Objective To explore the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in the early diagnosis of cervical lymph node recurrence after radiotherapy of nasopharyngeal carcinoma, aiming to provide reference for targeted diagnosis and treatment of these patients. Methods The MR-DWI features of 17 patients with recurrent cervical lymph nodes after radiotherapy from 2005 to 2016 were retrospectively analyzed. The results of diagnosis and treatment after lymph node recurrence were summarized. Results The recurrent lymph nodes of 17 patients showed a high signal or mixed signal on MR-DWI images. The sensitivity of MR-DWI and T2WI fat suppression sequence was 100% and 60%. Positron emission tomography-computed tomography (PET-CT) or biopsy was performed to validate the diagnosis in patients with highly suspected single cervical recurrence. Besides, surgical treatment yielded better clinical prognosis. Conclusions MR-DWI is highly sensitive to recurrent cervical lymph nodes of nasopharyngeal carcinoma after radiotherapy,especially for the small lymph nodes of 5-10 mm in diameter,which are easily ignored. PET-CT examination should be performed, the nature of the lymph nodes should be confirmed by multi-modality imaging diagnosis,and timely operation has important clinical significance in improving the therapeutic effect and quality of life for patients with cervical lymphnode recurrence.

Objective To explore the impact of oral nutritional supplements in the local advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy. Methods From 2016 to 2018, we prospectively collected 114 patients into our study, including intervention group (n=58) and control group (n=56).Patients in the intervention group were given oral nutritional supplements from the beginning of radiotherapy, while the control group patients were receiving usual diet care. We collected data of weight, hematological index and nutrition related information before, during and after treatments. Results All patients experienced weight loss during radiotherapy. The declining trend was more obvious in intervention group but with no statistical difference (P>0.05). Radiotherapy interruption was lower, completion rateof2 cycles of concurrent chemotherapy was higher(78% vs 64%, P=0.02)and level of total serum protein and albumin was more stable (P=0.003,0.001) in the intervention group. No difference was found in acute toxicities between the two groups (P>0.05). During the treatment period, the nutrition risk screening score declined, more patients with NRS 2002 ≥3 in the control group than the intervention group (P<0.05), while no statistically significant difference was found in PG-SGA between the two groups (P>0.05). Conclusions Oral nutritional supplements can improve treatment tolerance and keep the stability of serum protein level, nevertheless, it has no obvious advantage in maintenance of weight and short-term nutritional status

Objective To comparatively analyze the acute adverse reactions of helical tomotherapy (HT) and intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods A total of 100 NPC patients treated with radiotherapy were selected and divided into the HT group (n=50) and IMRT group (n=50). All patients were treated with concurrent chemoradiotherapy. The prescription dose of radiotherapy was DT68.2-73.8 Gy/30-34F. The severity of acute adverse reactions of skin, oral mucosa, salivary glands and esophagus was evaluated with the established RTOG criteria. The differences between two groups were evaluated by paired t-test. Results The dose of organs at risk (OARs) in the HT group was significantly lower than that in the IMRT group (P<0.05),whereas the dose of target area of PTVnx, PTVnd (left) and PTVnd (right) did not significantly differ between two groups (all P>0.05). In the HT group, the incidence rate of grade 0-3 acute adverse reactions in the skin, oral mucosa, salivary glands and esophagus were (14%,68%,18%,0%),(10%,54%,36%,0%),(0%,74%,26%,0%) and (10%,60%,28%,2%), respectively. In the IMRT group, the corresponding results were (0%,52%,48%,0%),(0%,58%,42%,0%),(0%,28%,72%,0%) and (0,40%,60%,0%), respectively. The severity of acute adverse reactions of skin, salivary glands and esophagus in the HT group was slighter than those in the IMRT group (all P<0.05), the acute adverse reactions in the oral mucosa were similar between two groups (P>0.05). In the HT group, the onset time of acute adverse reactions in the skin was later than that in the IMRT group (P<0.05), and the onset time of other adverse reactions was similar between two groups (all P>0.05). Conclusions Both HT and IMRT can meet the requirements of the dose distribution in the target area for NPC, whereas HT is superior to IMRT in terms of the protection of OARs protection, the severity and onset time of acute adverse reactions.

Objective To comparatively evaluate the clinical efficacy and adverse events of chemoradiotherapy combined with/without radioactive iodine-125(125-I) implantation for locally advanced non-small cell lung cancer. Methods With locally advanced non-small cell lung cancer admitted to Department of Radiotherapy of Jianhu County People's Hospital and Yancheng Third People's Hospital from March 2014 to March 2015 of 38 patients were enrolledand randomly divided into the observation (chemoradiotherapy+ radioactive 125-I implantation, n=20) and control groups (chemoradiotherapy, n=18). All patients underwent conventional three-dimensional conformal radiotherapy and TC chemotherapy. In the observation group, 125-I implantation was performed at 3 months after chemoradiotherapy. The short-term clinical efficacy,progression-free survival,overall survival and adverse events were statistically compared between two groups. Results The total effective rate in the observation group was 85%,significantly higher than 56% in the control group (P=0.046). Until May, 2018,the progression-free survival rates in the observation and control groups were 65% and 61%(P=0.457),the overall survival rates were 32% and 26%,and the median survival time was 22.8(95%CI:20.5-23.5) and 21.3(95%CI:15.9-26.0) months (P=0.633). The incidence rates of adverse events in the observation and control groups were 45% and 78%(P>0.05). Conclusions Concurrent chemoradiotherapy combined with radioactive 125-I implantation yields high short-term efficacy in the treatment of locally advanced non-small cell lung cancer. It can prolong the long-term survival to certain extent and yield a low incidence rate of severe adverse events,which deserves to be validated by large sample-size investigations.

Objective To explore the role of radiotherapy in the treatment of primary central nervous system lymphoma. Methods Clinical data of 60 patients diagnosed with primary central nervous system lymphoma from September 2010 to December 2017 were retrospectively analyzed. Among them, 50 cases were diagnosed by histopathological examination after stereotactic biopsy or tumor resection and 10 patients were diagnosed by gadolinium enhanced magnetic resonance imaging (MRI). Fifty-two patients underwent chemotherapy,and 45 of them received methotrexate-based chemotherapy,25 received rituximab-based regimen. Twenty-seven patients were given with planned whole brain radiotherapy, while 33 patients were not. Salvage radiotherapy was delivered in 9 patients after treatment failure. Results The median follow-up time was 28 months (5-70 months). The median overall survival time and median progression-free survival time of the whole patients was 22 months (5-65 months) and 13 months (5-55 months), respectively. The 4-year overall survival rate and progression-free survival rate were 61% and 33%, respectively. The 4-year overall survival rates between patients with and without planned whole brain radiotherapy were 68% and 54%(P=0.083). The 4-year progression-free survival rates between patients with and without planned whole brain radiotherapy were 47% and 20%(P=0.014),respectively. Patients with and without salvage whole brain radiotherapy had a 4-year overall survival of 49% and 68%,respectively (P=0.398). Among patients who received whole brain radiotherapy,patients with a lower dose of ≤36 Gy had a similar overall survival compared with those with a higher dose of>36 Gy (80% vs. 45%,P=0.136). Conclusions Radiotherapy is part of the comprehensive treatment of primary central nervous system lymphoma. Planned radiotherapy may bring clinical benefits to patients during the comprehensive therapy. However,the irradiation dose to the whole brain should not be too high because of neurotoxicity.

Objective To investigate the quality of life,sexual quality of life and its influencing factors in cervical cancer patients undergoing radiotherapy. Methods Pre-menopausal patients of 87 cases were diagnosed with cervical cancer treated with radiotherapy at Peking Union Medical College Hospital from December 2013 to December 2018 were recruited in this study. The functional assessment of cancer therapy-cervix (FACT-Cx V4.0) and the female sexual function index (FSFI) were evaluated. Demographic and treatment data were collected. The influencing factors were analyzed by multiple linear regression analysis. Results The total score of quality of life was 114(100-126),19(16-21) for physiology,21(18-24) for social/family,19(17-21) for emotion,19(14-22) for function and 39(34-43) for additional attention,respectively. The end time of radiotherapy was the influencing factor of the total score (P=0.034),physiology (P=0) and function (P=0.008). Family was the influencing factor of social family dimension (P=0.010). The total score of FSFI was 8.0(5.0-20.5),1.8(1.2-3.0) for sexual desire,1.5(0-2.7) for sexual arousal,0.3(0-3.6) for vaginal lubrication,0(0-3.6) for orgasm,3.2(2-4) for satisfaction and 0(0-3.6) for sexual pain,respectively. The total score was less than 27 in 97%(84/87) of the patients and had sexual dysfunction. Age was the influencing factor of sexual arousal (P=0.005) and vaginal lubrication (P=0.039). Occupation was the influencing factor of sexual pain (P=0.004). Conclusions The quality of life of premenopausal patients with cervical cancer is affected by multiple factors. Radiotherapy-related complications should be actively treated to improve the quality of life and sexual life of patients.

Objective To investigate the radiation induced pulmonary fibrosis with a dose-response mouse model, based on the CT image changes of pulmonary fibrosis.Methods Female C57BL6 mice aged 8-10 weeks were randomly divided into 20 Gy or escalated doses of X-ray whole thoracic irradiation (WTI) groups.CT scan was performed at different time points before and after radiation. The average lung density and lung volume changes were obtained by three-dimensional segmentation algorithm. After gene chip and pathological validation,the parameters of CT scan were subject to the establishment of logistic regression model. Results At the endpoint of 24 weeks post-irradiation,the lung density in the 20 Gy irradiation group was (-289.81±12.06) HU,significantly increased compared with (-377.97±6.24) HU in the control group (P<0.001). The lung volume was (0.66±0.01) cm³ in the control group,significantly larger than (0.44±0.03) cm³ in the irradiated mice (P<0.001). The results of quantitative imaging analysis were in accordance with the findings of HE and Mason staining,which were positively correlated with the fibrosis-related biomarkers at the transcriptional level (all R²=0.75,all P<0.001). The ED50 for increased lung density was found to be (13.64±0.14) Gy (R²=0.99,P<0.001) and (16.17±4.36) Gy (R²=0.89,P<0.001) for decreased lung volume according to the logistic regression model. Conclusions Quantitative CT measurement of lung density and volume are reliable imaging parameters to evaluate the degree of radiation-induced pulmonary fibrosis in mouse models. The dose-response mouse models with pulmonary fibrosis changes can provide experimental basis for comparative analysis of high-dose hypofractioned irradiation-and half-lung irradiation-induced pulmonary fibrosis.

Objective To evaluate the effect of GOLPH3 on the proliferation, apoptosis and radiosensitivity of OE33 esophageal cancer cell line. Methods The expression levels of GOLPH3 mRNA and protein in the esophageal cancer cells and normal esophageal epithelial cells were detected by qRT-PCR and Western blot, respectively. The OE33 esophageal cancer cells were transfected with GOLPH3 siRNA and subject to irradiation treatment simultaneously. The cell proliferation was detected by MTT assay. The cell apoptosis was detected by flow cytometry. The radiosensitivity was assessed by cell cloning test. The expression levels of cleaved Caspase-3, Bax and cleaved Caspase-9 protein levels were quantitatively measured by Western blot. Results The expression levels of GOLPH3 mRNA and protein in the esophageal cancer cells were significantly higher than those in the normal esophageal epithelial cells (both P<0.05). GOLPH3 siRNA could obviously down-regulate the expression levels of GOLPH3 mRNA and protein in the OE33 esophageal cancer cells. The proliferation activity of esophageal cancer cells was decreased, whereas the apoptosis rate was increased and the expression levels of cleaved Caspase-3, Bax and cleaved Caspase-9 were up-regulated after down-regulating the expression of GOLPH3 or irradiation treatment (all P<0.05). After down-regulating the expression of GOLPH3 in the esophageal cancer cells treated with irradiation, the cell proliferation activity was more significantly decreased, whereas the apoptosis rate was elevated and the expression levels of cleaved Caspase-3, Bax and cleaved Caspase-9 were more evidently up-regulated (all P<0.05). In the irradiated OE33 esophageal cancer cells after down-regulating the expression of GOLPH³, the radiosensitization ratio of the cells was 1.673. Conclusions GOLPH3 is highly expressed in the esophageal cancer cells. Down-regulating the expression of GOLPH3 can increase the radiosensitivity, induce the apoptosis and inhibit the proliferation of OE33 esophageal cancer cells.

Objective To evaluate the effect of RNF2 gene knockdown in ECA109 cells on the radiosensitivity to esophageal cancer cell xenograft in nude mice. Methods Thirty-six male BALB/c/nu nude mice were randomly divided into 6 groups:control group, control+ irradiation group, NC group,NC+ irradiation group,RNF2 shRNA group and RNF2 shRNA+ irradiation group. The nude mouse models with transplanted tumors were established by subcutaneous inoculation of EAC109 cells and given with irradiation at a dose of 3 Gy for 5 times. The longest (a) and shortest (b) diameters of the transplanted tumor were measured every 2 to 3 day sincethe fourteenth dayafter inoculation. The time of tumor formation was recorded. The tumor volume was calculated according to the formula (ab²/2). The growth curve was delineated. Three nude mice were sacrificed in each group at 24 h after the initial irradiation. The expression of RNF2 at the mRNA and protein levels in transplanted tumor tissues was measured by qRT-PCR and immunohistochemistry, respectively. The growth and tumor volume of the other nude mice in each group were observed. The cell apoptosis of transplanted tumor tissues was detected by TUNEL assay. The expression of Bcl-2 and Bax at the mRNA and protein levels in transplantated tumor tissues was quantitatively measured by qRT-PCR and immunohistochemistry, respectively. Results The tumor growth rate was the highest in the control and NC groups. The knockdown of RNF2 reduced the growth rate of xenografts and the tumor growth rate was the slowest in the RNF2 shRNA+ irradiation group (P<0.05). TUNEL assay revealed that the cell apoptosis rates in all groups were significantly increased after irradiation (all P<0.05). Before and after irradiation, the apoptosis rate in the RNF2 shRNA group was markedly higher than those in the control and NC groups (both P<0.05). Prior to irradiation, the expression levels of RNF2 mRNA and protein in the RNF2 shRNA group were significantly lower compared with those in the control and NC groups (all P<0.05), and the tendency became more significant after irradiation. Compared with the control and NC groups, the expression levels of Bcl-2 mRNA and protein were significantly down-regulated in the RNF2 shRNA group before and after irradiation (all P<0.05), whereas those of Bax mRNA and protein were considerably up-regulated (all P<0.05). Conclusions In vivo experiment demonstrates that RNF2 knockdown effectively increases the radiosensitivity of esophageal carcinoma EAC109 cells in nude mouse models with transplanted tumors, which is intimately associated with inducing the cell apoptosis.

Objective To evaluate the clinical application value of a novel immobilization system in total marrow irradiation (TMI) with MVCT image. Methods From 2016 to 2017,a retrospective analysis of the setup errors of 22 patients receiving TMI in two groups(twelve patients were immobilized with the novel immobilization system in group 1, ten patients were immobilized with the combinatorial immobilization devices in group 2) was performed in this study on Zhongnan Hospital of Wuhan University. Two-sample t-test was used to analyze the differences of setup errors and the consistency of setup between two groups. Results In group 1,the setup errors on left-right,superior-inferior,anterior-posterior and rotation directions were (1.06±0.79),(1.34±0.66),(2.45±1.48) mm and (0.63°±0.65°) for the head and neck position,(1.58±1.13),(2.38±1.99),(2.05±1.68) mm and (0.31°±0.32°) for the chest position,(1.67±1.24),(3.88±2.20),(1.96±1.32) mm and (0.48°±0.53°) for the pelvis position,and (0.95±0.73),(1.99±1.35),(3.66±2.13) mm and (0.24°±0.31°) for the lower limb,respectively. In group 2,the setup errors were (2.59±2.58),(3.28±1.85),(3.71±2.43) mm and (1.15°±1.18°) for the head and neck position,(4.38±3.69),(5.64±3.78),(2.72±1.91) mm and (1.55°±0.86°) for the chest position,(4.14±2.97),(6.97±3.68),(2.21±2.26) mm and (1.23°±0.74°) for the pelvis position,(2.28±1.15),(5.97±3.00),(3.44±1.93) mm and (1.09°±0.94°) for the lower limb,respectively. The setup errors significantly differed between two groups on the left-right,superior-inferior and rotation directions for all positions (all P<0.05). The setup consistency significantly differed between two groups on the left-right,superior-inferior and rotation directions for the chest and pelvis positions (all P<0.05). Conclusion The novel immobilization system can significantly improve the setup accuracy and setup consistency,and enhance the precision of treatment for patients.

Pelvic insufficiency fractures (PIF) is a vital complication after radiotherapy for pelvic neoplasms. It often leads to intractable pain and limited activity and is likely to be misdiagnosed as bone metastases and improperly treated. MRI is a common method for the diagnosis and differential diagnosis of PIF. The optimal approach to prevent PIF is to correctly identify the high-risk population and provide drug intervention when necessary. The low bone density state serves as a pivotal predictor at the beginning of radiotherapy. Reasonable selection of irradiation dose in pelvic lymphatic drainage area and minimizing the dose of pelvic bone probably reduce the incidence of PIF after radiotherapy.