trend with the increase in IC. For the profiles in the x direction:(1) in the main beam region (-200 to 200 mm), the shoulder area of the profiles increased regularly with the increase in IC. There were no significant changes for the profiles when the IV values ranged from 6.42 V to 6.54 V, and the shoulder area of the profiles reached the highest point with IV=6.60 V, then decreased with further increase in IV. The shoulder area of the profiles decreased regularly with the increase in PFN.(2) In the penumbral region (±200 mm outside), all the three parameters had no effect on the profiles. For the profiles in the y direction:(1) in the main beam region (-20 to 20 mm), the profiles showed an upward trend in the area with an off-axis distance less than 16 mm when IC values were 5.40 V and 5.46 V, and showed an upward trend in the area with an off-axis distance less than 16 mm. But on the whole, the shoulder area of the profiles increased with the increase in IC, and was not affected by IV and PFN.(2) In the penumbral region (±20 mm outside), the profiles decreased regularly with the increase in IV, and was not affected by IC and PFN. IC had the highest influence on the profiles in the main beam region, followed by PFN and IV. Only IV had impact on the profiles in the penumbral region. Conclusions When the energy needs to be adjusted, the IC value should be given a priority, and PFN should be taken as a supplementary factor. When the profile needs to be adjusted, the IC value should be given a priority, and IV should be used as an auxiliary factor in the main beam region. But in the penumbral region, adjustment of parameters is only related to the profiles in y direction, so the IV value should be adjusted. This study has a guiding role in the quality control of energy and profiles, which can reduce the blindness of quality control, thus saving the time.
		2017 Vol. 26 (9): 1072-1076 [Abstract] ( 1042 ) [HTML 1KB] [ PDF 986KB] ( 0 )

	1077	A comparative study of measurement of small field data and calculation based on Monte Carlo method
		Chen Ning,Zhou Jianliang,Qiu Jie,Yang Bo,Pang Tingtian,Liu Nan,Liu Xia,Yu Lang,Li Wenbo,Dong Tingting,Zhang Fuquan
		Objective To compare the relative dose of small fields measured by clinically common detectors and those obtained from Monte Carlo simulation in order to obtain the accurate measurement method, and to modify the inappropriate detectors. Methods The percentage depth-dose distribution curve and profile (flatness and symmetry) curves were collected at 2 cm×2 cm, 3 cm×3 cm, and 4 cm×4 cm under 6-MV X-ray of Trilogy linear accelerator by CC13, PFD, SFD, and blue phantom. The results were compared with the stimulation results from Monte Carlo method (the current gold standard). The correction factors for the detectors with large error were calculated to provide reference data for clinical practice. Results The results measured by SFD detector were most close to the results from Monte Carlo simulation. The measurement errors of CC13 and PFD detectors were large. The correction factor in the penumbra for CC13 and PFD detector was 0.664-1.499. Conclusions SFD detector is better than CC13 and PFD detector in the measurement of small fields, but CC13 and PFD detector can provide reference data for clinical practice after the corresponding correction.
		2017 Vol. 26 (9): 1077-1079 [Abstract] ( 1011 ) [HTML 1KB] [ PDF 848KB] ( 0 )

	1080	Setup error of Orfit versus vacuum bag in radiotherapy for cervical cancer
		Gao Lijuan,Huang Jiamin,Huang Jun,Su Jianxin,Wu Yuqi,Lin Chengguang
		Objective To compare the setup errors of the negative pressure vacuum air cushion(vacuum bag) and the Orfit body foam fixator (Orfit frame) in radiotherapy for cervical cancer. Methods A total of 40 patients receiving three-dimensional radiotherapy for cervical cancer were enrolled in this study and equally and randomly divided into vacuum bag group and Orfit frame group. And the two groups were divided into Orfit-1 group, Orfit-2 group, vacuum-1 group, and vacuum-2 group according to the treatment course. The Orfit-1 group and vacuum-1 group were the data in the first 12 treatments, while the Orfit-2 group and vacuum-2 group were the data in the following 13 treatments. A cone-beam computed tomography scan was performed before each treatment to analyze setup error and then the body position was corrected to start the treatment. Comparison of continuous data between groups was made by paired t-test, while comparison of categorical data was made by chi-square test. Results There was a significant difference in the setup error in y-axis direction between the Orfit-1 group and the Orfit-2 group (P=0.003) and the setup error in r-axis direction between the vacuum-1 group and the vacuum-2 group (P=0.013). There were no significant differences in the setup errors in four directions (x-axis, y-axis, z-axis, and r-axis) between the Orfit-1 group and the vacuum-1 group (P>0.05). There were significant differences in the setup errors in y-axis and z-axis directions between the Orfit-2 group and the vacuum-2 group (P=0.007;P=0.001). Conclusions The Orfit frame and the vacuum bag have their own advantages and disadvantages in the fixation of body position in radiotherapy for cervical cancer. The setup error can be improved by long vacuum bags, ultrasound bladder capacity scanner, image-guided radiotherapy, or sectional radiotherapy plan.
		2017 Vol. 26 (9): 1080-1083 [Abstract] ( 1317 ) [HTML 1KB] [ PDF 857KB] ( 0 )

	1084	*Liver kinase B1 gene enhances radiosensitivity of lung cancer H460 cells:an in vivo* study**
		Li Hao,Zhang Wei,Huang Haoying,Qiu Xiangnan,Tong Shaodong,Zhang Xinjun,Wang Hui,Xie Ruilin,Qin Zhaohui,Yao Yuanhu
		Objective To investigate the effect of liver kinase B1(LKB1) on the radiosensitivity of subcutaneous xenograft tumor of lung cancer H460 cells in nude mice. Methods Human lung cancer H460 cells were implanted into female nude mice (BALB/c-nu) to establish a subcutaneous xenograft tumor model of lung cancer. A total of 24 female nude mice in which the model was successfully established were equally and randomly divided into four groups:pEGFP-Ctrl plasmid (empty vector plasmid) group, irradiation (IR)+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid (overexpressing LKB1) group, and IR+pEGFP-LKB1 plasmid group. The growth of xenograft tumors was observed and the tumor inhibition rate and enhancement factor (EF) were calculated. The expression of LKB1 in each group was measured by immunohistochemistry and Western blot to analyze the relationship between LKB1 and radiosensitivity. Results Compared with the pEGFP-Ctrl plasmid group, the IR+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid group, and IR+pEGFP-LKB1 plasmid group showed varying degrees of inhibition of tumor growth, particularly in the IR+pEGFP-LKB1 plasmid group, and the tumor inhibition rates were 31.30%, 14.78%, and 43.48%, respectively. The EF of LKB1 in the IR+pEGFP-LKB1 plasmid group was 1.18.The immunohistochemistry and Western blot showed that LKB1 could be effectively expressed in the pEGFP-LKB1 plasmid group and IR+pEGFP-LKB1 plasmid group, but not in the other two groups. Conclusions The subcutaneous xenograft tumor model of human lung cancer H460 cells has been successfully established in nude mice. LKB1 has a radiosensitizing effect on the subcutaneous xenograft tumor of lung cancer H460 cells in nude mice.
		2017 Vol. 26 (9): 1084-1088 [Abstract] ( 1159 ) [HTML 1KB] [ PDF 1003KB] ( 0 )

Review Articles

	1089	Recent advances in delineation of clinical target volume in radiotherapy for rectal cancer
		Yang Yongqiang,Zhu Yaqun,Tian Ye
		The delineation of clinical target volume (CTV) is a critical step in planning conformal radiotherapy for rectal cancer. Several guidelines suggest different subvolumes and anatomical boundaries in radiotherapy for rectal cancer, potentially leading to a misunderstanding of CTV definition. This article reviews recent advances in the delineation of CTV in radiotherapy for rectal cancer.
		2017 Vol. 26 (9): 1089-1093 [Abstract] ( 1198 ) [HTML 1KB] [ PDF 897KB] ( 0 )

	1094	Research progress in internal mammary lymph node irradiation for breast cancer
		Cong Binbin,Yu Jinming,Wang Yongsheng
		Internal mammary lymph node irradiation (IMLNI) could reduce local recurrence and distant recurrence and improve survival. The NCCN Guidelines have updated the recommends in IMLNI. However, the relative toxicities of IMLNI to the heart and lungs should be carefully considered by clinicians, so individualized indications for IMLNI are needed. Internal mammary sentinel lymph node biopsy (IM-SLNB) could be an accurate technique to guide IMLNI with minimally invasive staging, and provide more survival benefits to patients. This article reviews the benefits of IMLNI, controls of the side effect, and discussion of IMLNI guided by IM-SLNB.
		2017 Vol. 26 (9): 1094-1098 [Abstract] ( 1460 ) [HTML 1KB] [ PDF 842KB] ( 0 )

	1099	Understanding of radiation enteritis and its possible pathogenic mechanism
		Zhang Ximei,Wang Peiguo,Yuan Zhiyong,Wang Ping
		Radiation enteritis significantly affects the quality of life in the patients receiving radiotherapy due to pelvic tumor. As an intestinal inflammation related to radiotherapy, radiation enteritis is an inflammation of the mucous membrane in nature based on some basic research. Studies demonstrate that programmed necroptosis might play a role in the development of inflammatory bowel disease;therefore, as a subtype of inflammatory bowel disease, programmed necroptosis also might play a role in the development and progression of radiation enteritis. This paper aims to review the studies about the nature and pathogenic mechanism in order to contribute to the treatment of radiation enteritis and improve patients’ quality of life.
		2017 Vol. 26 (9): 1099-1102 [Abstract] ( 1004 ) [HTML 1KB] [ PDF 807KB] ( 0 )

	1103	Recent advances in DNA damage repair mechanism
		Dong Yiping,Zhang Dan,Han Suxia
		The stability of cell genetic material is influenced by a variety of factors, both internal and external, which can cause various types of DNA damage, such as DNA alkylation, oxidation, mismatching, loop structure, atypical DNA structure, single-strand break, and double-strand break. These DNA damages disrupt cellular homeostasis and dynamic equilibrium, which cause gene mutations, chromosomal abnormalities, and even degradation, aging, and death at different biological levels. By searching and identifying DNA damage sites, the cell activates a series of biochemical pathways, coordinates the progress of DNA replication and transcription, and then repairs the DNA damage. In this way, the cell maintains its independence and stability. While radiotherapy plays a role in eliminating tumors by DNA damages, it also initiates DNA damage responses. Among the responses, base excision repair, nucleotide excision repair, mismatch repair, double-strand break repair, and post-translesion synthesis repair play a key role in repairing the damages. The dysfunction of these repair pathways will cause differences in tumor radiation sensitivity. This paper summarizes recent research results in DNA damage repair, and focuses on the types of DNA damage and their repair mechanisms, so as to promote the understanding of the great significance of this field and to provide a theoretical basis for exploring the application of DNA damage repair pathways in tumor therapy.
		2017 Vol. 26 (9): 1103-1108 [Abstract] ( 1066 ) [HTML 1KB] [ PDF 857KB] ( 0 )

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		2017 Vol. 26 (9): 1109-1109 [Abstract] ( 831 ) [HTML 1KB] [ PDF 707KB] ( 0 )

	1110


		2017 Vol. 26 (9): 1110-1110 [Abstract] ( 852 ) [HTML 1KB] [ PDF 703KB] ( 0 )

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