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.4 Published 2018-04-01

	Head and Neck Tumors Abdominal Tumors Thoracic Tumors Investigation Research Guideline Physics Biology Technique Revies Articles

Guideline

	335	Basic guidelines of quality control for radiotherapy
		He Jie,Wang Luhua,Li Yexiong,Dai Jianrong,Ma Pan,Hu Zhihui,Liu Qingfeng,Tian Yuan
		Radiotherapy is one of the three principal modalities used in the treatment of cancer. In contrast to other medical modalities, radiotherapy, with its use of ionizing radiation in the treatment of cancer, relies heavily on modern technology and the collaborative efforts of several professionals. Quality control in radiotherapy is the regulatory process through which the actual quality performance is measured, compared with existing standards, and the actions necessary to keep or regain conformance with the standards. Quality control is one part of overall quality assurance system. In order to standardize the quality control, Expert Committee of Quality Control in Radiotherapy, National Cancer Diagnosis and Treatment Quality Control Center,National Cancer Center, develops a set of basic guidelines in accordance with the relevant national laws and regulations, and through referring to the relevant international guidelines. The guidelines covers the following topics:the basic conditions for the carrying out radiotherapy, the type, quantity and qualifications of staff to be equipped with radiotherapy as well as the organizational structure and management system, the basic equipments for carrying out conventional and precise radiotherapy techniques, the development of corresponding quality control procedures, area and shielding of various sites, the process of diagnosis, plan design and treatment implementation of radiotherapy, radiation protection of staffs and patients, and documentation related to patients, equipment and staff.
		2018 Vol. 27 (4): 335-342 [Abstract] ( 871 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Investigation Research

	343	Investigation and research of physics technique and quality assurance for radiotherapy in east guangdong province
		Peng Xun,Huang Baotian,Liu Zhihua,Yu Xuanyi,Ke Qi,Chen Jingbin,Ouyang Dan,Ma Tianbin,Gao Dongsheng,Lin Zhixiong,Deng Xiaowu
		Objective To investigate the physics technique and quality assurance (QA) during radiotherapy in the institutions from the East Guangdong province, aiming to provide reference for the construction of radiotherapy discipline and rational allocation of resources in the primary hospitals from the eastern Guangdong province. Methods From March 15 to May 20, 2016, the general conditions, radiotherapy equipment, available technique and quality assurance (QA) in the medical institutions from eastern Guangdong were investigated and analyzed by online combined with on-spot surgery. Results There were 8 institutions which provided radiotherapy with 966 ward beds, a daily capacity of 632 patients and 222 radiotherapy practitioners. Radiotherapy equipment included 12 linear accelerators, 5 after-loading devices, 1γ-knife, 8 CT simulators and 9 radiotherapy planning systems. Five institutions performed IMRT/VMAT, IGRT and ART. Dose verification was performed before precision radiotherapy delivery in all institutions except for 1 center. QA procedures were missing for the linear accelerators, CT simulators and after-loading devices. Short-term advanced studies and hand-by-hand teaching were the main approaches for staff professional training. Conclusions The resource allocation for radiotherapy in the medical centers from the eastern Guangdong province is scarce. The technique and QC levels greatly differ among different institutions. Standard QA protocols are urgently to be established and implemented. Extensive attentions should be paid to the the professional training for technicians.
		2018 Vol. 27 (4): 343-347 [Abstract] ( 803 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and neck Tumors

	348	Case-control study of fractionated stereotactic radiotherapy combined with temozolomide for large brain metastases
		Ma Yuchao,Xiao Jianping,Bi Nan,Zhang Hongmei,Xu Yingjie,Zhang Ye,Liu Qingfeng,Deng Lei,Wang Wenqing,Liu Feng,Wang Kai,Zhao Ruizhi,Yang Siran,Li Yexiong
		Objective To retrospectively analyze and compare the clinical efficacy and safety between fractionated stereotactic radiotherapy (FSRT) combined with and without temozolomide in the treatment of large brain metastases. Methods Between 2009 and 2017,84 patients with large brain metastases (tumor size ≥ 6 cm³) were recruited and assigned into the CRT group (concurrent TMZ and FSRT,n=42) and RT group (FSRT alone, n=42).The radiation dose was 52.0 Gy in 13 fractions or 52.5 Gy in 15 fractions. Patients were reexamined by magnetic resonance imaging (MRI) during treatment. The radiation field would be shrunk if the gross target volume (GTV) was reduced. The clinical efficacy was evaluated at postoperative 2 to 3 months. The primary end-point event was local recurrence-free survival (LRFS) and the secondary end-point events included intracranial progression-free survival (IPFS), progression-free survival (PFS), overall survival (OS), brain metastasis-specific survival (BMSS) and adverse events. The survival rates were assessed with Kaplan-Meier method and log-rank test and monovariate analysis. Results The median GTV in the CRT and RT groups was 16.9 cm³ and 15.7 cm³.During the treatment,75% of the lesions in the CRT group were reduced compared with 34% in the RT group (P=0.000).The local control (LC) rate in the CRT and RT groups was 100% and 98%.The median follow-up time was 16.1 months (range,2.1-105.7 months).In the CRT group, the LRFS (P=0.040),IPFS (P=0.022),PFS (P=0.045),OS (P=0.013) and BMSS (P=0.006) were significantly better than those in the RT group, respectively. In the CRT group, the incidence of grade Ⅰ-Ⅱ gastrointestinal adverse events was 33%, significantly higher compared with 26% in the RT group (P=0.006).No grade IV-V adverse events occurred in both groups. Conclusion Combined application of temozolomide and FSRT can further enhance the LC and survival rates and do not increase the risk of severe adverse events in patients diagnosed with large brain metastases.
		2018 Vol. 27 (4): 348-353 [Abstract] ( 794 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	354	Analysis of lymph node metastasis for hypopharyngeal carcinoma based on computed tomography
		Wang Dongqing,Li Ling,Zhai Limin,Li Baosheng
		Objective To explore the pattern of lymph node metastasis and provide guidance for the delineation of clinical target volume for patients diagnosed with hypopharyngeal squamous cell carcinoma (HSCC). Methods A total of 123 patients who were initially diagnosed with HSCC by electrolaryngoscope and computed tomography (CT) of the head and neck in Shandong Tumor Hospital between 2014 and 2017 were recruited in this study. The lymph node metastasis was evaluated based on the diagnostic criteria of CT scan. The lymphatic metastasis ratio (LMR) at each node level was calculated. Analysis of variance(ANOVA) and χ² test were used to analyze the relationship between LMR and primary tumors. ResultsAmong 123 patients,primary tumors were originated from the pyriform sinus (PS) in 101 cases (82.1%),posterior pharyngeal wall (PPW) in 15(12.2%) and postcricoid (PC) in 7(5.7%),respectively. The overall LMR was calculated as 84.6%(n=104),in detail, 84.2% for patients with primary tumors originating from PS,93.3% for those from PPW and 71.4% for patients from PC,respectively. For PS-derived tumors, the ipsilateral neck LMR at the level Ⅰ a,Ⅰ b,Ⅱ a,Ⅱ b,Ⅲ,Ⅳ,Ⅴ,Ⅵ a,Ⅵ b,and Ⅶ was 0,3.0%,66.3%,42.6%,46.5%,10.9%,5.0%,2.0%,7.9%,and 11.9%,respectively, and 0,0,14.9%,5.0%,3.0%,2.0%,0,0,3.0%,and 2.0% for the contralateral neck. For PPW tumors,the ipsilateral neck LMR at the level Ⅰ a,Ⅰ b,Ⅱ a,Ⅱ b,Ⅲ,Ⅳ,Ⅴ,Ⅵ a,Ⅵ b,and Ⅶ was 6.7%,6.7%,66.7%,46.7%,46.7%,20.0%,0,13.3%,33.3%,and 60.0%,respectively, and 6.7%,6.7%,33.3%,26.7%,20.0%, 20.0%,0,0,13.3%,and 33.3% for the contralateral neck. For PC tumors,the ipsilateral neck LMR at the level Ⅱ a,Ⅱ b,Ⅲ,Ⅳ,Ⅴ and Ⅵ b was 71.4%,28.6%,14.3%,14.0%,14.0%,and 14.3%,respectively, and the LMR at the level Ⅱ a was 14.3% for the contralateral neck. No lymph node metastasis occurred in other lymph node levels. The mean levels of lymph node metastasis for the T1-T4 stage tumors were 2.4,1.9,2.2,3.3 with statistical significance (P=0.023), and 2.2, 4.5 and 1.6 for patients with the tumors originated from PS,PPW and PC (P=0.000).The PPW invasion was significantly correlated with the level Ⅶ metastasis (P=0.000),and PC or esophageal invasion was intimately correlated with the level Ⅵ metastasis (P=0.002 and 0.001). Conclusions The most common lymphatic metastasis includes ipsilateral neck Ⅱ a,Ⅲ,and Ⅱ b,whereas the level Ⅰ and Ⅴ are rarely observed. For PPW-derived tumors, the LMR at the level Ⅶ is up to 60.0%. The incidence of PC or esophageal invasion enhances the risk of level Ⅵ lymph node metastasis.
		2018 Vol. 27 (4): 354-359 [Abstract] ( 724 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	360	Clinical study of the effect of oral ulcer protective agent on the prevention and treatment of radioactive oral mucositis in nasopharyngeal carcinoma and serum inflammatory factors
		Huang Guang,Li Zhaojun,Kong Fanzhong,Lin Shaomin,Fu Qiya
		Objective To evaluate the clinical efficacy of oral ulcer protective agent in the prevention and treatment of oral mucositis in nasopharyngeal carcinoma (NPC) radiotherapy and its effect upon serum inflammatory factors. Methods A total of 90 patients diagnosed with nasopharyngeal carcinoma presenting with grade I oral mucositis caused by radiotherapy in our hospital were selected and randomly divided into two groups. In the experimental group, oral ulcer protective agent was given, and Kangfuxin gargle was administered in the control group. The incidence time and degree of radioactive oral mucositis, visual analogue scale (VAS) pain score, serum levels of CRP, TGF-β1, IL-6 and T lymphocyte subsets were statistically compared between two groups by independent-sample t-test. Results At 4 and 6 weeks after corresponding treatment, the incidence of grade Ⅱ and Ⅲ oral mucositis in the experimental group was significantly lower than that in the control group (P=0.018,0.021,0.027,0.014)). In the experimental group, the incidence of moderate and severe pain assessed by VAS was significantly lower compared with that in the control group (P=0.019,0.025);After corresponding treatment, the CRP levels in both groups were down-regulated and the CRP level in the experimental group was considerably lower than that in the control group (P=0.013). The levels of TGF-β1 and IL-6 in the control group were significantly increased (P=0.015、0.021), whereas dramatically declined in the experimental group (P=0.012,0.019). CD3(+),CD4(+),CD8(+) and CD4(+)/CD8(+) were remarkably elevated in two groups, and more significant increase was observed in the experimental group (P=0.024,0.036,0.029,0.017). Conclusions Oral ulcer protective agent can effectively inhibit the progression of oral mucosal injury, shorten the healing time and relieve the pain of oral mucosal injury in patients with NPC., which is worthy of clinical application.
		2018 Vol. 27 (4): 360-364 [Abstract] ( 977 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	365	Comparative analysis of clinical efficacy between stereotactic ablative radiotherapy and surgery for early-stage non-small cell lung cancer
		Cui Yingying,Fan Chengcheng,Sun Yanan,Luo Hui,Zheng Xiaoli,Yang Chengliang,Ye Ke,Ge Hong
		Objective To compare the clinical efficacy and safety between stereotactic ablative radiotherapy (SABR) and surgery in the treatment of early-stage non-small cell lung cancer (NSCLC). Methods A total of 227 patients who were initially diagnosed with early-stage NSCLC and with complete clinical data admitted to Henan Cancer Hospital between June 2012 and December 2016 were recruited and assigned into the SABR (n=73) and surgery groups (n=154).Kaplan-Meier method was used to calculate survival rate and survival comparison was performed using the log-rank test. Chi-square test was adopted to compare the baseline data between two groups. Results All patients completed corresponding treatment. The samples of SABR group and operation group were 74 and 155 cases respectively. The 1-year and 3-year overall survival (OS) rates in the SABR and surgery groups were 97.2%, 81.9% and 96.5%, 78.2%(P=0.603),respectively. The 1-year and 3-year progression-free survival (PFS) rates in the SABR and surgery groups were 90.1%,66.9% and 89.2%,66.9%(P=0.565),respectively. The 1-year and 3-year locoregional recurrence-free survival rates in the SABR and surgery groups were 92.8%,84.0% and 96.5%,90.8%(P=0.133),respectively. The 1-year and 3-year distant metastasis-free survival rates in the SABR and surgery groups were 97.2%,75.4% and 89.2%,69.8%(P=0.095),respectively. Conclusions SABR and surgery yield similar OS,PFS,locoregional recurrence-free and distant metastasis-free survival rates in the treatment of early-stage NSCLC. Therefore, SABR is an alternative treatment for patients with early-stage NSCLC.
		2018 Vol. 27 (4): 365-369 [Abstract] ( 899 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	370	Comparative study of three different methods in the determination of length of gross target volume for esophageal cancer radiotherapy
		Hai Ping,Zhao Ren,Yang Xiaorong,Wang Yanyang,Pan Wenyan,Bai Jialin,Bai Zhoulan,Lu Haiyang
		Objective Compared with chest CT, endoscopic ultrasonography (EUS) can more accurately determine the upper and lower margins of esophageal cancer, and marking the upper and lower margins of the esophageal cancer with titanium clip contributes to the delineation of target area of esophageal cancer during radiotherapy. To compare the effects of esophageal X-ray, chest computed tomography (CT) scan and EUS-assisted placement of marker clip in the determination of the length of gross target volume (GTV), aiming to provide reference for the determination of GTV during esophageal cancer radiotherapy. Methods Thirty patients who were initially diagnosed with thoracic esophageal cancer by histological and cytological examinations and scheduled to receive radiotherapy were recruited in this investigation. All patients received esophageal X-ray, CT scan, and EUS-assisted placement of marker clip. The length of GTV was quantitatively measured and statistically compared among three different Methods. Results The length of GTV was (6.1±1.4) cm,(6.8±1.9) cm and (6.3±1.9) cm determined by esophageal X-ray,CT scan and EUS-assisted placement of marker clip,respectively. Compared with CT scan,the length of GTV determined by EUS-assisted placement of marker clip did not significantly differ (P=0.11).The length of GTV determined by esophageal X-ray was significantly shorter than that by CT scan (P=0.03). Among all patients, the length of GTV determined by EUS-assisted placement of marker clip was longer compared with that by chest CT scan in 22.2% of patients. The length of GTV determined by EUS-assisted placement of marker clip was the same as that by chest CT scan in 11.1% of patients. The length of GTV determined by EUS-assisted placement of marker clip was shorter compared with that by chest CT scan in 66.7% of patients. Conclusions EUS-assisted placement of marker clip differs from esophageal X-ray and CT scan in determining the length of GTV,which acts as one of the effective Methods in the determination of the length of GTV during esophageal cancer radiotherapy.
		2018 Vol. 27 (4): 370-373 [Abstract] ( 801 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	374	Follow-up observation of rectal cancer patients with clinical complete response receiving non-operative and standard operative management after neo-adjuvant chemoradiotherapy
		Zhang Shu,Wei Jiawang,Xiao Weiwei,Wang Qiaoxuan,Chang Hui,Zeng Zhifan,Ding Peirong,Chen Gong,Pan Zhizhong,Gao Yuanhong
		Objective To investigate the feasibility of non-operative management (NOM) by comparing the therapeutic effects between NOM and total mesorectal excision (TME) for rectal cancer patients with clinical complete response (cCR) after neo-adjuvant chemoradiotherapy. Methods A total of 135 patients with stage Ⅱ/Ⅲ rectal cancer who obtained cCR after neo-adjuvant chemoradiotherapy in Sun Yat-sen University Cancer Center from 2006 to 2016 were recruited and assigned into the NOM (n=43) and standard operative management (SOM) groups (n=92). The local recurrence rate,accumulative local control (LC) rate after salvage therapy,disease-free survival (DFS),overall survival (OS) and sphincter preservation rate were statistically compared between two groups. Kaplan-Meier analysis and log-rank test were utilized to calculate the LC, OS and DFS.Chi-square test was performed to calculate the sphincter preservation rate. Results The mean follow-up duration was 39 months (range:10-127 months).Of 135 patients, the local recurrence rate and distant metastasis rate were 3.7% and 11.1%,and the 3-year DFS and OS were 90.5% and 97.0%.In the NOM and SOM groups, the 3-year DFS were 87% and 93%, and the 5-year DFS were 73% and 87%(P=0.089).The 3-year OS were 98% and 99%, and the 5-year OS were 98% and 97%(P=0.578).In the NOM group, the local recurrence rate was 12%(n=5),80% of patients received salvage treatment and the accumulative LC rate was calculated as 98%.In the SOM group, the local recurrence rate was 0, which was significantly lower than that in the NOM group (P=0.010).In the NOM group, the sphincter preservation rate was 93%, significantly higher compared with 70% in the SOM group (P=0.030). Conclusions It is feasible for rectal cancer patients with cCR to receive NOM following neo-adjuvant chemoradiotherapy. Partial locally recurrent patients can be healed by timely salvage therapy,thereby averting TME and relevant complications and enhancing the quality of life of rectal cancer patients.
		2018 Vol. 27 (4): 374-377 [Abstract] ( 727 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	378	Analysis of clinical treatment of 50 cases of vaginal intraepithelial neoplasia
		Zhong Wei,Na Renhua,Gulina·kuerban
		Objective To investigate the clinical features and treatment of vaginal intraepithelial neoplasia (VAIN). Methods Clinical data of 50 patients with VAIN, aged 33-76 years, were retrospectively analyzed. Among them, 16 patients were diagnosed with grade Ⅰ VAIN, 5 with grade Ⅱ VAIN and 29 with grade Ⅲ VAIN. Results A majority of VAIN patients presented with no clinical symptoms, whereas few cases were manifested with increased vaginal secretion. The lesions were located in the vaginal fornix or the upper 1/3 of the vagina in 82% of patients, and in the middle and lower 1/3 of the vagina in the remaining 18% cases. Patients with VAIN Ⅰ were observed during follow-up, VAIN Ⅱ patients were given with local administration of medication, and VAIN Ⅲ patients received three-dimensional high-dose rate after loading intracavitary radiotherapy. Human papilloma virus (HPV) infection was positively correlated with VAIN grade (P=0.028). Conclusions The VAIN grade is positively correlated with high-risk HPV infection. Afterloading intracavitary radiotherapy is an efficacious therapeutic approach for VAIN Ⅲ patients,which yields slight adverse events and high cure rate.
		2018 Vol. 27 (4): 378-381 [Abstract] ( 667 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics Biology Technique

	382	Comparative analysis ofapplication value and setup error between two setup methods in proton and carbon ion therapy for prostate cancer
		Song Huaguo,Bu Ruirui,Li Yongqiang,Ren Wei,Fu Shen
		Objective To compare the application values and setup errors between vacuum bag plus body mask and customized alpha cradle duringproton and carbon therapy using Siemens 6D robotic couch in prostate cancer patients. Methods Nineteen patients received vacuum bag plus body mask setup were allocated into the vacuum bag group and19 patients with alpha cradle were assigned into the alpha cradle group. Orthogonal X-ray portals were performed to verify the treatment position before beam delivery in every fraction. The couch correction between the portal and reference DRR through manual image registration was recorded as setup errors in 6 directions including the lateral, supine-inferior, anterior-posterior, yaws, roll and pitch,respectively. Two-tail t-test was used to analyze the setup error data from each direction between two groups. Results In total, 452 and 436 sets of data errors were collected from the vacuum bag and alpha cradle groups. The average setup errors and standard deviation in the vacuum bag and alpha cradle groups in the lateral, supine-inferior, anterior-posterior, yaws, roll and pitch directions were (0.63±0.48) cm vs. (0.33±0.24) cm (P=0.000),(0.40±0.3) cm vs. (0.31±0.25) cm (P=0.000),(0.69±0.61) cm vs. (0.82±0.69) cm (P=0.006),0.65°±0.47°vs 0.32°±0.25°(P=0.000),1.05°±0.95°vs 1.16°±0.94°(P=0.100) and 0.67°±0.56°vs 0.40°±0.36°(P=0.000),respectively. The maximum setup errors were detected in the pitch direction for both groups. Conclusions During the proton and carbon therapy using Siemens 6D robotic couch, two setup Methods using vacuum bag plus body mask and customized alpha cradle should be selected according to the individual conditions of patients. A customized foot fixer should be utilized to reduce the uncertainty in the femoral head region.
		2018 Vol. 27 (4): 382-386 [Abstract] ( 794 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	387	Research on the precision and stability of optical surface imaging technology in guiding radiotherapy positioning
		Yang Lu,Zhong Renming,Li Guangjun,Shen Jiuling,Li Liqin,Bai Sen
		Objective To investigate the precision and stability of optical surface imaging (OSI) system Catalyst in guiding radiotherapy positioning. Methods A total of 52 patients with five different tumor sites who underwent cone-beam computed tomography (CBCT)-guided radiotherapy were recruited in this investigation. For the first treatment fraction,the setup error was recorded as C after online CBCT correction, and the surface images of patients taken by Catalyst were set as the reference images Cref. For the following treatment fraction,patients were pre-corrected according to the Catalyst Cref image with the acceptable errors within 2 mm/ 2,and the pre-corrected errors were recorded as C1.Then,after online CBCT correction,the setup errors were recorded as C.The errors between post-corrected Catalyst surface image and Cref image were recorded as C2.For each treatment fraction,the difference between Catalyst correction errors C1 and CBCT corrected errors C was recorded as d1, and the difference between the post-corrected Catalyst errors C2 and Cref image was recorded as d2. d3=d1-d2.The values of d1 and d3 in the 6 dimensions were analyzed using single sample t-test. The correlation between C-C1 and d1-d2 was statistically analyzed by Pearson correlation analysis. Results The mean value of d1 and d3 for 52 patients were within 2 mm/ 2 °. CBCT-C1 and d1-d2 were both significantly correlated (R=3,7,P=0.00,0.01). Conclusions OSI system yield high accuracy and stability in radiotherapy positioning,which is of certain significance in radiotherapy positioning for cancer patients.
		2018 Vol. 27 (4): 387-391 [Abstract] ( 728 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	392	Comparison of CTV-PTV setup margins during IMRT for cervical cancer patients with different body mass index by bladder volume measurement device-assisted CBCT
		Guan Shikuo,Xu Qing,Meng Yiran,Ke Guihao,Zhu Jun,Wu Xiaohua
		Objective To investigate the clinical target volume (CTV)-planned target volume (PTV) setup margins during intensity-modulated radiotherapy (IMRT) for cervical cancer patients with different body mass index (BMI), aiming to provide reference for precise individual therapy. Methods Forty patients diagnosed with cervical cancer undergoing IMRT in Cancer Hospital of Fudan University between March and September 2017 were recruited and assigned into the BMI≤18.4, 18.5-23.9, 24.0-27.9 and ≥28 kg/m² groups according to the BMI classification criteria proposed by National Health and Family Planning Commission (NHFPC) of the People′s Republic of China. Assisted with the bladder volume measurement device, 9 cycles of kilo-voltage cone beam computed tomography (CBCT) images were subject to online registration and imaging analysis. CTV-PTV setup margins were calculated based on the formula of MPTV= 2.5Σ+0.7σamong four groups. Single factor variance analysis was performed. LSD test was utilized for two-group comparison. Results Among four groups, the CTV-PTV setup margins in the x,y and z directions were (6.87 mm,6.06 mm,8.49 mm),(3.13 mm,3.02 mm,3.14 mm),(4.70 mm,4.86 mm,5.31 mm) and (7.63 mm,8.28 mm,8.54 mm),respectively (P=0.038,0.048 and 0.004). Conclusions The setup errors in the BMI≤18.4 and ≥28 kg/m² groups are significantly larger compared with those in the remaining groups Consequently, CTV-PTV setup margins should be enlarged to certain extent for patients with BMI≤18.4 and ≥28 kg/m².
		2018 Vol. 27 (4): 392-395 [Abstract] ( 816 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	396	Quantitative analysis of setup errors in lung SBRT with R624-SCF immobilization equipment
		Zhang Jun,Huang Xiaotian,Xie Conghua,Liu Hui,Bao Zhirong,Wang Dajiang,Chen Cheng,Zhou Yunfeng
		Objective KV-CBCT was utilized to evaluate the setup errors in lung SBRT with R624-SCF immobilization equipment,quantitatively analyze the percentage of all types of errors in the cumulative errors and unravel the main sources of setup errors. Methods The CBCT data weekly and QA data monthly from 32 patients diagnosed with lung neoplasms were collected to quantitatively analyze the setup errors. The cumulative errors were calculated by statistical model. The proportion and source of each type of setup error was analyzed. Results All 32 patients received a total of 420 times of CBCT.The setup errors of immobilization equipment in the lateral,supine-inferior,anterior-posterior directions were (0.03±0.72) mm,(0.73±1.16) mm and (-0.21±0.95) mm,respectively. The errors of tumor motion in three directions were (0.71±2.61) mm,(-0.80±2.60) mm and (0.075±1.77) mm,respectively. According to the calculation formula proposed by Vance Keeling,the proportion of the cumulative error was 54.55%,9.21% for immobilization equipment,12.97% for tumor motion,2.55% for couch sagging,5.70% for Gantry radiation isocenter,4.73% for Collimator radiation isocenter,4.61% for couch radiation isocenter and 5.70% for X-ray field isocenter,respectively. Conclusions The main factors of setup errors during SBRT treatment for lung cancer are setup random,tumor motion,immobilization equipment,couch sagging and machine isocenter. During radiotherapy,targeted control of tumor motion is of significance for minimizing the cumulative errors.
		2018 Vol. 27 (4): 396-400 [Abstract] ( 777 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	401	Comparison of dosimetric characteristics between flattening-filter-free and flattening filter mode VMAT plans in nasopharyngeal carcinoma
		He Xiantao,Tan Junwen,Long Yusong,Wei Ting,Wang Zhanyu,Chen Shaojun
		Objective To compare the dosimetric characteristics of the VMAT plans between the flattening-filter-free (FFF) and flattening filter (FF) modes for nasopharyngeal carcinoma and analyze the feasibility of VMAT plans in the FFF model applied in clinical practice. Methods Ten patients diagnosed with stage Ⅱ nasopharyngeal carcinoma between 2016 and 2017 were recruited in this investigation. For the CT image and clinical target volume (CTV) of the identical patient, FFF-and FF-mode VMAT plans were established with the identical prescription dose of 6975 cGy and the identical modified parameters on the RayStation platform (6 MV X-ray). The dosimetric characteristics, the number of machine hops and the time of beam were recorded and statistically compared between the FFF and FF modes. Results The minimum dose D98% target,target coverage, conformal index (CI) did not significantly differ between the FF and FFF plans (P=0.262-0.975),whereas the maximum dose of D2%,the average dose of Dmean and target homogeneity index (HI) of the FF plans were slightly advantageous to those of the FFF plan (P=0.004-0.038).The acceptable dose of bilateral lenses,the volume of the left parotid gland with an acceptable dose of> 30 Gy and the average dose of the left temporal lobe in the FFF mode were declined compared with those in the FF mode (P=0.002-0.025).The volume of normal tissues (Body) within the dose range of 2-30 Gy in the FFF mode was less than that in the FF mode (P=0.000-0.003).In the FFF mode, the mean number of machine hops was 1.188 times (P=0.000) and the average time of beam was 91.2% of the FF plan (P=0.024). Conclusions Both the FF and FFF plans qualify the dosimetric requirements in clinical settings. FF plan is advantageous in terms of the dose distribution in the target area,whereas FFF plan yields better OAR protection and low-dose irradiation. In spite of the increasing quantity of machine hops, the time of beam is declined in the FFF plan. Consequently, FFF mode probably contributes to enhance the clinical efficacy.
		2018 Vol. 27 (4): 401-405 [Abstract] ( 917 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	406	Mechanism of endoplasmic reticulum stress pathway inhibitor salubrinal enhancing the apoptosis of head and neck squamous carcinoma cells
		Sun Chaonan,Qiao qiao,Li Guang
		Objective To explore the mechanism underlying the effect of endoplasmic reticulum stress pathway inhibitor Salubrinal on enhancing the apoptosis of head and neck squamous carcinoma cells. Methods Three types of head and neck squamous carcinoma cell lines (KB,Fadu,Detroit562) were divided into the control,Salburinal (sal), irradiation (IR) and sal combined with IR (IR+sal) groups. The expression levels of p-ATM/ATM,DNA-PK and cleaved Caspase-3 were quantitatively measured. The cell apoptosis rate was detected among four groups. The effect of Salburinal on cell viability was evaluated by MTT assay. Results Compared with the IR group, the expression level of p-ATM/ATM (t=3.5,8.43 and 9.42,all P<0.05) was significantly up-regulated, whereas that of DNA-PK (t=9.19,17.44,16.67,all P<0.05) was considerably down-regulated in the IR+sal group. The expression level of cleaved Caspase-3 in the IR+sal group was significantly higher compared with those in the other three groups (t=6.79,9.76 and 9.78,all P<0.05).Compared with the IR group, the cell apoptosis rate was significantly enhanced in the IR+sal group (t=5.67,6.95 and 7.28,all P<0.05).Salubrinal exerted an effect upon the apoptosis of three cell lines in a concentration-and time-dependent manner. Conclusions As an endoplasmic reticulum stress pathway inhibitor, Salubrinal can enhance the apoptosis rate of head and neck squamous carcinoma cells. The underlying mechanism is probably correlated with irradiation-induced DNA double strand injury, suppressing the repairing of DNA damage and thereby increasing the apoptosis of tumor cells.
		2018 Vol. 27 (4): 406-409 [Abstract] ( 562 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	410	Impact of immobilization base plates composed of various materials on the imaging quality of MR simulation during radiotherapy
		Hu Qiaoqiao,Liu Zhuolun,Zhang Jian,Li Sha,Yue Haizhen,Wang Meijiao,Li Tian,Jin Sunjun,Zhang Yibao
		Objective To compare the impact of immobilization base plates composed of 7 types of materials on the MR-simulation imaging quality used for radiotherapy, aiming to provide reference data for clinical applications. Methods Using identical T1 and T2 sequences of Siemens MR-simulator, the MR images of ACR Large Phantom were acquired on the Orfit carbon fiber laminate,polycarbonate (PC),high precision base plate (HP),Jinan Huayuxin BR,WR,KP and SP materials, respectively. The imaging quality without any plate was used as the baseline data. The following metrics were compared:1.High-contrast spatial resolution:the sharpness of 3 pairs of hole arrays was observed, which represented resolutions of 1.1 mm,1.0 mm and 0.9 mm on the LR and AP directions;2.Image intensity uniformity in terms of percent integral uniformity (PIU):PIU=100×[1-((high-low)/(high+low)];3. Low-contrast resolution:distinguishable spokes representing resolutions of 5.1%, 3.6%, 2.5% and 1.4% were recorded. According to ACR recommendations, high-contrast resolution of 1.0 mm, PIU of T1WI and T2>82%and low-contrast spoke difference<3 were considered as clinically acceptable. Results High-contrast T1WI and T2WI resolutions of no plate, PC plate, HP plate and KP material were all 0.9 mm, and those of the remaining materials were worse than 0.9 mm. The T1WI and T2WI PIU of no plate was>87%, and the PIU of carbon fiber plate was reduced by> 25%. The PIU decrease of remaining materials was within ±4%. Except the carbon fiber plate, the low-contrast spokes of the remaining materials were within ±3 compared with the reference. Conclusions In clinical settings, carbon fiber plate exerts the most significant effect upon the MR-simulation imaging quality, which is unsuitable for MR simulation. Imaging quality of PC and HP plates are consistent with that of no plate. BR and KP materials exert slight effect upon MR signal. The remaining materials are of potential values for the manufacture of immobilization devices and accessories.
		2018 Vol. 27 (4): 410-415 [Abstract] ( 718 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Revies Articles

	416	Research progress on postoperative radiotherapy for T3N0-1M0 non-small cell lung cancer with chest wall invasion
		Muyasha·Abulimiti, Jun Liang
		Currently,lung cancer is the most common malignant tumor in the world. The local control (LC) rate is only 20%-40% for patients with local advanced non-small cell lung cancer (NSCLC).Hence,reducing the LC rate and enhancing the overall survival (OS) are pivotal research objectives. However,postoperative adjuvant treatment for patients with early NSCLC with chest wall invasion is still controversial. In this article,the research progress on T3N0-1M0 NSCLC with chest wall invasion was reviewed from the perspectives including anatomical features,types of resection,patterns of failure and postoperative radiotherapy,etc.
		2018 Vol. 27 (4): 416-419 [Abstract] ( 820 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	420	Research progress on biomarkers in predicting radiosensitivity of non-small cell lung cancer
		Zhu Lucheng,Xu Yasi,Xia Bing,Deng Qinghua,Zhang Shirong,Chen Sumei,Ma Shenglin
		Radiotherapy is a critical approach for the comprehensive treatment of non-small cell lung cancer. Deep understanding of the individualized radiosensitivity of lung cancer patients plays a pivotal role in the selection of radiotherapy dosage and regime and establishment of comprehensive therapeutic strategies. Currently, multiple researchers have identified a variety of biomarkers in predicting the radiosensitivity of lung cancer patients. In this article, research progress on the biomarkers in predicting radiosensitivity of non-small cell lung cancer was reviewed.
		2018 Vol. 27 (4): 420-424 [Abstract] ( 927 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	425	Research status and progress on exosomes in the diagnosis and treatment of malignant glioma
		Tang Shaohua,Yin Jun,Wang Weidong,Lang Jinyi
		In recent years, exosomes has gradually captivated widespread attention. It plays a crucial role in the proliferation, differentiation and metastasis of malignant tumors. As nanosized vesicles,exosomes can penetrate through the blood-brain barrier. Thus,exosomes may be a novel tool for the diagnosis and treatment of malignant glioma. In this paper, 57 relevant literatures were reviewed to summarize the research status and progress on the role of exosomes in the incidence, progression, liquid biopsy, prognosis evaluation and clinical therapy of malignant glioma.
		2018 Vol. 27 (4): 425-429 [Abstract] ( 854 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	430	Research progress on exosomes in radiotherapy for malignant tumors
		Li Guangxin,Cao Bangwei
		Exosomes are cell-derived vesicles and have biological activity. The diameter of exosomes is between 30 and 120 nm. Exosomes participate in the invasion,metastasis and multi-drug resistance of malignant tumors. In the field of radiotherapy,it has been proven that radiation-induced changes in the secretion of exosomes from tumor cells can affect intercellular communication and enhance the radiotherapy resistance of tumor cells. In this article,the research progress on exosomes in the radiotherapy for malignant tumors was reviewed.
		2018 Vol. 27 (4): 430-432 [Abstract] ( 756 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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