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.6 Published 2019-06-15

	Head and Neck Tumors Thoracic Tumors Physics·Biology·Technique Review Articles

Head and Neck Tumors

	401	Value of MORC2-IDH1 detection in molecular subtyping of glioblastoma patients treated with postoperative chemoradiotherapy
		Tang Meng, Xu Hui, Wang You, Ding Qianshan, Zhou Fuxiang
		Objective To investigate the expression of microrchidia 2(MORC2) in glioblastoma patients and to evaluate its prognostic value of MORC2 expression combined with IDH1 mutation status for chemoradiotherapy efficacy and new molecular subtype.Methods The expression level of MORC2 in 45 glioblastoma tissues was measured by immunohistochemical staining and its correlation with clinicopathological characteristics and clinical prognosis after chemoradiotherapy was analyzed. Further more,the prognostic values of the expression of MORC2 combined with the status of IDH1 were assessed in a glioblastoma CGGA mRNA dataset.Results High expression of MORC2 was observed in 76% of glioblastoma patients, which was negatively correlated with overall survival (HR=2.928,95%CI:1.582-5.418,P=0.002;recurrence-free survival (HR=2.204,95%CI:1.186-4.095,P=0.022).Moreover,according to the prognosis value of MORC2 expression and IDH1 mutation status, glioblastoma patients were divided into 3 molecular subtypes. Patients with the subtype of IDH1^mt/MORC2^lowobtained the best clinical prognosis with a median survival of 22 months (95%CI:13.98-30.02), whereas those with the subtype of IDH1^wt/MORC2^highobtained the worst clinical prognosis with a median survival of 5.63 months (95%CI:3.92-7.34,HR=4.15,95%CI:3.92-7.34,P=0.002).Among IDH1^wtglioblastoma patients, MORC2^highpatients had worse clinical prognosis compared with MORC2^lowcounterparts, prompting that IDH1^wt/MORC2^highglioblastoma tissues yielded higher capability of DNA injury repairing and resistance to chemoradiotherapy.Conclusions The high expression of MORC2 can be used as a potential indicator of poor prognosis of glioblastoma patients after chemoradiotherapy. IDH1 mutation status combined with MORC2 expression can establish a novel molecular subtyping, which provide evidence for stratified therapy for glioblastoma patients.
		2019 Vol. 28 (6): 401-404 [Abstract] ( 601 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	405	Comparison of clinical efficacy and prognosis of intensity-modulated radiotherapy and three dimensional conformal radiotherapy in patients with stage Ⅱ/Ⅲ esophageal cancer:a multi-center retrospective analysis in Beijing, Tianjin and Hebei province (3JECROG R-06)
		Xu Yonggang, Wang Xin, Li Chen, Wang Lan, Han Chun, Chen Junqiang, Zhang Wencheng, Wang Xiaomin, Ge Xiaolin, Shen Wenbin, Hu Miaomiao, Yuan Qianqian, Hao Chongli, Zhou Zhiguo, Qie Shuai, Lu Na, Pang Qingsong, Wang Ping, Zhao Yidian, Sun Xinchen, Zhang Kaixian, Li Ling, Qiao Xueying, Liu Miaoling, Wang Yadi, Zhu Shuchai, Chen Dazhi, Wu Qinhong, Gao Hong, Xiu Xia, Li Gaofeng, Xiao Zefen
		Objective To compare the therapeutic effects between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in patients with stage Ⅱ/Ⅲ esophageal cancer and investigate the prognostic factors.Methods Medical record of 2132 patients with stage Ⅱ/Ⅲ esophageal cancer who underwent definitive radiotherapy with/without chemotherapy in 10 hospitals from January 2002 to December 2016 from were retrospectively analyzed. Among these patients, 37.9% of them were aged≥70 years, 33.9% with neck and upper esophageal tumors and 66.1% with middle and lower esophageal and borderline tumors. The median gross tumor volume (GTV) and lymph node gross tumor volume (GTVnd) was 41.6 cm³.Among them, 32% were stage Ⅱ and 68% were stage Ⅲ.A total of 723 patients received 3DCRT and 1409 cases received IMRT.Patients received an equivalent dose in 2 Gy (EQD2) ≥ 60 Gy accounted for 86.1%, and 41.1% of them received concurrent chemoradiotherapy.Results The median follow-up time was 60.8 months. The 1-, 3-and 5-year overall survival (OS) of all patients was 73.9%, 41.7% and 32.6%, and the 1-, 3-and 5-year progression-free survival (PFS) was 62.2%, 37.3% and 32%, respectively. Multivariate analysis demonstrated that age, primary tumor location, clinical stage, tumor target volume, EQD2 and concurrent chemoradiotherapy were the independent prognostic factors for OS.Age, primary tumor location, clinical stage, tumor target volume and EQD2 were the independent prognostic factors for PFS.The OS and PFS did not significantly differ among the low-risk, low-/moderate-risk, moderate-/high-risk and high-risk groups according to age≥70 years, tumor diameter>5 cm, tumor volume≥41.6 cm³and stage Ⅲ(P<0.001).After the propensity score matching (PSM) method, neither 3DCRT nor IMRT yielded significant advantages in OS or PFS (P=0.971;P=0.658).However, IMRT tended to yield survival benefits in low-risk patients (P=0.125).Conclusions Both 3DCRT and IMRT yield relatively high OS rate in patients with stage Ⅱ/Ⅲ esophageal cancer. The prognosis model established in this investigation can properly predict the survival of patients. Low-risk patients tend to obtain survival benefits from IMRT.
		2019 Vol. 28 (6): 405-411 [Abstract] ( 473 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	412	Analysis of prognostic factors and nomogram for predicting survival for patients with locally resectable esophageal cancer after preoperative chemoradiation therapy
		Gao Bingyu, Ma Mingwei, Wang Huahong, Xiong Hui, Li Junxia
		Objective The SEER database was utilized to analyze the prognosis and related factors for patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy. A nomogram for predicting survival was established to provide reference for screening patients receiving preoperative chemoradiotherapy.Methods Patients diagnosed with stage T1b-4aN0-3M0(7^thversion AJCC in 2010) resectable esophageal cancer receiving preoperative chemoradiotherapy between 2010 and 2015 were selected from the SEER database. The survival rate was determined by Kaplan-Meier method. The univariate analysis was performed by log-rank test. The multivariate analysis was conducted by Cox test. The nomogram for survival prediction was established by using R software. The predicting accuracy of the nomogram was evaluated by C-index and calibration curve.Results A total of 1 697 eligible patients were included. Univariate analysis showed that sex,T stage,N stage and tumor differentiation were significantly associated with overall survival (OS) and cancer-specific survival rate (CSS)(all P<0.001),and age (P=0.027) was significantly correlated with OS.Multivariate analysis demonstrated that age,sex,tumor differentiation and N stage were significantly associated with OS.Sex,tumor differentiation,T stage and N stage were significantly correlated with CSS (all P<0.05).After the prognostic factors were included into the nomogram,the C-index for 5-year OS and CSS was 0.60 and 0.61.The model for predicting survival of patients with esophageal squamous cell cancer was established by using the same method. The C-index for the OS and CSS was 0.62 and 0.64.Conclusions Sex,clinical stage and tumor differentiation are prognostic factors of CSS in patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy followed by surgery. The nomogram established according to the data above can provide certain reference for the selection of preoperative chemoradiotherapy combined with surgery.
		2019 Vol. 28 (6): 412-416 [Abstract] ( 402 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	417	Combined use of NLR, V20 and Dmean to predict radiation-induced lung injury in lung cancer patients:an external validation study
		Pan Wenyan, Kong Wei, Wang Yanyyang, Hai Ping, Bai Xuehong, Bai Zhoulan, Lu Haiyang, Zhao Ren
		Objective To externally validate the accuracy of combined use of neutrophil-lymphocyte ratio (NLR),V20,and Dmean in predicting the incidence of grade Ⅲ or higher radiation-induced lung injury (RILI) in lung cancer patients.Methods A total of 166 lung cancer patients, who participated in the model establishment were selected into the internal validation group, and 85 lung cancer patients who received intensity-modulated radiotherapy in our department between June 2016 and June 2018 were assigned into the external validation group. The incidence rate of grade 3 or higher RILI was statistically compared between the internal and external validation groups. Multivariate logistic analysis was performed for NLR, V20 and Dmean. The discrimination degree of the predictive model was evaluated by using ROC curve in combination with NLR, V20 and Dmean. The calibration degree of the predictive model was assessed by Hosmer-Lemeshowtest.Results The incidence rate of grade 3 or higher RILI in the internal and external validation groups was 23.8% and 22.9%. Multivariate logistic analysis demonstrated that NLR, V20 and Dmean significantly differed in the internal validation group (P=0.032, 0.006 and 0.005). However, only V20 significantly differed in the external validation group (P=0.038). The discrimination and calibration degree of RILI was almost consistent between the internal and external validation groups (both P>0.05). The area under the curve (AUC) predicted by NLR, V20, Dmean and the combination of three indexes were 0.611, 0.646, 0.682 and 0.775 in the internal validation group, and 0.544, 0.702, 0.658 and 0.754 in the external validation group, respectively. The calibration degree in the internal validation group was P=2.797 and 0.834, P=2.452 and 0.653 in the external validation group. Conclusion Combined application of NLR, V20 and Dmean can accurately predict the incidence of grade Ⅲ or higher RILI in lung can cancer patients, which has been validated by external dataset.
		2019 Vol. 28 (6): 417-420 [Abstract] ( 532 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	421	Investigation and analysis of thereasons for omission of adjuvant radiotherapy after breast-conserving surgery for early-stage breast cancer
		Cui Xiaoying, Sheng Liming, Ji Yongling, Chen Ying, Cheng Lei, Qiu Guoqin, Zhou Xia, Bao Wuan, Yang Yang, Yang Hongjian, Du Xianghui
		Objective To investigate and analyze the reasons for the omission of adjuvant radiotherapy after breast-conserving surgery (BCS) in patients with breast cancer.Methods The clinicopathologial characteristics and socioeconomic data of 55 breast cancer patients undergoing BCS without postoperative adjuvant radiotherapy in our hospital from 2012 to 2016 were retrospectively analyzed.Results Among the 55 patients who did not receive radiotherapy, 25 patients were due to low local recurrence risk,12 patients were due to economic or family reasons,12 patients were due to fear of adverse reactions of radiotherapy, and 5 patients were not recommended by primary physicians for radiotherapy.In addition, 3 cases with multiple distant metastases and 3 cases with concomitant thyroid cancer didn't received radiotherapy.Conclusions Low risk local recurrence is the main reason for the omission of adjuvant radiotherapy, followed by the fear of radiation-induced toxicity and poor financial support. Patient education and medical insurance may improve the adjuvant radiotherapy compliance.
		2019 Vol. 28 (6): 421-424 [Abstract] ( 462 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	425	Clinical efficacy of radical rectal cancer surgery combined with irradiation in treatment of rectal cancer and its effect on angiogenesis and survival rate
		Wang Xiaofei, Jin Yan, Li Xuemin, Xing Guochen, Duan Xibin, Yi Shanyong, Ma Chao
		Objective To evaluate the clinical efficacy of radical surgery combined with irradiation in the treatment of rectal cancer and its effect on the angiogenesis and survival rate.Methods A total of 200 colorectal cancer patients admitted to Zhengzhou Central Hospital from March,2014 to March,2015 were recruited and divided into the observation group (n=105) and control group (n=95) by using random number table method. In the control group,radical surgery was performed,and radical surgery combined with irradiation was conducted in the observation group. The clinical efficacy,the serum levels of vascular endothelial growth factor-C (VEGF-C) and prostaglandin E2(PGE2) were statistically compared between the control and observation groups. The changes of the microvascular morphology and microvessel density (MVD) in the rectal cancer tissues were observed and recorded. The 3-year survival rate was calculated during postoperative follow-up.Results After corresponding treatment,the clinical overall response rate was 86.67% in the observation group,and 70.53% in the control group (P>0.05).The 2-year survival rate did not significantly differ between two groups (P>0.05).The 3-year survival rate in the observation group was significantly higher than that in the control group (P<0.05).After treatment,the serum levels of VEGF-C and PGE2 were significantly improved in two groups (both P<0.05).In the observation group,the serum levels of VEGF-C and PGE2 were significantly lower compared with those in the control group (both P<0.05).The microvessel morphology in the cancer tissues remarkably differed between two groups. The microvessel diameter did not significantly differ,whereas the lumen diameter in the observation group was significantly smaller than that in the control group. The MVD in the observation group was 12.25±3.35,significantly lower than 28.14±17.26 in the control group (P<0.05). Conclusion Radical surgery combined with irradiation is an efficacious treatment of rectal cancer,which can effectively improve the serum levels of VEGF-C and PGE2,decrease the MVD,reduce the lumen diameter in the cancer tissues,lower the angiogenesis in rectal cancer and enhance the survival rate,which deserves widespread application in clinical practice.
		2019 Vol. 28 (6): 425-427 [Abstract] ( 425 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	428	The efficacy and safety of neoadjuvant therapy followed by radical surgery versus definite chemoradiotherapy in the treatment of ⅠB2-ⅡB cervical cancer:a meta-analysis
		Xie Ruilin, Wang Hui, Tong Shaodong, Li Na, Qin Qingwei, Wang Sheng, Zhao Xue, Qi Zhaohui, Yao Yuanhu
		Objective To systematically evaluate the efficacy and safety between neoadjuvant therapy followed by radical surgery and definite chemoradiotherapy in the treatment of ⅠB2-ⅡB cervical cancer.Methods A computerized search was performed in PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang Data, CNKI and VIP to collect controlled clinical trials related to neoadjuvant therapy followed by radical surgery versus definite chemoradiotherapy in the treatment of ⅠB2-ⅡB cervical cancer. The meta-analysis of survival data and adverse events was performed by Review Manager 5.3 software.Results Nine controlled clinical trials involving 3 914 patients were included in this meta-analysis. There were no significant differences in overall survival (HR=0.83, P=0.31) and progression-free survival (HR=0.85,P=0.57) between two groups. Compared with patients receiving definite chemoradiotherapy, those in the neoadjuvant therapy group had a significantly lower risk of irradiation enteritis (RR=0.27,P=0.03), whereas no significant difference was observed in the risk of irradiation cystitis (RR=0.30,P=0.34) and grade ≥3 neutropenia (RR=0.77,P=0.46) between two groups. Conclusion In the treatment of locally advancedⅠB2-ⅡB cervical cancer, two modalities show similar survival benefits. Although the neoadjuvant therapy group yields a lower incidence of irradiation enteritis, the incidence rates of irradiation cystitis and grade ≥3 neutropenia do not significantly differ between two groups. Neoadjuvant therapy followed by radical surgery is not superior to the standard therapeutic regime.
		2019 Vol. 28 (6): 428-431 [Abstract] ( 387 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	432	Multi-task learning-based three-dimensional dose distribution prediction for multiple organs in a single model
		Guo Futong, Li Yongbao, Jia Qiyuan, Qi Mengke, Wu Aiqian, Kong Fantu, Mai Yanhua, Song Ting, Zhou Linghong
		Objective To establish a three-dimensional (3D) dose prediction model, which can predict multiple organs simultaneously in a single model and automatically learn the effect of the geometric anatomical structure on dose distribution.Methods Clinical radiotherapy plans of patients diagnosed with the same type of tumors were collected and retrospectively analyzed. For every plan, each organs at risk (OAR) voxel was regarded as the study sample and its deposited dose was considered as the dosimetric feature. A regularized multi-task learning method than could learn the relationship among different tasks was employed to establish the relationship matrix among tasks and the correlation between geometric structure and dose distribution among organs. In this experiment, the spinal cord, brainstem and bilateral parotids involved in the intensity-modulated radiotherapy (IMRT) plan of 15 nasopharyngeal cancer patients were utilized to establish the multi-organ prediction model. The relative percentage error between the predicted dose of voxel and the clinical planning dose was calculated to assess the feasibility of the model.Results Ten cases receiving IMRT plans were utilized as the training data, and the remaining five cases were used as the test data. The test results demonstrated a higher prediction accuracy and less data demand. And the average voxel dose errors among the spinal cord, brainstem and the left and right parotids were (2.01±0.02)%,(2.65±0.02)%,(2.45±0.02)% and (2.55±0.02)%,respectively. Conclusion The proposed model can accurately predict the dose of multiple organs in a single model and avoid the establishment of multiple single-organ prediction models, laying a solid foundation for patient-specific plan quality control and knowledge-based treatment planning.
		2019 Vol. 28 (6): 432-437 [Abstract] ( 472 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	438	Study on the significance of consistency of preoperative and postoperative bladder filling in patients with cervical cancer for target area and organ at risk in IMRT
		Zhang Wei, Xu Qing, Ke Guihao, Zhu Jun, Guan Shikuo, Zhang Yanjun
		Objective Bladder filling in patients with cervical cancer before and after operation during intensity-modulated radiotherapy (IMRT) was controlled by using bladder volume measurement instrument (BVI 9400). The displacement errors of the target area and the changes of the irradiation dose and the morphology of the filling bladder were compared. The significance of consistency of preoperative and postoperative bladder filling in IMRT for cervical cancer was investigated.Methods Forty-five patients with cervical cancer treated with radiotherapy in our hospital in 2018 were recruited and divided into A,B and C groups (n=15). In group A, patients did not undergo surgery, patients in group B received radical resection of cervical cancer (bladder volume measurement (BVI 9400) was utilized to monitor the bladder urine volume in both A and B groups before treatment). In group C, patients who self-controlled urination without monitoring bladder urine volume before treatment were randomly selected. All patients in three groups underwent KV-CBCT scan before treatment for online registration analysis. The displacement errors in the x-(left and right),y-(head and foot),z-axis directions (ventral and dorsal), PTV coverage volume percentage(V100) and percentage difference (ΔV100) of the prescription dose were calculated.Results The average displacement errors in the x-, y-, z-axis directions were as follows:1.67 mm,1.55 mm and 1.67 mm in group A, 1.43 mm,1.58 mm and 1.84 mm in group B, and 2.27 mm,2.30 mm and 2.08 mm in group C, respectively. In group A, the V100 was calculated as 96.96% and ΔV100 was 1.17%. In group B, V100 was95.9% and ΔV100 was 1.29%. In group C, V100 was 94.02% and ΔV100 was 2.17%.Conclusions Controlling the consistency of bladder filling can reduce the effect of inconsistency of bladder filling upon the displacement errors to certain extent, which can guarantee the accuracy of the target location and the irradiation dose of the target, protect the bladder, small intestine and rectum, and alleviate the radiation-induced response of cervical cancer patients.
		2019 Vol. 28 (6): 438-441 [Abstract] ( 648 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	442	Effect of hypoxia on epithelial growth factor receptor expression and cell apoptosis of breast cancer and cervical cancer xenografts in nude mice
		Zhang Tingting, Liu Baocai, Lu Yinliang, Yu Xinyue, Zhang Ning, Tang Yuhuan, Cheng Guanghui
		Objective To observe the effect of hypoxia on the expression of epithelial growth factorreceptor (EGFR) and cell apoptosis of breast and cervical cancer xenografts in nude mouse models.Methods The nude mouse models with MCF-7 and HeLa xenografts were established. The degree of hypoxia and EGFR expression were observed by confocal microscopy. The influence of EGFR expression on cell apoptosis under hypoxia was observed by TUNEL assay.Results EGFR expression was either up-regulated or down-regulated in the MCF-7 and HeLa cells with high degree of hypoxia. Furthermore,the degree of apoptosis was reduced in tumor tissues with high EGFR expression compared with that in those with low expression of EGFR. Conclusion The hypoxia in MCF-7 and HeLa cells exerts heterogeneous effect on EGFR expression. Under hypoxic conditions,EGFR expression is negatively correlated with cell apoptosis.
		2019 Vol. 28 (6): 442-444 [Abstract] ( 400 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	445	The effect of STC1 gene on radiosensitivity of human lung cancer A549 cell line
		An An, Hou Liangxue, Qi Feng, Li Guiying, Kang Shengwei
		Objective To investigate effect of stanniocalcin-1(STC1) gene on the proliferation,apoptosis and radiotherapy sensitivity of non-small cell lung cancer.Methods The STC1 siRNA (STC1-siRNA) and the non-interfering siRNA (negative control group) were transfected into the human lung cancer A549 cells by Lipofectamine^TM2000,and the blank control group was established. The expression level of STC1 protein was detected after transfection for 48 h by Western blotting. Clone forming test was adopted to detect the proliferation of A549 cells after STC1-siRNA and irradiation treatment. CCK8 assay was performed to detect the cell viability after treatment with STC1-siRNA and STC1-siRNA+8 Gy. The cell apoptosis was detected by flow cytometry. The expression levels of Ki67,Bax,STAT3 and p-STAT3 proteins were quantitatively measured by Western blotting.Results The expression level of STC1 protein in the A549 cells transfected with STC1-siRNA was significantly down-regulated than that in the blank control group (P<0.05).Compared with the blank control group,the sensitization ratio was significantly enhanced after STC1-siRNA transfection. Compared with the blank control group,the cell viability and the expression levels of Ki67 and p-STAT3 protein were significantly decreased,whereas the apoptosis rate and the expression of Bax protein were significantly increased in the STC1-siRNA group. Compared with the STC1-siRNA group,the cell viability and the expression levels of Ki67 and p-STAT3 proteins were significantly decreased,whereas the cell apoptosis rate and the expression of Bax protein were remarkably increased in the STC1-siRNA+8 Gy group (all P<0.05). Conclusion Inhibition of STC1 gene expression can enhance the radiotherapy sensitivity and down-regulate the STAT3 signaling pathway in non-small cell lung cancer.
		2019 Vol. 28 (6): 445-447 [Abstract] ( 426 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	448	Analysis of the inter-and intra-fraction setup errors and residual errors during stereotactic radiotherapy for brain metastasis
		Zhang Yanxin, Fu Guishan, Xu Yingjie, Chen Bing, Fang Hao, Liu Bofei, Liu Qingfeng, Xiao Jianping, Dai Jianrong
		Objective To evaluate the necessity of arc by arc setup verification in patients with brain metastases receiving stereotactic radiotherapy (SRT) by analyzing the inter-and intra-fraction setup errors and residual errors collected from the ExacTrac X-ray portal image.Methods Clinical data of brain metastases patients treated with SRT in the previous two years were retrospectively analyzed. The ExacTrac X-ray setup images were collected after the normal setup procedure. Setup errors were calculated by registering the cranial bony structures of the ExacTrac X-ray setup images to that of the digitally reconstructed setup images. The inter-and intra-fraction setup errors and residual errors were statistically analyzed.Results Seventy-five patients from 116 lesions received 337 cycles of SRT of the head. The inter-and intra-fraction translational setup errors in the x,yand zdirections were (0.93±0.86) mm and (0.15±0.59) mm;(1.83±1.27) mm and (0.25±0.73) mm;(0.96±0.80) mm and (0.14±0.56) mm,respectively. The inter-and intra-fraction rotational setup errors in the x,y,zdirections were (0.65°±0.62°) and (0.19°±0.40°);(0.97°±0.94°) and (0.13°±0.25°);(0.92°±0.71°) and (0.10°±0.29°),respectively. The residual translational setup errors in the x,y,zdirections were (0.06±0.23) mm,(0.08±0.24) mm and (0.08±0.22) mm,and (0.12°±0.27°),(0.09°±0.18°) and (0.06°±0.19°) for the residual rotational setup errors,respectively. For a reference setup error threshold of 0.7 mm/0.7°,99.1% of the SRT exceeded the threshold and required setup correction. For 1 006 non-coplanar arcs,rotating the treatment couch from 0° to the treatment angle made 66.4% of arcs exceed the threshold and require at least once setup correction.Conclusions During SRT for brain metastasis,the inter-and intra-fraction setup errors should be emphasized. It is necessary to perform arc by arc setup error verification.
		2019 Vol. 28 (6): 448-451 [Abstract] ( 518 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	452	Small field output factor measurement and correction method based on IAEA report No.483
		Li Minghui, Ma Pan, Tian Yuan, Miao Junjie, Men Kuo, Zhang Ke, Niu Chuanmeng, Dai Jianrong
		Objective The IAEA report No. 483 describes the latest method of small field dosimetry. The field output factor measurement and correction methods are used to improve the accuracy and consistency of the measurement results for different type detectors.Methods The field output factors from 0.6 cm×0.6 cm to 10 cm×10 cm were measured using IBA′s CC13 ionization chamber, CC01 ionization chamber, PFD semiconductor detector, EFD semiconductor detector and Razor semiconductor detector, respectively. The field output correction factors were used to correct the measurement result.Results Compared with the corrected data, the results of ionization chamber are mainly affected by the volume averaging and the fluence perturbation effect, lead to the measurement result which is 4.70% lower at 0.6 cm×0.6 cm;The results of Shielded semiconductors are mainly affected by fluence perturbation effect, lead to the measurement result which is 4.80% higher at 0.6 cm×0.6 cm. The results of unshielded semiconductors are mainly affected by energy response and fluence perturbation effect, resulting in lower measurement results at the field size>0.8 cm×0.8 cm, 2.10% lower at field size of 1.5 cm×1.5 cm, higher measurement results at field size<0.8 cm×0.8 cm and 1.1% higher at field size of 0.6 cm×0.6 cm. Before the correction, the measurement results from different types of detectors are quite different, average standard deviation is 0.016 6. After the correction, the difference among the detectors is significantly reduced, average standard deviation is 0.006 6.Conclusions For detectors such as ionization chambers and semiconductors, the field output correction factors can be used to correct the output factors of the small field to improve the accuracy and consistency of the measurement results.
		2019 Vol. 28 (6): 452-456 [Abstract] ( 427 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	457	Application of the accelerator log file combined with the film to verify the accuracy of AAA and AXB algorithms in the heterogeneous medium
		Lin Xiutong, Liu Xiao, Wang Zhen, Sun Tao, Lu Jie, Yin Yong
		Objective The accelerometer log files generated when the simulation plans were executed on the chest phantom,the modified log files including multi-leaf collimator (MLC) and Gap motion error were imported into the treatment planning system and then the dose was reconstructed by Analytical Anisotropic Algorithm (AAA) and Acuros XB (AXB) algorithms. The calculation accuracy of these two algorithms was analyzed according to the measured value of film.Methods The targets and organs at risk (OARs) of the mediastinum and peripheral lung cancer were contoured on the chest phantom,intensity-modulated radiation therapy (IMRT) plans were designed and then the dose was calculated with the AAA and AXB algorithms. The films were placed in the phantom to measure the dose when the simulation plans were executed through the accelerator. The log files were extracted by Varian Argus software and the MLC,Gap motion deviation information was imported into the treatment planning system. The dose was reconstructed by two algorithms. The differences of target dose ( D2,D98,Dmax,Vprescribed) and OAR dose (lung:V5,V10,V20,Dmean;Heart:V30,Dmean;Spinal cord:Dmax) were statistically compared between two algorithms. The measured dose of film was compared with the isocenter doses of the two algorithms.3mm/3% standard was adopted to analyze the gamma-pass rates . Pass rates of high-dose region (target region) and low-dose region (upper, lower, left and right directions outside the target region) were analyzed with different size matrices.Results The dose differences were detected in the simulation plans of mediastinum and peripheral lung cancer by using the AAA and AXB algorithms. The maximum dose differences of the two targets were D98(2.47%) and Vprescribed (4.21%) using the AAA and AXB algorithms. The maximum differences of the OARs were the left lung (Dmean=3.58%、V10=-2.76%),the right lung(V5=-1.96%,Dmean=0.18%),the heart (Dmean=1.15%,Dmean=0.18%) and the spinal cord (Dmax=-3.34%,1.79%),respectively. Compared with the measured dose of film,the average gamma-pass rate in the mediastinum and peripheral lung cancer by using two algorithms of different sizes of matrix were 94.07%±1.32%(AAA),93.81%±1.43%(AXB) and 93.73%±1.31%(AAA),94.39%±1.32%(AXB).In the low dose region of the two targets,the average gamma-pass rate by the AXB algorithm was higher than that by the AAA algorithm.Conclusions The AAA and AXB algorithms differ in the calculation of target areas for the mediastinum and peripheral lung cancer simulated on the chest phantom. The average gamma-pass rate of the AXB algorithm is better compared with that of the AAA algorithm referring to the measured dose of the film,which is closer to the measured value of the film in the cavity.
		2019 Vol. 28 (6): 457-462 [Abstract] ( 421 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	463	Research progress on dosage and segmentation of thoracic radiotherapy for limited-stage small cell lung cancer
		Xu Jinbiao, Qiu Feng
		At present, surgery, systemic chemotherapy, thoracic radiotherapy and prophylactic cranial irradiation have been widely recognized to treat the limited-stage small cell lung cancer. In recent decades, no significant breakthrough has been reached in drug therapy. In the field of radiotherapy, the timing, target volume, mode of dose fractionation and prophylactic cranial irradiation are the hot issues. In this article, the research progress on the dose and the mode of dose fractionation for limited-stage small cell lung cancer was briefly analyzed.
		2019 Vol. 28 (6): 463-466 [Abstract] ( 472 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	467	Research progress on radiotherapy for brain metastasis from non-small-cell lung cancer with ALK rearrangement
		Wang Wenhui, Sun Xin, Hui Zhouguang
		Brain metastasis is common in non-small-cell lung cancer (NSCLC) with driver gene mutations. At present, brain radiotherapy combined with tyrosine kinase inhibitor (TKI) is a hot topic. Anaplastic lymphoma kinase (ALK) gene rearrangement is one of the common driver mutations in NSCLC.However, the treatment of brain metastasis from NSCLC with ALK gene rearrangement has been rarely investigated. The prognosis of these patients,the role of brain radiotherapy and the proper combination of radiotherapy with ALK-TKI are worthy of further exploration.
		2019 Vol. 28 (6): 467-471 [Abstract] ( 495 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	472	Establishment and effect evaluation of a variety of radiation-induced lung injury animal models
		Qi Runzhi, Liu Jiangang, Wu Xianwen
		Radiation-induced lung injury (RILI) is a common complication after radiotherapy for thoracic tumors. It is one of the most urgent problems to explore the optimal animal model and evaluate the effect for basic research and drug intervention along with the extensive studies of radiation pneumonia. By reviewing the literatures published in recent 10 years, the selection of irradiation site, determination of irradiation dosage, irradiation method and effect evaluation were statistically compared among different RILI animal models, aiming to explore a stable method of establishing the animal model with RILI and identify a definite effect mechanism. It provides a reliable approach for basic research and drug development to prevent and mitigate the incidence and development of RILI.
		2019 Vol. 28 (6): 472-475 [Abstract] ( 479 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	476	Artificial Intelligence:opportunities and challenges in radiotherapy
		Li Yimin, Lan Mei, Zhang Jiayu, Wang Pei, Lang Jinyi
		Artificial Intelligence are emerging as poweful tools for many field including medicine. It has be applied to radiation therapy in different degree,such as automatic OAR or tumor volume segmentation,automatic radiotherapy planning,prediction of toxicity and prognostic,etc. In this article,the research progress on Artificial Intelligence in the radiotherapy for malignant tumor was reviewed.
		2019 Vol. 28 (6): 476-480 [Abstract] ( 694 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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友情链接

China Association for
　Science and Technology

Chinese Medical Association

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

Chinese Anti-Cancer
　Association

Chinese Journal of Lung
　Cancer

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CNKI

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