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.2 Published 2018-02-15

	Head and Neck Tumors Physics?Biology?Technique Abdominal Tumors Thoracic Tumors Review Articles Consensus Symposium

Consensus

	123	Expert consensus of China on radiation therapy for gliomas in 2017
		Lang Jinyi
		Gliomas is a global cell-originated tumor that is the most common primary intracranial tumor. World Health Organization (WHO) classification of glioma isWHO Ⅰ-Ⅳ,and WHO Ⅰ-Ⅱ are the lower-grade gliomas(LGG),WHO Ⅲ-Ⅳ are the higher-grade gliomas(HGG).With the development of modern radiotherapy and radiobiology,radiation therapy become an integral role in treating gliomas.Different grade of the gliomas will have different characteristics and treatment strategy. China expert diagnosis and treatment guildline of central nervous system glioma has been published in 2016. However, there was no relevant consensus specialized on glioma radiotherapy in China untill now.Therefore,after discussion and communication according to evidence-based medicine,a consensus was made among China Society for Radiation Oncology (CSTRO) composed of Chinese glioma experts.The consensus includes radiation therapy for HGG,LGG,diffuse intrinsic pontine glioma, ependymom, recurrent spinal cord glioblastoma,elderly patients,pediatric gliomas and pseudoprogression.The consensus will provide in-depth analysis and summarize the concernedquestion of radiation therapy in clinical work.Meanwhile,this consensus would strive to further standardize the application of radiation therapy in glioma treatment to provide evidence-based guidance.
		2018 Vol. 27 (2): 123-131 [Abstract] ( 1393 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	132	Clinical analysis of gamma-ray fractionated stereotactic radiotherapy for intracranial metastatic polycystic tumors
		He Xuan, Zhao Chennian, Du Jianfei, Gao Hongxiang, Zhang Junwei, Wang Yang, Zhang Xuecheng
		Objective To analyze the clinical efficacy of gamma-ray fractionated stereotactic radiotherapy (FSRT) in the treatment of intracranial metastatic polycystic tumors. Methods Forty cases with 61 metastatic polycystic tumors were selected from 189 patients with 373 intracranial metastatic tumors admitted to our hospital from 2013 to 2015. All cases received gamma-ray FSRT. The isodose line at 50% was defined as the prescription dose. The prescription dose was ranged from 40 to 48 Gy/10-12f. The survival rate was calculated by Kaplan-Meier method. The single factor analysis was performed by Log-rank method. Results The median follow-up time was 21months (range:6-39 months).The median survival time was 15.3 months. The 6-month, 1-and 2-year local control rate was 93%, 82% and 79%, respectively. The 1-and 2-year survival rate was 63% and 30%. Single factor analysis demonstrated that the volume of cysts and the volume of lesions were not significantly correlated with local control rate (P=0.17 and 0.48). Conclusion Gamma-ray FSRT can be adopted to treat intracranial metastatic polycystic tumors, which yields similar clinical efficacy to metastatic solid tumors. It deserves wide application in clinical practice due to high local control rate and safety.
		2018 Vol. 27 (2): 132-134 [Abstract] ( 1072 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	135	Abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma:risk factors and guidance for postoperative radiotherapy
		Shen Wenbin, Gao Hongmei, Zhu Shuchai, Li Teng, Li Shuguang, Li Youmei, Liu Zhikun, Su Jingwei, Li Juan, Xu Jinrui
		Objective To analyze the risk factors for abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma (TE-SCC), and to design the target volume for postoperative radiotherapy based on the Results. Methods A retrospective study was performed among 913 patients with middle TE-SCC undergoing radical surgery who were admitted to our hospital from 2007 to 2012. Influencing factors were analyzed for abdominal lymph node recurrence after treatment. The efficacy was compared between different treatment Methods in the high-risk population. Comparison of categorical data was made by chi-square test. The overall survival rates (OS) were calculated by the Kaplan-Meier method and analyzed by the univariate log-rank analysis. The influencing factors for abdominal lymph node recurrence were analyzed by the multivariate logistic regression equation. Results After treatment, 37 patients had abdominal lymph node recurrence, yielding a recurrence rate of 4.1%. A total of 53 recurrent sites were found. The univariate analysis showed that no/low differentiation, pT3+4 stage, no less than 3 positive postoperative lymph nodes, and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P=0.032,0.001,0.009,0.000). The multivariate regression analysis showed that pathological T staging and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P=0.011, 0.000). For patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes, postoperative radiotherapy improved OS and local control rates but failed to reduce the distant metastasis-free rate. Conclusions T staging and positive postoperative abdominal lymph nodes are important risk factors for abdominal lymph node recurrence after radical surgery in patients with middle TE-SCC. Postoperative adjuvant therapy is recommended for patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes.
		2018 Vol. 27 (2): 135-139 [Abstract] ( 824 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	140	Analysis of outcomes and prognostic factors in 307 stages Ⅱ-Ⅲ esophageal cancer patients treated with concurrent chemoradiotherapy
		Cheng Xinyu, Wu Hui, Zhang Ruirui, Sun Xueming, Yan Zhumin, Liu Xiao, Chen Yongshun
		Objective To summarize the outcomes and prognostic factors in esophageal cancer (EC) patients. Methods A total of 307 EC patients of stages Ⅱ-Ⅲ were treated with concurrent chemoradiotherapy in our hospital from September 2006 to July 2014.There were 73 patients with stage Ⅱ and 234 with stage Ⅲ.The radiotherapy dose was 50-70 Gy (median 60 Gy).Concurrent chemoradiotherapy were used with fluorouracil plus platinum (PF,166),paclitaxel plus platinum (TP,82) or platinum only (P,59).The Kaplan-Meier method was used to calculate overall survival (OS) and progression-free survival (PFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results The 1-,3-5-year OS and PFS rates were85.6%,53.8%,36.9% and 74.6%,43.7%,33.1%,respectively. The median OS and PFS were 41.6 months and 29.8 months. The univariate analysis indicated that T stage,N stage,clinical stage,lesion location,lesion length and chemotherapy regimen were prognostic factors for OS and PFS (P=0.007 and 0.013,0.000 and 0.000,0.000 and 0.000,0.002 and 0.000,0.141 and 0.005,0.018 and 0.165).Multivariate analysis showed that T stage,N stage,lesion location and chemotherapy regimen were prognostic factors for OS (P=0.024,0.000,0.007 and 0.028),lesion location,lesion length and N stage were prognostic factors for PFS (P=0.004,0.033 and 0.035).The median OS and PFS for EC patients treated by total dose 50-60 Gy,>60-70 Gy were 47.4 months,37.8 months(P=0.469) and 34.1 months,25.1 months (P=0.0.233),there were no statistic difference. Conclusions The outcome of EC patients treated with concurrent chemoratherapy could obtain a long-term survival,combination chemotherapy is superior to single drug,there are no statistical difference between high-dose and low-dose,and the acute toxic effects can be tolerated.
		2018 Vol. 27 (2): 140-144 [Abstract] ( 820 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	145	Analysis of risk factors of recurrence of pT1-3N0M0 esophageal squamous cell carcinoma after two-field esophagectomy
		Wang Yuxiang, Dong Shilei, He Ming, Li Jing, Yang Jie, Qi Zhan, Zhu Shuchai, Qiao Xueying
		Objective To retrospectively analyze the factors of postoperative recurrence of stage pT1-3N0M0 esophageal squamous cell carcinoma. Methods A total of 488 patients who underwent two-field R0 esophagectomy, pathologically classified as stage pT1-3N0M0, without adjuvant radiotherapy and/or chemotherapy before or after surgery and postoperative survival time≥ 3 months were enrolled in this study. Multivariate analysis was performed by using Cox model. Results At the end of follow-up, the overall recurrence rate was 36.9%(180/488);the local recurrence rate was 21.5%(105/488), the distant metastasis rate was 6.8%(33/488) and the local recurrence rate complicated with the distant metastasis rate was 8.6%(42/488).Cox multivariate analysis demonstrated that tumor site and pT staging were the factors affecting the overall/local recurrence rate and distant metastasis. The recurrence rate in patients with the upper esophageal squamous cell carcinoma and stage pT3 was the highest, followed by those with the middle esophageal squamous cell carcinoma or stage pT2 and the lowest recurrence rate was observed in patients with the lower esophageal squamous cell carcinoma or stage pT1. Conclusions Tumor site and pT staging are the pivotal factors for postoperative recurrence of stage pT1-3N0M0 esophageal squamous cell carcinoma after two-field R0 esophagectomy, which contributes to offer guidance to the selection of indications for postoperative adjuvant radiotherapy.
		2018 Vol. 27 (2): 145-149 [Abstract] ( 793 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	150	Application of repeated enhanced 4DCT to detect the changes of heart volume during concurrent chemoradiotherapy for esophageal cancer
		Wang Xue, Li Jianbin, Wang Jinzhi, Zhang Yingjie, Li Fengxiang, Wang Wei, Guo Yanluan, Shao Qian, Xu Min, Liu Xijun, Wang Yue
		Objective To detect the changes of heart volume during concurrent chemoradiotherapy for esophageal cancer based on repeated enhanced 4DCT. Methods Patients with squamous cell esophageal cancer underwent repeated enhanced 4DCT and 3DCT scans before and after 10,20 and 30 fractions of radiotherapy, respectively. The heart was contoured on 3DCT,end expiratory (EE) and maximum intensity projection (MIP) of 4DCTimages. The changes in theheart volume,blood pressure and heart rate were statistically compared at different time points. Results A total of forty-six patients completed 4 fractions of 3DCT and enhanced 4DCT scans. Compared with the initial values, the heart volume was significantly decreased by 3.27%,4.45% and 4.52% after 10 fractions of radiotherapy,and reduced by 6.05%,5.64% and 4.51% following 20 fractions of radiotherapy on 3DCT,EE and MIP,respectively (P=0.000-0.027).The heart volume after 30 fractions of radiotherapy did not significantly differ from the initial volume (P>0.05).After radiotherapy,there was a significant decrease inboth systolic and diastolic blood pressure (P=0.000 and P=0.009) and a significantincrease in the heart rate (P=0.001) compared with those measured before radiotherapy. ConclusionsEnhanced 4DCT scan can clearly reflect the changes of heart volume throughout concurrent chemoradiotherapy. The heart volume starts to shrink during the early stage of radiotherapy and continue to decrease until the middle-and late-stage, whereas it restores to the initial volume after radiotherapy. Simultaneously, blood pressure declines and heart rate is accelerated during radiotherapy.
		2018 Vol. 27 (2): 150-154 [Abstract] ( 821 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	155	Prognostic value of anemia in patients with extranodal nasal-type NK/T cell lymphoma:A multi-center study from CLROG
		Fang Hui, Zhu Suyu, Xu Liming, Wang Peiguo, Wu Tao, Qian Liting, Zhang Fuquan, Hou Xiaorong, Qi Shunan, Yang Yong, Jin Jing, Zhang Yujing, Zhu Yuan, Cao Jianzhong, Lan Shengmin, Wu Junxin, Li Yexiong
		Objective To evaluate the prognostic value of anemia in patients diagnosed with extranodal nasal-type natural killer (NK)/T cell lymphoma (NKTCL). Methods Clinical data of 1225 NKTCL patients receiving the first course of treatment from 10 medical institutions in China were retrospectively analyzed. According to the diagnostic criteria in China, anemia was defined as the hemoglobin (Hb) level< 120 g/L for the male and< 110 g/L for the female from the sea-level area. The severity of anemia was classified into the extremely severe anemia (Hb ≤ 30 g/L), severe anemia (31-60 g/L), moderate anemia (61-90 g/L) and mild anemia (>90 g/L). Results Among 1225 patients, 199(16.2%) were complicated with anemia, who had more adverse prognostic factors compared with their counterparts without anemia. Among NKTCL patients with anemia, the proportion of patients with stage Ⅱ-IV, a median age> anemia, Eastern Cooperative Oncology Group (ECOG) score of 2-4 and NK/T-cell lymphoma prognostic index (NKTCLPI) ≥ 2 was relatively high. Patients with anemia obtained worse clinical prognosis than those without anemia. The 5-year overall survival (OS) and progression-free survival (PFS) in NKTCL patients with anemia were calculated as 49.4% and 35.4%, significantly lower compared with 63.3% and 56.0% in their counterparts without anemia (both P<0.01). Single factor analysis demonstrated that anemia, age, ECOG score, group B symptom, lactate dehydrogenase, primary tumor site, primary tumor invasion and staging were the prognostic factors of OS and PFS. Multivariate analysis revealed that anemia was still the independent prognostic factor. Conclusions Anemia is not common in patients with NKTCL and these patients obtain poor clinical prognosis. Anemia is an independent prognostic factor for patients with NKTCL.
		2018 Vol. 27 (2): 155-160 [Abstract] ( 895 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	161	Clinicopathological analysis of primary non-Hodgkin’s lymphoma of the female reproductive system
		Hou Xiaorong, Chang Xiaoyan, Chen Jie, Hu Ke, Zhang Fuquan
		Objective To retrospectively analyze the clinical pathological features and treatment outcomes of primary non-Hodgkin’slymphoma (NHL) of the female reproductive system. Methods A retrospective analysis was performed on the clinical data of 28 patients with primary NHL of the female reproductive system who were admitted to our hospital from 1990 to 2016. The lymphomas were classified and staged based on the WHO histological classification and the Ann Arbor staging system,respectively. Of the 28 patients,18(64%) underwent surgery,27(96%) received chemotherapy, and 8(29%) received radiotherapy. The Kaplan-Meier method was used to calculate survival rates. Results The 5-year follow-up rate was 86%.The median age was 56.5 years (13-80 years). The ovary was involved in 11 patients (39%). The lymphoma was staged as IVE in 18 patients (64%).The most common pathological type was diffuse large B-cell lymphoma. The median survival time was 23.5 months. The 1-, 3-, and 5-year overall survival rates were 89%, 74%, and 59%, respectively. Conclusions Primary NLH of the female reproductive system is an extremely rare neoplastic disorder with no typical clinical symptoms and mostly diagnosed in advanced stage. The combined treatment with surgery,chemotherapy, and radiotherapy plays an important role in the treatment of the disorder.
		2018 Vol. 27 (2): 161-164 [Abstract] ( 773 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	165	Clinical efficacy and prognosis of adjuvant radiotherapy after breast-conserving surgery for stage Ⅰ—Ⅱ breast cancer
		Zhong Qiuzi, Rong Qinglin, Tang Yu, Yang Yong, Long Liuhua, Jin Jing, Liu Yueping, Song Yongwen, Fang Hui, Chen Bo, Qi Shunan, Li Ning, Tang Yuan, Zhang Jianghu, Lu Ningning, Li Yexiong
		Objective To evaluate the clinical efficacy and analyze the prognostic factors of radiotherapy after breast-conserving surgery for stage Ⅰ—Ⅱ breast cancer patients. Methods Clinical efficacy of adjuvant radiotherapy in 1376 patients with stage Ⅰ and Ⅱ(T1-2N0-1M0/T3N0M0) breast cancer after undergoing unilateral breast-conserving surgery between 1999 and 2013 was retrospectively reviewed. Among them, 930 patients (67.6%) received radiotherapy combined with chemotherapy including 517 receiving radiotherapy followed by chemotherapy and 413 receiving chemotherapy followed by radiotherapy. In total, 1055 patients (76.7%) were treated with endocrine therapy. Eighty-six patients (39.6%) positive for HER-2 received targeted therapy. The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method. Univariate analysis was performed by Log-rank test and multivariate analysis was conducted by Cox regression method. Results The median follow-up time was 55 months. The quantity of patients receiving follow-up for ≥ 10 years was 90. The 5-and 10-year OS rates for all patients were 98.6% and 91.5%, and 94.6% and 82.8% for 5-and 10-year DFS rates. Mutivariate analysis revealed that age (P=0.016),T staging (P=0.006),N staging (P=0.004), lymphovascular invasion (P=0.038) and time interval between radiotherapy and surgery (P=0.048) were independent prognostic factors for DFS rate. Multivariate analysis demonstrated that N staging (P=0.044) and ER (P=0.026) were independent prognostic factors for DFS in the radiotherapy alone group. Conclusions The radiotherapy-based comprehensive treatment yields favorable clinical outcomes for stage Ⅰ—Ⅱ breast cancer patients after undergoing breast conserving surgery. The prognostic factors for DFS include age, T staging, N staging, lymphovascular invasion and the time interval between radiotherapy and breast-conserving surgery. In the radiotherapy alone group, DFS rate is associated with N staging and ER level.
		2018 Vol. 27 (2): 165-169 [Abstract] ( 925 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	170	Long-term efficacy of preoperative chemoradiotherapy combined with total mesorectal excision for locally advanced rectal cancer:an analysis of 241 patients
		Li Shuai, Jin Jing, Tang Yuan, Li Ning, Yu Jing, Ren Hua, Wang Xin, Liu Wenyang, Wang Shulian, Song Yongwen, Wang Weihu, Liu Yueping, Fang Hui, Lu Ningning, Tang Yu, Chen Bo, Li Yexiong
		Objective To retrospectively analyze the long-term efficacy of and prognostic factors after preoperative chemoradiotherapy combined with total mesorectal excision (TME) in the treatment of 241 patients with locally advanced rectal cancer. Methods A total of 241 patients who were consecutively admitted to our hospital and diagnosed with locally advanced mid-low rectal adenocarcinoma by pelvic magnetic resonance imaging or computed tomography from January 2006 to November 2014 were enrolled as subjects. All patients received preoperative radiotherapy with doses ranging between 42.0 and 50.4 Gy (median dose=50 Gy) and concurrent chemotherapy with capecitabine±oxaliplatin. Patients received TME (R0 excision) at 4-15 weeks (median time=7 weeks) after chemoradiotherapy. Adjuvant postoperative chemotherapy was given depending on the recovery and preference of each patient. Disease-free survival (DFS), locoregional recurrence (LRR), overall survival (OS), and distant metastasis (DM) rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. The Cox model was used for multivariate analysis. Results In all the patients, the median follow-up time was 42 months;the 3-year LRR, DFS, OS, and DM rates were 3.8%, 76.2%, 85.9%, and 20.6%, respectively. The subgroup analysis showed that ypT0-2, ypN-, pCR, and TRG4 were associated with improved DFS (ypT0-2 vs. ypT3-4:86.0% vs. 69.3%, P=0.002;ypN-vs ypN+:88.1% vs. 56.9%, P=0.000;pCR vs. non-pCR:100% vs. 72.4%, P=0.001;TRG4 vs. TRG2-3 vs. TRG0-1:94.9% vs. 73.6% vs. 66.3%, P=0.011). The multivariate analysis revealed that the postoperative ypN status was an independent prognostic factor for DFS (P=0.000). Conclusions For patients with locally advanced mid-low rectal adenocarcinoma, preoperative chemoradiotherapy combined with radical surgery achieves satisfactory outcomes in local control. The major reason for treatment failure lies in distant metastasis. The ypN status after chemoradiotherapy is an independent prognostic factor for DFS.
		2018 Vol. 27 (2): 170-176 [Abstract] ( 925 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	177	Clinical efficacy of CyberKnife stereotactic body radiation therapy for hepatic hilar cancer
		Qiu Minghan, Meng Maobin, Zhuang Hongqing, Wang Huanhuan, Dong Yang, Wang Jingsheng, Yuan Zhiyong, Wang Ping
		Objective To evaluate the efficacy and safety of CyberKnife stereotactic body radiation therapy (SBRT) in the treatment of hepatic hilar cancer. Methods A retrospective study was performed on the clinical data of 36 patients with hepatic hilar cancer who were admitted to our hospital and treated with CyberKnife SBRT from 2009 to 2015. In the 36 patients, 37 lesions were found with tumor diameters ranging from 1.5 to 5.5 mm (median diameter 3 cm). The Synchrony respiratory tracking system was used for 21 lesions in 20 patients, while the XSight spinal tracking system was used for 16 lesions in 16 patients. Local progression was evaluated based on contrast-enhanced computed tomography and/or magnetic resonance imaging. The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates, and the log-rank test was used for survival comparison and univariate prognostic analysis. Results The median follow-up time was 12.7 months. The 1-and 2-year postoperative LC rates were 90% and 76%, respectively. The 1-year OS and progression-free survival (PFS) rates were 63% and 39%, respectively. The median OS and PFS times were 15.2 and 10 months, respectively. The incidence of grade 3 adverse reactions was 11%. Conclusions The CyberKnife SBRT is a safe and effective way to treat hepatic hilar cancer.
		2018 Vol. 27 (2): 177-180 [Abstract] ( 1145 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	181	Analysis of adverse events after radiotherapy for primary and metastatic prostate carcinoma in patients with oligometastasized castration resistant prostate carcinoma
		Li Hongzhen, Gao Xianshu, Qi Xin, Qin Shangbin, Ji Chen, Zhang Min, Li Xiaoying, Wang Qingguo, Li Xiaomei
		Objective To analyze the adverse events in patients diagnosed with oligometastasized castration resistant prostate carcinoma (CRPC) receiving radiotherapy for the primary and metastatic prostate carcinomas. Methods Twenty patients with oligometastasized CRPC admitted to our hospital between 2011 and 2015 were treated with image-guided volumetric modulated arc therapy (VMAT). The dose for prostate+ seminal vesicle was 76 Gy/38 f,46 Gy/23 f for the pelvic lymph node and the median dose for the metastatic lesions was 60 Gy (52-66)/23 f. Relevant clinical data and adverse events were analyzed. Results All patients completed the radiotherapy. Only 1 patient showed grade Ⅲ urinary obstruction and received catheterization. In terms of acute adverse events of ≥ grade Ⅱ, urinary tract was observed in 4 cases (20%), rectum in 2(10%) and blood system in 2(10%). The rectal V50 was correlated with acute adverse events of ≥ grade Ⅱ. The median follow-up time was 24.2 months. No patient suffered from late adverse events of ≥ grade Ⅱ. All cases showed a decline in the level of prostate specific antigen (PSA) after radiotherapy. The median PSA reduction rate was 99%. Among them, 16 cases (80%) had a PSA reduction rate of over 90%. Conclusions It is safe and efficacious to perform radical dosage radiotherapy for primary and metastatic prostate carcinomas in patients with oligometastasized CRPC.
		2018 Vol. 27 (2): 181-184 [Abstract] ( 841 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics?Biology?Technique

	185	Backup and restore of planning process in Pinnacle treatment planning system
		Fu Guishan, Huang Peng, Zhang Ke, Han Fei, Tian Yuan, Dai Jianrong
		Objective To design and implement a planning backup and restore system and evaluate its clinical effectiveness. Methods The default TPS menu of data save (File-Save) and system exit (File – Exit) was replaced by user designed script (Script_Save and Script_Exit) which backup the current planning status in a special format besides performing the normal save and exit operation. The treatment plan can be rolled back to any previously saved backup status in case the data were damaged or, the plan quality was deteriorated in the try and error planning process. Results The save and exit operation was simplified by using the user designed script. An extra disk space of 59.4MB per patient was required to backup the planning process and the backup was performed with no impact to the normal planning operation.1.9% of the plans were restored during the planning process. For all of the restoring operations, 65% were performed within 1 day, 80% were performed within 1 week, and 87.6% were performed within 1 month. Some restoring operations were even performed 4 months after the planning. Conclusions The designed backup and restore system is clinical applicable and valuable. Clinical using of the system can improve the planning efficiency and patient data safety.
		2018 Vol. 27 (2): 185-189 [Abstract] ( 690 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	190	Catalyst system in patient positioning during breast cancer radiotherapy:clinical application and influencing factors
		Luo Huanli, Peng Haiyan, Jin Fu, Xiao Peng, Cao Shaoai, He Yanan, Dong Wenling, Li Xuemin, Yang Dingyi, Wang Ying
		Objective To evaluate the clinical application of Catalyst system in patient positioning during breast cancer radiotherapy, and to analyze its correlation with age and body mass index (BMI). Methods Twenty-four patients with breast cancer who were admitted to our hospital from May to August, 2016 were enrolled as subjects. For all patients, auxiliary positioning was made by the optical surface imaging system (C-Rad Catalyst) before each treatment. The kV-kV imaging was executed weekly to verify positioning. Age, BMI, and setup errors of the two systems in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) directions were recorded and analyzed by independent samples t-test and Pearson correlation analysis. Results The C-Rad Catalyst system had a significantly larger setup error in the AP direction than the kV-kV imaging (0.22±0.17 vs. 0.18±0.13 cm, P<0.05). There were no significant differences in setup errors in the SI or LR direction between the two systems (0.23±0.18 vs. 0.19±0.15 cm, P>0.05;0.28±0.28 vs. 0.20±0.15 cm, P>0.05). Age and BMI of patients had significant impacts on the C-Rad Catalyst system but the kV-kV imaging (P>0.05):there were significant differences in setup errors in the AP and SI directions between patients ≤44 years of age and those 45-59 years of age (all P<0.05);there were significant differences in setup errors in the AP and LR directions between patients ≤44 years of age and those ≥60 years of age (all P<0.05);there was a significant difference in setup error in the LR direction between patients 45-59 years of age and those ≥60 years of age (P<0.05);there was a significant difference in setup error in the SI direction between patients with BMIs of<25 and ≥25 kg/m²(P<0.05). For patients ≥60 years of age, setup error of the C-Rad Catalyst system in the SI direction was correlated with age (r=-0.496, P<0.05). For patients with BMI of<25 kg/m², setup error of the C-Rad Catalyst system in the AP direction was correlated with BMI (r=-0.445,P<0.05). For patients with a BMI of ≥25 kg/m², setup error of the C-Rad Catalyst system in the SI direction was correlated with BMI (r=-0.252,P<0.05). Conclusions There is significant difference in setup error in the AP direction between the C-Rad Catalyst system and the kV-kV imaging. Age and BMI have impacts on patient positioning by the C-Rad Catalyst system.
		2018 Vol. 27 (2): 190-194 [Abstract] ( 1168 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	195	An investigation of precision of full six-degree target shift corrections using the ArcCHECK system
		Bai Penggang, Dai Yitao, Chen Rongqin, Li Qixin, Cheng Yanming, Chen Chuanben, Fei Zhaodong, Chen Kaiqiang, Chen Jihong
		Objective To investigate the precision of full six-degree target shift corrections using the ArcCHECK system. Methods Fourteen patients receiving intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) in Fujian Medical University Cancer Hospital from May to September, 2015 were selected. The first treatment setup errors were obtained using cone-beam computed tomography. The setup errors were simulated in ArcCHECK, and the full six-degree target shift corrections was used to correct the errors. The plans without and with setup errors and the plan with corrected setup errors were taken. The paired t-test was used to compare dose to agreement (DTA) and Gamma passing rates betweenthe plan without setup errors and the plan with setup errors and plan with corrected setup errors. ResultsThe DTA and Gamma passing rates were (96.76±1.57)% and (98.35±0.92)% for the plan without setup errors,(59±21.42)% and (62.86±21.63)% for the plan with setup errors, and (91.41±4.82)% and (94.11±4.33)% for the plan with corrected setup errors. There were significant differences between the plan without setup errors and the plan with setup errors and plan with corrected setup errors in DTA passing rate (t=6.64 and 5.13, both P<0.05) and Gamma passing rate (t=6.15 and 4.19, both P<0.05). Conclusions The full six-degree target shift corrections can be used in IMRT for NPC, with good Results in correcting setup errors and improving the precision for IMRT dose distribution.
		2018 Vol. 27 (2): 195-198 [Abstract] ( 798 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	199	Neck skin dose planning for early-stage nasopharyngeal carcinoma:a comparative study of three radiotherapy methods
		Zhang Yulei, Liao Xiongfei, Li Jie, Bai Lixin, Xu Peng, Li Churong, Chen Yazheng, Wang Pei
		Objective To compare the neck skin dose between fixed-field dynamic intensity-modulated radiation therapy (dIMRT), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) in the treatment of early-stage nasopharyngeal carcinoma. Methods A total of 16 early-stage nasopharyngeal carcinoma patients undergoing radiotherapy were enrolled as subjects. The neck skin was delineated by contraction of the outer edge of neck by 3 mm. Dose planning was made by the traditional method (TP group) and a new method (NP group), in which the neck skin was considered as the organ at risk. Dmean and V5-V70 for the neck skin were recorded. The paired t-test was used to analyze the differences between two plans in each radiotherapy method. An analysis of variance was used to compare the same plan between the three radiotherapy Methods. Results The HT group had significantly higher Dmean and V5-V70 for the neck skin than the dIMRT group and the VMAT group (P=0.00,0.00,0.00,0.00,0.00,0.00,0.00,0.02). Using dIMRT, the Dmean and V10-V60 for the neck skin were reduced by 7%, 8%, 22%, 25%, 38%, 59%, and 85% in the NP group than in the TP group (P=0.00,0.00,0.00,0.00,0.00,0.00,0.00). Using VMAT, the Dmean and V20-V40 for the neck skin were reduced by 4%, 19%, 29%, and 34% in the NP group than in the TP group (P=0.02,0.01,0.02,0.01). Using HT, the V30-V60 for the neck skin were reduced by 20%, 29%, 50%, and 67% in the NP group than in the TP group (P=0.00,0.00,0.00,0.00,0.03). Conclusions In the treatment of early-stage nasopharyngeal carcinoma, HT causes a higher radiation dose to the neck skin than dIMRT and VMAT, while dIMRT and VMAT have similar neck skin doses. The neck skin dose can be significantly reduced with the neck skin as the organ at risk.
		2018 Vol. 27 (2): 199-203 [Abstract] ( 926 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	204


		2018 Vol. 27 (2): 204-205 [Abstract] ( 645 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	206	Research progress on predictive factors and time points of adaptive re-planning in intensity-modulated radiation therapy for head and neck cancer
		Guo Qi, Qian Jianjun, Tian Ye
		Adaptive re-planning contributes to improve the dosimetric uncertainties induced by anatomical changes during intensity-modulated radiation therapy (IMRT) for head and neck cancer patients and can enhance the local control rate and quality of life of patients. Previous research has demonstrated that presence of relatively large lymph nodes before treatment and significant loss of body weight during treatment are pivotal predictive factors of re-planning during IMRT. At 4 weeks after IMRT, the volume of the target and peripheral organ at risk (OAR) tends to steadily decrease. One to two cycles of adaptive re-planning are recommended at 3 or 4 weeks after IMRT.
		2018 Vol. 27 (2): 206-209 [Abstract] ( 744 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	210	Current status and research progress on diagnosis and treatment of choroid plexus carcinoma
		Chang Xiaojing, Xue Xiaoying
		Choroid plexus carcinoma is a relatively rare primary intracranial malignant tumor which is derived from the choroid plexus epithelium. It is classified as World Health Organization (WHO) grade Ⅲ and mainly occurs in children. Currently, maximal surgical resection is still the main therapeutic strategy. The clinical efficacy of postoperative adjuvant therapies remains controversial. Recent studies have promoted that postoperative combination of radiotherapy and chemotherapy can enhance the clinical prognosis and prolong the survival time for choroid plexus carcinoma patients undergoing sub-radical resection. In this review, relevant articles published in the recent 15 years were retrieved to summarize the current status and research progress on the diagnosis and treatment of choroid plexus carcinoma.
		2018 Vol. 27 (2): 210-213 [Abstract] ( 918 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	214	Application and prospect of optical surface imaging technique in radiotherapy
		Xiao Qing, Zhong Renming
		Currently, image-guided radiation therapy (IGRT) is the most advanced technique in the field of radiation oncology. However, the most commonly used image-guided techniques, such as cone beam computed tomograhpy (CBCT) and electronic portal imaging device (EPID) are limited due to extra radiation, poor image quality and failure of real-time monitoring. Optical surface imaging technique generates no additional radiation and can conduct real-time monitoring. Multiple researches have demonstrated that it has significant advantages in terms of guiding positioning, real-time monitoring of the fractionated and divided motion, reducing the frequency of CBCT scanning, breathing door control, etc. In this paper, this novel technique and its application prospect in radiotherapy are reviewed.
		2018 Vol. 27 (2): 214-217 [Abstract] ( 790 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Symposium

	218	Introduction of relevant criteria for quality assurance and quality control of tumor radiotherapy at home and abroad
		Fu Qingguo, Dai Jianrong, Zhu Xiaodong, Chen Long, Liu Zhijie
		Multiple institutions at home and abroad have established and issued the standards, guidelines, criteria or reports of the quality assurance (QA) and quality control (QC) of radiotherapy. At present, no institutions in China have implemented systematic classification of QA-and QC-related criteria of radiotherapy. Complete standard system of QA and QC of radiotherapy should consist of clinical and physical technologies. Physical technology includes equipment, technological flow and radiation protection. The QA and QC of physical technology play a pivotal role in tumor radiotherapy. This paper introduces relevant criteria of QA and QC of radiotherapy at home and abroad.
		2018 Vol. 27 (2): 218-221 [Abstract] ( 903 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	222	Introduction of image-guided stereotactic radiotherapy systems for small animals
		Qing Gan, Wang Jiazhou, Hu Weigang, Zhang Zhen
		The theory and application of small animal radiotherapy models is critical for the research and development of radiobiology and clinical radiotherapy. Considering universality and cost effects, mouse models are widely used to explore the radiobiological mechanisms of cancerous and normal tissues. In recent years, there has been tremendous progress in image-guided stereotactic radiotherapy equipment for small animals, which could simulate the human radiotherapy process. This article introduces stereotactic radiotherapy systems for small animals guided by different imaging modalities, such as cone-beam computed tomography and magnetic resonance imaging, and then reviews small animal fluorescence imaging technology and summarizes the application of different bioluminescence and fluorescence imaging equipment in small animal imaging systems. Finally, we put forward the prospect of optimization direction of radiotherapy equipment for small animals in future.
		2018 Vol. 27 (2): 222-225 [Abstract] ( 495 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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China Association for
　Science and Technology

Chinese Medical Association

Cancer Hospital of Chinese
　Academy of Medical
　Sciences Department of
　Radiation Oncology

Chinese Anti-Cancer
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Chinese Journal of Lung
　Cancer

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CNKI

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