Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2018 Vol.27 Issue.1 Published 2018-01-15

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

Consensus

	1	Expert consensus on nutrition support therapy for head and neck cancer patients receiving radiotherapy
		Cancer Radiotherapy Nutrition Group, Cancer Nutrition and Support Committee of China, China Anti-cancer Association, Zhao Chong (writing)
		Radiotherapy is the most commonly used treatment for head and neck cancer (HNC).Due to the metabolic abnormalities of malignant tumors and acute and advanced-stage toxic events,the incidence of malnutrition in HNC patients is high up to 44%-88%,and 20%-40% for severe malnutrition. The treatment tolerance and sensitivity will be reduced and the risk of complications will be elevated once patients present with malnutrition,which prolong the length of hospital stay,increase the medical expanse and eventually affect the clinical efficacy. Consequently,nutrition support therapy is a pivotal part of clinical treatment for HNC patients. In order to deliver reasonable and effective nutrition support therapy for HNC patients,it is of high necessity to establish expert consensus on nutrition support therapy for HNC patients in China according to the current situation of cancer radiotherapy and nutrition treatment in China and relevant guidelines at home and abroad.
		2018 Vol. 27 (1): 1-6 [Abstract] ( 970 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	7	Expert consensus on the diagnosis of recurrent or metastatic nasopharyngeal carcinoma
		Committee of Nasopharyngeal Cancer of Chinese Anti-Cancer Association, Li Jingao, Chen Xiaozhong, Lin Shaojun, Hu Chaosu
		Locoregional recurrenceand distant metastasis are the major reasons for nasopharyngeal carcinoma (NPC) treatment failure. Nearly 10% of patients suffer locoregional recurrenceafter intensity-modulated radiotherapy with or without chemotherapy. Additionally,4% to 10% of patients newly diagnosed with NPC and 15% to 30% of patients receiving radical treatment have distant metastasis. Early accurate diagnosis and timely intervention contribute to better therapeutic outcomes of recurrent or metastatic NPC,because salvage therapy based on misdiagnosis may bring severe complications to patients. To date,there are no global guidelines or expert consensus on the diagnosis of recurrent or metastatic NPC.Herein,this expert consensus raisesthe recommendations and suggestions for the diagnosis ofrecurrent or metastatic NPC,providing a reference for clinical practice.
		2018 Vol. 27 (1): 7-15 [Abstract] ( 961 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	16	Expert consensus on the treatment of recurrent nasopharyngeal carcinoma
		Committee of Nasopharyngeal Cancer of Chinese Anti-Cancer Association, Lin Shaojun, Chen Xiaozhong, Li Jingao, Hu Chaosu
		With the application of intensity-modulated radiotherapy,the locoregional control rate of nasopharyngeal carcinoma (NPC) has been significantly increased. However,there are still 10%-15% of patients suffering the recurrenceof NPC.Re-treatment of recurrent NPC is a difficult clinical problem. In addition,the options of recurrent NPC treatment are diverse and each one has its own advantages and disadvantages,which makes the treatment of recurrent NPC more confusing. Due to the lack of strong evidence of clinical trials,treatment guidelines and criteria cannot be formed and standardized. This consensus reviews the literature and clinical trials about the treatment of recurrent NPC,and further stratifies and summarizes the radiotherapy,surgical treatment,chemotherapy,and target therapy for recurrent NPC.Based on expert experiences,we draft out this article for clinically significant issues without sufficient clinical data,which aims to reach a preliminary consensusonthe best therapeutic strategy for recurrent NPC.
		2018 Vol. 27 (1): 16-22 [Abstract] ( 754 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	23	Expert consensus on the treatment of metastasis nasopharyngeal carcinoma
		Committee of Nasopharyngeal Cancer of Chinese Anti-Cancer Association, Chen Xiaozhong, Li Jingao, Lin Shaojun, Hu Chaosu
		As the application of intensity modulated-radiotherapy and improvement of local control about nasopharyngeal carcinoma,metastases have been an urgent problem needed to be solved. Due to the great heterogeneities of metastasis NPC,the treatment strategies and prognoses are very different. At present,no treatment guideline has been achieved in this field. This consensus tries to give some directions on the treatment of metastasis NPC.We discuss and summarize treatment models for the metastases at first diagnosis,after radical treatment and after failure of platinum-based chemotherapy respectively by reviewing relevant literatures and clinical trials. For some clinically significant problems without enough supports of clinical data,we draft out it according clinical experiences of experts,in order to reach a consensus about the best treatment strategies for metastasis nasopharyngeal carcinoma.
		2018 Vol. 27 (1): 23-28 [Abstract] ( 850 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Special Feature

	29	The past,present,and future of radiotherapy for stage IV non-small cell lung cancer
		Lu Bing, Su Shengfa, He Zhixu
		The efficacy of palliative care was definitive with two-dimensional radiotherapy for stage IV non-small cell lung cancer (NSCLC).However,theimpact of radiotherapy on survival was not well indicated,and some study resultsindicating prolonged survival were not accepted. Along with the advancesin three-dimensional radiotherapy (3DRT),wide application of comprehensive treatment,and the understanding of the association between different metastatic status and survival,prospective and retrospective studies have demonstrated that chemotherapy combined with 3DRT for primary tumor is more effective than chemoradiotherapy alone in improving symptoms and prolonging survival,especially for oligometastases of stage IV NSCLC.The dose to primary tumor is closely related to survival,and high-dose radiotherapy may be more likely to prolong survival. Further studies,however,areneeded to take into accountproblems such as thedose,timing,and technical selection of radiotherapy.
		2018 Vol. 27 (1): 29-34 [Abstract] ( 950 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	35	Efficacy of radical radiotherapy for primary tumors in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma
		Huang Shuang, Chen Yuanyuan, Jiang Feng, Hu Qiaoying, Chen Xiaozhong
		Objective To investigate the prognostic factors for survival in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma who received radical radiotherapy for primary tumors. Methods From 2008 to 2011,39 patients with newly diagnosed oligometastatic nasopharyngeal carcinoma received 1-6 cycles of chemotherapy and radical radiotherapy for primary tumors. In those patients,10 received conventional radiotherapy and 26 received intensity-modulated radiotherapy. The Kaplan-Meier method was used to calculate survival rates. The log-rank test and Cox model were used for univariate and multivariate prognostic analyses,respectively. Results The median follow-up time was 38 months. The 1-,2-,and 3-year overall survival rates were 97%,87%,and 70%,respectively,while the 1-,2-,and 3-year progression-free survival rates were 87%,65%,and 59%,respectively. Age,number of metastatic lesions,scheme of induction chemotherapy,and use of concurrent chemotherapy or not were independent prognostic factors for survival. The patients with no more than 3 metastatic lesions had a higher survival rate than those with more than 3 metastatic lesions (P=0.023).The patients undergoing chemotherapy with docetaxel had a significantly higher survival rate than those undergoing chemotherapy without docetaxel (P=0.041). Conclusions Induction chemotherapy and radical radiotherapy for primary tumors can still achieve long-term survival in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma,particularly in young patients with no more than 3 metastatic lesions. Compared with chemotherapy without docetaxel,chemotherapy with docetaxel may provide a greater survival benefit for patients.
		2018 Vol. 27 (1): 35-39 [Abstract] ( 880 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	40	Dosimetric effects of multileaf collimator leaf width on inverse intensity-modulated radiotherapy in intracranial stereotactic radiosurgery
		Wan Huan, Tao Dan, Yang Zengjing, Long Wenhua, Huang Yali, Huang Hui, Long Zhixiong
		Objective To compare the dosimetric effects of micro-multileaf collimator (MLC)(2 mm leaf width) and conventional MLC (10 mm leaf width) on inverse intensity-modulated radiotherapy (IMRT) in intracranial stereotactic radiosurgery (SRS). Methods In view of the fact that the micro-MLC has a small open field, 30 patients with intracranial tumor with a<10 cm diameter were enrolled in this study. Their inverse dynamic IMRT plans were established using conventional MLC (conventional group) and micro-MLC (micro group) with the same other conditions. The radiation doses to the target volume and the organs at risk (OAR) were compared between the two groups with t test. Results Compared with the conventional group, the micro group had a significantly better dose distribution in the target volume (P=0.019). However, there were no significant differences in D98, D95, D50, and D3 between the two groups (P=0.774,0.650,0.170,0.080). The micro group had a 58.7% lower mean homogeneity index and a 20.1% higher mean conformity index than the conventional group (P=0.000). The micro group had significantly lower radiation doses to OAR than the conventional group (P=0.044). The mean Dmean and Dmax of the brain stem in the micro group were 10.0% and 8.2%, respectively, lower than those in the conventional group (P=0.768,0.753). The mean Dmean and Dmax of the right eye and left eye in the micro group were 16.5%, 19.3%, 21.4%, and 13.4%, respectively, lower than those in the conventional group (P=0.572,0.775 and 0.734,0.630). The mean Dmax of the left lens, right lens, left optic nerve, right optic nerve, and optic chiasm in the micro group were 50.4%, 24.1%, 38.5%, 27.8%, and 5.7%, respectively, lower than those in the conventional group (P=0.172,0.467,0.521,0.740,0.899). The PRV100, PRV50, and PRV25 of the normal tissue in the micro group were no more than those in the conventional group (P=0.839,0.832,0.972). Conclusions In inverse IMRT in intracranial SRS, micro-MLC is better than conventional MLC because it can improve CI of the target volume and reduce the radiation doses to OAR.
		2018 Vol. 27 (1): 40-43 [Abstract] ( 1029 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	44	Influence of enteral nutrition on nutritional status,treatment toxicities,and short-term outcomes in esophageal carcinoma patients treated with concurrent chemoradiotherapy:a prospective,multicenter,randomized controlled study (NCT 02399306)
		Lyu Jiahua, Li Tao, Zhu Guangying, Li Jie, Zhao Ren, Zhu Shuchai, Wang Jianhua, Xing Ligang, Yang Daoke, Xie Conghua, Shen Liangfang, Zhang Hailin, Shi Anhui, Wang Jing, Pan Wenyan, Li Fang, Wang Qifeng, Lang Jinyi, Shi Hanping
		Objective To investigate the influence of enteral nutrition on body weight,nutritional status,treatment toxicities,and short-term outcomes in esophageal carcinoma patients treated with concurrent chemoradiotherapy (CCRT). Methods Eligible esophageal carcinoma patients were randomly assigned (2:1) to receive either CCRT combined with enteral nutrition (study group) or CCRT alone (control group).The primary endpoint was changes in the body weight during and after radiotherapy. The secondary endpoints were nutrition-related hematological parameters,the toxicities of chemoradiotherapy,the completion rate of treatment,and short-term outcomes. The differences was using χ² or t-test. Results Between September 2014 and June 2017,203 patients were included in the study,consisting of 139 patients in the study group and 64 patients in the control group. Compared with the control group,the study group had significantly less body weight loss during and after radiotherapy (P<0.05) and significantly less decreases in serum albumin and hemoglobin (P<0.05),but there was no significant difference in the reduction in total lymphocyte count between the two groups (P>0.05).The study group had significantly lower incidence rates of grade ≥3 myelosuppression and infection and a significantly higher completion rate of chemoradiotherapy compared with the control group (P<0.05).The incidence of radiation pneumonitis and esophagitis showed no significant difference between the two groups (P>0.05).The study group had an insignificantly higher Objective response rate than the control group (P>0.05). Conclusions For esophageal carcinoma patients treated with CCRT,enteral nutrition can reduce body weight loss during and after radiotherapy,improve nutritional status and treatment tolerance,and reduce toxicities.
		2018 Vol. 27 (1): 44-48 [Abstract] ( 1063 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	49	Timing of radiotherapy for limited-stage small cell lung cancer in the elderly
		Wang Youyou, Xu Kunpeng, Xu Liming, Wang Jun, Pang Qingsong, Yuan Zhiyong, Zhao Lujun, Wang Ping
		Objective To investigate the effect of the timing of radiotherapy on the prognosis of limited-stage small cell lung cancer (LS-SCLC) in the elderly. Methods A retrospective analysis was performed on the clinical data of 80 elderly patients with LS-SCLC who were treated with radical sequential thoracic chemoradiotherapy from 2008 to 2014.The correlations of SER (time from the start of any treatment to the end of radiotherapy) and the number of induction chemotherapy cycles with overall survival (OS) and progression-free survival (PFS) rates was analyzed. The treatment outcomes were compared between early radiotherapy group (no later than 3 cycles of induction chemotherapy,n=37) and late radiotherapy group (after 3 cycles of induction chemotherapy,n=43).The Kaplan-Meier method was used for survival analysis. Results In all patients,the median OS and PFS were 23.5 and 13.3 months respectively. SER was significantly correlated with OS and PFS (P=0.001;P=0.001).The median OS in patients undergoing radiotherapy after 2,3,4,5,and 6 cycles of induction chemotherapy was 33.2,26.7,20.6,16.9,and 17.9 months (P=0.000),respectively. The median OS time and 1-,2-,and 5-year OS rates were 27.8 months,87%,62%,and 34%,respectively,in the early radiotherapy group,and 17.9 months,74%,37%,and 15%,respectively,in the late radiotherapy group (P=0.017).The median PFS time and 1-,2-,and 5-year PFS rates were 17.1 months,65%,43%,and 28%,respectively,in the early radiotherapy group,and 11.9months,49%,21%,and 14%,respectively,in the late radiotherapy group (P=0.022). Conclusions Shorter SER achieves better treatment outcomes in elderly patients with LS-SCLC undergoing sequential chemoradiotherapy. Early radiotherapy provides a survival benefit for patients.
		2018 Vol. 27 (1): 49-52 [Abstract] ( 1148 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	53	A preliminary study on target motion in esophageal cancer during normal breathing with four-dimensional computed tomography
		Yang Yan, Li Jiancheng, Chen Jianling, Wang Shengqiang, Tang Xianjun
		Objective To investigate the characteristics of target motion in esophageal cancer during normal breathing with four-dimensional computed tomography (4DCT). Methods Twenty patients with primary esophageal cancer received respiratory gated 4DCT to obtain the target motion during normal breathing and delineate the gross tumor volume (GTV). The center coordinate and volume of each GTV were measured and recorded to calculate the displacement of the GTV center and the change in volume in different respiratory phases. Results The displacement of the GTV center in each esophageal segment in superior-inferior direction (0.521±0.319 cm) was significantly greater than that in right-left direction (0.169±0.083 cm) and that in anterior-posterior direction (0.167±0.095 cm)(all P<0.05). The maximum displacement of the GTV center in each direction was significantly different in different esophageal segments (all P<0.05). The displacement of the GTV center in each direction was not entirely consistent in different respiratory phases. The displacement of the GTV center in each direction in T50 phase was greatest when T0 phase was the reference phase. The volume of GTV had no significant changes at the end of the expiratory phase and the inspiratory phase (P=0.313). Conclusions The displacement of GTV center in each esophageal segment in superior-inferior direction is significantly greater than that in right-left direction and that in anterior-posterior direction and the displacement of GTV center in each direction is significantly different in different esophageal segments. Therefore, all the factors should be considered to develop a reasonable target for precise radiotherapy. For esophageal cancer in cervical and upper chest esophageal segment, it is reasonable to delineate ITV based on the fusion image of the images at the end of inspiratory phase and expiratory phase. The deformation of target volume of the esophageal cancer in the cervical and upper chest esophageal segment is not significant in the respiratory cycle.
		2018 Vol. 27 (1): 53-57 [Abstract] ( 748 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	58	A comparative analysis of the efficacy and prognosis of concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy for stage ⅡB-ⅢB cervical squamous cell carcinoma
		Zheng Jie, Wu Xingrao, Ye Lan, Wu Pengfei, Ai Yiqin
		Objective To investigate the long-term efficacy and prognosis of concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy for stage ⅡB-ⅢB cervical squamous cell carcinoma. Methods A retrospective analysis was performed among 171 patients with stage ⅡB-ⅢB cervical squamous cell carcinoma who were admitted to our hospital and had complete follow-up data from February 1,2005 to October 31,2011. Results The median follow-up time was 66 months. There were no significant differences in the 3-or 5-year overall survival rates between the concurrent group and the neoadjuvant group (81.4% vs. 75.9%,74.3% vs. 67.2%,P=0.469).According to the subgroup analysis,there was no correlation between lymph node metastasis and survival curve (P=0.310,P=0.151).The univariate and Cox multivariate analyses showed that tumor size,lymph node metastasis,and concurrent chemotherapy method were independent prognostic factors for cervical cancer (P<0.05).For the patients with lymph node metastasis,the neoadjuvant group had a significantly higher pelvic local recurrence rate than the concurrent group (P=0.047),while there were no significant differences in mortality,distant metastasis,or long-term adverse reactions between the two groups (all P>0.05).For the patients without lymph node metastasis,the neoadjuvant group had a significantly higher incidence of grade 3-4 bone marrow suppression than the concurrent group (P=0.016),while there were no significant differences in mortality,local recurrence,distant metastasis,or long-term adverse reactions between the two groups (all P>0.05). Conclusions Concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy achieve similar treatment outcomes in patients with stage ⅡB-ⅢB cervical squamous cell carcinoma,no matter whether they have lymph node metastasis or not. Tumor size,lymph node metastasis,and concurrent chemotherapy method are independent prognostic factors. Neoadjuvant chemotherapy increases the risk of grade 3-4 marrow suppression during concurrent chemoradiotherapy,prolongs irradiation time,and increases the risk of local recurrence.
		2018 Vol. 27 (1): 58-62 [Abstract] ( 844 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	63	Comparison of incidental irradiation dose to the internal mammary nodes among I-IMRT,F-IMRT,and 3DCRT after breast-conserving surgery
		Song Yuanfang, Wang Wei, Li Jianbin, Sun Tao, Xu Min, Shao Qian
		Objective To explore the dosimetric variance in incidental irradiation to the internal mammary nodes among inverse intensity-modulated radiotherapy (I-IMRT),forward intensity-modulated radiotherapy (F-IMRT),and three-dimensional conformal radiotherapy (3DCRT) after breast-conserving surgery,and to provide a basis for deciding whether to spare the internal mammary nodes in clinical treatment. Methods A total of 84 patients undergoing breast-conserving surgery were enrolled as subjects. The internal mammary nodes in the first three intercostal spaces were contoured. Three radiotherapy plans were designed for each patient. The internal mammary nodes were not included in the planning target volume. Comparison was made among the three plans. The Results were compared using Wilcoxon signed rank test. Results The I-IMRT,F-IMRT,and 3DCRT plans had similar median Dmean values for the internal mammary nodes,which were 2740.2,2973.9,and 2951.4 cGy,respectively. The analyses of the three individual intercostal spaces showed that there was no difference in Dmean for the first intercostal space or the second intercostal space between the three plans;For the third intercostal space,however,I-IMRT had a significantly higher Dmean than 3DCRT and F-IMRT. The analyses of the three individual plans showed that for each plan,the Dmean was the highest in the third intercostal space,followed by the second intercostal space and the first intercostal space. Conclusions All the three plans fail to attain an adequate prescribed dose to cure subclinical disease,and there is no significant difference among the three plans. Therefore,it is risky to exclude the internal mammary nodes using any one of the three radiotherapy techniques for patients with clinical indications for internal mammary nodes radiation. In the combination therapy including chemotherapy,endocrine therapy,and targeted therapy,however,further follow-up is needed to determine whether the incidental irradiation dose to the internal mammary nodes could meet clinical requirement.
		2018 Vol. 27 (1): 63-67 [Abstract] ( 662 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	68	Effect of image guidance on doses to the rectum and bladder in radiotherapy for cervical cancer
		Liu Qing, Zhang Zongkai, Wang Yadi, Lu Na, Zhang Fuli
		Objective To analyze the effect of image guidance on the doses to the rectum and bladder in radical external beam radiotherapy for cervical cancer, and to investigate the reasonable application mode of image-guided radiotherapy (IGRT) in the treatment of cervical cancer. Methods A total of 20 patients with cervical cancer who underwent helical tomotherapy (HT) in PLA Army General Hospital from 2012 to 2016 were enrolled in this study. A megavoltage computed tomography (MVCT) scan was performed before each treatment. The obtained MVCT images were used for dose reconstruction in the adaptive module of HT to obtain the actual dose (Plan-1) and the non-image-guided dose was simulated (Plan-2). Each single dose distribution and the corresponding fused CT image were sent to the software MIM 6.0 to obtain the total radiation dose by dose superposition. The radiation doses and volumes of the rectum and bladder were compared between the two therapeutic plans. Results The radiation doses to the rectum and bladder in Plan-2 were significantly higher than those in Plan-1. There were significant differences in Dmax and V50 of the rectum and V50 of the bladder between Plan-1 and Plan-2(P=0.040;P=0.000;P=0.047). Compared with Plan-1, there were statistical differences in inter-fractional Dmax and V50 during the initial treatment (P=0.047,0.037), and V50 of the rectum within the 13^th to 21^st radiotherapy, respectively (P=0.009, 0.017, 0.028). Besides, differences regarding Vmax and V50 in the initial treatment and the 21^st to 23^rd radiotherapy were close to the statistical significance when compared to those in Plan-1, respectively (P=0.061,0.053;P=0.072,0.058). Conclusions IGRT can reduce the radiation doses and volumes of the rectum and bladder, especially the rectum. The therapeutic plan should be rescheduled when tumor retraction is evident at half of the total radiation dose (around 13^th fraction) in external beam radiotherapy. If it is difficult to achieve image guidance in each treatment, selective image guidance could be performed to effectively reduce the injuries of the rectum and bladder.
		2018 Vol. 27 (1): 68-73 [Abstract] ( 755 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	74	Dosimetric analysis of CT-guided salvage interstitial brachytherapy for recurrent cervical cancer
		Liu Zhongshan, Guo Jie, Zhao Yangzhi, Lin Xia, Zhang Zhiliang, Wang Hongyong, Li Yunfeng, Ren Xiaojun, Zhang Bingya, Wang Tiejun
		Objective To analyze the dosimetric advantages of CT-guided interstitial brachytherapy for recurrent cervical cancer. Methods A total of 16 patients with recurrent cervical cancer after radical surgery and adjuvant external beam radiotherapy received interstitial brachytherapy with CT-guided implantation of metal needles. The high-risk clinical target volume (HR-CTV) was given 36 Gy in 6 fractions. D90 for HR-CTV in the brachytherapy and the cumulative D2 cm³ values for the bladder, rectum, and sigmoid colon in the previous external beam radiotherapy and the brachytherapy were analyzed. Results The mean D90 value for HR-CTV was 52.5±3.3 Gy. The cumulative D2 cm³ values for the bladder, rectum, and sigmoid colon were 85.6±5.8 Gy, 71.6±6.4 Gy, and 69.6±5.9 Gy, respectively. The mean number of metal needles was 6.1±1.5 in each brachytherapy. The actual 1-year overall survival and local control were 81% and 69%, respectively. Conclusions CT-guided interstitial brachytherapy for recurrent cervical cancer shows good dose-volume histogram parameters and few complications, so it may be clinically feasible. However, its long-term clinical efficacy needs further observation.
		2018 Vol. 27 (1): 74-78 [Abstract] ( 867 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	79	Study on patient movements features during radiotherapy
		Tan Tingqiang, Li Li, Huang Renbing
		Objective To study the patient movements features during radiotherapy. Methods Randomly selected 120 patients treated in our hospital from February to July on 2016,including 60 thorax treatment and 60 abdomen treatment. The movement data of patient treatment location during radiotherapy treatment was real time monitored by using Sentinel system,movement features of patient's location during radiotherapy was analyzed. Paired t-test difference. Results During radiotherapy,patient's treatment location movement types and proportion were motionless type 14.0%,Moving stable type 64.0%,Jumping type 8.7%,increasing type 13.3%.Patients with thoracic and abdominal radiotherapy,the maximum deviation of IMRT and VMAT treatment were (6.55±2.34) mm and (4.97±1.24) mm (P=0.002),(3.97±1.80) mm and (2.69±1.42) mm (P=0.004).In single treatment,the deviation value of the patient's treatment location increased gradually with the treatment time increasing and the deviant of thoracic is greater than abdominal at the same time after the treatment beginning. Conclusions Patient's treatment location movement during radiotherapy is commonly exist,using the technology of VMAT treatment can effectively reduce the treatment site movement of the patient during the treatment and ensure the accuracy of dose.
		2018 Vol. 27 (1): 79-82 [Abstract] ( 597 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	83	Effect of different patient positions on target dose coverage in rectal cancer IMRT
		Qian Jianjun, Yang Yongqiang, Guo Qi, Chen Liesong, Lu Xueguan, Tian Ye
		Objective To compare the effect between the supine and prone patient positions upon target dose coverage during intensity-modulated radiotherapy (IMRT) for rectal cancer, aiming to provide clinical reference for the selection of position for rectal cancer patients. Methods Twenty-four patients diagnosed with rectal cancer receiving postoperative adjuvant radiotherapy were selected and divided into the supine (n=12) and prone position groups (n=12). Before and during the IMRT (1-4 weeks), all patients received CT scans, which were defined as:Plan, 1W, 2W, 3W and 4W, respectively. The organs at risk were delineated based on CT scan images. Plan, 1W, 2W, 3W and 4W CT scan images were fused. The CTV and PTV from Plan CT scan were copied to the 1-4W CT scan images, and the therapeutic plans from Plan CT scan were copied as well. The target dose coverage was assessed and the failure rate of target dose coverage was calculated. The couch-position data for each patient during each cycle of IMRT were recorded by using the MOSAIQ network and the overall deviation (S) of couch position was calculated. Results The failure rates of CTV and PTV target dose coverage in the prone position group were higher than those in the supine position group (18.60% VS 0%, 69.76% VS 53.65%).The S value was significantly correlated with the target dose coverage (r=-0.683,P=0.000). The S value in the prone position group was (1.23±0.76) cm, significantly greater than (0.28±0.18) cm in the supine position (P=0.001), and the most significant deviation was noted in the y (head and foot) and z (frontal and dorsal) directions (P=0.003 and 0.003). Compared with the supine group, the V5 and V10 of the small intestine were significantly less (P=0.003 and 0.004) and the chronic toxicity (NTCPC) was considerably reduced (P=0.041) in the prone position group. Conclusions A better target dose coverage can be maintained during IMRT with a supine position during rectal cancer IMRT, whereas the positioning repeatability is worsened with a prone position due to use of the belly board, thereby affecting the target dose coverage. Although the prone position combined with belly board can reduce the tolerated dosage of the small intestine, effective measures should be taken to guarantee the patient positioning repeatability.
		2018 Vol. 27 (1): 83-88 [Abstract] ( 729 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	89	Analysis of utility of optical surface imaging system for patients who received radiotherapy with active breath control
		Zhong Renming, Ye Chengwei, Li Liqin, Li Wan, Gong Pan, Shang Qiang, Xiao Qing, Liu Fubo, Bai Sen, Li Guangjun
		Objective To analyze the precision and stability of optical surface imaging system for patients who received radiotherapy with active breath control. Methods Eighteen radiotherapy patients with lung metastasis were managed by active breath control (ABC).The difference error detected by optical surface imaging system and CBCT were defined as the precision of optical surface imaging system. The variation among the error of optical surface imaging positioning the value of correction of treatment position and the error detected by optical surface imaging again were defined as the stability of optical surface imaging system. Intrafractional errors were analyzed by optical surface imaging system through whole treatment process (including breath hold and free breath). Results The optical surface imaging system had precision (systematic (Σ) and random errors (σ)) of 1.78/3.42 mm 2.54/6.57 mm and 2.79/3.22 mm respectively and stability of2.12/2.54 mm 3.09/4.02 mm and 1.37/3.55 mm respectively in lateral-medial superior-inferior and anterior-posterior directions. The intrafractional errors (Σ and σ) were 0.42/0.85 mm 0.41/1.47 mm and 0.41/1.47 mm respectively for breath hold duration and 4.76/4.16 mm 6.54/7.78 mm and 3.13/5.92 mm for free breath duration in lateral-medial superior-inferior and anterior-posterior directions. Conclusions As an effective method for validate breath hold;Optical surface imaging system can improve the precision and safety of active breath control.However,the factors that affect the accuracy and stability of the optical surface imaging system in patients undergoing radiotherapy with ABC are not clear; it cannot replace the CBCT for positioning verification.
		2018 Vol. 27 (1): 89-93 [Abstract] ( 970 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	94	Feasibility of helical tomotherapy intensity-modulated radiation therapy applied in total marrow irradiation
		Zhu Feng, Wu Weizhang, Chang Dongshu, Zhu Fuhai, Wang Yong, Li Xinji, Wang Shanshan, Wei Qiang, Xia Tingyi, Wang Yingjie
		Objective To introduce the therapeutic procedures of helical tomotherapy based total marrow irradiation(HT-TMI), and validate the feasibility of TMI.Methods At 1 week before bone marrow transplantation, 12 patients received TMI conditioning regimen at a prescriptive dose of 12 Gy in 3 times, once daily. Patient immobilization, CT simulation, target delineation, plan design and dosimetric verification were implemented in sequence according to the TMI procedures. The dosimetric paramaters of the target and normal tissues were analysed. The correlation between the dose verification and image-guided Results was observed.Results Compared with total body irradiation(TBI), TMI could significantly reduce the irradiation dose to normal tissues. The median dose D50 of all normal tissues except the oral cavity were lower than 6 Gy, where The D50 of lens, brain, lung and liver are (1.8±0.1) Gy, (5.7±0.2) Gy, (5.2±0.2) Gy, and (4.6±0.2) Gy, respectively. Pass rate of γ Index was larger than 95% with 3mm/3% criterian for each section. The positioningerror of head and neck was relatively lower than that of pelvis at x-axis, and was higher at z-axis.Conclusions Helical tomotherapy based TMI is a feasible and reasonable approach, which has evident dosimetric advantage.
		2018 Vol. 27 (1): 94-100 [Abstract] ( 1352 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	101	PDTC attenuates radiation-induced heart damage by inhibiting the activation of NF-κB and its downstream signaling pathways in rats
		Liu Lina, Wu Yajing, Gao Guangbin, Guo Yin, Tian Yanming, Wang Sheng, Wang Jun
		Objective To investigate whether pyrrolidine dithiocarbamate (PDTC) can attenuate the acute radiation-induced heart damage (RIHD) by inhibiting the activation of NF-κB and its downstream signaling pathways in rat models. Methods Twenty-one male adult Sprague-Dawley (SD) rats were randomly divided into the blank control, irradiation and PDTC plus irradiation groups (n=7 for each group). In the irradiation and PDTC+ irradiation groups, the rats received 6 MV X-ray at a single fraction of 20.0 Gy. In the PDTC+ irradiation group, intraperitonal injection of PDTC was administered at a dose of 120 mg/kg body weight,30 minutes prior to radiation, once daily for 1-14 days. On the 14^th day,pathological changes of myocardial tissue were observed. Masson’s trichrome staining was performed to calculate the collagen volume fraction (CVF) of myocardial cells. The expression levels of NF-κB family members including p50, p65,HIF-1α,connective tissue growth factor (CTGF) and collagen type 1(COL-1) proteins and mRNA were quantitatively measured by Western blot and quantitative real-time PCR (qPCR). Statistical analysis was conducted by using t-test. Results HE staining demonstrated that compared with the irradiation group, the severity of myocardial edema was alleviated, the infiltration of inflammatory cells was mitigated and the quantity of fibroblasts was reduced in the PDTC+irradiation group. Masson’s trichrome staining revealed that PDCT intervention could decrease the deposition of collagen fiber in the interstitial tissues. Semi-quantitative analysis demonstrated that the CVF value in the PDTC+irradiation group was (9.99±0.32)%, significantly lower compared with (22.05±0.21)% in the irradiation group (P<0.05). Western blot and qRT-PCR demonstrated that the expression levels of p50,p65,and HIF-1αproteins and mRNA in the PDTC+ irradiation group were significantly down-regulated compared with those in the irradiation group (all P<0.05). Compared with the irradiation group, the expression levels of CTGF protein and mRNA tended to decline (all P>0.05),and the expression levels of COL-1 protein and mRNA were equally inclined to decrease (P<0.05 and P>0.05). Conclusion PDTC can alleviate the acute RIHD by suppressing the activation of NF-κB and its downstream HIF-1α transcription.
		2018 Vol. 27 (1): 101-106 [Abstract] ( 631 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	107	Progress in treatment of previously untreated oligometastatic nasopharyngeal carcinoma
		Huang Shuang, Chen Xiaozhong
		The treatment strategies and prognosis of previously untreated oligometastatic nasopharyngeal carcinoma (NPC) are extremely different due to the heterogeneity of this disease. More and more studies have found the survival advantages of oligometastatic NPC over NPC with multiple metastases. In addition to systemic chemotherapy, the primary tumor and metastatic lesions should be considered in the treatment of previously untreated oligometastatic NPC.Adding radical radiotherapy for primary tumor and aggressive managements for metastatic lesions to the systemic chemotherapy can substantially improve the survival of patients, even achieving a radical cure. Several molecular markers and prognostic models can screen out some patients who will benefit from aggressive treatment, but more studies are needed in the future.
		2018 Vol. 27 (1): 107-111 [Abstract] ( 974 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	112	Controversies and progresses in prophylactic cranial irradiation for small cell lung cancer
		Sun Han, Zhao Lujun
		Small cell lung cancer (SCLC) is a kind of highly invasive malignant neoplasm, which is characterized by short survival and high-risk cranial metastasis. Therefore, application of prophylactic cranial irradiation (PCI) is of clinical significance to reduce the incidence of brain metastasis and prolong the patients’ survival on the basis of radio-and chemo-therapy. Nevertheless, the indications and clinical value of PCI have been controversial in recent years. These controversies mainly include the significance of PCI for extensive-stage SCLC, the indications of PCI for limited-stage SCLC and the alternative approaches for PCI. In this paper, the controversies and progresses of PCI applied in clinical practice are investigated and reviewed.
		2018 Vol. 27 (1): 112-115 [Abstract] ( 831 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	116	Nuclear EGFR:a potential target for radiosensitizer
		Zhang Tingting, Liu Baocai, Cheng Guanghui
		Nuclear epithelial growth factor receptor (EGFR) plays an important role in the development, metastasis, treatment, and prognosis of cancer. Radiotherapy, one of the main therapies for malignant tumor, causes EGFR transfer into the nucleus along with tumor therapy, thereby reducing radiosensitivity. Insight into the biological characteristics and functions of nuclear EGFR has an important reference value for improving radiosensitivity. Therefore, this article elaborates on EGFR transport into the nucleus, the features of nuclear EGFR, and its relationship with radiosensitivity and clinical targeted therapy.
		2018 Vol. 27 (1): 116-120 [Abstract] ( 709 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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