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.7 Published 2019-07-15

	Head and Neck Tumors Thoracic Tumors Review Articles Investigation Research Abdominnal Tumors

Investigation Research

	481	Safety analysis of anti-radiation-induced injury drug of Andorin capsule——based on real-world big data research
		Zhong Qiuzi, Yu Ning, Li Gaofeng, Xiu Xia, Ma Wenping
		Objective To retrospectively analyze the safety of anti-radiation injury drug of Andorin using real-world big data. Methods A total of 87 053 hospitalized cancer patients receiving radiotherapy from 2015 to 2017 were analyzed. Ten medical institutions with the largest number of patients treated with Andorin capsules were screened. Patients with 5 types of cancer including lung cancer, cervical cancer, nasopharyngeal carcinoma, breast cancer and colorectal cancer with/without use of Andorin capsule were subject to propensity score matching (PSM). The safety of Andorin capsule as an adjuvant drug in the radiotherapy for cancer patients was evaluated by the Results of blood biochemical detection and liver and kidney function test. Results In the relevant indexes of liver function, the AST and TBIL levels in the lung cancer patients with use of Andorin capsule were significantly lower than those in their counterparts without use of Andorin capsule (22.1 U/L vs.24.7 U/L,P=0.04 and 9.8 mmol/L vs.11.4 μmol/L, P=0.01),but all the Results were within the normal range. In patients with cervical cancer, the ALT level in patients treated with Andorin capsule was considerably higher than that in those without use of Andorin capsule (24.7 U/L vs.21.1 U/L,P=0.01) and both the Results were within the normal range. In terms of the renal function-related indexes, CRE and UREA were similar between patients with and without use of Andorin capsule in 5 types of tumors (P=0.09-0.86). In patients with cervical and colorectal cancer, the LDH in patients with Andorin capsule was significantly lower compared with that in those without use of Andorin capsule (P=0.04,0.00),but both the Results were within the normal range. Regarding the nutrition-related indexes, the TB level in breast cancer patients with use of Andorin capsule was significantly higher than that in those without use of Andorin capsule (69.4 g/L vs.67.1 g/L, P=0.030), but both the Results were within the normal range. Conclusion As the first anti-radiation traditional Chinese medicine in China, Andorin capsule is utilized as an adjuvant drug for radiotherapy, which yields no significant liver and kidney toxicity and possesses high safety.
		2019 Vol. 28 (7): 481-485 [Abstract] ( 345 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head And Neck Tumors

	486	Treatment modalities and clinical prognosis of 46 patients with nasopharyngeal adenoid cystic carcinoma
		Sun Meng, Wang Kai, Qu Yuan, Zhang Shiping, Yi Junlin, Li Suyan, Xiao Jianping, Gao Li, Xu Guozhen, Huang Xiaodong, Luo Jingwei
		Objective To analyze the clinical treatment modalities and clinical prognosis of patients diagnosed with primary nasopharyngeal adenoid cystic carcinoma (NACC). Methods The medical records of 46 patients with NACC between March 1971 and November 2015 were retrospectively analyzed. Among them, 22 patients were male and 24 female. The median age of all patients was 47 years (range:23-74 years). Among them,34 patients received radiotherapy alone including 25 patients treated with conventional radiotherapy and 9 receiving intensity-modulated radiation therapy (IMRT). Five patients underwent salvage surgery for the residual tumors after radiotherapy. Twelve patients were treated with a comprehensive treatment modality (surgery combined with radiotherapy). Results The median follow-up time was 66.0 months (range:11.0-270.6 months). The 5-and 10-year overall survival, locoregional failure-free survival, and distant metastasis failure-free survival rates were 70% and 40%,64% and 47%,70% and 62%,respectively. In the radiotherapy alone group,12(35%) cases obtained complete response,13 had partial response and 9 remained stable after radiotherapy. The 5-year overall survival and locoregional failure-free survival rates in the radiotherapy alone and combined therapy groups were 69% and 74%,63% and 66%, respectively (all P>0.05). Conclusion The course of NACC is relatively slow. Radiotherapy is recommended for patients with high sensitivity towards radiotherapy. Salvage surgery is feasible for those who are insensitive to radiotherapy or with residual tumor after radiotherapy.
		2019 Vol. 28 (7): 486-489 [Abstract] ( 399 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	490	Effect of tumor length on clinical stage for non-operative esophageal squamous cell carcinoma patients—multicenter retrospective data analysis (3JECROG R-01D)
		Zhou Zhiguo, Wang Xin, Wang Lan, Chen Junqiang, Zhang Wencheng, Wang Xiaomin, Ge Xiaolin, Shen Wenbin, Hu Miaomiao, Yuan Qianqian, Xu Yonggang, Hao Chongli, Qie Shuai, Lu Na, Pang Qingsong, Wang Ping, Zhao Yidian, Sun Xinchen, Zhang Kaixian, Li Gaofeng, Li Ling, Liu Miaoling, Wang Yadi, Li Chen, Zhu Shuchai, Xiao Zefen, Han Chun, Qiao Xueying
		Objective To retrospectively analyze the effect of tumor length on the prognosis in stage Ⅱ/Ⅲ esophageal squamous cell carcinoma (ESCC) patients treated with definitive radiotherapy and to evaluate the role of tumor length in clinical stage for non-operative ESCC patients. Methods The data of 2 086 ESCC patients who were treated with definitive radiotherapy from 2002 to 2016 in 10 hospitals (3JECROG) were analyzed. The effect of tumor length on overall survival (OS) was analyzed and stratified analysis of tumor length was done in different stages of ESCC. Results The median OS and median progression-free survival (PFS) time of the whole group were 25.6 months and 18.2 months respectively. The Cox multivariate analysis showed that treatment mode,age,clinical stage and tumor length were independent prognostic factors. The median,1-,3-,and 5-year OS were 28.9 months,77.3%,45.0%,and 36.3% versus 21.9 months,69.9%,37.9%,and 28.1% for patients with ≤5 cm and patients>5 cm respectively (P<0.05). For stage Ⅱ patients,the median OS were 42.1 and 38.9 months respectively in ≤5 cm group and>5 cm group (P=0.303). And for stage Ⅲ patients,the median OS were 23.9 and 19.3 months respectively in ≤5 cm group and>5 cm group (P<0.001). The median OS with N1was 24.1 and 18.4 months,respectively in≤5 cm group and>5 cm group (P<0.001). Conclusions The tumor length was an independent prognostic factor for stage Ⅱ/Ⅲ patients treated definitive radiotherapy. The tumor length may be helpful in clinical staging of ESCC,especially for stage Ⅲ and N1.
		2019 Vol. 28 (7): 490-494 [Abstract] ( 352 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	495	Observation of short-term clinical efficacy and adverse reactions with stereotactic radiotherapy in locally recurrent non-small cell lung cancer
		Xu Xiuli, Hu Zongtao, Lu Donghui, Gao Shile
		Objective To investigate the short-term clinical efficacy and adverse reactions of stereotactic radiotherapy (SRT) in the treatment of locally recurrent non-small cell lung cancer (NSCLC). Methods Clinical data of 120 cases of recurrent NSCLC after radiotherapy admitted to our hospital from October 2009 to October 2015 were retrospectively analyzed. SRT was adopted for further radiotherapy. The prescription dose was 50% dose curve surrounding the target area. The total dose was 40-50 Gy, with a single dose of 4-5 Gy for 8-12 times. The chest CT was re-examined every 2 months after radiotherapy. The short-term clinical efficacy and adverse reactions were evaluated. The changes of Karnofsky performance score (KPS) and quality of life (QOL) were recorded before and after radiotherapy. Results One patient terminated the radiotherapy due to grade 3 acute radiation-induced pneumonia,25 patients (21.0%) obtained complete remission (CR), 61 cases (51.3%) of partial remission (PR), 19 cases (16.0%) of stable disease (SD), 14 cases (11.8%) of progress disease (PD), 86 cases (72.3%) of objective remission rate (CR+PR), and 105 cases (88.2%) of disease control (CR+PR+SD), respectively. Thirty-one patients experienced radiation-induced pneumonia, 23 cases of radiation-induced myelosuppression and 1 case of acute radiation-induced heart injury. All these adverse reactions were mitigated after symptomatic treatment. The KPS was significantly increased from 68.16±15.22 before SRT to 78.39±11.50 after SRT (P<0.05). The QOL was considerably elevated from 27.58±5.37 prior to SRT to 38.16±8.39 following SRT (P<0.01). Conclusion SRT is an efficacious and safe treatment of locally recurrent NSCLC, which yields controllable and tolerable adverse reactions and enhances the QOL of patients.
		2019 Vol. 28 (7): 495-498 [Abstract] ( 343 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	499	Therapeutic value of thoracic radiotherapy in elderly patients with extensive-stage small cell lung cancer
		Qi Jing, Xu Liming, Luo Jing, Sun Jian, Wang Xin, Zhao Lujun
		Objective To evaluate the effect of thoracic radiotherapy (TRT) on the prognosis of elderly patients with extensive-stage small cell lung cancer (ES-SCLC). Methods Clinical data of 83 patients aged≥65 years diagnosed with metastatic ES-SCLC admitted to our hospital from 2010 to 2016 were retrospectively analyzed. All enrolled patients received etoposide plus cisplatin or carboplatin as the standard regimen for chemotherapy. After the propensity score matching (PSM), 70 cases were either assigned into the TRT (n=35) or non-TRT groups (n=35). Among them, 56 patients were male and 14 female. The median age was 69 years (range:65-85 years). The median chemotherapy cycle was 4 cycles (range:1-11 cycles). The median chest irradiation dose was 50 Gy (range:30-60 Gy). Overall survival (OS), progression-free survival (PFS) and local recurrence-free survival (LRFS) were regarded as end-point of observation. The survival rate was calculated by using Kaplan-Meier method and statistically compared between two groups by using Log-rank test. Multivariate prognostic analysis was performed using Cox regression model. Results For all patients, the 1-year OS, PFS and LRFS rates were 40%, 16% and 21%, respectively. Patients undergoing TRT obtained better survival outcomes than their counterparts without TRT:the 1-year OS, PFS and LRFS were 52% vs.29%(P=0.005), 30% vs.3%(P<0.001), 38% vs. 6%(P<0.001), respectively. Furthermore, TRT did not increase the incidence of adverse reactions in elderly patients (P=0.690). Conclusion The addition of TRT for elder ES-SCLC patients can significantly improve the rate of chest tumor control and prolong the survival time, which is worthy of further validation by prospective studies with large sample size.
		2019 Vol. 28 (7): 499-504 [Abstract] ( 350 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	505	Effect of different nutritional support methods on esophageal cancer patients receiving radiotherapy
		Cheng Guowei, Sun Li, Zhang Tao, Chen Ping, He Xiangling, Su Dan, Xi Hengzhi, Zang Dingqi
		Objective To compare the effect of nutritional support with and without tube feeding on the incidence of adverse reactions in radiotherapy for esophageal cancer. Methods A total of 120 esophageal cancer patients with high-risk factors receiving radiotherapy were selected and randomly assigned into the tube feeding (TF,n=60) and non-tube feeding groups (NTF,n=60) according to the random number method. Nutritional interventions were performed during radiotherapy in both groups. The incidence of esophagitis and myelosuppression,pulmonary infection,nutritional status and the completion of radiotherapy were observed and statistically compared between TF and NTF groups. Results In the TF group,the incidence of ≥ grade 2 esophagitis was lower than that in the NTF group. The incidence of grade 3 esophagitis significantly differed between two groups (P<0.05). The incidence of grade 1-2 myelosuppression did not differ between two groups,whereas the incidence of grade 3 myelosuppression in the TF group was significantly lower than that in the NTF group (P<0.05). In the TF group,the incidence of pulmonary infection was remarkably lower than that in the NTF group (P<0.05). The changes of BMI and prealbumin in the TF group were better than those in the NTF group (both P<0.05). One patient in the NTF group failed to complete the radiotherapy due to grade IV esophagitis,and 5 cases in the NTF group (P<0.05). In the TF group,the length of hospital stay was significantly shortened by 6.2 d on average (P<0.05). Conclusions During radiotherapy for esophageal cancer patients with high-risk factors,nutritional support with tube feeding can effectively reduce the incidence of adverse reactions,improve the completion rate of treatment,and shorten the average length of hospital stay.
		2019 Vol. 28 (7): 505-508 [Abstract] ( 358 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	509	Efficacy and safety between brachytherapy combined with external beam radiation therapy and external beam radiation therapy alone for prostate cancer:a meta-analysis
		Jia Pengfei, Zhou Xiaoxi, Ji Bin, Zhao Hui
		Objective To systematically evaluate the efficacy and safety of brachytherapy (BT)combined with external beam radiation therapy (EBRT) and EBRT alone for prostate cancer. Methods Databases including PubMed, Web of Science, Cochrane Library, CNKI, WanFang Data and VIP were searched from the inception to July 2018 to collect the clinical trials which comparatively analyzed the efficacy and safety between EBRT plus BT and EBRT alone for prostate cancer. According to the inclusion and exclusion criteria, data of the included studies were extracted and the methodological quality was evaluated. Then, a meta-analysis was performed using RevMan 5.3. Results Ten studies of 23 393 patients were included, in which 6 were randomized controlled trials (RCTs) and the other 4 were non-RCTs.The 3-year biochemical progression-free survival (b-PFS)[OR=2.03(95%CI:1.11 to 3.73),P=0.02]and the 5-year b-PFS of intermediate-risk patients[OR=2.27(95%CI:1.49 to 3.45),P<0.01] in the EBRT+BT group were significantly higher compared with those in the EBRT group. The 3-and 5-year b-PFS, 5-year overall survival and 5-year metastasis-free survival did not differ between two groups. in the incidence of ≥grade 2 acute[OR=1.44(95%CI:1.11 to 1.38),P<0.01] and chronic genitourinary adverse reactions[OR=3.06(95%CI:1.37 to 6.80), P<0.01],≥grade 3 acute[OR=1.75(95%CI:1.14 to 2.69), P=0.01] and chronic genitourinary adverse reactions[OR=3.41(95%CI:2.42 to 4.82), P<0.01] in the EBRT group were significantly lower than those in the EBRT+BT group. The incidence of gastrointestinal adverse reactions did not significantly differ between two groups. Conclusion Compared with EBRT alone, EBRT combined with BT can effectively improve the 3-and 5-year b-PFS, whereas increase the incidence of genitourinary adverse reactions for patients with intermediate-risk prostate cancer.
		2019 Vol. 28 (7): 509-513 [Abstract] ( 347 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	514	Efficacy and safety of high-dose versus conventional-dose conventionally fractionated external beam radiotherapy for stage T1b-4N0-1M0 prostate cancer:a meta-analysis
		Wang Hui, Xie Ruilin, Qin Qingwei, Li Na, Wang Sheng, Zhao Xue, Qin Zhaohui, Yao Yuanhu
		Objective To systematically evaluate the clinical efficacy and safety between high-dose (74 to 80 Gy) and conventional-dose (64.0 to 70.2 Gy) conventionally fractionated external beam radiotherapy for stage T1b-4N0-1M0 prostate cancer in this meta-analysis. Methods A literature search was performed in PubMed,Embase,Cochrane Library,Web of Science,CBM,Wanfang Data,CNKI and Chongqing VIP to collect clinical trials on high-dose versus conventional-dose conventionally fractionated external beam radiotherapy of prostate cancer from the inception to July 1, 2018. The included literatures were evaluated by Cochrane quality evaluation criteria and subject to meta-analysis by using Review Manager 5.3 statistical software. Results A total of 7 randomized controlled clinical trials involving 4 132 patients were included in the meta-analysis. The meta-analysis showed that the high-dose and conventional-dose groups yielded similar 10-year overall survival (RR=1.01,95%CI:0.96 to 1.07,P=0.64) and 10-year prostate cancer-specific survival (RR=1.01,95%CI:0.98 to 1.03,P=0.47). The biochemical failure rate in the high-dose group was significantly lower than that in the conventional-dose group (RR=0.78,95%CI:0.70 to 0.86,P<0.01). Compared with the conventional-dose group,the incidence of late grade ≥2 gastrointestinal and genitourinary adverse reactions (RR=1.48,95%CI:1.31 to 1.67,P<0.01;RR=1.35,95%CI:1.06 to 1.73,P=0.02) was significantly higher in the high-dose group. Conclusion High-dose conventionally fractionated external beam radiotherapy has advantages in reducing the biochemical failure rate of patients with stage T1b-4N0-1M0 prostate cancer. Nevertheless, whether it can improve overall survival and prostate cancer-specific survival remains to be validated. High-dose radiotherapy also induce a higher incidence rate of late grade ≥2 gastrointestinal and genitourinary adverse reactions compared with conventional-dose radiotherapy.
		2019 Vol. 28 (7): 514-517 [Abstract] ( 326 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	518	Preliminary analyses of efficacy and safety of Cyberknife stereotactic body radiotherapy for 26 patients with recurrent cholangiocellular carcinoma after surgery
		Liu Zhuang, Qiu Minghan, Wu Zhiqiang, Meng Maobin, Wang Huanhuan, Wang Zhongqiu, Dong Yang, Yuan Zhiyong, Wang Ping
		Objective To evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) using Cyberknife in the treatment of patients with recurrent cholangiocellular carcinoma (RCC) after surgery. Methods Clinical data of 26 patients with recurrent RCC after surgery undergoing Cyberknife SBRT from 2010 to 2015 were retrospectively analyzed. The median recurrence time was 10 months (range 2.0-63.0 months) and the median tumor diameter was 2.8 cm (range 1.2-4.8 cm). The median prescription dose/fraction was 45 Gy/5f (range 40-50 Gy/3-8 f). The tumor progression was evaluated based on enhanced CT or MRI. Overall survival (OS),progression-free survival (PFS) and local control rate (LC) were analyzed by Kaplan-Meier method. Toxicity was assessed using the common terminology criteria for adverse events version 4.0. Results For the entire cohort, the median OS and PFS were 13.5 months and 6.5 months at a median follow-up of 29.3 months (range 2.1-62.0 months). The 1-and 2-year OS and PFS rates were 52% and 21% as well as 28% and 15%,respectively. Among them,4 patients (4/26,15%) were recurrent in situ after SBRT. Three patients experienced grade Ⅲ adverse reactions including 1 case of gastrointestinal reaction, 1 case of liver dysfunction and 1 case of biliary tract infection. Only 1 patient suffered from ≥grade IV gastrointestinal bleeding during the advanced stage. Conclusions SBRT using Cyberknife is a safe and effective treatment for patients with recurrent RCC after surgery. The adverse reactions can be tolerated by patients.
		2019 Vol. 28 (7): 518-521 [Abstract] ( 388 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	522	Clinical efficacy of HDR brachytherapy with concomitant complementary IMRT boost for bulky uterine cervical cancer
		Lu Shun, Fan Zixuan, Sun Chang, Tan Mingyu, Zhang Hanyi, Feng Mei, Yin Jun, Yin Gang, Li Jie, Lang Jinyi
		Objective To investigate the clinical outcomes of patients with locally advanced uterine cervical cancer (UCC) treated by 3-dimensional high dose rate-intracavitary brachytherapy (3D HDR-ICBT) combined with complementary applicator-guided external beam radiotherapy (EBRT). Methods A total of 120 patients pathologically diagnosed with locally advanced UCC (tumors with a maximum diameter≥6 cm or≥5 cm complicated with eccentric tumor growth) treated with concurrent chemoradiotherapy (CCRT) from June 2010 to June 2015 were recruited. Five fractions of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy were performed. The prescribed dose for HR-CTV and IR-CTV was 7 Gy(D90) and 5-6 Gy(D90). The rectum, sigmoid colon, bladder and adjacent small intestine were delineated as the organs at risk. Intensity-modulated radiation therapy (IMRT) was used for EBRT (45 Gy/25f) combined with cisplatin-based chemotherapy every three weeks (75 mg/m²). Results The median follow-up time was 46 months (14-96 months). The 5-year local control rate (LCR),disease-free survival (DFS),and overall survival (OS) were 92.8%,76.6% and 81.0%,respectively. The incidence rate of grade I-Ⅱ genitourinary and gastrointestinal acute toxicities were 57.8% and 14.6%, whereas 8.1% and 2.9% for grade Ⅲ toxicities. The incidence rate of later grade Ⅰ-Ⅱ genitourinary and gastrointestinal toxicities were 8.4% and 5.3%, and 0.97% and 1.3% for grade Ⅲ late toxicities. Conclusions The combination of HDR-ICBT with an applicator-guided IMRT (ICBT+IMRT) yields low incidence of severe adverse events, relatively high LC and OS rate for locally advanced UCC. It is an efficacious comprehensive treatment of locally advanced bulky UCC.
		2019 Vol. 28 (7): 522-526 [Abstract] ( 394 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominnal Tumors

	527	Study on the sensitivity of different 3D detectors to MLC positioning errors in volumetric modulated arc therapy (VMAT) plan for nasopharyngeal carcinoma
		Zhang Peng, Yan Bing, Xue Xudong, Wu Aidong
		Objective To compare the sensitivity of Delta⁴ and ArcCHECK 3D detectors to detect the multi-leaf collimator (MLC) positioning errors in the dose verification of volumetric modulated arc therapy (VMAT) plans for nasopharyngeal carcinoma (NPC). Methods Ten NPC patients receiving VMAT plans were selected. The positioning error of 0.5-4.0 mm was introduced into the leaves of each MLC segment in the original file to expand,contract or shift the whole segments. The possible positioning errors of MLC in the treatment of VMAT were simulated. The Delta⁴ and ArcCHECK were utilized to verify the measurements. The absolute gamma passing rate was compared between the calculated dose and the measured dose of the VMAT plan by using the paired t-test. Results When the evaluation criterion was taken as 3 mm/3%,the absolute passing rate verified by the original plans of two detectors was greater than 95%. The positioning errors of MLC expansion,contraction and shifting detected by Delta⁴ and ArcCHECK were 1.5 mm,1.0 mm,2.0 mm and 3.0 mm,1.0 mm,and 3.0 mm,respectively. When taking 2 mm/2% as the evaluation criterion,the absolute passing rate verified by the original plan was decreased significantly. Delta⁴ and ArcCHECK detected that the positioning errors of MLC expansion,contraction and shifting were 1.0 mm,1.0 mm,2.0 mm and 1.5 mm,0.5 mm,and 2.0 mm,respectively. Conclusions The dose verification of the VMAT plan for NPC by Delta⁴ and ArcCHECK can detect different types and sizes of MLC positioning errors,whereas the detection sensitivity slightly differs between Delta⁴ and ArcCHECK. Both of them are not sensitive to detect the MLC positioning errors less than 1.0 mm. It is fairly necessary to strengthen the quality assurance of MLC in the daily work.
		2019 Vol. 28 (7): 527-531 [Abstract] ( 438 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	532	Study of setup error in cone beam CT for whole breast intensity-modulated radiotherapy with breast board immobilization
		Yu Shufei, Wang Shulian, Tang Yu, Song Yongwen, Chen Siye, Li Minghui, Jin Jing, Liu Yueping, Fang Hui, Chen Bo, Qi Shunan, Li Ning, Tang Yuan, Lu Ningning, Li Yexiong
		Objective To investigate the setup errors and influencing factors of the whole breast intensity-modulated radiotherapy (IMRT) after breast-conserving surgery, and to identify the margins from clinical target volume (CTV) to planning target volume (PTV). Methods Thirty patients with left-sided (n=15) or right-sided breast cancer (n=15) receiving whole breast hypofractionated IMRT with breast board immobilization after breast-conserving surgery in Cancer Hospital from 2016 to 2017 were enrolled. The kilo-voltage cone-beam computed tomography (CBCT) was used to compare the errors of planning CT and treatment unit and determine the setup errors. The margins from CTV to PTV were calculated. The setup errors under different conditions were statistically compared by t-test. Results A total of 151 sets of CBCT images were taken in the whole cohort,(5.0±1.3) sets per patient on average. The setup errors in the x-axis (left-right direction), y-axis (cranial-caudal direction) and z-axis (anterior-posterior direction) were (2.2±1.7) mm,(3.1±2.5) mm and (3.3±2.3) mm, respectively. The margins from CTV to PTV were 6.39 mm, 10.00 mm and 8.57 mm, respectively. The setup error in anterior-posterior direction in the first week was (3.7±2.5) mm, significantly larger than (2.6±1.6) mm in the following week (P=0.002). The setup error of the patients with overweight or obesity was (3.9±2.6) mm, significantly higher than (2.9±2.0) mm in those with normal weight in the z-axis direction (P=0.033). Conclusion The margins from CTV to PTV are recommended to be ranged from 6 to 10 mm during hypofractionated whole breast IMRT with breast board immobilization after breast-conserving surgery. More frequent imaging verification should be applied in the first week of IMRT.
		2019 Vol. 28 (7): 532-535 [Abstract] ( 517 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	536	The study of automatic treatment planning of prostate cancer based on DVH prediction models of organs at risk
		Zhou Jieping, Peng Zhao, Song Yuchen, Pei Xi, Sheng Liusi, Wu Aidong, Zhang Hongyan, Qian Liting, Xu Xie
		Objective To evaluate the feasibility of utilizing dose-volume histogram (DVH) prediction models of organs at risk (OARs) to deliver automatic treatment planning of prostate cancer. Methods The training set included 30 cases randomly selected from a database of 42 cases of prostate cancer receiving treatment planning. The bladder and rectum were divided into sub-volumes (Ai) of 3 mm in layer thickness according to the spatial distance from the boundary of planning target volume (PTV). A skewed normal Gaussian function was adopted to fit the differential DVH of Ai,and a precise mathematical model was built after optimization. Using the embedded C⁺⁺ subroutine of Pinnacle script,the volume of each Ai of the remaining validation set for 12 patients was obtained to predict the DVH parameters of these OARs,which were used as the objective functions to create personalized Pinnacle script. Finally,automatic plans were generated using the script. The dosimetric differences among the original clinical planning,predicted value and the automatic treatment planning were statistically compared with paired t-test. Results DVH residual analysis demonstrated that predictive volume fraction of the bladder and rectum above 6 000 cGy were lower than those of the original clinical planning. The automatic treatment planning significantly reduced the V70,V60,V50 of the bladder and the V70 and V60 of the rectum than the original clinical planning (all P<0.05),the coverage and conformal index (CI) of PTV remained unchanged,and the homogeneity index (HI) was slightly decreased with no statistical significance (P>0.05). Conclusion The automatic treatment planning of the prostate cancer based on the DVH prediction models can reduce the irradiation dose of OARs and improve the treatment planning efficiency.
		2019 Vol. 28 (7): 536-542 [Abstract] ( 516 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	543	A fast quality assurance method for three-dimensional Afterloading treatment plan
		Ji Tianlong, Zhao Jing, Shen Hao, Li Guang
		Objective To study the relationship between tumor size,source intensity,prescription dose and source dwell time in the after-loading treatment plan,and to establish a method that can be used for rapid quality control of after-loading plans.Methods The all of gynecological cancer patients treated in this hospital were selected:84 cases of all three tubes of Fletcher applicator,58 cases of uterine alone and 39 cases of vaginal applicator. Each patient was scanned with CT before treatment. Contouring the target and organs at risk,the treatment plan was optimized using IPSA. Record the source strength,prescription dose,source dwell time,and tumor volume of the prescribed dose for each case. Calculate CI values and Rv. The k-value analyzes the CI distribution characteristics and the correlation with the Rv value. In addition,46 cases of gynecologic tumor patients were used to verify the method.Results The fitting index of the after-loading scheme of the three applicators showed a normal distribution. The mean value of the Fletcher applicator CI was 0.720±0.067,the k value was 1 394,Rvalue was 0.894. The mean value of the uterine alone CI was 0.697±0.076,the k value was 1 428,R=0.940,the mean value of the vaginal applicator CI was 0.742±0.067,the k value was 1 362,and R=0.909.Conclusions Using this method,it can quickly assess whether the planned target volume,radiation source intensity,prescription dose and treatment time match,and find the cause of deviation based on the feedback Results to ensure that the after-loading treatment plan can be quickly,accurately,and efficiently implemented according to clinical requirements.
		2019 Vol. 28 (7): 543-546 [Abstract] ( 339 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	547	The role of magnetic resonance imaging in radiation therapy for breast cancer
		Jin Meng, Hou Xiaorong, Zhang Fuquan
		In recent years, along with the clinical exploration and application of magnetic resonance simulation localization and radiotherapy equipment, more and more studies have been performed to focus on the excellent ability of MRI in identifying soft tissues, aiming to explore the potential application value of magnetic resonance imaging (MRI) in radiotherapy for breast cancer patients. In this article,the research progress on MRI in radiotherapy after breast-conserving surgery was reviewed to provide certain ideas and references for subsequent research.
		2019 Vol. 28 (7): 547-550 [Abstract] ( 360 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	551	Research progress on target delineation for radiotherapy in hepatocellular carcinoma with
		Lin Haimin, Liu Chengxin, Han Dali, Yu Jinming
		Modern medical imaging techniques, such as computed tomorgraphy (CT), magnetic resonance imaging (MRI) and position emission tomorgraphy/computed tomorgraphy (PET-CT) can accurately delineate the gross target volume (GTV) of hepatocellular carcinoma (HCC). Comparison of postoperative pathological subclinical lesions, imaging and clinical parameters contributes to the precise delineation of clinical target volume (CTV). Moreover, radiotherapy-assisted techniques, such as four-dimensional computed tomography (4DCT), compression of abdomen, active breathing control and respiratory gating, can minimize the internal target volume (ITV). In addition, immobilization with vacuum cushion and body membrane can reduce the set-up error,minimize the planning target volume (PTV) and avoid or decrease the irradiation error or missing irradiation. All these approach can minimize the target volume, elevate the dose and reduce the complications during radiotherapy for HCC. In this article, the research progress on the target delineation for external beam radiotherapy in HCC patients was reviewed.
		2019 Vol. 28 (7): 551-554 [Abstract] ( 320 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	555	Nutritional treatment of radiotherapy-induced mucosal injury
		Wang Shuan, Wang Kongcheng, Yuan Li, Xu Ping, Yan Jing
		Mucosal injury is the most common complication of radiotherapy for head and neck neoplasms. The relevant symptoms include oral pain, dysphagia, decreased diet intake, and secondary infection, which can lead to the interruption of treatment and even affect the clinical efficacy and quality of life. Wound repair depends on nutrition supply. Inappropriate nutrition plan may affect the healing process. Therefore, proper nutritional strategy plays a pivotal role in promoting the healing of mucosal injury. Based on current researches on radiotherapy-induced mucosal injury and the effect of nutrients on wound healing, the epidemiology, pathophysiology, clinical manifestations and nutritional therapy for radiotherapy-induced mucosal injury were reviewed, aiming to provide references for clinical practice.
		2019 Vol. 28 (7): 555-558 [Abstract] ( 292 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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