Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2020 Vol.29 Issue.1 Published 2020-01-15

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

Consensus

	1	Consensus on integrated application of domestic radiotherapy equipment-Nasopharyngeal carcinoma homogeneous IMRT:quality control& assurance

		The complexity of intensity-modulated radiotherapy (IMRT) equipment and the accuracy of clinical radiotherapy require extremely high standards for the,quality control of IMRT for nasopharyngeal carcinoma. Reasonable, reliable and targeted quality control is an essential part of precise radiotherapy. At present, domestic radiotherapy equipment is developing rapidly. Nevertheless, radiotherapy equipment, personnel composition and quality control significantly differ among hospitals. Therefore, it is difficult to achieve homogeneity in the quality control of radiotherapy. Establishing an expert consensus on the quality control of domestic radiotherapy equipment can clarify the content of quality control, testing procedures, testing conditions and personnel qualification and requirement. It can effectively ensure the standardization and homogeneity of the quality control and establish the responsibility, procedures, processes and quality management of the quality control, aiming to offer the optimal radiotherapy to each patient.
		2020 Vol. 29 (1): 1-5 [Abstract] ( 365 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	6	Patterns and risk factors of lymph node metastasis in locally advanced supraglottic squamous cell carcinoma
		Xu Yi, Zhang Ye, Liu Shaoyan, Wang Xiaolei, Huang Xiaodong, Qu Yuan, Wang Kai, Wu Runye, Chen Xuesong, Liu Qingfeng, Sun Shiran, Luo Xi, Luo Jingwei, Gao Li, Xu Guozhen, Yi Junlin
		Objective To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3,T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume. Methods Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed. All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ). The LNM ratio of each node level was calculated. The risk factors of LNM were identified by univariate and multivariate logistic regression analyses. Results LNM was found in 156 of 272 patients (57.1%). According to the location of primary lesions, all patients were divided into group A (n=72;unilateral without midline involvement), group B (n=86;unilateral with midline involvement) and group C (n=114;giant or central). In group A, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and Ⅳ was 36.3%, 26.4% and 6.9%, whereas 13.9%, 8.3% and 1.4% at the contralateral level, respectively. In group B, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and IV was 1.9%,29.1% and 11.6%, whereas 18.6%,14.0% and 1.2% at the contralateral level, respectively. In group C, the LNM ratio at the left neck level Ⅱ, Ⅲ and Ⅳ was 24.6%, 23.7% and 2.6%, whereas 21.9%, 26.3% and 6.1% at the right neck, respectively. Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3%,25.0%,P=0.093). Ipsilateral level Ⅲ metastasis (OR=2.929,95%CI 1.041-8.245,P=0.042) and clinical N stage (OR=0.082,95%CI 0.018-0.373,P=0.001) were associated with contralateral LNM. Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009) metastasis were risk factors of the ipsilateral level Ⅳ metastasis. Conclusion s Neck levels Ⅱ and Ⅲ are the high-risk LNM regions, whereaslevels Ⅳ and V are the low-risk areas. Ipsilateral level Ⅱ or Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM. Contralateral neck LNM rarely occurs in cN0 stage patients.
		2020 Vol. 29 (1): 6-10 [Abstract] ( 253 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	11	Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy
		Chen Yuanyuan, Li Peijing, Yang Shuangyan, Fang Jiaben, Zhang Jiang, Hu Qiaoying, Chen Ming, Chen Xiaozhong, Tian Ye
		Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients. Methods A total of 150 AJCC 7^th stage Ⅱ-IVB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study. Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure. A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria. The prediction value of two methods for A-ROM was statistically compared. Results The incidence rate of ≥3 grade A-ROM was 33.3%. In univariate analysis,V5,V10,V15,V45,V50,V55,V60,V65 and V70 of OCC and V5,V10,V50,V55,V60,V65,V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P<0.05). In binary logistic regression analysis,gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs. female:OR=0.141,95%CI=0.037-0.538,P=0.004;smoking vs.non-smoking:OR=5.109,95%CI=1.413-18.470,P=0.013). For MSC,gender,smoking,N stage and MSC- V55 were the independent predictors (male vs. female:OR=0.129,95%CI=0.032-0.519,P=0.004;smoking vs.non-smoking:OR=4.448,95%CI=1.224-16.164,P=0.023;N stage:OR=2.291,95%CI=1.268-4.137,P=0.006;MSC-V55:OR=1.432,95%CI=1.008-2.033,P=0.045). The cutoff value of MSC-V55 was 7.70%, the area under ROC curve was 0.754, the sensitivity and specificity were 0.680 and 0.740, retrospectively (all P<0.001). Conclusion s Compared with OCC, MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.
		2020 Vol. 29 (1): 11-16 [Abstract] ( 463 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	17	Prognosis of different irradiation methods in patients with T2-3N0M0 esophageal squamous cell carcinoma
		Shen Wenbin, Gao Hongmei, Zhu Shuchai, Cao Yankun, Li Shuguan, Xu Jinrui
		Objective To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, aiming to select the optimal treatment for these patients. Methods A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study. All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups. The composition ratio, prognostic factors and adverse events were analyzed between two groups. Results The median overall survival (OS) time was 35.5 months (95%CI :30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95%CI:19.00-28.00). According to the multivariate analysis results, all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group). Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038),and T stage and radiotherapy were the independent factors affecting DFS (P=0.002,0.032). The incidence of ≥grade Ⅱ adverse events did not significantly differ between two groups (P=0.819,0.756). However,patients with combined chemotherapy experienced more adverse events. Conclusion ENI can prolong the OS and DFS of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma,and does not increase the incidence of severe adverse events.
		2020 Vol. 29 (1): 17-21 [Abstract] ( 288 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	22	Efficacy and safety of neoadjuvant concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma:a Meta-analysis
		Xie Ruilin, Li Na, Qin Qingwei, Wang Sheng, Zhao Xue, Qin Zhaohui, Yao Yuanhu
		Objective To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma. Methods Literature review was performed from Embase,PubMed,Web of Science,Cochrane Library,CBM,Wanfang Data,CNKI and Chongqing VIP. The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved. The meta-analysis of survival data,R0 resection rate,incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software. Results A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis. The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14,95%CI:1.05-1.23,P=0.00) and progression-free survival rate (RR=1.56,95%CI:1.05-2.32,P=0.03).R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10,95%CI:1.05-1.14,P=0.00). Compared with the surgery alone group,the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was significantly higher (RR=2.45,95%CI:1.37-4.38,P=0.00). However,there was no significant difference in the overall incidence of postoperative complications (RR=1.12,95%CI:0.79-1.59,P=0.51) and incidence of peritreatment mortality (RR=1.78, 95%CI:0.90-3.52,P=0.10) between two groups. Conclusion s Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma, whereas it does not increase the risk of postoperative complications. Consequently,neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.
		2020 Vol. 29 (1): 22-25 [Abstract] ( 254 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	26	Prognostic analysis of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgical treatment
		Fan Chengcheng, Feng Zhuo, Ge Hong, Ye Ke, Wang Hao, Zheng Xiaoli, Zhang Yougai, Luo Hui
		Objective To evaluate the clinical efficacy and prognostic factors of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery. Methods From December 2011 to December 2015,152 cases of recurrent thoracic esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery were retrospectively analyzed. The overall survival (OS) after treatment failure, clinical efficacy and prognostic factors of different salvage treatments were analyzed. OS was calculated by Kaplan-Meier method. Prognostic analysis was performed by using multivariate Cox regression model. Results The median interval of the first recurrence was 10.6(2.0 to 69.1) months. The median OS after recurrence was 8.0(0.8 to 43.3) months. The 1-, 2-and 3-year OS rates after recurrence were 36.0%,15.1% and 5.2%,respectively. The median OS of patients with locoregional recurrence alone, distant metastasis alone and locoregional recurrence combined with distant metastasis was 11.3(1.8 to 43.3) months,6.7(1.2 to 28.6) months and 5.1(0.8 to 22.9) months, respectively. Multivariate analysis demonstrated that neoadjuvant chemotherapy (P=0.009), ypTNM stage (P=0.012), comprehensive treatment after recurrence (P=0.000) and locoregional recurrence (P=0.026) were independently correlated with the OS of patients with recurrent esophageal squamous cell carcinoma. Conclusion s Neoadjuvant therapy, ypTNM stage, recurrence pattern and post-recurrence treatment are the independent risk factors for clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery. Clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy is not satisfactory. After recurrence, combined treatment mode should be adopted according to the site of recurrence and neoadjuvant treatment mode to maximize the benefits of salvage treatment.
		2020 Vol. 29 (1): 26-30 [Abstract] ( 208 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	31	Failure patterns of locoregional recurrence in women with T1-2N1 breast cancer after modified radical mastectomy
		Zhao Xuran, Wang Shulian, Song Yongwen, Tang Yu, Yang Yong, Fang Hui, Wang Jianyang, Jing Hao, Zhang Jianghu, Sun Guangyi, Chen Siye, Jin Jing, Liu Yueping, Chen Bo, Qi Shunan, Li Ning, Tang Yuan, Lu Ningning, Li Yexiong
		Objective To analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T1-2N1 breast cancer patients undergoing modified radical mastectomy. Methods From September 1997 to April 2015, 2472 women with T1-2N1 breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital. 1898 patients who did not undergo adjuvant radiotherapy were included in this study. The distribution of accumulated LRR was analyzed. The LR and RR rates were estimated by the Kaplan-Meier method, and the prognostic factors were identified in univariate analyses with Log-rank test. Multivariate analysis was performed using Cox logistic regression analysis. Results With a median follow-up of 71.3 months (range 1.1-194.6),164 patients had LRR,including supraclavicular/infraclavicular lymph nodes in 106(65%),chest wall in 69(42%),axilla in 39(24%) and internal mammary lymph nodes (IMNs) in 19 patients (12%). In multivariate analysis, age (>45 years vs.≤45 years),tumor location (other quadrants vs. inner quadrant),T stage (T1 vs. T2),the number of positive axillary lymph nodes (1 vs. 2-3),hormone receptor status (positive vs. negative) were significant prognostic factors for both LR and RR. Conclusion s In patients with T1-2N1 breast cancer after modified radical mastectomy,the most common LRR site is supraclavicular/infraclavicular nodal region,followed by chest wall. The axillary or IMN recurrence is rare. The prognostic factors for LR and RR are similar,which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.
		2020 Vol. 29 (1): 31-34 [Abstract] ( 212 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	35	Preliminary clinical analysis of radiation proctitis treated with argon plasma coagulation combined with submucosal injection
		Lu Guanlin, Fang Shilin, Peng Yanan, Zhao Qiu, Shi Xianyan, Liu Jing
		Objective To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP), especially for refractory RP. Methods Clinical data of 22 RP patients were retrospectively analyzed. The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman′s classification (B). The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment). Results All 22 patients were successfully treated. Among them, 18 patients (82%) had no bleeding. According to the classification of A, 15 patients (68%) had mild proctitis and 7(32%) experienced severe proctitis. Based on B classification, 9 patients (41%) were categorized as mild proctitis and 13(59%) as severe proctitis. Using the classification of A, the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score)(Spearman’s r=0.86,P<0.001). Conclusion sPreliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP, but also maintains long-term efficacy for refractory RP. Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.
		2020 Vol. 29 (1): 35-38 [Abstract] ( 194 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	39	Dosimetric comparison between non-coplanar volumetric modulated arc therapy using flattening filter and flattening filter-free beams during stereotactic radiosurgery for brain tumors
		Li Dingjie, Liu Ru, Yang Chengliang, Chen Jinhu, An Tai, Ge Hong
		Objective To compare relevant dosimetric parameters of non-coplanar volumetric modulated arc therapy (VMAT) in treating brain tumors in conventional flattening filter (FF) or flattening filter-free (FFF) delivery mode, aiming to explore the appropriate evaluation method of accelerator for stereotactic radiosurgery (SRS). Methods Clinical data of 10 patients with single cranial tumor were retrospectively analyzed. All patients received non-coplanar VMAT at a prescription dose of 25 Gy in 1 fraction. Dosimetric parameters including conformity index (CI),heterogeneity index (HI),gradient index (GI50,GI25),gradient,volume of the brain tissue receiving larger than 10 Gy and 12 Gy(V10 and V12) and beam-on time were statistically compared between two treatment plans by paired sample t-test. Results When FFF-VMAT was compared with FF-VMAT in SRS for intracranial tumors, Paddick gradient index GI50 was 2.91±0.34 vs.3.07±0.35, 6.91±0.28 vs.7.35±0.27 for GI25,(0.57±0.07) cm vs.(0.61±0.08) cm for gradient, respectively (all P<0.05), whereas CI did not significantly differ (P>0.05). For the normal brain tissues, the average dose was (160.64±43.64) cGy vs.(174.27±53.98) cGy,(45.35±30.32)% vs.(48.37±30.88)% for V10 and (36.69±25.15)% vs.(39.48±25.37)% for V12,respectively (all P<0.05). Conclusion s Non-coplanar VMAT in FFF delivery mode can improve dose distribution and normal brain tissue sparing in the treatment of intracranial single tumors. Meanwhile, supplement of GI index and gradient index can implement comprehensive evaluation of the SRS planning.
		2020 Vol. 29 (1): 39-42 [Abstract] ( 257 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	43	3D-printing non-coplanar template assisted ¹²⁵I seed implantation for head and neck tumor:individualized template design and application
		Cui Yue, Sun Haitao, Jiang Yuliang, Wang Junjie
		Objective To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography (CT)-guided and 3D-printing non-coplanar template-assisted ¹²⁵I seed implantation for head and neck tumor, aiming to explore the safety, feasibility and accuracy of the individualized template design method. Methods A total of 42 patients with recurrent/metastatic malignant head and neck tumor admitted toPeking University Third Hospitalfrom January to December 2016 were recruited in this study. A prescribed dose of 110-160Gy was adopted.3D-printing non-coplanar templates were designed for 42 cases. The dosimetric parameters including D90,minimum peripheral dose (mPD),V100,V150,V200,conformal index (CI),external index (EI) and homogeneity index (HI) were statistically compared before and after surgery. Results All templates were properly implanted intraoperatively. Compared with preoperative planning, postoperative D90,V100,CI,EI and HI did not significantly differ (P=0.490, 0.407, 0.893, 0.143 and 0.079), whereas mPD,V150 and V200 significantly differed (P=0.036, 0.007 and 0.000). Conclusion After postoperative verification, the main dosimetric parameters have high therapeutic accuracy and properly match with preoperative planning, which can meet clinical requirements.
		2020 Vol. 29 (1): 43-46 [Abstract] ( 410 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	47	The effect of age on skin elasticity and setup error in optical surface image-guided radiotherapy
		He Yang, Lei Jinyan, Peng Haiyan, Luo Huanli, Mao Kaijin, Wang Dengyan, Peng Lifeng, Zhu Yiyu, Min Qinghong, Wang Xuechun, Tang Huan, Xiao Peng, Xiao Qiang, Wang Ying, Jin Fu
		Objective To investigate the correlation between skin elasticity and setup error in optical surface image-guided radiotherapy. Methods The skin elasticity (R7) data of the head, chest and abdomen were extracted and analyzed its correlation with age by systematic literature review. Fifty-four patients diagnosed with nasopharyngeal carcinoma, breast cancer and cervical cancer were recruited in this study. Firstly,the patients were positioned based on the room laser and markers. Subsequently, the patient position was verified by the Varian On-Board Imager, and then C-Rad Catalyst was adopted to obtain surface images in two states (mask or non-mask) as reference images. In the subsequent fraction treatment,after initial positioning,the local calibration was performed by Catalyst,and setup errors in three directions were recorded. Meanwhile,the patient setup was verified by CBCT twice a week. The Pearson correlation analysis was performed to analyze the correlation between setup error and age. Results The skin elasticity was negatively correlated with aging (P<0.01). The correlation coefficient between random error and age in head-and-neck cancer were 0.645,0.624 and 0.866 in the AP,SI and LR directions (all P<0.05) for male patients without mask,respectively. The system error was significantly correlated with age in the LR direction (P<0.05) for male patients,and in the AP direction (P<0.05) for female patients with head-and-neck cancer without mask. The setup error had a significant correlation with skin elasticity in male patients with head-and-neck cancer,and the sequence of absolute value of correlation coefficient was LR>SI>AP. Conclusion In optical surface-guided radiotherapy of head and neck cancer,skin elasticity may be a significant index for assessing the setup errors in male patients.
		2020 Vol. 29 (1): 47-51 [Abstract] ( 223 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	52	Silencing lncRNA GIHCG increases radiosensitivity of glioma cells by up-regulating miR-146a-3p
		Li Xueyuan, Liu Qiankun, Yuan Shanpeng, Zhen Yingwei, Wu Lixin, Luo Wenzheng, Wang Kang, Wang Zhuang, Gao Peng, Liang Tiansong, Yan Dongming
		Objective To investigate the effect of lncRNA GIHCG on the radiosensitivity of glioma cells and its mechanism. Methods The expression levels of GIHCG and miR-146a-3p in human brain normal glial cells HEB and glioma cell lines U251, A172, SHG139 and U87 were quantitatively measured by qRT-PCR assay. U251 and SHG139 cells were used for subsequent experiment. After silencing the expression of GIHCG or overexpressing miR-146a-3p in U251 and SHG139 cells, cell proliferation was detected by MTT assay, cell apoptosis was detected by flow cytometry, cell radiosensitivity was detected by colony formation assay and the expression levels ofCDK1,CyclinD1,Bcl-2 and Bax proteins were measured by Western blot. The bioinformatics software predicted the presence of a binding site for GIHCG and miR-146a-3p. Dual luciferase reporter gene assay and qRT-PCR assay were adopted to verify the targeting relationship between GIHCG and miR-146a-3p. Results Compared with HEB cells, the expression of GIHCG was significantly up-regulated in glioma U87,U251,A172 and SHG139 cells (all P<0.05),whereas that of miR-146a-3p was remarkably down-regulated (P<0.05). Silencing GIHCG expression or overexpression of miR-146a-3p significantly decreased the U251 and SHG139 cell survival rate, survival fraction and the expression of CDK1,CyclinD1 and Bcl-2 proteins (all P<0.05), whereas considerably increased the apoptotic rate and expression of Bax protein (both P<0.05). GIHCG performed targeted negative regulation of miR-146a-3p expression in U251 and SHG139 cells and inhibition of miR-146a-3p expression reversed the effect of silencing GIHCG on proliferation, apoptosis and radiosensitivity of glioma cells. Conclusion Silencing GIHCG expression up-regulates the expression of miR-146a-3p,thereby enhancing the radiosensitivity of glioma cells.
		2020 Vol. 29 (1): 52-56 [Abstract] ( 242 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	57	Silencing LncRNA OIP5-AS1 increases radiosensitivity of non-small cell lung cancer A549 cell line by up-regulating miR-34c-5p expression
		Mao Kai, Ding Xiaohua, Wu Liping, Mao Yujing, Zhang Liguo, Li Jun, Lu Jiang
		Objective To investigate the effect of LncRNA OIP5-AS1 on radiosensitivity of non-small cell lung cancer (NSCLC) cells and its mechanism. Methods The radiation-resistant cell A549R was established by using A549 cells irradiated by X-ray 6Gy in 5 fractions. The expression levels of OIP5-AS1 and miR-34c-5p in A549 and A549R cells were detected by qRT-PCR. OIP5-AS1 inhibitor or miR-34c-5p mimetic was transfected into A549R cells, or OIP5-AS1 overexpression plasmid was transfected into A549 cells. Cell apoptosis was detected by flow cytometry. Cell radiosensitivity was analyzed by colony formation assay. The expression levels of p-Chk2 and p-ATM proteins were measured by Western blot. Dual luciferase assay was adopted to verify the relationship between OIP5-AS1 and miR-34c-5p. Results Compared with A549 cells, the expression of OIP5-AS1 was significantly up-regulated in A549R cells (1.97±0.11 vs.1.01±0.05,P<0.05), whereas the expression of miR-34c-5p was remarkably down-regulated (0.43±0.02 vs.1.02±0.06,P<0.05). The expression levels of p-Chk2 and p-ATM proteins in A549R cells in the silencing OIP5-AS1+6Gy group were significantly lower (0.43±0.03 vs.1.39±0.15,0.51±0.0 5 vs.1.21± 0.11,both P<0.05), whereas the apoptotic rate was significantly higher than those in the silencing control+6Gy group [(13.29±1.25)% vs. (28.47±2.31)%,P<0.05)]. The expression levels of p-Chk2 and p-ATM proteins in A549 cells in overexpressing OIP5-AS1+6Gy group were significantly higher than those in overexpression control+6Gy group (1.23±0.13 vs.0.75±0.06,1.08±0.11 vs.0.59±0.04,both P<0.05). Inhibiting miR-34c-5p expression reversed the effect of silencing OIP5-AS1 on survival fraction of A549R cells (SER=1.42). OIP5-AS1 negatively regulated the expression of miR-34c-5p. Conclusion Silencing OIP5-AS1 enhances the radiosensitivity of radiation-resistant A549 cells by up-regulating the expression of miR-34c-5p, providing a potential target for radiotherapy of NSCLC cells.
		2020 Vol. 29 (1): 57-60 [Abstract] ( 208 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	61	Research progress onneoadjuvant therapy in stage ⅢA-N2 non-small cell lung cancer
		Sun Xin, Men Yu, Hui Zhouguang
		ⅢA-N2 NSCLC is a group of heterogeneous diseases. The optimal treatment modality remains controversial. How to choose suitable neoadjuvant treatment modalities including chemotherapy,radiotherapy,target therapy and immunotherapy remains unclear. In this article, research progress on neoadjuvant therapy of NSCLC was reviewed to evaluate the efficacy and safety for different modalities.
		2020 Vol. 29 (1): 61-64 [Abstract] ( 194 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	65	Clinical application and research progress on dose-guided radiotherapy
		Zhang Xiangbin, Li Guangjun, Zhang Yingjie, Bai Sen
		Dose-guided radiotherapy (DGRT) is a potentially useful adaptive radiotherapy method which dosimetrically compensates for interfractional non-rigid deformation. With the improvement of in-room imaging quality,development of the deformation registration algorithm and innovation of computer science,the wide application of DGRT might be realized. The purpose of this article is to briefly summarize the work flow, clinical application and prospect of DGRT.
		2020 Vol. 29 (1): 65-68 [Abstract] ( 209 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	69	Progress on clinical research of hyperthermia combined with radiation therapy
		Zou Liqing, Li Yida, Yang Xi, Zhu Zhengfei
		Hyperthermia has been a research hot spot since it was approved by FDA as one of the 5 major therapeutic modalities for tumor since 1989. Pre-clinicaland clinical researches have confirmed the prominent radiosensitizing effect of hyperthermia. In this article, the research progress on hyperthermia combined with radiation therapy was summarized based upon clinical evidence. The challenges and issues during the procedure of hyperthermia combined with radiation therapy were analyzed from the perspectives of treatment temperature, frequency and interval time of hyperthermia, interval time and time sequence between hyperthermia and radiation therapy, etc. Besides, the application progress and prospect of hyperthermia combined with radiation therapy were reviewed, aiming to provide clinical evidence for the combination of hyperthermia and radiation therapy.
		2020 Vol. 29 (1): 69-72 [Abstract] ( 227 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	73	Progress on standardized treatment for patients with general cancer pain and cancer pain during "peri-radiotherapeutic period"
		Tan Bingxu, Cheng Yufeng
		Cancer pain is one of the main symptoms of patients suffering from malignant tumors. If it is not timely treated,it will lead to refractory pain and increase the burden on both the individuals and society. In China,the program titled"Good Pain Management" has been carried out for nearly 7 years,which increases the overall assessment and treatment levels for cancer pain among medical personnel. Nevertheless, the clinical efficacy for cancer pain treatment is not satisfactory. As an important treatment for malignant tumors,radiation therapy is also one of the main methods for treating cancer pain. For the first time,we proposed the concept of "peri-radiotherapeutic period",and emphasized the continuous analgesic treatment for patients with cancer pain before,during and after radiotherapy. In this article,current status of cancer pain treatment at home and abroad was illustrated,and standardized assessment and management of cancer pain during the "peri-radiotherapeutic period" were summarized.
		2020 Vol. 29 (1): 73-78 [Abstract] ( 202 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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