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.2 Published 2020-02-15

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

Head and Neck Tumors

	81	Long-term efficacy and adverse reactions of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma in non-endemic northwest China
		Xu Man, Shi Mei, Zang Jian, Wang Janghua, Zhao Lina, Luo Shanquan, Xiao Feng, Xu Lin
		Objective To retrospectively analyze the characteristics of nasopharyngeal carcinoma, long-term efficacy, adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade. Methods Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed. All patients were treated with IMRT. The survival analysis was performed by Kaplan-Meier method. The multivariate analysis was conducted with Cox’s regression model. Results In non-endemic northwest China, a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma, and a majority of them were pathologically characterized as differentiated subtypes. The 5-year overall survival (OS),disease-free survival (DFS),local recurrence-free survival (LRFS),regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7%,70.1%,91.2%,97.0% and 81.0%, respectively. Multivariate analysis showed that age, pathological type, nasopharyngeal tumor volume>23 cm³ and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P<0.05). Age, pathological type, neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P<0.05). N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P<0.05). Conclusions Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area. Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.
		2020 Vol. 29 (2): 81-87 [Abstract] ( 224 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	88	A comparative analysis of SRT and SRS in the treatment of brain metastases from lung adenocarcinoma
		Li Yong, Liu Fenghua, Liang Kangning, Shao Xianjun, Zhang Li, Liang Xiaohua, Pan Mianshun
		Objective To compare the clinical efficacy of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) in the treatment of brain metastases from January 2006 to December 2016,lung adenocarcinoma and analyze the related factors. Methods In this multi-center retrospective analysis, clinical data of 208 patients with brain metastases from lung adenocarcinoma were retrospectively analyzed and assigned into the SRT (n=86) and SRS groups (n=122). The clinical characteristics of patients in two groups were analyzed. The local tumor control rate,median survival time and radiation brain injury were statistically compared between two groups. Results At the end of follow-up,the Objective response rates (ORR) were 70.9% and 71.3% in the SRT and SRS groups (P=0.772). The local tumor control rates at 12 months were 89% and 86% in the SRT and SRS groups (P=0.383). The median overall survival time of all patients was 14.3 months,15.6 months in the SRT group and 13.7 months in the SRS group (P=0.349). Multivariate analysis showed that large target volume (P<0.001),low GPA score (P=0.012) and no insensitive gene mutation (P<0.001) were the main factors of poor prognosis. The incidence of late radiation brain injury was 5.8% and 14.8% in two groups (P=0.043). Conclusions SRT and SRS yield similar clinical efficacy in the treatment of brain metastases from lung adenocarcinoma. SRT may have a lower incidence of late radiation brain injury than SRS.
		2020 Vol. 29 (2): 88-92 [Abstract] ( 194 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	93	Survival analysis and quality of life of pediatric low grade glioma treated by postoperative radiotherapy
		Xing Pengfei, Wang Hangzhou, ChenMin, Tian Ye
		Objective To analyze the clinical characteristics of children with low grade glioma (LGG) and evaluate their survival status and quality of life in LGG pediatric patients after postoperative radiotherapy. Methods Clinical data of 27 LGG children aged≤14 years admitted to Department of Radiation Oncology of our hospital from January 2011 to December 2017 were retrospectively analyzed. The 5-year overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method.The quality of life was evaluated by body mass index (BMI), WeeFIM and enrollment situation. Results The 5-year OS and PFS of 27 pediatric patients were 92% and 87%. BMI was measured in 25 children who were still alive and the results showed that 1 child was slightly emaciated, 3 were overweight and 21 were normal. The total score of WeeFIM was> 108 in 21 cases and< 90 in 4 cases. In terms of social role-playing assessment, 5 cases delayed enrollment for≥ 2 years, 2 cases had good adaptation except the difficulties due to lameness, 7 of them had poor study performance, but had no communication barrier. Conclusions Children with LGG can obtain relatively excellent OS and PFS after postoperative radiotherapy. Part of the children with long-term survival may experience a declined quality of life, which is mainly manifested with a decline in motor and cognitive functions.
		2020 Vol. 29 (2): 93-95 [Abstract] ( 187 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	96	Effect of locoregional risk factors on long-term prognosis of patients with N0 stage esophageal cancer receiving intensity-modulated radiotherapy
		Shen Wenbin, Gao Hongmei, Xu Jinrui, Cao Yankun, Li Shuguang, Li Youmei, Zhu Shuchai
		Objective To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with N0 esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients. Methods Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed. Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients. Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients. The survival analysis was carried out by Kaplan-Meier method. The prognosis analysis was performed by multivariate Cox’s regression model. Results A total of 143 patients (38.2%) had recurrence in GTV. The maximum transverse diameter (GTV-D),GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008,0.043,0.001). ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D,GTV-L,GTV-V and GTV-V/L for GTV recurrence were 3.5 cm,5.5 cm,24.0 cm³ and 4.6 cm²,respectively (P=0.000,0.003,0.000 and 0.000),and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000,0.002,0.001 and 0.000). GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009). The 3-, 5-and 10-year survival rates of all patients in the whole group were 42.9%, 23.2% and 7.9%, respectively. Multivariate analysis demonstrated that age, T stage, concurrent radiochemotherapy, GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027, 0.000, 0.018, 0.009 and 0.034). The main cause of death in patients with a survival time of more than 5 years was still associated with cancer. Conclusions The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with N0 esophageal squamous cell carcinoma undergoing radical radiochemotherapy, which can be utilized as the predicting markers. Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients.
		2020 Vol. 29 (2): 96-101 [Abstract] ( 185 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	102	Retrospective clinical analysis of 133 cases of stage Ⅳ esophageal cancer
		Guo Junjun, Gao Wei, Wang Qian, Fu Shenbo, Xi Pan
		Objective To investigate the clinical significance of radiotherapy for stage Ⅳ esophageal cancer. Methods Clinical data of 133 stage Ⅳ esophageal cancer patients admitted to our hospital from 2012 to 2018 were retrospectively analyzed. All patients were assigned into the radiochemotherapy (n=89) and chemotherapy groups (n=44). The survival analysis was performed by Kaplan-Meier method. The multivariate prognostic analysis was conducted by Cox’s regression model. Results The 1-,2-and 3-year overall survival rates of the entire cohort were 53.5%,20.4% and13.6% respectively. Cox’s regression analysis showed that gender,ECOG score,number of distant metastases,and whether the primary lesions received radiotherapy were the independent prognostic factors (all P<0.05). The 1-,2-and 3-year survival rates in the radiochemotherapy group were 61%,29% and19%, and 40%,4%,0% in the chemotherapy group,respectively. In the radiochemotherapy group, the progression-free survival (PFS) and local progression-free survival (LPFS) were 8 months and 12.6 months, significantly longer compared with 4.7 months and 5.3 months in the chemotherapy group (both P<0.05). The OS of patients receiving dose> 50Gy and ≤50Gy was 14.3 months and 8.2 months (P<0.05), 8.6 months and 2.8 months for the PFS (P<0.05), and 15.2 months and 4.7 months for the LRFS (P<0.05), respectively. The number of distant metastases and the clinical efficacy for primary lesions were the independent prognostic factors in the radiochemotherapy group (both P<0.05). Conclusion Radiotherapy can improve the clinical prognosis of patients with stage Ⅳ esophageal cancer.
		2020 Vol. 29 (2): 102-105 [Abstract] ( 173 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	106	A study of prediction model of lung dose in early stage non-small cell lung cancer with stereotactic body radiotherapy
		Bai Xue, Wang Binbing, Shao Kainan, Yang Yiwei, Shan Guoping, Chen Ming
		Objective To study a lung dose prediction method for the early stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy based on machine learning algorithm,and to evaluate the feasibility of application in planning quality assurance. Methods A machine learning algorithm was utilized to achieve DVH prediction. First, an expert plan dataset with 125 cases was built,and the geometric features of ROI,beam angle anddose-volume histogram(DVH) parameters in the dataset were extracted. Following a correlation model was established between the features and DVHs. Second,the geometric and beam features from 10 cases outside the training pool were extracted,and the model was adopted to predict the achievable DVHs values of the lung. The predicted DVHs values were compared with the actual planned results. Results The mean squared errors of external validation for the 10 cases inmean lung dose (MLD)MLD and V20 of the lung were 91.95 cGy and 3.12%,respectively. Two cases whose lungdoseswere higher than the predicted values were re-planned,and the results showed that the the lung doses were reduced. Conclusion It is feasible to utilize the anatomy and beam angle features to predict the lung DVH parameters for plan evaluation and quality assurance in early stage NSCLC patients treated with stereotactic body radiotherapy
		2020 Vol. 29 (2): 106-110 [Abstract] ( 171 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	111	Salubrinal increases the apoptosis of oral cancer cells by inhibiting radiation-induced activation of NF-κB
		Wang Jie, Zhang Miao, Li Gaiyan, Lyu Xintong, Qiao Qiao
		Objective To explore the mechanism of the role of Salubrinal in regulating the radiation-induced apoptosis of oral cancer cells. Methods Radioresistant KBR cell line was constructed (4 Gy per fraction, every 7-10 d for 4 times). The radiosensitivity of oral cancer cells after Salubrinal pretreatment was measured by colony formation assay. The expression levels of NF-κB-HIF-1α signaling pathway and apoptosis biomarker cleaved PARP in oral cancer cells were measured by Western blot. The apoptosis rate was detected by Annexin V, PI staining and flow cytometry. Results Colony formation assay demonstrated that Salubrinal increased the radiosensitivity of oral cancer cells. The radiosensitization ratios of KB and KBR cells were 1.19 and 1.24. Western blot revealed that the activation of NF-κB-HIF-1α was time-dependent in the radiation-induced oral cancer cells, whereas Salubrinal inhibited the radiation-induced abnormal activation. In addition, Salubrinal increased the expression of apoptosis biomarker cleaved PARP and apoptosis index in radiation-induced oral cancer cells, whereas TNF-α, an activator of NF-κB, reversed the effect, suggesting that Salubrinal increased the apoptosis of radiation-induced oral cancer cells by suppressing the activation of NF-κB. Pretreatment of NF-κB inhibitor Bay11-7082 also increased the cell apoptosis. The expression levels of cleaved PARP of KB and KBR cell lines in the Bay11-7082+IR group were 2.67±0.26 and 1.91±0.17, significantly higher compared with 2.1±0.16 and 1.44±0.15 in the IR group (both P<0.05). Conclusion Salubrinal can aggravate the apoptosis of radiation-induced oral cancer cells by inhibiting the radiation-induced activation of NF-κB, thereby regulating the radiosensitivity of oral cancer cells.
		2020 Vol. 29 (2): 111-114 [Abstract] ( 221 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	115	Effect and mechanism of down-regulating REV7 expression on the radiosensitivity of human colon cancer cell HCT116
		Yuan Chengyang, Ma Lu, Kong Feifei, Xu Fang
		Objective To evaluate the effect and mechanism of down-regulating the expression of REV7 on the radiosensitivity of human colon cancer cell HCT116. Methods HCT116 cells were cultured and the expression of REV7 was down-regulated by RNA interference technique. HCT116 cells were divided into the blank group, negative control transfected with negative RNA oligo group and REV7 expression down-regulation transfected with REV7 RNA oligo group, respectively. The cell proliferation was determined by colony formation assay. The expression levels of the proteins of relevant genes were detected by Western blot. The level of cell apoptosis and non-homologous end joining was evaluated. Results The colony formation rate was significantly reduced in THE REV7 siRNA group after 6Gy irradiation (P<0.05). The down-regulating efficiency rate of REV7 gene was>60% in the REV7 siRNA group. The expression levels of γH2AX and Caspase9 were significantly up-regulated, whereas those of KU80 and XRCC4 were remarkably down-regulated in the REV7 siRNA group (all P<0.05). Conclusions The radiosensitivity of human colon cancer cell HCT116 can be increased by down-regulating the expression of REV7. The underlying mechanism may be related to the lower incidence rate of non-homologous end joining.
		2020 Vol. 29 (2): 115-117 [Abstract] ( 194 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	118	Mechanism of miR-32-5p targeting TOB1 gene in regulating radiosensitization, migration and invasion of colorectal cancer cells
		Zhang Hui, Liang Hong, Zhang Chao
		Objection To investigate the effect of miR-32-5p on the radiosensitivity, migration and invasion of colorectal cancer cells and the underlying mechanism. Methods Human colorectal cancer SW480 cells and normal colonic epithelial NCM460 cells were cultured. The colorectal cancer cells were divided into the non-transfected and transfected groups (transfected with anti-miR-NC, anti-miR-32-5p, pcDNA, pcDNA-TOB1, anti-miR-32-5p+si-NC and anti-miR-32-5p+si-TOB1, respectively). The expression of miR-32-5p and TOB1 at the mRNA and protein levels was detected by RT-qPCR and Western blot. The radiosensitivity of the transfected cells was determined by colony formation assay. The migration and invasion ability of the transfected cells were detected by Transwell assay. Whether miR-32-5p targeted TOB1 was validated by dual luciferase reporter gene assay and Western blot. Results Compared with human colonic epithelial cells, the expression of miR-32-5p was significantly up-regulated, whereas the expression of TOB1 mRNA and protein was remarkably down-regulated in the colon cancer cells (all P<0.05). Compared with the anti-miR-NC, the quantity of cell migration and invasion was significantly decreased (both P<0.05) and the radiosensitivity ratio was 1.801 in the anti-miR-32-5p group. Compared with the pcDNA group, the quantity of cell migration and invasion was significantly decreased (both P<0.05) and the radiosensitivity ratio was 1.764 in the pcDNA-TOB1 group. Dual luciferase reporter gene assay and Western blot confirmed that miR-32-5p negatively regulated the expression of TOB1 protein. Compared with the anti-miR-32-5p+si-NC group, the quantity of cell migration and invasion was significantly increased (both P<0.05) and the radiosensitivity ratio was 0.591 in the anti-miR-32-5p+si-TOB1 group. Conclusions Inhibition of miR-32-5p expression can significantly enhance the radiosensitivity of colorectal cancer cells and suppress cell migration and invasion. The underlying mechanism might be related to the targeted up-regulation of TOB1 expression.
		2020 Vol. 29 (2): 118-121 [Abstract] ( 179 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	122	Dosimetric analysis of 3D-printing non-coplanar template combined with CT-guided¹²⁵I seed implantation for the treatment of spinal metastasis
		Cui Jianing, Jiang Yuliang, Ji Zhe, Guo Fuxin, Peng Ran, Sun Haitao, Fan Jinghong, Li Weiyan, Wang Junjie
		Objective To compare the preoperative and postoperative dosimetric parameters in the treatment of spinal metastasis, and to verifythe accuracy of 3D-printing non-coplanar template (3D-PNCT) combined with CT-guided ¹²⁵I seed implantation for the treatment of spinal metastasis.Methods The treatment plans of 7 patients with spinal metastasis (9 lesions)from 2016 to 2018receiving 3D-PNCT in combination with CT-guided ¹²⁵I seed implantation were retrospectively analyzed. The dosimetric parameters including homogeneity index (HI),conformal index (CI),external index (EI),dose of 90% target volume(D90),mPD, volume percent of 100%,150%,and 200% prescribed dose V100、V150、V200 and D2cm³ of spinal cord were compared before and afteroperation. The british columbia cancer ageny particle implantation quality evaluation standard was applied to evaluate the quality of implantation. Results The HI,EI and CI, D90,mPD,V100,V150,V200 and D2cm³ of spinal cord did not significantly differ before and after the plan (all P>0.05). Five were evaluated as excellent and 4 were assessed as good. Conclusion The postoperative dosimetric parameters of 3D-PNCT combined with CT guided ¹²⁵I seed implantation of spinal metastasis are basically consistent with preoperative dosimetric parameters. The postoperative plans are evaluated as excellent or good, suggesting that the technology has a good therapeutic accuracy in the treatment of spinal metastasis.
		2020 Vol. 29 (2): 122-125 [Abstract] ( 186 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	126	A verification study of Offset values of different applicators in afterloading brachytherapy
		Liu Min, Wang Xianliang, Yuan Ke, Wan Bin, Yang Feng, Kang Shengwei, Li Jie, Wang Pei
		Objective To investigate the Offset values of different applicators in afterloading brachytherapy. Methods Six types of applicators were selected in this study which included stainless steel interstitial needle (Part#083.062),proguide round needle (Part#189.608),proguide sharp needle (Part#189.601),vaginal multi-channel applicator (Part#110.800),fletcher CT/MR applicator (Part#189.745) and henschke titanium applicator (Part#110.437). According to the sources imaging in the fluorography film, the distance of applicators between the first dwell position and the top could be measured. Marker was pasted on the surface of applicator corresponding to the first dwell position. And then the applicator was put into the pelvic phantom for a CT scan. During applicator reconstruction in the treatment planning system, the Offset values of all applicators could be acquired through adjusting the value of offset to superimpose the first dwell and the marker images. On account of the density of plastic material applicators were similar to human tissues, it was difficult to reconstruct the top of the applicator. With the help of stopper or simulation source, the value of offset could be acquired for plastic material applicators. Based on the measurement results, the differences were analyzed among different applicators. Results The Offset values significantly differed among various applicators. The Offset value for stainless steel interstitial needle was -11.4 mm,-4.1 mm for proguide round needle,-3.5 mm for proguide sharp needle, 0 mm or -5.0 mm for vaginal multi-channel applicator,-6.5 mm for fletcher CT/MR applicator and -7.5 mm for henschke titanium applicator, respectively. Conclusion To adapt to the rapid development of precise radiotherapy, it is necessary to verify the Offset value in afterloading brachytherapy.
		2020 Vol. 29 (2): 126-130 [Abstract] ( 239 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	131	A study of an independent dose verification software for brachytherapy
		Wang Xianliang, Wang Pei, Li Churong, Li Jie, Kang Shengwei, Liu Min, Tang Ting, Wu Zhangwen, Hou Qing
		Objective To report an implementation method and results of an independent brachytherapy dose verification software (DVS). Methods The DVS was developed based on Visual C++ and the modular structure design was adopted. The DICOM RT files exported from the treatment planning system (TPS) were automatically loaded into the DVS. The TG-43 formalism was employed for dose calculation. Six cervical cancer patients who underwent brachytherapy were retrospectively selected to test the DVS. Different applicators were utilized for each patient. Dosimetric parameters and γ analysis (0.1cm, 5%) were used to evaluate the dose difference between the DVS and the TPS. Results Compared with the TPS dose,the γ pass rates of the doses calculated by the DVS were higher than 98%. For CTV, the dosimetric differences were less than 0.29% and 0.53% for D100% and D90%. For bladder, rectum and sigmoid, the agreement of D0.1cm³, D1cm³and D2cm³ within a 0.5% level. Conclusion With minimal human-computer interactions, the DVS can verify the accuracy of dose calculated by TPS for brachytherapy.
		2020 Vol. 29 (2): 131-135 [Abstract] ( 225 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	136	Evaluation and prediction of pelvic dose in postoperative IMRT for cervical cancer
		Sun Yanze, Yang Yongqiang, Qian Jianjun, Tian Ye
		Objective To evaluate and predict the pelvic dose by analyzing two pelvic contour definitions and identify the influencing factors of the pelvic dose in postoperative IMRT for cervical cancer, aiming to provide reference for postoperative pelvis-sparing IMRT for cervical cancer. Methods Sixty cervical cancer patients receiving postoperative IMRT with unrestricted pelvic dose were selected. Two sets of pelvic contours (pelvic anatomy and pelvic Mell) were delineated as per the anatomical and Mell methods. The dose relationship between two methods was analyzed after redesigning the treatment plan by limiting dose of pelvic anatomy. The correlation analysis was performed by Pearson’s correlation method. The factors affecting the pelvic anatomy dose were identified by Logistic multivariate regression analysis and a dose prediction model was subsequently established. Results The volumes of pelvic anatomy and pelvic Mell were 925.82 cm³ and 1141.20 cm³(P=0.000). There was a significant correlation between them (r>0.622,P=0.000). The dose of pelvic anatomy was significantly higher than that of pelvic Mell. The relationship of V10,V20 and V30 between them was y=-8+1.01x,y=-13+1.05x and y=-4+0.9x, respectively. The dose limits of pelvic Mell recommended by literatures(V10<90%,V20<75%,V30<60%) were translated into V10<97%,V20<83% and V30<70%, respectively. The pelvic anatomy dose was significantly reduced after dose limiting. The V10,V20,V30 and Dmean were significantly decreased by 3.64%,12.69%,12.02% and 6.93%(P=0.000,0.000,0.000), respectively. Multivariate analysis showed that the overlapping volume of pelvic anatomy within PTV was an independent influencing factor of pelvic anatomy dose (P<0.05). Patients with a relative overlapping volume of less than 18% could easily meet the dose limiting requirement. Conclusions Both two pelvic contour definitions can be applied in postoperative pelvis-sparing IMRT for cervical cancer. Use of pelvic dose limiting can significantly reduce the IMRT dose. The overlapping volume of the pelvis within PTV is an independent influencing factor of pelvic dose. Patients whose overlapping volume within the PTV relative to pelvis is less than 18% can easily meet the dose limiting requirement.
		2020 Vol. 29 (2): 136-140 [Abstract] ( 185 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	141	Feasibility of automatic IMRT planning for cervical cancer based on a database of previously-treated patients
		Chen Jihong, Bai Penggang, Chen Wenjuan, Chen Kaiqiang, Li Qixin, Zhang Xiuchun, Dai Yitao, Weng Xing, Qian Jiewei
		Objective To develop and evaluate an automatic intensity-modulated radiation therapy (IMRT) program for cervical cancer based on a database of overlap volume histogram (OVH) and high-quality cervical IMRT plans for previously-treated patients. Methods A database consisting of high-quality IMRT plans and OVHs from 200 cervical cancer patients was established. OVHs of another 26 cervical cancer patients were converted into gray level images to calculate the image similarity compared with those from the database. The planning optimization function of the patients from the database with the highest image similarity was selected and inherent Pinnacle³ scripts were utilized to automatically generate IMRT plan. Finally,the dosimetric parameters,plan quality and design time were statistically compared between the automatic and manual plans. Results The target coverage,conformity index and homogeneity index did not significantly differ between two plans (all P>0.05). The V40,V45 and mean dose for the rectum in the automatic plans were significantly decreased by 6.1%,1.3% and 50.7 cGy than those in the manual plans (all P<0.05). Compared with the manual plans,the mean dose for the intestine and femur in the automatic plans were significantly reduced by 31.7 cGy and 188.9 cGy (both P<0.05),whereas the mean dose for the ilium was slightly decreased by 92.3 cGy in the automatic plans (P>0.05). The plan design time was shortened by 71% in the automatic plans. Conclusions The automatic IMRT plans based on a database of OVH and high-quality IMRT plans can not only significantly shorten the plan design time,but also reduce the irradiated dose of normal tissues without compromising the target coverage and conformity index.
		2020 Vol. 29 (2): 141-145 [Abstract] ( 172 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	146	Clinical diagnosis and treatment of perineural invasion of head and neck malignant tumors
		Wang Zekun, Luo Jingwei
		Perineural invasion is a unique biological behavior of tumors via nerve dissemination and metastasis,which is intimately correlated with the recurrence,metastasis and prognosis. With the deepening research, the clinical significance of perineural invasion has been widely recognized. However,due to the low incidence of head and neck neoplasms and the varying incidence of perineural invasion in different anatomical sites and pathological types,high-level evidence-based medical evidence is still lacking. Currently,the pathological mechanism of perineural invasion has not been clearly clarified. No specific treatment has been available for perineural invasion. Therefore,the treatment of perineural invasion of head and neck tumors is an enormous challenge for clinicians. In this article, the current status of clinical diagnosis and treatment of perineural invasion in head and neck malignancies was reviewed.
		2020 Vol. 29 (2): 146-149 [Abstract] ( 162 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	150	Research progress on radiation-resistant and radiation-sensitive proteomics in glioma stem cells
		Zhang Shanshan, Shen Yuntian, Fan Qiuhong, Tian Ye, Huang Qiang
		After multidisciplinary treatment including radiotherapy, the median survival of patients with glioblastoma multiforme (GBM) remains approximately 1 year. The heterogeneity of the genome and proteome of glioblastoma stem cells (GSC) is the fundamental factor affecting the prognosis. Proteomics-based sensitization of key radioresistance proteins is expected to improve the prognosis of GBM patients. In this article, literature review was conducted from PubMed and other databases in the previous 10 years to systematically discuss the research progress on various commonly used protein quantitative techniques, tools for data processing analysis and the application in radioresistance and radiosensitization of GSCs.
		2020 Vol. 29 (2): 150-153 [Abstract] ( 185 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	154	Research progress on treatment strategy for elderly patients with locally advanced rectal cancer
		Fan Shaonan, Zhu Yaqun
		Rectal cancer is one of the most common malignant tumors in China, and the proportion of elderly patients is also increasing. Due to the lack of prospective evidence-based medical research for elderly patients, no consensus on the optimal treatment model has been reached. In this article, relevant researches on the comprehensive treatment strategy of locally advanced rectal cancer in the elderly patients were reviewed, aiming to provide reference for individualized treatment of elderly patients.
		2020 Vol. 29 (2): 154-157 [Abstract] ( 177 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	158	Research progress on ultrasound image-guided brachytherapy for cervical cancer
		Zeng Jing, Pang Qingsong, Wang Ping, Qu Pengpeng, Jiang Shan
		Brachytherapy is an integral part of radiotherapy treatment for cervical cancer. With the rapid development of medical imaging technology,three-dimensional (3D) imaging modality has been applied in the brachytherapy for cervical cancer. After computed tomography (CT) and magnetic resonance imaging (MRI), 3D ultrasound has been gradually applied to guide the brachytherapy for cervical cancer due to its superior soft tissue imaging characteristics,economy,high efficiency and convenience. In this article, the research progress on the application of ultrasonography in brachytherapy was summarized according to literature review,aiming to provide reference for subsequent research.
		2020 Vol. 29 (2): 158-160 [Abstract] ( 172 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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