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.38 Issue.3 Published 2019-03-20

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

Special Feature

	161	Research progress of radiation-induced heart injury—clinical
		Wang Jun,Wu Yajing
		At present,the heart has become an important organ at risk during radiotherapy for thoracic,mediastinal and breast carcinoma. Heart is relatively sensitive to radiation because of its anatomical location and structure. Long-term survival of patients have been affected by cardiac adverse effect post-radiotherapy. In this paper,the progress of clinical manifestations,risk factors,screening methods,prevention and treatment of radiation-induced cardiac damage were reviewed as follows.
		2019 Vol. 38 (3): 161-167 [Abstract] ( 799 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	168	Preliminary Observation of Carbon Ion Radiotherapy for Tracheal Adenoid Cystic Carcinoma
		Chen Jian,Mao Jingfang,Ma Ningyi,Lu Jiade,Jiang Guoliang
		Objective To observe the short-term effect and toxicities after carbon ion radiotherapy (CIRT) for tracheal adenoid cystic carcinoma (TACC). Methods From March 2016 to October 2017,a total of 10 patients with TACC were treated using CIRT.Among them,three patients had recurrent disease (two after surgery,and one after brachytherapy),one received bronchoscopic cryosurgery for stage Ⅰ disease,and the other 9 had locally advanced disease (3/6 received endoscopic treatment before CIRT).All patients received CIRT using pencil-beam scanning technique. Except that the patient with recurrent disease after brachytherapy received 60 GyE/20 Fx,the patient received cryosurgery and one recurrent patient after surgery received 66 GyE/22 Fx,all other patients received 69 GyE/23 Fx. Results The median follow-up time was 5.5(1.5-16.4) months. Among the 9 patients with gross tumors,3 patients achieved complete response,2 achieved partial response,and 4 remained stable disease per RECIST 1.1 criteria. The post-cryosurgery patient remained no evidence of disease. Except 1 patient experienced grade 4 tracheal stenosis,no other grade ≥3 adverse effects were observed. Grade 2 acute toxicities included 1 hoarseness and 1 neutropenia,both relieved after CIRT.Hypothyroidism in one patient was the only observed grade 2 late toxicity. Conclusion CIRT is safe and effective in the management of TACC during a short-time observation.
		2019 Vol. 38 (3): 168-172 [Abstract] ( 753 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	173	Clinical efficacy and safety of hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma
		Long Bin,Zhou Guanghua,Yang Xinhui,Shi Xiaoyan,Long Jun
		Objective To evaluate the clinical efficacy and safety of the hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma. Methods Clinical data of 153 patients with recurrent nasopharyngeal carcinoma admitted to our hospital from 2008 to 2013 undergoing hypofractionated three-dimensional conformal radiotherapy (3 Gy for each time, 5 times a week, a total dose of 51-60 Gy, 17-20 times/4 weeks) were retrospectively analyzed. The short-and long-term radiation-induced injury, Karnofsky performance score (KPS), short-and long-term clinical efficacy were evaluated. Results For the short-term radiation-induced injury, the incidence of oral mucosa and fatigue significantly differed before and after treatment (both P<0.05). Regarding the long-term radiation-induced injury, the incidence of dry mouth (95.4%) and deafness (51.0%),difficulty in opening mouth (79.1%),maxillofacial fibrosis (33.3%) and radiation-induced encephalopathy (15.0%) significantly differed before and following treatment (all P<0.05). The actual long-term radiation-induced injury included dry mouth (91.5%), deafness (50.9%), difficulty in opening mouth (76.5%), maxillofacial fibrosis (32.0%) and radiation-induced encephalopathy (14.4%). The number of patients with changes in the KPS scores significantly differed between the end of treatment and 3 months after treatment (P<0.05). The local control rates were 29.4%, 68.6%, 79.1%, 83.7% and 86.9% at 1-, 3-, 6-, 9-and 12-month after corresponding treatment, respectively. The local control rate significantly differed between 1 and 3 months, and between 3 and 6 months after treatment (both P<0.05). The 1-, 2-, 3-, 4-and 5-year survival rates were calculated as 96.1%,80.4%,68.5%,57.9% and 51.1%,respectively. Conclusions Hypofractionated three-dimensional conformal radiotherapy is an efficacious and safe treatment of recurrent nasopharyngeal nasopharyngeal carcinoma, which yields relatively high short-and long-term clinical efficacy, high local control rate and well tolerance by the patients.
		2019 Vol. 38 (3): 173-179 [Abstract] ( 811 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	180	Analysis of optimal dose of thoracic radiotherapy for patients with extensive stage small cell lung cancer
		Kunpeng Xu,Li Ming Xu,Jing Luo,Xin Wang,Jian Sun,Wencheng Zhang,Lujun Zhao,Ping Wang
		Objective To investigate the optimal dosage of thoracic radiotherapy in patients diagnosed with extensive stage small cell lung cancer (ES-SCLC). Methods Clinical data of ES-SCLC patients admitted to Tianjian Medical University Cancer Institute& Hospital between February 2010 and October 2015 were retrospectively analyzed. All patients received the first-line induction chemotherapy. Subsequently, 216 patients without progression after the first-line induction chemotherapy were apportioned to the thoracic radiotherapy (n=180) group and chemotherapy alone group (n=36).According to the distribution characteristics of the biological equivalent dose, all patients were assigned into the A (31.3-40.2 Gy, n=23), B (46.0-46.8 Gy, n=38), C (49.5-53.7 Gy, n=43) and D groups (55.1-60.6 Gy, n=76).For the subgroup analysis, the low (31.3-46.8 Gy, n=61) and high dose groups (49.5-60.6 Gy, n=119) were divided. Kaplan-Meier survival analysis was used for prognostic analysis. Cox’s regression model was conducted for multivariate prognostic analysis. Propensity score matching was utilized to control the confounding variables. Results The median overall survival of all patients was 13.2 months, and 8.3, 11.0, 15.8, 17.8 and 8.1 months for patients in the A, B, C, D and chemotherapy alone groups, respectively (all P=0.000).The median overall survival did not significantly differ between A and B/chemotherapy groups (P=0.172, P=0.495), and similar results were obtained between the C and D groups (P=0.624).The median overall survival in the B group was significantly longer than that in the chemotherapy alone group (P=0.020).Statistical significance was noted between C and D groups, and A and B groups (all P<0.05).The median progression-free survival for all patients was 8.7 months, and 6.5, 7.6, 11.8, 12.4 and 6.1 months in the A, B, C, D and chemotherapy alone groups, respectively (all P=0.000).The median progression-free survival did not significantly differ between A and B chemotherapy groups (P=0.588, P=0.668).The progression-free survival in the B group was slightly longer than that in the chemotherapy group without statistical significance (P=0.070).No statistical significance was observed between the C and D groups (P=0.627).Statistical significance was noted between C and D groups, and A and B groups (all P<0.02).Uni-and multi-variate analyses prompted that the number of metastatic lesions and dose of thoracic radiotherapy were the independent predictors of the overall survival and progression-free survival (both P<0.05).Concurrent chemoradiotherapy was the independent predictor of the overall survival (P=0.018).After the propensity score matching, the median overall survival and progression-free survival significantly differed between the low (n=50) and high dose groups (n=50)(10.9 vs. 17.5 months, P=0.045;7.4 vs. 10.7 months, P=0.014). Conclusions A relatively high dose ranging from 49.5 to 53.7 Gy is recommended during thoracic radiotherapy for ES-SCLC patients. An excessively low dose (≤40.2 Gy) probably fails to prolong the survival time, and an extremely high dose (≥55.1 Gy) cannot enable the patients to obtain survival benefits.
		2019 Vol. 38 (3): 180-184 [Abstract] ( 848 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	185	Preliminary clinical study of Nituzumab combined with neoadjuvant concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma
		Wu Xiaoyuan,Xing Wenqun,Li Xu,He Chunyu,Yang Yuanyuan,Jiang Qiong,Liu Jinsong,Ge Hong,Wang Jianhua
		Objective To determine the treatment outcome of nimotuzumab in combination with neoadjuvant concurrent chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC). Methods A total of 23 ESCC patients were enrolled. The preoperative strategies consisted of nimotuzumab (200 mg per week in week 1-5), concurrent chemotherapy by paclitaxel (45 mg/m² per week in week 2-5) and cisplatin (20 mg/m² per week in week 2-5) and radiotherapy by a total dose of 40 Gy (2. 0 Gy/d,5 days per week in week 2-5). Esophagectomy was performed 4 weeks after the completion of preoperative therapies. Results All of the 23 patients enrolled completed the planned combined therapy method, and 22 patients underwent final surgery. The clinical response rate of nimotuzumab in combination with preoperative chemoradiotherapy was 96%. The most frequent Grade 1/2 toxicities observed were gastrointestinal reaction, bone marrow suppression, and esophagitis. The rate of radical resection was 100%, and the pathological complete response rate was 41%.The incidence rate of postoperative pulmonary infection, anastomotic leak, hoarseness, and arrhythmia were 14%, 9%, 4%, and 4%, respectively. No perioperative deaths occurred in our study. The 1-, 3-, and 5-year overall survival (OS) rate for all the patients were 86%, 52% and 52%, respectively. The median survival time (MST) was 28.9 months. Postoperative pathologic results showed 15 patients with lymph node negative and 7 patients with lymph node positive. the 1-, 3-, and 5-year OS for pN0 group were 100%, 62% and 62%, versus 57%, 29% and 29% for pN+ group (P=0.033). The MST for pN0 group was 42.6 months versus 14.2 months for pN+ group. Conclusions The regimen of nimotuzumab in combination with preoperative concurrent chemoradiotherapy followed by surgery is safe and effective for locally advanced ESCC. Patients with lymph node negative after surgery have significantly improved long-term survival.
		2019 Vol. 38 (3): 185-187 [Abstract] ( 890 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	188	Prognostic significance of fibrinogen concentration combined with neutrophil-to-lymphocyte ratio in esophageal squamous cell carcinoma patients receiving neoadjuvant therapy
		Feng Zhuo,Luo Hui,Sun Yanan,Liu Xiao, Li Xue,Cui Yingying,Wang Chenyu,Zheng Xiaoli,Wang Hao,Ye Ke,Fan Chengcheng, Ge Hong
		Objective To evaluate the prognostic value of a novel prediction model based on fibrinogen concentration in combination with neutrophil-to-lymphocyte ratio (F-NLR score) in patients with esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant therapy and investigate their relationship with pathologic complete response (pCR). Methods Clinical data of 218 eligible ESCC patients treated with neoadjuvant therapy in the Affiliated Cancer Hospital of Zhengzhou University between 2012 and 2015 were retrospectively analyzed. The cut-off values for fibrinogen and neutrophil-to-lymphocyte ratio (NLR) were defined by the receiver operating characteristic (ROC) curve. The effects of different F-NLR scores on survival and pCR were evaluated. The survival rate was analyzed using the Kaplan-Meier method. The relationship among fibrinogen, NLR and pCR was analyzed by using Wilcoxon rank sum test. Results The 3-year overall survival (OS) rates with F-NLR scores of 0,1 and 2 were 72.1%,66.5% and 50.2%(P=0.010), respectively. The corresponding 3-year disease-free survival (DFS) rates were 64.1%, 60.2% and 45.4%(P=0.012), respectively. The clinical prognosis of patients with an F-NLR score of 2 was significantly worse compared with those of their counterparts with an F-NLR score of 0-1(P=0.003). Multivariate analysis demonstrated that the F-NLR score (P=0.004) and TNM stage (P=0.000) were the independent prognostic factors. Conclusions The F-NLR score can be used as an independent prognostic factor for ESCC patients treated with neoadjuvant therapy, which is promising supplement to current TNM staging system, thereby facilitating more accurate risk stratification analysis and achieving individualized multidisciplinary treatment for ESCC patients.
		2019 Vol. 38 (3): 188-192 [Abstract] ( 860 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	193	Clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy to the tumor center in the first course radiotherapy for bulky cervical cancer with massive bleeding
		Ma Jun,Song Wei,Huang Wei,Yu Dahai
		Objective To evaluate the clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) to the tumor center in the treatment of bulky cervical cancer with massive bleeding in the first course radiotherapy. Methods Twenty-one cases with bulky cervical cancer complicated with massive vaginal bleeding were enrolled. At the first three times of external irradiation, a high dose radiotherapy (15 Gy/3 fractions) was delivered to the tumor center (the region retracted 2 cm from the periphery of cervical mass), followed by conventional irradiation (2 Gy/fraction) in the posterior course. Conventional dose irradiation (46 Gy/23 fractions) was given to the tumor periphery and pelvic lymphatic drainage area throughout the whole course. Concurrent chemotherapy by cisplatin at a dose of 25 mg/m² was delivered weekly. After the external irradiation, intracavitary radiotherapy was given (20 Gy/4 fractions). Results Within 24 h after the first course radiotherapy, the volume of vaginal bleeding was significantly decreased by 50% and the bleeding was almost stopped within one week. The hemostasis rate was 100%. Conclusions SIB-IMRT into the center of bulky cervical cancer is an efficacious treatment of massive vaginal bleeding.
		2019 Vol. 38 (3): 193-197 [Abstract] ( 687 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	198	Clinical application of Catalyst system in cervical cancer radiotherapy
		Peng Haiyan, Luo Huanli, Mao Kaijin, He Yang, Wang Dengyan, Peng Lifeng, Zhu Yiyu, Wang Xuechun, Min Qinghong, Jin Fu, Wang Ying
		Objective To evaluate the clinical application of Catalyst system in positioning patients during cervical cancer radiotherapy, and to analyze its correlation with the bladder volume and body mass index (BMI) of patients. Methods A total of 33 patients diagnosed with cervical cancer from July to December 2017 in our hospital were included in the study. All patients were auxiliary positioned by an optical surface imaging system (C-Rad Catalyst) before each treatment. The CBCT imaging was executed twice a week. The setup errors from Catalyst and CBCT in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions were recorded. Each patient′s bladder volume and BMI were also recorded. Results The setup errors between Catalyst with masks and CBCT had the significant difference in SI (P<0.05) and LR (P<0.05). For Catalyst without masks, the setup errors with the bladder volume of 200–300 ml had the significant association in SI (R=-0.316, P<0.05). For the bladder volume of>300 ml, the setup errors for Catalyst with masks had the significant association in AP (R=-0.493, P<0.05), and that without masks had the significant association in SI and LR (R=0.335, P<0.05, R=-0.348, P<0.05). For patients of<25 kg/m², setup errors for Catalyst with masks had the significant association with the BMI in LR (R=0.197, P<0.05);for ≥25 kg/m², that with masks had the significant association in AP and SI (R=0.818, P<0.05;R=-0.498, P<0.05), that without masks had the significant association in AP and LR (R=0.652, P<0.05;R=-0.558, P<0.05). Conclusion Unlike CBCT system, the patient positioning by Catalyst system was easily affected by the bladder volume and BMI of patients.
		2019 Vol. 38 (3): 198-202 [Abstract] ( 827 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	203	Dosimetry study of fourtypes of radiotherapy plan optimization methods in the hypofractionated radiotherapy for lung cancer
		Shao Ying,Zhang Fuli,Wang Shi,Xu Weidong,Jiang Jing
		Objective To discuss the dosimetric differences in the planning methods between physical and biological optimization during thehypofractionated radiotherapy for lung cancer. MethodsTen cases of non-small cell lung cancer (NSCLC) receiving radiotherapy were selected in this retrospective study. The VMAT plans for all patients were re-designed by physical functions (DV group),biological combined with physical functions (DV+EUD group and EUD+DV group) and biological functions (EUD group). The constrained functions were different, whereas the constrained conditions and optimized parameters were identical among four groups. The dosimetric differences among four optimization methods during thehypofractionated radiotherapy for lung cancer were evaluated through calculating and analyzing each dosimetry parameter. Results For the target area, the equivalent uniform dose was approximate between the EUD and EUD+DV groups. The EUD in these two groups was approximately 2.8%-3.6% and 3.2%-3.7% higher than those in the DV and DV+EUD groups. The average tumor control probability (TCP) in the EUD and EUD+DV groupswas considerably higher than those in the other two groups (both P<0.05). The homogeneity index (HI) significantly differed (all P<0.05),whereas the conformity index (CI) did not differ (all P>0.05). For the organ at risk (OAR) area,the differences of EUD,V5,V10,V20,V30 of normal lung tissues and the difference of dosimetry parameters in heart and spinal cord were not statistically significant (all P>0.05).The mean dose of all lungs in the EUD and EUD+DV groupswas slightly lower than those in the other two groups. ConclusionsBiological optimization method has certain advantages in increasing EUD and TCP in the target area and decreasing the irradiation dose of normal lung tissues, which provides references for selecting the optimization method with biological functions in clinical practice.
		2019 Vol. 38 (3): 203-208 [Abstract] ( 918 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	209	Preliminary study on dosimetry verification of VMAT on the basis of TG119 report
		Lyu Meng,Zhang Jun,Zhou Lixin;Su Huanfan,Cao Tingting,Quan Hong
		Objective To preliminarily verify the feasibility of utilizing TG119 report to commission the volumetric modulated arc therapy (VMAT) plans. Methods Based on the test cases mentioned in TG119 report,7-/9-field intensity-modulated radiation therapy (IMRT) and dual-arc VMAT plans were devised by using two types of beam energy (6 MV and 10 MV) in the Eclipse TPS system according to the requirement of this report. All the plans were verified using 0.125cc semiflex thimble ionization chamber,MatriXX and Delta 4,respectively. The final results were statistically compared with the results measured by multiple institutions in the TG119 report. Results The results of both IMRT and VMAT plans met the requirement of the TG119 report. The discrepancy of point dose in the high/low dose region of VMAT plans using different photon beams was ranged from -2.55% to 2.55%,and ±1.85% for the IMRT plans. The percentage of γ passing points (±3%/3 mm) for the IMRT plans using 6 MV and 10 MV photon beams was 99.38% and 99.53%,99.32% and 99.46% for the VMAT plans. The γ passing rate of the compound field exceeded 98%. Conclusions The VMAT plans with 6 MV and 10 MV photon beams meet the requirement of the TG119 report. TG119 report provides certain guidance for establishing a benchmark for dosimetry verification of the VMAT plans.
		2019 Vol. 38 (3): 209-213 [Abstract] ( 762 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	214	The application of transmission reference ionization chamber in the relative dosimetry of stereotatic radiotherapy
		Tang Bin, Li Jie, Wang Pei, Kang Shengwei, Lucia Clara Orlandini
		Objective To investigate the application value of a transmission reference stealth ionization chamber in the relative dosimetry of stereotactic radiotherapy. Methods The relative dosage ofVarianNovalis 6 MV photon rays equipped with Brainlabconical applicators was determined by two different approaches in theIBABlue Phantom. One approach was designed to utilizeIBA SFD3G semiconductor ionization chamber alone in the “step by step” measurement mode, whereas the other method was to utilizeIBA SFD as the field detector combined with stealth ionization chamber as the reference detector in the “continuous” measurement mode. The central axial percentage depth dose (PDD) and off axis ratio (OAR) in a diameter of 4 and 15 mm were measured and the time spent on each measurement was recorded. Results The PDDs at the central axis and OARs at a depth of 10 cm for both conical applicators were in good agreement between the two measurement approaches with a dose difference of< 1%. The time spent on PDDs and OARs measurement with stealth ionization chamber was shortened by 13.1% and 20.7% compared with those without Stealth ionization chamber. Conclusion Stealth ionization chamber can be applied in the relative dosimetry of stereotactic radiotherapy with high dose accuracy and high efficiency.
		2019 Vol. 38 (3): 214-216 [Abstract] ( 752 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	217	Breast board combined with a thermoplastic head mask immobilization can improve the reproducibility of the treatment setup for breast cancer patients receiving whole breast and supraclavicular nodal region irradiation
		Ma Mingwei,Wang Shulian,Qin Shirui,Li Minghui,Zhang Jianghu,Tang Yu,Qi Shunan,Chen Siye, Ma Yuchao,Liu Xin,Li Yexiong
		Objective To quantify the setup errors measured with kV cone-beam CT (CBCT) using breast board with or without a thermoplastic head mask in breast cancer patients who received whole breast and supraclavicular nodal region irradiation. Clinical target volume (CTV) to planning target volume (PTV) in 3 directions were also calculated. Methods The study included thirty patient receiving both whole breast and supraclavicular nodal region irradiation on Elekta Versa HD linear accelerators (Elekta Oncology Systems,Crawley,UK) between June 2016 and January 2018.The setup error data were retrospectively analyzed. All the patients were immobilized in the supine position on a breast board system (Carbon fibre breast board,Civco,Iowa,USA) with both arms raised. Twenty of the patients added an extra thermoplastic head mask to immobilize the neck. A CBCT scan was taken before treatment at the first 3 to 5 fractions and then once every week. Registration with the planning CT was performed and adjusted to match the target volume of the supraclavicular nodal region and the cervical vertebra by experienced medical staff,the position of the arms and the breast were also considered. For all patients the couch shifts in left-right (x),superior-inferior (y),anterior-posterior (z) were recorded. Statistical analysis included two-tails significance tests (t-Student and Manne-Whitney test for means, χ² test for variances).Population of the two groups was compared in terms of distribution of the mean shift (systematic error) and their standard deviations (random error).Van Herk′s setup margin defined as MPTV=2.5Σ＋0.7δ was calculated in patients with or without mask immobilization. Results Altogether,56 images and 109 images were acquired in breast board only group and head mask group,respectively. Shifts of the breast board only group and the head mask group in x,y,z were 0.212±0.174 cm vs.0.272±0.242 cm (P=0.070);0.364±0.246 cm vs.0.242±0.171 cm (P=0.001);0.423±0.302 cm vs.0.364±0.269 cm (P=0.204).Proportion of the shift less than 5 mm in the breast board only group and the head mask group were 91.07% vs. 85.32%(P=0.294);67.86% vs.89.91%(P=0.001);67.86% vs.74.31%(P=0.381).The CTV to PTV margin in x,y,z were 0.645 cm,0.981 cm,1.317 cm in breast board only group and 0.873 cm,0.709 cm,0.961 cm in head mask group,respectively. Setup error in the x direction was significantly correlated with BMI (P=0.001). Conclusions For the alignment and immobilization of patients who received whole breast and supraclavicular nodal region irradiation,using a breast board in combination of a thermoplastic head mask may significantly help to reduce the shift variance in superior-inferior direction compared to using breast board only. The anterior-posterior error is relatively large,other immobilization device or patient alignment methods are needed to be further explored to improve the accuracy.
		2019 Vol. 38 (3): 217-221 [Abstract] ( 885 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	222	The role of whole brain radiation therapy in treatment of primary central nervous system lymphoma:necessary or not
		Wei Liqun,Yang Liu,Liu Yu,Zhang Junhong,Xie Conghua,Zhou Yunfeng
		Primary central nervous system lymphoma (PCNSL) is a type of extranodal non-Hodgkin lymphoma. Whole brain radiation therapy (WBRT) combined with high-dose methotrexate is the standard treatment. Although PCNSL patients are sensitive to radiation therapy, the duration of response is relatively short and it is likely to provoke delayed neurotoxicity, especially in the elderly patients. Reduced-dose WBRT and autologous stem cell transplantation (ASCT) can lower the risk of neurotoxicity, whereas the clinical efficacy remains to be validated. For the elderly patients with PCNSL, application of WBRT in the first-line treatment should be cautiously considered.
		2019 Vol. 38 (3): 222-225 [Abstract] ( 822 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	226	The application of multimodal MRI in radiotherapy for patients with high-grade glioma
		Zha Yilin,Xu Xiaoting
		Radiotherapy is one of the most important treatments of high-grade gliomas (HGG).Currently,there has been no consensus on the standards for the delineation of the gross tumor volume (GTV) based on the simulated computed tomography (CT) scanning and conventional magnetic resonance imaging (MRI).As the radiological technology advances,researchers have found that the application of multimodal MRI including ¹H magnetic resonance spectroscopy (¹H-MRS),blood oxygenation level dependent functional MRI (BOLD-fMRI),diffusion-weighted MRI (DWI) and diffusion tensor imaging (DTI) can evaluate the range of HGG invasion and locate the surrounding vital tissues,thereby serving as a supplement for the delineation of target volume and protection of organs at risk. Moreover,multimodal MRI can be utilized to evaluate the clinical efficacy of radiotherapy,detect the radiation-induced injury and differentiate the progressive disease from pseudoprogression. In this article,the application of multimodal MRI in the postoperative radiotherapy for patients with high-grade glioma was reviewed.
		2019 Vol. 38 (3): 226-229 [Abstract] ( 703 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	230	Progress in application of radiomics in lung cancer
		Shao Yan, Wang Hao, Chen Hua, Gu Hengle, Xu Zhiyong
		The mortality rate of lung cancer is relatively high and the incidence of lung cancer has been increased year by year. Consequently, early screening and diagnosis plays a crucial role. The traditional screening method is biopsy, which has multiple defects. Radiomics can resolve these limitations and improve the diagnosis and prognosis of lung cancer in a noninvasive and low-cost manner, assisting the clinicians to make decisions in clinical practice. In this paper, the process and application, prospects and challenges of radiomics in the screening of lung cancer were introduced, aiming to promote the development of radiomics.
		2019 Vol. 38 (3): 230-232 [Abstract] ( 867 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	233	Research developments of adjuvant therapies for hepatocellular carcinoma after resection
		Cheng Shuhui,Chen Bo,Li Yexiong
		Hepatocellular carcinoma (HCC) is a common malignancy with high rate of morbidity and mortality.Liver resection is the most effective curative treatment,yet subsequent recurrence and death are common,with 5-year overall survival rate remaining about 50% and 5-year postoperative recurrence reaching as high as 60%-70% reported by previous publications. Therefore,it is essential to identify the optimal adjuvant therapy for patients with unfavorable prognostic factors to decrease the postoperative recurrence or metastasis,thereby to deliver the promise of improved outcomes. However,there is no consensus about it and several treatment options were under investigation,including transcatheter arterial chemoembolization (TACE),radiotherapy,targeted therapy,and other treatments. Here,we review studies on the role of adjuvant therapies,to provide evidences for further research and clinical practice.
		2019 Vol. 38 (3): 233-237 [Abstract] ( 1163 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Symposium

	238	Experience in repair and maintenance of the Varian Linear accelerator multi-leaf collimator
		Lin Zhixue,Wang Zhongwen, Wang Ke
		This thesis introduce the Multi-Leaf Collimator of Varian Linac, analyse the regular faults and show how to troubleshoot by every part. At the same time it introduce the daily maintenance of MLC and specific methods.
		2019 Vol. 38 (3): 238-240 [Abstract] ( 718 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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