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.12 Published 2017-12-10

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

Head and Neck Tumors

	1359	Relationship between positive lymph nodes and distant metastasis after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma
		Liao Xueyin, Kang Min, Xu Meng, Wang Rensheng
		Objective To explore the relationship between positive cervical lymph nodes and distant metastasis after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods A retrospective analysis was performed on the clinical data of 474 patients who were newly diagnosed with NPC but no distant metastasis and received IMRT from 2010 to 2012. The survival rates were calculated by the Kaplan-Meier method. The log-rank test was used for comparison of survival rates and univariate prognostic analysis. The multivariate analysis was made by the Cox regression model. Results In the 474 patients, 400 had positive cervical lymph nodes and 122 had residual masses in the neck after IMRT. The four-year distant metastasis, overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival (DMFS) rates were 13.71%(65/474), 82.9%, 81.4%, 93.5%, and 86.3%, respectively. The univariate and multivariate analyses showed that treatment approach, lymph node metastases in lower neck Ⅳ/Ⅴb/Ⅴc regions, the greatest diameter of the positive cervical lymph nodes, the diameter of residual lymph nodes, and time to lymph node recession were independent prognostic factors for DMFS (all P<0.05). Conclusions Chemoradiotherapy can reduce the distant metastasis rate after IMRT for NPC. The larger the cervical lymph nodes are, the more likely there are residual masses;the larger the residual cervical lymph nodes are, the higher risk of distant metastasis there is. Large cervical lymph nodes (≥6 cm), residual masses larger than 1 cm, and residual masses at 3 months after IMRT are negative prognostic factors for DMFS after IMRT for NPC. Better intervention treatment approaches need to be explored.
		2017 Vol. 26 (12): 1359-1364 [Abstract] ( 930 ) [HTML 1KB] [ PDF 1273KB] ( 0 )

	1365	Dosimetric parameters predicting grade ≥3 acute oral mucosal toxicity induced by radiation:an independent validation study comparing oral cavity versus mucosal surface contouring
		Li Kaixin, Chen Yuanyuan, Hu Qiaoying, Chen Ming, Xing Peiling
		Objective To investigate whether the mucosal surface volume can be an alternative to the oral cavity volume for predicting grade 3/4 acute oral mucosal toxicity in patients with locally advanced nasopharyngeal carcinoma (LANPC). Methods A total of 92 patients with LANPC who underwent intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy were enrolled in this study. The delineation of the oral mucosa was performed using oral cavity contours (OCC) or mucosal surface contours (MSC). Dosimetric comparisons of toxicity were performed based on the obtained dose-volume histograms (DVHs). The receiver operating characteristic (ROC) curve and logistic regression analysis were used to do statistical analysis of the data obtained from the two different contour methods. Results Both contouring methods showed a significant dose-volume association between oral mucosal exposure and acute oral mucosal toxicity. Logistic regression analysis showed that body weight loss was the independent associated factor for grade 3/4 toxicity in both OCC group and MSC group (P=0.017 and 0.005). And the independent correlation factors for dosimetric parameters in OCC group and MSC group were V30(P=0.003) and V50(P=0.003), respectively. The area under the ROC curve (AUC) of OCC at V30 was 0.753(P=0.001) and the AUC of MSC at V50 was 0.714(P=0.004). Conclusions DVH analysis of mucosal surface volume can accurately predict grade ≥3 oral mucosal toxicity in patients with LANPC who receive IMRT and concurrent chemotherapy. However, OCC is superior to MSC in clinical application.
		2017 Vol. 26 (12): 1365-1369 [Abstract] ( 830 ) [HTML 1KB] [ PDF 1212KB] ( 0 )

	1370	Value of BOLD-fMRI in the protection of visual function during postoperative intensity-modulated radiotherapy for cerebral gliomas
		Gao Wenqi, Zhao Chaoyun, Wang Minglei, Xia Xinshe, Guo Yanhong, Shi Yanan, Huang Xueying, Ma Hui, Wang Xiaodong, Guo Yulin Xia Hechun
		Objective To investigate the clinical value of blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in the protection of visual function during postoperative radiotherapy for occipital lobe gliomas. Methods Twenty-eight patients with occipital lobe gliomas receiving postoperative radiotherapy from 2014 to 2016 were enrolled as subjects. All patients underwent computed tomography (CT) simulation, conventional MRI, and BOLD-fMRI before radiotherapy. The location and scope of the visual cortex on 3DT1 anatomical images were used to guide the labeling of the visual cortex on simulated CT images. A visual cortex protective radiotherapy plan and a conventional radiotherapy plan were made by intensity-modulated radiotherapy. The feasibility of the visual cortex protective radiotherapy plan was evaluated using conformity index (CI), homogeneity index (HI), Dmax, and Dmean for planning target volume (PTV) and Dmax and Dmean to the visual cortex. Results For the two plans, if the effective dose to target volume was guaranteed and the doses to conventional organs at risk were acceptable, there were no significant differences in CI or HI for PTV between them (P=0.874,P=0.602).Compared with the conventional radiotherapy plan, the Dmax and Dmean to the ipsilateral visual cortex were reduced by 8.40% and 9.25%, respectively, while the Dmax and Dmean to the contralateral visual cortex were reduced by 13.26% and 14.77%, respectively, in the protective radiotherapy plan. Conclusions With a guaranteed prescribed dose to target volume and BOLD-fMRI used as a guide, the visual cortex protective radiotherapy, compared with the conventional plan, can reduce the dose to the visual cortex and protect the corresponding functional areas.
		2017 Vol. 26 (12): 1370-1375 [Abstract] ( 736 ) [HTML 1KB] [ PDF 3232KB] ( 0 )

Thoracic Tumors

	1376	Establishment of the NTCP model for radiation-induced lung injury in patients with non-small cell lung cancer
		Chen Xinyuan, Sun Shuai, Wang Lyuhua, Dai Jianrong
		Objective To examine the incidence of radiation-induced lung injury (RILI) after involved-field intensity-modulated radiation therapy (IMRT) in patients with locally advanced non-small cell lung cancer (NSCLC), and to evaluate the predictability of different models. Methods The clinical data of 242 inoperable or unresectable stage Ⅲ NSCLC patients treated in our hospital from 2007 to 2011 were reviewed. Grade 2 and grade 3 RILI that occurred within 6 months after IMRT were selected as outcome events in this study. The principal component analysis (PCA) model, Lyman-Kutcher-Burman (LKB) model, and mean lung dose (MLD) model were each used to establish a predictive model of normal tissue complication probability (NTCP) for evaluating the dosimetric parameters of IMRT. Results Four principal components were used in the PCA model. The areas under the receiver operating characteristic curve (AUCs) of grade 2 and grade 3 RILI were 0.652 and 0.611, respectively. For the LKB model, the fitted parameters were m=0.46, n=1.35, and D50=23.59 Gy for grade 2 RILI, and m=0.36, n=0.27, and D50=72.67 Gy for grade 3 RILI. The AUCs of grade 2 and grade 3 RILI in the LKB model were 0.607 and 0.585, respectively. For the MLD model, the estimated parameters were γ50=1.073 and D50=24.66 Gy for grade 2 RILI, and γ50=0.97 and D50=48.45 Gy for grade 3 RILI. The AUCs of grade 2 and grade 3 RILI in the MLD model were 0.604 and 0.569, respectively. Conclusions The use of large data set from a single patient population with the same mode of treatment is very important for improving model predictability and stability. Both the LKB model and PCA model can predict the probability of RILI, whereas the MLD model is less effective in predicting grade 3 RILI.
		2017 Vol. 26 (12): 1376-1380 [Abstract] ( 721 ) [HTML 1KB] [ PDF 1619KB] ( 0 )

	1381	Clinical efficacy and prognostic factors of stereotactic body radiotherapy for pulmonary oligometastases
		Li Zhijun, Li Chunyang, Zhang Junhong, Wang Xiaoyong, Zhang Jun, Wang Dajiang, Zhong Yahua, Zhou Fuxiang, Zhou Yunfeng, Xie Conghua
		Objective To evaluate the clinical efficacy and prognostic factors of stereotactic body radiotherapy (SBRT) for pulmonary oligometastases, and to further explore the patients most suitable for SBRT. Methods From 2012 to 2105, 51 patients with 76 oligometastatic lung tumors were treated with SBRT. In those patients, 27 had primary lung tumors and the others had extrapulmonary tumors. Seven patients had squamous cell carcinoma, thirty-five had adenocarcinoma, and the rest had other types of cancer. The patients received radiotherapy at a dose of 50 Gy in five fractions or 60 Gy in three fractions. Survival analysis was made by the Kaplan-Meier method. A multivariate analysis was made by the Cox model. Results The 1-and 2-year local control rates were 86%(65/76) and 80%(61/76), respectively. The 1-and 2-year overall survival (OS) rates were 80%(41/51) and 55%(28/51), respectively. The median survival time was 30(2-57) months, while the median progression-free survival time was 8(1-32) months. Twenty-one patients had grade 1 radiation pneumonitis (RP), while one patient had grade 2 RP. The multivariate analysis revealed that no more than 2 oligometastatic lung tumors, progression-free interval (PFI), and a performance score (PS) no higher than 1 were independent factors for OS (all P<0.05). Conclusions SBRT is effective and safe for treating pulmonary oligometastases. The number of oligometastatic lung tumors, PFI, and PS are independent prognostic factors for OS. Suitable patients and the appropriate timing of treatment are key to the efficacy of SBRT.
		2017 Vol. 26 (12): 1381-1384 [Abstract] ( 727 ) [HTML 1KB] [ PDF 779KB] ( 0 )

	1385	Effect of CT pitch on the GTV delineation of solitary pulmonary lesion
		Shang Dongping, Wang Lizhen, Zhang Qiang, Yu Jinmin, Yin Yong
		Objective To explore the effect of pitch in three-dimensional computed tomography (3DCT) on the gross tumor volume (GTV) and spatial position of solitary pulmonary lesion (SPL), and to evaluate the feasibility of high-pitch 3DCT simulation for SPL. Methods Twenty-two patients with peripheral lung cancer or metastatic SPL were divided into groups A and B according to the tumor location. All patients underwent spiral CT scans at different pitches (pitch_CON=0.938, pitch_S=0.438, and pitch_B=1.188) during free breathing. All GTVS were delineated by the same radiation oncologist using the same contouring protocol. GTVCON generated at pitch_CON, GTVS generated at pitches, and GTVB generated at pitchB were compared in terms of volume and geometric position, and GTVS and GTVB were registered to GTVCON gained at the conventional pitch. The Friedman M and Wilcoxon rank-rum test were used for comparison. Results The volumes of GTVCON, GTVS, and GTVB were 11.58±16.42 cm³, 11.63±17.73 cm³, and 12.09±17.46 cm³, respectively (P=0.11). There were no significant differences in the centroid position in x, y, and z directions between GTVCON, GTVS, and GTVB (Px=0.33, Py=0.81, Pz=0.39). The same result was found in group B (Px=0.92, Py=0.05, Pz=0.37). The matching index (MI) between GTVS and GTVCON was related to the tumor location, so was the MI between GTVB and GTVCON. Conclusions The pitch in 3DCT simulation has no significant effect on the GTV and spatial position of SPL. Increasing CT pitch appropriately can improve the scanning speed and shorten the duration of 3DCT simulation, so high-pitch 3DCT simulation is feasible for SPL.
		2017 Vol. 26 (12): 1385-1388 [Abstract] ( 773 ) [HTML 1KB] [ PDF 791KB] ( 0 )

	1389	Effects of gross tumor volume and positive lymph node volume on prognosis of intensity-modulated radiotherapy for esophageal squamous cell carcinoma
		Shi Xiangyu, Zhang Wencheng, Guan Yong, Qian Dong, Jiang Wei, Zeng Jing, Liu Xiaojie, Wang Daquan, Wang Jun, Wang Ping, Pang Qingsong
		Objective To analyze the effects of gross tumor volume (GTV-T) and positive lymph node volume (GTV-LN) on the prognosis of radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma (ESCC). Methods A total of 79 patients with stage N1 ESCC undergoing radical radiotherapy in our hospital from 2012 to 2015 were enrolled as subjects. GTV-T and GTV-LN were calculated by the Pinnacle³ 9.0 treatment planning system. The receiver operating characteristic (ROC) curves were used to evaluate the value of the GTV-LN/GTV-T ratio in the prediction of local recurrence (LR) and distant metastasis (DM) of ESCC. Results The median follow-up time was 17.2 months in all patients. The ROC curves were made using the GTV-LN/GTV-T ratio. The optimal cut-off values of GTV-LN/GTV-T ratio for predicting the risk of LR and DM were 0.34 and 0.59, respectively. The statistical analysis revealed that the LR rates were 50% and 8% in patients with GTV-LN/GTV-T ratios of<0.34 and ≥0.34, respectively (P<0.01), while the DM rates were 11% and 43% in patients with GTV-LN/GTV-T ratios of<0.59 and ≥0.59, respectively (P=0.003). Conclusions The GTV-LN/GTV-T ratio may be a predictor of LR and DM in patients with ESCC. Further studies on the GTV-LN/GTV-T ratio may help to make personalized chemoradiotherapy strategies for patients with ESCC.
		2017 Vol. 26 (12): 1389-1393 [Abstract] ( 683 ) [HTML 1KB] [ PDF 790KB] ( 0 )

	1394	Prognostic value of FDG PET-CT metabolic parameters before radiotherapy in patients with esophageal cancer receiving radiotherapy
		Lin Hongxiao, Qian Liting, Pan Bo, Yan Jianhua
		Objective To investigate the prognostic value of metabolic parameters of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) before radiotherapy in patients with esophageal cancer receiving radiotherapy. Methods We retrospectively analyzed the clinical data of 37 patients with stage Ⅱ-Ⅲ esophageal squamous cell carcinoma admitted to Anhui Provincial Hospital from 2010 to 2015, who underwent PET-CT scans within 4 weeks before radiotherapy. The following information was collected:age, sex, the location of primary lesion, clinical stage, and treatment regimen. The maximum standard uptake value (SUVmax), mean standard uptake value (SUVmean), metabolic tumor volume (MTV), PET tumor length (PTL), and total lesion glycolysis (TLG) were calculated. The optimal cut-off values of SUVmax, SUVmean, MTV, PTL, and TLG were determined by the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival comparison and univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis of significant variables. Results The area under the ROC curve suggested that MTV>TLG>PTL=0.713>0.679>0.670. The Kaplan-Meier survival analysis showed that patients had better survival time when MTV was less than 27.44 cm³, TLG was less than 166.2 g, and PTL was less than 36.74 mm (P<0.05). The Cox multivariate regression analysis showed that only MTV was an independent prognostic factor for radiotherapy in patients with esophageal cancer (P=0.000). Conclusions MTV, TLG and PTL have certain values in predicting the prognosis of patients with esophageal cancer before radiotherapy, and are helpful for selecting and adjust the clinical treatment regimen and improving the survival rate and prognosis.
		2017 Vol. 26 (12): 1394-1398 [Abstract] ( 661 ) [HTML 1KB] [ PDF 1032KB] ( 0 )

Abdominal Tumors

	1399	Anatomic distribution and clinical target volume of metastatic inguinal nodes in gynecological malignancies
		Cheng Shuxia, Wang Zhicheng, Zhang Mingchuan, Zhang Xinhui
		Objective To determine the anatomic distribution of metastatic inguinal nodes in gynecological malignancies, and to explore the delineation of clinical target volume (CTV). Methods A retrospective study was performed among 34 patients with gynecological malignancies and inguinal lymph node metastases. According to the anatomic distribution of metastatic inguinal nodes, CTV covering more than 95% of inguinal lymph nodes and the relationship of inguinal nodes with the femoral vein, greater saphenous vein and its branches, superficial fascia, and deep fascia were analyzed using vascular enhancement images obtained by computed tomography and magnetic resonance imaging as well as 3D reconstruction using the Eclipse Planning System. Results The 34 patients had a total of 145 positive inguinal nodes. In the 131 superficial nodes below the inguinal ligament, 129 were located between the superficial fascia and the deep fascia;the upper group of superficial nodes, containing 25 nodes, was located at 1 cm above the public symphysis and along superficial iliac circumflex vein;the middle group, containing 85 superficial nodes and 11 patients with single superficial node metastasis, was located at the same level of the public symphysis and close to the junction of the saphenous vein and the femoral vein;the lower group, containing 21 superficial nodes, was beneath the public symphysis and along the greater saphenous vein and medial and lateral superficial femoral veins. The 14 deep nodes were located on the medial side of the femoral vein. There were no positive nodes on the posterolateral side of the link between the posterolateral edge of the femoral vein and medial edge of the sartorius muscle. The upper edge of CTV kept 142 lymph nodes beneath the upper edge of the superior pubis ramus and left 3 lymph nodes up to the upper edge of the femoral head. The lower edge of CTV kept 143 lymph nodes above the lower edge of the lesser trochanter and left 2 lymph nodes at 2 cm beneath the lower edge of the lesser trochanter. Conclusions For CTV covering 98% of positive inguinal nodes, the anterior edge is the superficial fascia;the medial edge is composed by the inguinal ligament and the border of medial muscle to the femoral vessels;the posterolateral edge is the link between the posterolateral edge of the femoral vein and the medial edge of the sartorius muscle;the upper edge is the upper border of the femoral head;the lower edge is the lower border of the lesser trochanter.
		2017 Vol. 26 (12): 1399-1402 [Abstract] ( 675 ) [HTML 1KB] [ PDF 1504KB] ( 0 )

	1403	Preliminary observation of superficial brachytherapy for the upper arm skin invasion of breast cancer
		He Mingyuan, Zhao Zhipeng, Cheng Guanghui, Wu Ning
		Objective To investigate the application of superficial brachytherapy in the treatment of the upper arm skin invasion of breast cancer. Methods This study was conducted on a female patient with ipsilateral chest wall, axillary, and clavicle recurrence, and circumferential skin and subcutaneous soft tissue invasion in the ipsilateral upper arm after modified radical mastectomy for breast cancer. The upper arm lesions were treated with ¹⁹²Ir high-dose-rate superficial brachytherapy at a dose of 50 Gy in 25 fractions. Dosimetric parameters were compared between superficial brachytherapy and electron irradiation plan. Treatment outcomes and adverse reactions were observed during and after treatment. Results The heterogeneity index (HI) for target volume was 1.62 and 1.94 in superficial brachytherapy and electron irradiation plan, respectively. The D90, D100, and V150% for clinical target volume were higher in superficial brachytherapy than in electron irradiation plan (205 vs. 189 cGy;163 vs. 110 cGy;6.3% vs. 3.23%). The D0.1, D1, and D2 for the humerus were also higher in superficial brachytherapy than in electron irradiation plan (155 vs. 80 cGy;147 vs. 55 cGy;145 vs. 36 cGy) and much lower than the bone tolerance dose in both treatments. The lesions partially subsidedafter superficial brachytherapy. The main adverse reaction was grade 2 radiation dermatitis. Conclusions Compared with electron irradiation plan, superficial brachytherapy is a simple and effective approach for irradiation of shallow target volume with a large curvature, such as circumferential upper arm skin invasion of breast cancer. Superficial brachytherapy achieves satisfactory homogeneity and dose distribution.
		2017 Vol. 26 (12): 1403-1406 [Abstract] ( 682 ) [HTML 1KB] [ PDF 1447KB] ( 0 )

Physics·Biology·Technique

	1407	Study on constancy of CT numbers of SIEMENS Sensation Open CT-simulator
		Shi Feiyue, Ren Jun, Wu Zhengcan, Qin Wei, Yin Xindao
		Objective To evaluate the constancy of CT numbers of SIEMENS Sensation Open CT-simulator by analyzing the CT numbers of seven materials obtained from quality assurance (QA) tests. Methods QA tests for SIEMENS Sensation Open CT-simulator were performed with the Catphan504 phantom monthly. The CT images were obtained using three scan protocols (HeadSeq,RT_Head,and RT_Abdomen) for the CTP404 module in the phantom. The DoseLab software was used to analyze the 72 CT images acquired from January 2014 to December 2015,and the CT numbers (Y) of seven materials were obtained. Statistical analysis was performed on the Y data. The mean,standard deviation,maximum,minimum,and range values of Y for seven materials were calculated in three scan protocols. Results The standard deviation values of air,polymethylpentene,low-density polyethylene,polystyrene,acrylic acid,polyoxymethylene resin (Delrin),and polytetrafluoroethylene (Teflon) were as follows:(1) HeadSeq:0.54,0.60,0.82,0.58,0.75,0.66,and 1.83 HU;(2) RT_Head:0.08,0.69,0.86,0.66,0.80,0.89,and 2.49 HU;(3) RT_Abdomen:0.11,0.61,0.76,0.72,0.78,0.96,and 2.56 HU. According to the statistical data,the constancy of CT numbers of the SIEMENS Sensation Open CT-simulator was in good condition in two years. Conclusions The variation of CT numbers of Teflon is the biggest among the seven materials. The relative values of CT numbers between different scan protocols vary with the relative electron density of materials.
		2017 Vol. 26 (12): 1407-1410 [Abstract] ( 786 ) [HTML 1KB] [ PDF 881KB] ( 0 )

	1411	Evaluation of an algorithm-based automatic treatment planning module for volumetric-modulated arc therapy planning in nasopharyngeal carcinoma
		Zhang Daguang, Jiang Shengpeng, Yang Chengwen, Wang Peiguo, Zhang Ximei, Wang Wei
		Objective To evaluate the performance of progressive optimization algorithm-based Auto-Planning module in automated volumetric-modulated arc therapy (VMAT) planning for nasopharyngeal carcinoma. Methods Thirteen treated VMAT plans of nasopharyngeal carcinoma were re-planed with Auto-Planning module. Only one cycle of automated optimization of the Auto-Planning module was performed for each plan without any manual intervention. The dosimetric parameters of the automated treatment plans were compared with those of the manual plans. Paired t-test was used for statistical analysis. The time required for automated planning using the Auto-Planning module was also measured. Results All plans generated with the Auto-Planning module met the routine dosimetric requirements and were acceptable for clinical use. The homogeneity index of targets was superior in the automated plans than in manual plans (P=0.000).In addition,the automated plans had significantly improved protection for some organs at risk than the manual plans. The mean dose to the left and right parotids were reduced by 7.75 Gy (P=0.000) and 5.79 Gy (P=0.000) in the automated plans,respectively. Furthermore,the V60(0.58% vs. 3.12%,P=0.000) and Dmean(34.11 Gy vs. 40.78 Gy,P=0.000) of the mandible were also significantly lower with Auto-Planning than with manual planning. Conclusions Auto-Planning module can improve the overall quality and consistency of treatment plans,and reduce the workload and time of treatment planning,resulting in substantially enhanced treatment planning efficiency.
		2017 Vol. 26 (12): 1411-1416 [Abstract] ( 803 ) [HTML 1KB] [ PDF 2661KB] ( 0 )

	1417	Effect of needle arrangement on the lung dose in interstitial brachytherapy for lung cancer
		Yang Bo, Sun Xiaoyang, Pang Haowen, Shi Xiangxiang, Zhang Guangpeng, Tan Longjing, Chen Renjin, Tang Tao, Wu Hong, Wu Jingbo
		Objective To analyze the effect of needle arrangement on the lung dose in interstitial brachytherapy for lung cancer. Methods For 15 patients undergoing interstitial brachytherapy for lung cancer, a virtual radiotherapy plan in which needle arrangement was not restricted by the ribs was designed and compared with the original plan. For the two plans, V5, V20, V30, and mean lung dose (MLD) of the whole lung were determined when the prescribed doses were 10, 30, 60, and 120 Gy, respectively. The data were analyzed by Wilcoxon signed-rank test. Results The lung V5, V20, V30, and MLD were significantly smaller in the virtual plan than in the actual plan (all P<0.05). Conclusions Irregular needle arrangement prevents a further reduction in the lung dose in interstitial brachytherapy for lung cancer. In the implantation surgery, therefore, the needles should be arranged as regularly as possible.
		2017 Vol. 26 (12): 1417-1420 [Abstract] ( 658 ) [HTML 1KB] [ PDF 1212KB] ( 0 )

	1421	A dosimetric study of 3D intracavitary brachytherapy in combination with applicator-guided IMRT boost for cervical cancer
		Zhao Xinyu, Zhao Jing, Gu Fei, Ji Tianlong, Xia bing, Zhang Shuo, Yao Lei, Li Guang
		Objective To evaluate the dosimetric feasibility of three-dimensional (3D) intracavitary brachytherapy in combination with applicator-guided intensity-modulated radiation therapy (IMRT) boost for patients with locally advanced cervical cancer who have unfavorable topography following external beam irradiation. Methods A total of 7 patients with locally advanced cervical cancer who had unfavorable topography following external beam irradiation were included. Two plans were generated for brachytherapy using Oncentra 4.3 treatment planning system:3D intracavitary brachytherapy and 3D intracavitary brachytherapy in combination with applicator-guided IMRT boost. To further evaluate cumulative doses to organs at risk (OAR) in the four fractions of combined plans, two methods were used:simple dose-volume histograms (DVH) parameter addition and deformable image registration (DIR)-based DVH accumulation. The D90, V100, and conformity index (CI) were evaluated. The paired t-test or Wi1coxon signed rank test was used for statistical analysis. Results Compared with the 3D plan, the combined plan yielded higher D90, V100, and CI (P=0.000), but showed no significant difference in D2cc of the rectum, sigmoid colon, and bladder (P>0.05). There were also no significant differences in D2cc of the rectum, sigmoid colon, and bladder calculated by the two methods for calculating OAR cumulative doses, simple DVH parameter addition and DIR-based DVH accumulation (P>0.05). Conclusions For patients with cervical cancer who have unfavorable topography following external beam irradiation, 3D intracavitary brachytherapy in combination with applicator-guided IMRT boost can improve target coverage and CI, without increasing OAR doses. DIR-based DVH accumulation and simple DVH parameter addition may be both acceptable for assessing OAR cumulative doses.
		2017 Vol. 26 (12): 1421-1425 [Abstract] ( 800 ) [HTML 1KB] [ PDF 1413KB] ( 0 )

	1426	Effect of respiratory motion on radiation dose to the margin of target volume in stereotactic body radiotherapy for lung cancer
		Tian Lingling, Mao Ronghu, Li Dingjie, Yang Chengliang, Jia Lijie, Ge Hong
		Objective To investigate the effect of respiratory motion on inadvertent irradiation dose (ⅡD) to the microscopic disease (MD) and expanding margin of target volume in stereotactic body radiotherapy for lung cancer. Methods Based on the pattern of respiration-induced tumor motion during lung radiotherapy, a probability model of MD entry into or exit from internal target volume (ITV) was established and the theoretical dose to MD was calculated according to the static dose distribution by four-dimensional computed tomography. The experimental dose to MD during respiratory motion was measured using a respiration simulation phantom and optically stimulated luminescence (OSL) and then compared with the theoretical value for model validation. Results For the target volume in periodic motion, the deviation of the theoretical dose to MD from the experimental value measured by OSL was less than 5%. A 10-mm margin around ITV received a biological dose higher than 80 Gy. Conclusions The dose model established in this study can accurately predict the irradiation dose to MD in the target volume in periodic motion. Respiratory motion increases ⅡD to MD and there is no need to expand clinical target volume.
		2017 Vol. 26 (12): 1426-1429 [Abstract] ( 737 ) [HTML 1KB] [ PDF 1552KB] ( 0 )

	1430	Application of semiconductor matrix in synchronization test in helical tomotherapy
		Yu Lang, Yang Bo, Liu Xia, Sun Xiansong, ShenJie, Hu Ke, Qiu Jie, Zhang Fuquan
		Objective To investigate how to use the ArcCHECK to complete synchronization test in helical tomotherapy (HT). Methods According to the synchronization test suggested by AAPM TG148, three aspects should be tested.(1) Gantry angle consistency:ArcCHECK device in the long axis was perpendicular to the rotation plane using virtual isocenter positioning. A delivery sequence was defined with a slice width of 2.5 cm, a pitch of 0.1, and a minimum of 40 rotations. The control sinogram was set to open the middle two leaves (No. 32 and 33) at projections centered at 0°, 120°, and 240°.(2) Couch speed uniformity:The ArcCHECK was fixed on the treatment couch by positioning the long axis in the movement direction of couch. An irradiation was done with a static gantry in the 0° position, the collimation set to 1 cm, and all MLC leaves open. A couch travel distance of 20 cm was programmed using a clinically common couch speed (0.3-0.5 mm/s for 2.5 cm treatment slice width) in the course of irradiation.(3) Synchronization of couch translation and gantry rotation:In this test, a rotational irradiation was used with the nominal 1.0 cm beam and a pitch of 1 for 13 rotations. The control sonogram was set to open all the leaves for a half rotation on the second, seventh, and twelfth rotations. The initial collected data were used as the baseline data of parameters. The subsequent measurements were compared with the baseline data using the point to point absolute dose pass rates of DD (dose difference, 1%). Results The gantry angle consistency could check the correct initial angles at the beginning of the treatment and the ability to reproduce the projection every rotation. There were six parallel and straight high-dose regions in ArcCHECK software. In the couch speed uniformity test, the relative dose in the long axis in the high-dose regions was changed less than 2%. In the synchronization test of couch translation and gantry rotation, three parallel high-dose regions with the same separation spacing were present in the ArcCHECK software. The synchronization tests were done twenty-eight times in the second, seventh, and twelfth irradiation rotations and the average pass rates were 93.2%±1.5%, 93.7%±1.1%, and 93.5%±1.3%, respectively. Conclusions The ArcCHECK device is a suitable alternative method for performing the synchronization test in HT due to its lower workload and costs compared with the film.
		2017 Vol. 26 (12): 1430-1433 [Abstract] ( 628 ) [HTML 1KB] [ PDF 2288KB] ( 0 )

	1434	Effect of angle correction factors of MatriXX on VMAT dose verification
		Yao Lei, Tan Caiyun, Liu Hancheng, Wang Haojie, Xia Bing
		Objective To investigate the effect of the angle correction factors of ionization chamber array Matrixx on the dosimetric verification of volumetric modulated arc therapy plan. Methods The Matrixx (IBA) was put in the middle of the MultiCube Phantom. Computed tomography scan was performed and the results were sent to the Raystation treatment planning system (TPS). All data calculated from TPS and actually measured using MatriXX were gained under the following conditions:6 MV, 100 MU, 28 cm×28 cm radiation field. And the directions of beam were from 0°to 180°with an interval of 5°(except an interval of 1° from 85° to 95°). The angle correction factors (CF)(θ) cor of MatriXX were calculated by the calculated dose values from TPS and the measured values using MatriXX and then mirrored to the opposite side. CF (θ) cor values were compared with CF (θ) def values that were given by manufacturer. The comparison was made by paired t-test. Results CF (θ) cor and CF (θ) def were different, and the difference was significant between 85° and 95°, with a maximum of 7.5%(P<0.05). The CF (θ) cor correction method had a higher gamma pass rate than the CF (θ) def correction method, with a maximum of 17%(P<0.05). Conclusions The ionization chamber array MatriXX has an angular dependence and the angle correction should be performed. The angle correction factors have the individual characteristics and are different in every unit ionization chamber of the MatriXX. Therefore, it is necessary to do angle correction for every unit ionization chamber of the MatriXX and the possible errors caused by various factors should be considered in order to improve the accuracy rate and gamma pass rate of the plan verification.
		2017 Vol. 26 (12): 1434-1437 [Abstract] ( 815 ) [HTML 1KB] [ PDF 1092KB] ( 0 )

	1438	Effect of brain-derived neurotrophic factor on the NFAT3/c4 signaling pathway after whole brain radiotherapy
		Xu Meiling, Zhang Junjun, Zhang Qixian, Wu Haohao, Fan Qiuhong, Tian Ye
		Objective To explore the effects of various radiation doses on the NFAT3/c4 signaling pathway and the improvement effect of exogenous brain-derived neurotrophic factor (BDNF) on this pathway. Methods Four groups of one-month-old Sprague-Dawley rats received radiation doses of 0, 2, 10, and 20 Gy, respectively, in a single radiation. At three days after radiation, exogenous BDNF was injected stereotaxically into the bilateral hippocampus. Western blotting and RT-PCR were used to assess the levels of NFAT3/c4-related proteins in the hippocampus. Results The results of Western blotting and RT-PCR showed that the level of NFAT3/c4 was reduced in a dose-and time-dependent manner after ionizing radiation. Compared with the radiation alone group, the ionizing radiation plus BDNF group had significantly increased levels of NFAT3/c4 and CaN with increases in radiation dose and time. Conclusions Whole brain radiotherapy inhibits the CaN/NFAT3/c4 signaling pathway. Exogenous BDNF can promote the NFAT-dependent transcription and then improve the cognitive function.
		2017 Vol. 26 (12): 1438-1442 [Abstract] ( 659 ) [HTML 1KB] [ PDF 1560KB] ( 0 )

	1443	Effect and mechanism of electroacupuncture intervention on radiation-induced hippocampal neuronal apoptosis in mice
		Gao Jianfeng, Zheng Wanjun, Lyu Minghui, Su Shaohua, Zhang Songjiang, Wu Xin
		Objective To investigate the effect and mechanism of electroacupuncture at acupoints on radiation-induced hippocampal neuronal apoptosis in C57 mice. Methods Forty one-month-old C57/6J mice were equally and randomly divided into control group, model group (8 Gy), acupoint-electroacupuncture group, and non-acupoint-electroacupuncture group. In the acupoint-electroacupuncture group, mice received electroacupuncture intervention at Baihui, Fengfu, and Shenshu points. The novel object recognition test was used to evaluate the cognitive, learning, and memory abilities in mice. Immunohistochemistry was used to determine the levels of caspase-3 and apoptosis-inducing factor (AIF). TUNEL assay was used to detect DNA breaks. The data were analyzed by one-way analysis of variance and the Tukey's multiple comparison. Results Compared with the control group, the model group had a significantly reduced recognition index (P=0.040);compared with the model group, the acupoint-electroacupuncture group had a significantly increased recognition index (P=0.043), shown by significantly longer time spent exploring novel objects (P=0.035). According to the results of immunohistochemistry, the model group had significantly higher apoptosis rate and levels of caspase-3 and AIF in hippocampal neurons than the control group (P=0.002, 0.003, 0.023), while the acupoint-electroacupuncture group had significantly lower apoptosis rate and levels of caspase-3 and AIF in hippocampal neurons than the model group (P=0.027, 0.005, 0.004). Conclusions Radiation can induce hippocampal neuronal apoptosis and damage cognitive function in mice. Electroacupuncture intervention can, to some degree, reduce above damages.
		2017 Vol. 26 (12): 1443-1448 [Abstract] ( 876 ) [HTML 1KB] [ PDF 2406KB] ( 0 )

	1449


		2017 Vol. 26 (12): 1449-1450 [Abstract] ( 571 ) [HTML 1KB] [ PDF 953KB] ( 0 )

Review Articles

	1451	Progress in quantitative imaging evaluation of tumor spatial heterogeneity
		Zhang Siying, Chen Feng
		Tumor heterogeneity is characteristic in malignant tumors. It is a new challenge in imageology to achieve the visualization of tumor heterogeneity and precise quantification using modern imaging techniques. To solve this problem, the newly emerging radiomics is applied to analyze tumor spatial heterogeneity, with a visualization effect. Image quantification methods, including histogram analysis, texture analysis, and parametric response mapping, can accelerate the research and development of new drugs, improve the efficacy prediction, modify the treatment regimen, and promote the prognostic evaluation.
		2017 Vol. 26 (12): 1451-1456 [Abstract] ( 732 ) [HTML 1KB] [ PDF 852KB] ( 0 )

	1457	Classification of medical image registration and its application in radiotherapy
		Sun Hongfei, Ni Xinye
		With the development of computer techniques and medical software in image analysis and visualization, medical image registration as a key step before image processing (e.g., image fusion) is important in research and medical diagnosis. Therefore, many studies have focused on medical registration methods and algorithms. Up to now, several registration methods have been applied in clinical practice. In this paper, we make a classification and analysis of registration methods clinically applied in radiotherapy. How to improve the accuracy, efficiency, and robustness of medical image registration remains an issue to be solved in the future.
		2017 Vol. 26 (12): 1457-1460 [Abstract] ( 649 ) [HTML 1KB] [ PDF 786KB] ( 0 )

	1461	Research advances in the effect of regulatory T cells on tumor radiotherapy and its mechanism
		Ma Yuxi, Wu Gang
		Radiotherapy can not only kill tumor cells directly, but also accelerate tumor regression by mediating systemic and local anti-tumor immune response. Regulatory T cells (Tregs) are known as a subset of T cells which suppress the immune system. Therefore, Tregs become one of the therapeutic targets for cancer. Recently, much attention has been paid to combination therapy with radiotherapy and anti-Tregs therapy. This article reviews the biological characteristics of Tregs and the interaction between Tregs and radiotherapy.
		2017 Vol. 26 (12): 1461-1464 [Abstract] ( 656 ) [HTML 1KB] [ PDF 804KB] ( 0 )

	1465	Research advances in mechanisms for combination therapy with stereotactic body radiation therapy and immunotherapy
		Li Jiaqi, Wang Hao, Yang Ruijie
		In recent years, a large number of pre-clinical and clinical investigations have indicated that stereotactic body radiation therapy (SBRT) can not only kill cancer cells directly,but also induce the immunogenic death of cancer cells through releasing numerous tumor-associated antigens and damage-associated molecular patterns to form in situ tumor vaccine. CD8(+) T cells in lymph nodes are cross-sensitized by activated antigen-presenting cells. SBRT initiates local and systemic anti-tumor immune response. Moreover, SBRT can induce the abscopal effect if combined with immunotherapy. In addition, SBRT improves the microenvironment for tumor immunosuppression and enhances the sensitivity of tumors to immunotherapy. This article reviews the research advances in the synergistic mechanisms for combination therapy with SBRT and immunotherapy.
		2017 Vol. 26 (12): 1465-1469 [Abstract] ( 662 ) [HTML 1KB] [ PDF 832KB] ( 0 )

	1470	Research advances in postoperative concurrent chemoradiotherapy (CCRT) for high-risk early stage cervical cancer
		Nie Fangfang, Chen Xiaoqin, Fu Jie
		Cervical cancer is one of the most common gynecologic malignancy,ranking fourth in new cases and deaths in 2012.High-risk early stage cervical cancer after operative need adjuvant treatment. Compared with postoperative radiotherapy alone,CCRT can reduce the pelvic recurrence rates and improve survival rates. And CCRT can extend median survival time and survival rates than sequential CRT after operative. CCRT plus consolidation chemotherapy may play a potential role in further improving survival outcomes for high-risk early stage cervical cancer patients compared with CCRT alone. Retrospective studies show that CCRT had equivalent effects with postoperative chemotherapy alone,but further research is needed. Factors influencing the efficacy of postoperative CCRT include chemotherapy regimens,radiotherapy technology,the interval time between surgery and CCRT,multiple pelvic lymph node metastasis and number of pelvic lymph node dissection. Toxicities mainly include hematologic and gastrointestinal toxicity. Hematologic toxicity is the most common. The incidence of toxicity can be reduced by improving radiotherapy techniques.
		2017 Vol. 26 (12): 1470-1474 [Abstract] ( 723 ) [HTML 1KB] [ PDF 835KB] ( 0 )

	1475	Classification of medical image registration and its application in radiotherapy
		Pan Xiaoqiang, Li Yunqian, Li Han, Wu Wei
		Collision neoplasm is a rare clinical disease which characterized by the existence of two distinct neoplasms emerging in the same anatomic location,It almost occured in any part of the body. Case reports of collision neoplasm is relatively few. There is no domestic relevant summary. The author read the reports in recent five years in the pubmed database,WANFANG data and CNKI to point out the location,common pathological types of collision tumor,pathogenesis and so on. Aim to help us better understand collision tumor.
		2017 Vol. 26 (12): 1475-1478 [Abstract] ( 803 ) [HTML 1KB] [ PDF 801KB] ( 0 )

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