Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2019 Vol.28 Issue.1 Published 2019-01-15

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

Special Feature

	1	Radiotherapy of soft tissue sarcoma
		Liu Yueping, Li Yexiong
		Radiation therapy is one of the primary treatment of soft tissue sarcomas. Pre-or postoperative radiotherapy can reduce the risk of tumor local recurrence. Extended local resection combined with pre-or postoperative radiotherapy can achieve long-term survival comparable to those of amputation while preserve the limb function. With the progress of radiation technology in recent years,radiation induced damages of normal tissue is declined.
		2019 Vol. 28 (1): 1-4 [Abstract] ( 631 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	5	Survival benefit of radiotherapy for metastatic nasopharyngeal carcinoma:a retrospective analysis based on SEER database
		Li Xiangpan, Zhang Huibo, Yu Jianxiong, Song Qibin, Xiao Jianping
		Objective To analyze survival benefits of radiotherapy in patients with nasopharyngeal carcinoma (NPC) with distant metastases and analyze relevant prognostic factors. Methods Medical records of 329 patients newly diagnosed with metastatic NPC screened from the Surveillance, Epidemiology and End Results (SEER) database (199 of 329 patients received radiotherapy) between 2010 and 2015 were retrospectively analyzed. Overall survival (OS) and disease-specific survival (DSS) were calculated by Kaplan-Meier curve. The effect of different clinicopathological factors on the clinical prognosis of metastatic NPC patients was evaluated by logrank test and Cox regression analysis. Results The median follow-up time was 12 months. The 3-and 5-year OS rates were 27.4% and 19.7%. The median OS was 17.9 months. Univariate analysis demonstrated that patients aged< 50 years, male, undifferentiated type, stage T3 or T4, positive regional lymph node, brain and liver metastases and 1-2 metastatic sites obtained OS and DSS benefits at 3 years after radiotherapy. Univariate and multivariate Cox analyses after propensity score matching showed that radiotherapy was an independent prognostic factor for metastatic NPC (OS,P=0.004;DSS,P=0.014). Besides, patients aged 60-69 years (OS,P=0.033;DSS,P=0.045), keratinizing squamous cell carcinoma (OS,P<0.05;DSS,P<0.05), stage T4(OS,P=0.002;DSS,P=0.024),1-2 metastatic sites (OS,P=0.039;DSS,P=0.058),3-4 metastatic sites (OS,P=0.003;DSS,P=0.005) and no chemotherapy (OS,P=0.000;DSS,P=0.000) had poor OS and DSS, whereas sex, race and degree of differentiation exerted no effect on OS and DSS. Conclusions Radiotherapy can significantly improve the OS and DSS of patients with metastatic NPC. Prospective and randomized controlled studies are required to further explore the role of radiotherapy in the management of metastatic NPC.
		2019 Vol. 28 (1): 5-12 [Abstract] ( 601 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	13	The optimal timing of radiotherapy for refractory choroidal hemangioma and its relationship with the curative effect
		Li Ji, Wang Shengzi, Xu Gezhi
		Objective To investigate the relationship between the timing and the curative effect of radiotherapy in the treatment of refractory choroidal hemangioma. Methods Clinical data of 23 patients (23 eyes) who were diagnosed with refractory choroidal hemangioma from August 2005 to August 2016 and treated in our hospital were retrospectively analyzed. Routine fractional radiotherapy was performed. The total dose of routine radiotherapy was 24 Gy (3 Gy/8F) for 14 eyes,34 Gy (2 Gy/17F) for five eyes and 46 Gy (2 Gy/23F) for four eyes,respectively. Patients were divided into the low-and high-dose groups,early-and late-radiotherapy groups,and active-and expectant-treatment groups according to the total dose of radiotherapy,whether they received active-or expectant-treatment before radiotherapy,and whether the time interval between the incidence of initial symptoms and the time of receiving radiotherapy exceeded one year. The curative effect between two groups was statistically compared by Fisher's exact test. Results A total of 70%(16/23) of the affected eyes were cured at 6 months after radiotherapy. The effective rate in the diseased eyes receiving radiotherapy within 1 year after the onset of initial symptoms was significantly higher than that in those receiving radiotherapy over 1 year (P<0.05),whereas no statistical significance was observed in the effective rate between the low-and high-dose groups,and between the active-and expectant-treatment groups (both P>0.05). Conclusions Radiatherapy is a safe and effective treatment of refratory choroidal hemangioma. Early radiotherapy contributes to the recovery of visual acuity of the affected eyes.
		2019 Vol. 28 (1): 13-16 [Abstract] ( 449 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	17	Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis
		Li Shuai, Wang Shulian, Song Yongwen, Tang Yu, Jin Jing, Wang Weihu, Liu Yueping, Fang Hui, Ren Hua, Wang Jianyang, Jing Hao, Zhang Jianghu, Rong Qinglin, Qi Shunan, Chen Bo, Lu Ningning, Li Ning, Tang Yuan, Liu Xinfan, Yu Zihao, Li Yexiong
		Objective To investigate the clinical efficacy and prognostic factors of breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM) receiving neoadjuvant chemotherapy, surgery combined with radiotherapy at diagnosis. Methods Therapeutic outcomes of 65 breast cancer patients with ISLNM treated in our hospital between 1999 and 2013 were retrospectively analyzed. All patients were pathologically diagnosed with breast cancer. They were complicated with ISLNM, without distant metastasis confirmed by pathological or imaging examinations. All patients received multi-modality therapy consisting of neoadjuvant chemotherapy, surgery and postoperative radiotherapy. Kaplan-Meier method was adopted to calculate the overall survival (OS),progression-free survival (PFS) and supraclavicular lymph node recurrence (SCFR).The differences between two groups were statistically analyzed by the log-rank test. Results The median follow-up time was 66 months (range:6-137 months).Five patients had SCFR after corresponding treatment. The overall 5-year SCFR,OS and PFS rates were 9.2%,71.5% and 49.5%,respectively. Following preoperative chemotherapy, the complete response (CR) of supraclavicular lymph node was a prognostic factor affecting OS. The 5-year OS rates in patients with and without CR were 81.4% and 53.9%(P=0.035).The size of supraclavicular lymph node (≤1 cm vs. >1 cm at diagnosis was a risk factor of the SCFR (0% vs. 21.0%,P=0.037) and OS rates (≤1 cm vs. >1 cm:86.1% vs. 55.6%,P=0.001). Conclusions Breast cancer patients with ISLM at diagnosis can obtain high OS rate and excellent tumor control after undergoing multi-modality therapy consisting of preoperative chemotherapy,surgery and postoperative radiotherapy.
		2019 Vol. 28 (1): 17-22 [Abstract] ( 633 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	23	Study on the correlation between acute radionuclitidis and improved body mass index in intensity-modulated radiation therapy after cervical cancer surgery
		Chen Enle, Yang Wan, Gu Jiale, Zhang Ke, Deng Qinghua, Ma Shenglin, Li Xiadong
		Objective To investigate the relationship between the body mass index (BMI)/ body mass index improved (BMIIMPd) and the dose of the small intestine as well as the acute radiation colitis in the intensity-modulated radiation therapy after cervical cancer surgery. Methods Thirty-nine cervical cancer patients underwent postoperative adjuvant radiotherapy. All patients received Philips large bore CT scan for enhanced CT scan,target delineation and organ at risk. All patients were treated with a single arc 10 MV VMAT plan. The correlation between the radiation dose of the small intestine and the acute radiation enteritis and BMI/BMIIMPd was analyzed. Results The BMI was calculated as (22.23±2.80) kg/m²,BMIIMPd was (21.49±3.95) kg/m²,the small intestine volume VSI was (1 155.71 ± 419.33 )cc³. The volume of the small intestine received more than 10 Gy(V10_SI) VMAT was (66.50±27.01)%,and the equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) were (4098.87±184.93) cGy and (7.98±8.73)%. One way ANOVA demonstrated that under the VMAT technology,the BMIIMPd,V30,V40,EUD (α=50) and NTCP in the small intestine were the influencing factors of the occurrence of acute radiation enteritis. Conclusions If the improved BMIIMPd is utilized to distinguish the BMI,the high dose area of the small intestine will be larger and the incidence of acute radiation enteritis will be higher for patients with BMIIMPd between 10.1 and 16.9(normal and thin). Conventional BMI cannot be utilized as a basis for the prediction of the incidence of acute radiation enteritis in patients with cervical carcinoma.
		2019 Vol. 28 (1): 23-26 [Abstract] ( 486 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	27	Research of effect of cavity between bolus and skin on dose deposition in shallow tissues
		Kong Dong, Hui Lin, Wei Xianding, Kong Yan, Ding Yang, Kong Xudong, Qian Danqi, Jin Jianrong, Yang Bo
		Objective To evaluate the effect of the thickness and area of the cavity between bolus and skin upon the dose deposition in the shallow tissues. Methods The linear accelerator head model of 6 MV X ray was constructed using Geant4,which simulated the accelerator working condition of 10 cm×10 cm field and recorded the information of emergent particles as phase space file. A water phantom of 30 × 30 × 30 cm³ was designed at the SAD level. A 30 cm × 30 cm × 1 cm water film was constructed adjacent to or with different cavities to the upper surface of the phantom. The phase space file was utilized as particle source to simulate the particle transport process. The axis depth dose distribution and lateral dose profiles in the center area of the field at a depth of 1 mm,5 mm,9 mm,15 mm and 21 mm of the phantom were obtained,respectively. The simulated data obtained from water film with different cavities were compared with those of adjacent to the water phantom. Results When the cavity was ≤ 5 mm,the cavity exerted slight effect. When the thickness was increased,the maximum dose depth (Dmax) was increased,the PDD at Dmax(PDDmax) became less,the depth of influenced lateral dose profiles was increased and the dose in the center area was decreased. Along with the increase of cavity area,the Dmax was initially increased and then decreased,the PDDmax was at first decreased and subsequently increased,the depth of influenced lateral dose profile was initially increased and then decreased,the dose in the center area was first decreased and subsequently increased. The lateral dose profile distant from the cavity or located at a depth ≥15 mm was almost not affected by the cavity. Conclusion The thickness of the cavity between bolus and skin should be less than 5 mm and the cavity area should be small as possible.
		2019 Vol. 28 (1): 27-31 [Abstract] ( 702 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	32	Study of the optimal thresholds of gamma passing rate in VMAT plan verification for cervical cancer
		Liu Lidong, Yang Zhen, Zhong Meizuo, Zhao Yuqian, Lei Mingjun, Cao Ying, Yang Xiaoyu, Tang Du, Zhang Xiaoming, Li Chen
		Objective To investigate the optimal thresholds of the passing rate with different gamma measurement criteria (percent dose difference/DTA) based on the Delta 4 three-dimensional dosimetric verification system in the verification of volumetric modulated arc-therapy (VMAT) plan for cervical cancer. Methods Thirty clinically-approved dual-arc VMAT plans using the RapidArcTM (Varian Medical Systems Inc.) for cervical cancer were randomly selected. The gamma analysis and dose-volume histogram (DVH) evaluation were performed using Delta 4. All the plans were classified according to the following two criteria:1. If the absolute percentage dose errors of all specific dosimetry indices on the DVH were less than 5%,the plan was regarded as clinically acceptable. 2. If the gamma passing rate was 90% or 95% under the criteria of 2%/2 mm and 3%/3 mm,the plan was regarded as acceptable. The sensitivity and specificity analyses were conducted based on the classification results and the receiver operating characteristic (ROC) curve was plotted. By calculating the Youden Index,the optimal thresholds under different Gamma criteria (global and local 2%/2 mm and 3%/3 mm) were investigated. Finally,the ability of distinguishing the plan was clinically acceptable or not between the conventional and optimal thresholds was quantitatively compared according to the sensitivity and specificity analyses. Results The optimal thresholds under the global 3%/3 mm and 2%/2 mm criteria were 98.3% and 87.05%;and 97.55%、86.05% for the local gamma analysis. Compared with the conventional thresholds,the sensitivity of the optimal thresholds was 0.93 by using the global and local gamma analyses under the 3%/3 mm criterion. Under the 2%/2 mm criterion,the sensitivity of the optimal thresholds was 0.65 and the specificity was 0.49 by using the global gamma analysis. The sensitivity was 0.7 and the specificity was 0.46 by using the local gamma analysis,suggesting that the sensitivity and the specificity were more balanced under the 2%/2 mm criterion. Conclusions Application of the optimal thresholds in the verification of VMAT plans can maintain the balance between the sensitivity and specificity,prevent the harm of clinically unacceptable plans to patients to certain extent and reduce the probability of increasing the daily work load for physicists due to the misjudgement of clinically acceptable plans.
		2019 Vol. 28 (1): 32-36 [Abstract] ( 454 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	37	Effects of the setup errors on dose distribution of target area and organs at risk for prostate cancer
		Qin Shirui, Zhang Yin, Li Hongjv, Wang Qian, Chen Cheng, Fu Guishan
		Objective To evaluate the effect of setup errors upon the target area and the organs at risk (OAR) during radiotherapy for prostate cancer. Methods Twelve prostate cancer patients receiving treatment in the recent 1 year were randomly recruited in this study. The position of each patient was verified by using cone beam CT (CBCT) for 6-10 times during the treatment. In treatment planning system (TPS), the isocenter position was moved along the setup errors with averaging error value (Plan_A) and each CBCT value (Plan_F). The dose distribution was recalculated without changing the beam setting, weight factors and monitor units (MUs). The dose difference was statistically compared between the simulation and original plans (Plan_O). Results For clinical target volume (CTV) D95, there was a significant difference between Plan_A and Plan_O (P=0.008), whereas no significant difference was observed between Plan_F and Plan_O. There were significant differences between Plan_F and Plan_O, Plan_A and Plan_O (P=0.004, and 0.041) for the planned target volume (PTV) D95.For OAR, rectal V60, Dmax, left femoral V20, Dmax and right femoral Dmax significantly differed between Plan_F and Plan_O (P=0.026,0.015,0.041,0.049,0.003).However, only left femoral Dmax significantly differed between Plan_A and Plan_O (P=0.045). The movement in the superior-inferior (SI) direction was significantly correlated with the changes in the rectal V40,V50 and V60 and PTV D95(r=-0.785,-0.887,-0.833,0.682).The movement in the anterior-posterior (AP) direction was significantly associated with the variations in the bladder V20,V30,V40,V50 and V60(r=-0.945,-0.823,-0.853,-0.818,-0.774).The evaluation indexes of all normal tissues in the re-plan could meet the clinical requirements. However, the volume of target prescription volume had different levels of deficit, and the deficit of Plan_F was greater than that of Plan_A. Conclusions The simulation results of averaging into the TPS underestimates the effect of daily setup errors on the dose distribution. The effect of setup errors on the dose distribution in target area is greater than that of normal tissues. Y-direction errors are more likely to cause the variations of the rectal and PTV dose, and the errors in the z-direction are inclined to cause the changes in the bladder dose.
		2019 Vol. 28 (1): 37-40 [Abstract] ( 751 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	41	Characteristics and clinical application of the TomoDose diode array for quality control of Tomotherapy
		Xiao Bin, Yue Qi, Zhang Li, Duan Jimei, Wang Zhiwei, Yang Xiumei, Gu Dan, Xie Lisiqi, Zhang Yong
		Objective To evaluate the dosimetric characteristics of the TomoDose diode and its application in detecting the couch velocity and assessing the beam Profile stability for convenient and efficient quality control of Tomotherapy. Methods Fundamental properties of the TomoDose detector,such as dose linearity,dose per pulse dependence,directional dependence and field size dependence were tested by the water-equivalent phantom and the results were statistically compared with those measured by the ion-chamber (0.057 cm³,A1SL).Five different couch velocities with a time interval of 0.0005 s were designed to test the sensitivity of TomoDose for detecting the couch velocity,and then the clinical data of 7 patients with different couch velocities were selected to verify the test accuracy. The beam profile of three different jaws of 1.0,2.5 and 5.0 cm were measured using TomoDose with water-equivalent phantom in the x and y directions under the same conditions as water tank with an underwater depth of 15,50,100,150 and 200 mm,respectively. The Profile data obtained by water tank and TomoDose were evaluated using the Gamma (γ) evaluation method with the 2%/1 mm criterion. Results The dose linearity of the TomoDose and ion chamber was in a linear pattern within the beam-on-time≤30 s. The difference between the TomoDose and ion chamber was less than 2% for the dose per pulse dependence,and the response trends of them were consistent. TomoDose showed angular response dependence with a maximum difference of 2.53% for the gantry angle of ±60°.For the field size dependence,the response difference between the TomoDose and ion chamber was increased with the decreasing field size when the Jaw was 5.0 cm,and the maximum deviation was 0.78% when the field size was 5.0 cm×2.5 cm. TomoDose could detect the couch distance error of 0.5 mm,and determine the couch velocity deviation of< 0.6%.For the Profile stability testing:In the x direction,there was always γ<1 at the underwater depth of 15 mm for all values of Jaw;when the underwater depth was not 15 mm,there was always γ<1 in the main beam region (off-axis distance< 200 mm),whereas in the penumbra region (off-axis distance> 200 mm),the value of γ was larger and even with γ>1.In the y direction,all comparison results of Profile under three field width demonstrated that γ index was larger on the edge of beam,whereas γ<1 was found in all cases. Conclusions TomoDose is suitable f or the quality control of Tomotherapy,which can accurately measure the couch velocity,precisely monitor the stability of beam Profile of Tomotherapy and complete the quality control process in a convenient and efficient manner.
		2019 Vol. 28 (1): 41-46 [Abstract] ( 583 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	47	Monte Carlo simulation of whole body dose distribution in patients with total body X (γ) ray irradiation
		Liu Yuanyuan, Wu Aidong, Liu Hongdong, Qi Yaping, Chen Zhi, Xu Xie
		Objective To explore the feasibility of application of the Monte Carlo method to simulate the whole body dose distribution in patients with total body X (γ) ray irradiation by comparing the actual measurement results. Methods A Monte Carlo model of a 6 MV Elekta Synergy Clinical linear accelerator was established by MCNPX. According to the relationship between the CT value and the density of the material, the CT of the ATOM physical phantom was converted into a voxel phantom for MCNPX calculation. The dose distribution of the whole body was simulated in the total body X (γ) ray irradiation. The simulated results were compared with the measurement values of the thermoluminescence dosimetry at different positions in the ATOM physical phantom to analyze the differences. Results The difference between the depth dose curve and the off-axis dose curve and the actual measurement values calculated by the 6 MV accelerator treatment head model in the water tank was less than 2%,with the maximum dose depth of approximately 1.5 cm and field size of 10 cm×10 cm, which were consistent with the actual measurement values. The maximum difference between the simulated results at different locations in the body and the thermoluminescence dosimeter was approximately 4%, and the simulated results of MCNPX were almost in good agreement with the results of thermoluminescence. Conclusions The whole body dose distribution in patient with total body X (γ) ray irradiation can be accurately simulated by MCNPX. Monte Carlo simulation makes it possible to optimize the uniformity of the total body dose during the total body irradiation process.
		2019 Vol. 28 (1): 47-51 [Abstract] ( 698 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	52	A method of describing the characteristics of flattening filter-free photon beam
		Fu Guishan, Wang qian, Chen Jiayun, Zhang Ke, Yan Lingling, Dai Jianrong
		Objective To establish a novel method of describing the off-axis ratio (OAR) characteristics of the flattening filter-free (FFF) beam. Methods The OAR curves at a depth of 1.5,5,10 and 20 cm were measured for Varian Edge,Elekta VersaHD and Tomotherapy using the water tank. The second derivatives of the OAR in the positive and negative directions were calculated. The center of the line connecting the maximum and minimum second derivatives was defined as the field edge. The distance between the left and right field edges was defined as the dosimetric field size. The OAR curve within the 80% of dosimetric field size was fitted using the gaussian function and the fitting parameters were adopted to describe the shape of OAR. Results The calculated field size error was less than 0.11 cm and the central axis position error was less than 0.05 cm. The fitting correlation coefficient was greater than 0.998.The fitting maximum error of OAR curve did not significantly alter with the depth, whereas slightly increased over the increased field size. The maximum error for a field size of 10,20,30 and 40 cm was 0.49%,0.67%,1.25% and 2.52%,respectively. Conclusions A method which can independently and accurately describe the OAR characteristics of FFF photon beam is established for the first time,which can calculate the field size of FFF beam and fit the OAR curve of FFF beam using the gaussian function.
		2019 Vol. 28 (1): 52-56 [Abstract] ( 457 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	57	he dosimetric and delivery efficiency between Halcyon-and Trilogy-based IMRT plans
		Li Chengqiang, Chen Jinhu, Li Zhenjiang, Lu Jie, Tao Cheng, Zhu Jian, Yin Yong
		Objective To compare the dosimetric and delivery efficiency between intensity-modulated radiation therapy (IMRT) plans based on Halcyon and Trilogy accelerator. Methods Clinical data of 12 patients with cervical cancer receiving Trilogy platform-based IMRT were retrospectively analyzed. The target area and organ at risk were introduced into the Eclipse version 15.1 TPS. The Halcyon-based IMRT was re-designed. The dose coverage of target area and organs at risk, monitor unit (MU) efficiency, delivery time and segment area and the differences between the proximal and distal segment area were statistically compared between two IMRT plans. Results The Halcyon treatment platform could meet the clinical objectives. Dose distribution of the target area was similar to that of the Trilogy plan (P>0.05). The volumes in the bladder and rectum receiving 30 Gy and the volumes in the left femoral head receiving 20 Gy of Halcyon plan and the mean dose (Dmean) of bladder, rectum and left femoral head were significantly lower compared with those of the Trilogy plan (P=0.001-0.043).The MUs of the Halcyon plan was 2 316.7±209.7, significantly higher than 1 692.5±259.5 of the Trilogy plan (P=0.000). The delivery time significantly differed between the Halcyon[(3.01±0.28) min] and Trilogy[(12.38±1.49) min](P=0.000).The average segment area of Halcyon plan for proximal and distal MLC was (43.7±32.5) cm² and (28.8±25.4) cm², the average segment area of Trilogy plan was (25.7±16.8) cm², the ratio of the proximal and distal segment area was 1.73±0.43, ranging from 0.71 to 6.28. Conclusions Halcyon treatment platform can meet the clinical requirements and reduce the dosage coverage of normal tissues with better delivery efficiency. The ratio of proximal and distal segment areas should be considered during the plan design.
		2019 Vol. 28 (1): 57-60 [Abstract] ( 569 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	61	Research progress in radiotherapy for brain metastases of non-small cell lung cancer
		Lv Jincai, Liu Bailong, Quan Xiaoyue, Liu Min, Dong Lihua
		Since the first application of whole brain radiation therapy (WBRT) to brain metastases in 1950 s,it has been regarded as a standard treatment for brain metastases of non-small cell lung cancer (NSCLC).Recently, more accurate radiotherapy technique and more effective systemic therapy have been developed. Especially, the molecular targeted drugs are upgraded rapidly with stronger targeting capability and better permeability of the central nervous system. With the prolonged survival of patients, long-term damage to the nervous system induced by WBRT causes widespread concerns. This article will review the related controversies and research progress in the application of WBRT to NSCLC with brain metastases in modern integrated therapy.
		2019 Vol. 28 (1): 61-64 [Abstract] ( 602 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	65	Research progress on radioresistance and sensitization of tumor cells in three-dimensional culture system
		Gao Jianong, Liang Shanshan, Yu Weiting, Wang Ruoyu
		Three-dimensional cell culture is a novel type of in vitro culture method. This system can mimic the microenvironment of cell growth in vivo, where cells exhibit similar state and function to that in the in vivo environment. Currently, three-dimensional culture system has been widely applied in tissue engineering and tumor cell biology fields, etc. Radiotherapy is an important treatment of cancer. Radioresistance of tumor cells is the main cause of treatment failure, tumor recurrence and metastasis. Tumor cells can exhibit the resistant characteristics in the three-dimensional culture system, similar to those of tumor cells in vivo. Therefore, three-dimensional culture system can be adopted to investigate the radioresistance and underlying mechanism of tumor cells and identify the key factors regulating the radioresistance of tumor cells, which plays a pivotal role in enhancing the radioresistance and improving the effect of radiotherapy. This article will review recent research progress in the radioresistance and sensitization of tumor cells under three-dimensional culture system, aiming to provide reference for relevant investigations.
		2019 Vol. 28 (1): 65-68 [Abstract] ( 437 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	69	Research progress of vaginal radioactivity injury
		Zhang Kaishuo, Liu Zi, Wang Tao, Su Jin, Shi Fan, Wang Juan
		Radiotherapy is an important treatment of cervical cancer,the treatment of locally advanced cervical cancer mainly depends on external beam radiotherapy and brachytherapy. However,in the process of the cervical cancer radiotherapy,the vagina has an ambivalent role in the treatment of cervical cancer,being as well a target organ (upper vagina) as an organ at risk. Vaginal radiation-induced injury will appear when it received high doses of radiation. And sexual dysfunction caused by radiation-induced injury has become an important problem cervical cancer survivor. In this article,recent vaginal dose and vaginal radiation injury-related studies have been summarized to unravel the pathophysiological changes,clinical symptoms,clinical diagnosis and treatment of vaginal radiation-induced injury.
		2019 Vol. 28 (1): 69-73 [Abstract] ( 538 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	74	Interpretation of ICRU report No.89— radiation physics
		Zhao Hongfu, Han Dongmei, Cheng Guanghui, Tang Yuhuan
		In this article, the content of radiation physics in the ICRU report No.89 were interpreted in details, aiming to provide reference in the radiation physics for radiologists performing brachytherapy for cervical cancer patients.
		2019 Vol. 28 (1): 74-77 [Abstract] ( 492 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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