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.3 Published 2020-03-15

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

Head and Neck Tumors

	161	Preliminary study of intensity-modulated carbon ion reirradiation for locoregionally recurrent nasopharyngeal carcinoma after definitive IMRT——Clinical experience from Shanghai Proton Heavy Ion Hospital
		Hu Jiyi, Gao Jing, Hu Weixu, Yang Jing, Guan Xiyin, Qiu Xianxin, Kong Lin, Lu Jiade
		Objective To evaluate the short-term efficacy and toxicities of intensity-modulated carbon ion radiotherapy (IMCT) for patients with locoregionally recurrent nasopharyngeal carcinoma after intensity-modulated radiotherapy (IMRT). Methods A total of 112 patients with locoregionally recurrent nasopharyngeal carcinoma undergoing salvaging IMCT between May 2015 and February 2018were enrolled in the study. All patients previously received one course of definitive X-ray IMRT. Among them,10 patients (9%) were diagnosed with stage Ⅰ,26 patients (23%) with stage Ⅱ,41 patients (37%) with stage Ⅲ and 35 patients (31%) with stage Ⅳnasopharyngeal carcinoma,respectively. The median age of the cohort was 48 years (range,17-70 years) old. The median dose to the gross tumor volume (GTV) was 60 GyE (range,50-69 GyE). Results With a median follow-up time of 20 months (range,5-45 months),20 patients died and 42 patients developed local recurrence. The 2-year overall survival (OS) and local progression-free survival (LPFS) rates were 85% and 52%. Both univariate and multivariate analyses demonstrated that stage Ⅳ disease was associated with significantly worse OS. No predictors were found for LPFS. No acute toxicity of grade 3 or higher was observed during reirradiation. Severe (grade 3 or above) late toxicities included xerostomia (n=1),hearing impairment (n=2),temporal lobe injury (n=1) and mucosal necrosis (n=19).Conclusions IMCT is an efficacious and safe treatment for patients with locoregionally recurrent nasopharyngeal carcinoma with acceptable toxicity profile. Long-term follow-up is necessary to further evaluate the long-term efficacy and late toxicities.
		2020 Vol. 29 (3): 161-165 [Abstract] ( 175 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	166	Prospective phase Ⅱ study of postoperative concurrent chemoradiotherapy for patients with high-risk malignant salivary gland tumors
		Wang Xin, Dou Shengjin, Li Rongrong, Wu Sicheng, Chen Gang, Zhang Lin, Yang Wenjun, Zhu Guopei
		Objective To assess the efficacy and safety of post operative adjuvant concurrent chemoradiotherapy for patients with high-risk salivary gland tumors (SGT). Methods Fifty-two patients with moderate or high malignant pathological stage complicated with locally advanced stage Ⅲ/ⅣA±positive margin/close margin admitted to Shanghai Ninth People′s Hospital from 2016 to 2018 were enrolled in this study. Among them, 35 patients were male and 17 female with a median age of 55.5 years old (range:21-73 years old). All 52 patients were treated with intensity-modulated radiotherapy and concurrent chemotherapy. Patients with adeno carcinoma of the salivary gland receives concurrent chemotherapy with TP regimen. Patients with lympho epithelial cancer and squamous cell carcinoma were treated with cisplatin regimen.Results Forty-seven patients (90%) completed two cycles of concurrent chemotherapy,and five patients (10%) completed one cycle of concurrent chemotherapy. The median follow-up time was 15.7 months (3.2-34.8 months). The 2-year disease-free survival (DFS) and overall survival (OS) rates were 74% and 98%. Three patients experienced regional lymph recurrence and 6 cases had distant metastasis. Grade Ⅲ oral mucositis was observed in 30 patients. Grade Ⅲ dermatitis occurred in 5 cases. Only one patient experienced Grade IV neutropenia,and 2 patients developed Grade Ⅲ neutropenia. DFS was positively correlated with the cycle of postoperative adjuvant concurrent chemotherapy (P=0.006).Conclusions Patients with high-risk SGT can obtain higher 2-year DFS and OS rates and tolerable adverse events after postoperative concurrent chemoradiotherapy. Nevertheless, the long-term outcomes remain to be validated by randomized controlled clinical trials.
		2020 Vol. 29 (3): 166-170 [Abstract] ( 158 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	171	Dose-escalation trial of lobaplatin weekly plus concurrent radiotherapy for local-regionally advanced nasopharyngeal carcinoma
		Pang Xuezhou, Qing Dong, Zhao Bin, Ma Daiyuan
		Objective To define the maximum-tolerated dose (MTD) of lobaplatin (LBP) in a weekly regimen combined with concurrent radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods A total of 18 cases with stage Ⅲ/IV A NPC were enrolled. Concurrent chemoradiotherapy was given to all the patients with a dose escalation of LBP. The initial dose of LBP was 15 mg/m² with an escalating dose of 5 mg/m². At least 3 patients were assigned into each group. Patients were proceeded into the next dose group if no dose-limiting toxicity (DLT) occurred until the MTD was achieved. Efficacy and toxicity were evaluated regularly. Results Three patients were assigned into the 10 mg/m², 3 into the 15 mg/m², and 6 into the 20 mg/m² and 25 mg/m² groups, respectively. Two patients experienced DLT in the 25 mg/m² group. Hence, the MTD was determined as 20 mg/m². At 3 months after corresponding treatment, the remission rate of nasopharyngeal tumors and neck-positive lymph nodes of the patients was 100%. The most common toxicity was reversible bone marrow suppression. Conclusions The MTD of weekly lobaplatin plus concurrent IMRT is 20 mg/m² for locally advanced NPC. This regimen is reliable and safe, which is worthy of further clinical study.
		2020 Vol. 29 (3): 171-174 [Abstract] ( 175 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	175	Analysis of local recurrence pattern for limited stage small cell lung cancer after IMRT plus chemotherapy
		Yan Wenbin, Liu Xuan, Zhou Zongmei, Wang Yuxia, Xiao Zefen, Feng Qinfu, Chen Dongfu, LüJima, Liang Jun, Deng Lei, Zhang Tao, Wang Wenqing, BI Nan, Wang Xin, wang xiaozhen, Hui Zhouguang, Wang Luhua
		Objective To investigate localized regional recurrence after chemotherapy and chest radiotherapy in limited stage small cell lung cancer (LS-SCLC),and explore the relationship between recurrence location and radiotherapy and chemotherapy and its influencing factors.Methods From 2006 to 2014,pathological LS-SCLC treated in CAMS,125 patients had local recurrence,Kaplan-Meier statistical method was used to analyze the survival rate and PFS of each recurrence site. Log-rank was used to compare the survival rate of each group. Univariate analysis includes Chi-squareand t-test for the factors for the recurrence site. Multivariate analysis using Logistic regression.Results The 1-,2-and 5-year overall survival rates were 92.0%,46.4% and 14.7%,respectively. The median progression time was 12.96 months,The median survival time after progression was 11.5 months,and the 1-,2-,and 5-year overall survival rates were 45.0%,23.0%,and 10.0%,respectively. The recurrence sites include intrapulmonary recurrence (67 patients),regional lymph nodes (21 patients),simultaneous intrapulmonary and regional lymph nodes (28 patients), and contralateral or supraclavicular lymph nodes (9 patients). The median survival time were 23.96 months,24.76 months,23.23 months,and 18.66 months,and the 2-year survival rates were 49%,52%,46%,and11%,respectively (P=0.000,0.004,0.008). In 6 patients (4.0%),5 patients were located in the supraclavicular region,and 1 patient (0.8%) in the field.Conclusions For LS-SCLC undergoing IMRT and chemotherapy,the local failure location is mainly located in the pulmonary,and further treatment of the split dose and targets requires further clinical exploration.
		2020 Vol. 29 (3): 175-178 [Abstract] ( 188 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	179	Analysis of recurrence pattern of neoadjuvant therapy combined with surgical treatment for esophageal squamous cell carcinoma
		Fan Chengcheng, Feng Zhuo, Ge Hong, Ye Ke, Wang Hao, Zheng Xiaoli, Zhang Yougai, Luo Hui
		Objective To evaluate the recurrence pattern and identify the risk factors of esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.Methods Clinical data of 275 patients with thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were retrospectively analyzed. The follow-up data of the enrolled patients were complete and analyzable. The recurrence pattern, recurrence time, recurrence location and influencing factors after neoadjuvant therapy in combination with surgery were analyzed. The recurrence rate was calculated by Kaplan-Meier method. The multivariate analysis was performed by Cox regression model. Results The median follow-up time was 32(3-84) months, and the median time of the first recurrence was 10.6(2.0-69.1) months. The 1-,2-and 3-year recurrence rates were 32.0%,45.1% and 52.3%, respectively. A total of 152 cases (55.3%) had recurrence. Among them,77 cases (50.6%) had local-regional recurrence (LRR),34 cases (23.4%) had distant metastasis (DM),33 cases (21.7%) had LRR+DM and 8 cases (6.0%) had recurrence in unknown site. Among the patients with LRR, lymph node recurrence was the most common (n=98,89.1%). For DM patients, lung metastasis (n=33,49.3%),liver metastasis (n=16,23.9%),bone metastasis (n=14,20.9%) and non-regional lymph node metastasis (n=14,20.9%) were commonly observed.The multivariate analysis showed that postoperative T stage (P=0.008), N stage (P<0.001) and the number of lymph node dissection (P<0.001) were the independent risk factors for recurrence after treatment.Conclusions The recurrence rate after neoadjuvant therapy remains relatively high for esophageal squamous cell carcinoma, and the regional lymph node is the most common site of recurrence. Postoperative pathological T staging, N staging and the number of lymph node dissection are the independent risk factors for recurrence after treatment.
		2020 Vol. 29 (3): 179-183 [Abstract] ( 181 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	184	Preliminary analysis of efficacy and safety of intensity-modulated radiotherapy for stage ⅣA thymoma
		Chang Dongshu, Li Ping, Li Jing, Wang Yong, Cui Jia, Wang Yingjie, Xia Tingyi
		Objective To preliminarily evaluate the efficacy and safety of intensity-modulated radiotherapy (IMRT) in the treatment of inoperable stage ⅣA thymoma. Methods A retrospective analysis of 15 patients with inoperable stage ⅣA thymoma receiving IMRT from January 2010 to December 2017 was performed. Among them, 9 patients were male and 6 female,aged 31-83 years with a medianof 59 years. The dose of radiotherapy was 50Gy/60Gy/70Gy/15-20 fractions for PTV/CTV/GTV. The short-term efficacy,overall survival rate and adverse reactions were analyzed. Results The follow-up rate was 100%. The median follow-up time was 48 months. The short-term partial remission rate was 93%(14/15). The 1-,3-and 5-year overall survival rates were 100%,75% and 75%,respectively. One patient presented with grade 3 hematological reaction. Four patients died of tumors.Conclusion Preliminary findings demonstrate that IMRT is an efficacious and safe treatment of stageⅣA thymoma, which can be applied for patients with unresectable thymoma.
		2020 Vol. 29 (3): 184-186 [Abstract] ( 184 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	187	Clinical comparison between ductal carcinoma in situ and ductal carcinoma in situ with microinvasion
		Liu Weixin, Wang Shulian, Tang Yu, Jing Hao, Wang Jianyang, Zhang Jianghu, Jin Jing, Song Yongwen, Wang Weihu, Liu Yueping, Fang Hui, Ren Hua, Qi Shunan, Lu Ningning, Tang Yuan, Li Ning, Li Yexiong
		Objective To analyze the differences in the treatment patterns,clinical characteristics,treatment outcomes and prognostic factors between breast cancer patients with ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinvasion (DCIS-MI).Methods Clinical data of 866 female patients including 631 DCIS cases and 235 DCIS-MI cases treated in our institution between 1999 and 2013 were retrospectively analyzed. The local control (LC),disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival analysis. The prognostic factors were identified by Log-rank test. Results Similar LC,DFS and OS rates were obtained between two groups (all P>0.05). The univariate analysis demonstrated that Her-2-positive patients had worse OS and DFS than Her-2-negative counterparts. Patients undergoing breast-conserving surgery without radiotherapy had lower LC and DFS rates compared with those receiving radical mastectomy. Conclusions DCIS and DCIS-MI patients have similar clinical prognosis in terms of OS,LC and DFS. Her-2 positive is an unfavorable prognostic factor for DFS and OS. The LC and DFS rates in the breast-conserving surgery alone group are worse than those in the mastectomy group.
		2020 Vol. 29 (3): 187-192 [Abstract] ( 191 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	193	The impact of a magnetic field on the dose distribution using the Bebig⁶⁰Co HDR sources
		Cui Zhenguo, Chen Jiayi, Yun Weikang, Liu Qi, Bai Yanling
		Objective To evaluate the impact of an external magnetic field on the dose distribution and electronic disequilibrium region around a Bebig type ⁶⁰Co HDR brachytherapy source and to judge the feasibility of applying MRI scanner during brachytherapy.Methods The source model was established based on the Monte Carlo package Geant4 software. The simulated geometries consisted of the ⁶⁰Co source inside a water phantom of 10.0cm×10.0cm×10.0cm in size. The magnetic field strength of the 0T,1.5T and 3.0T was considered,respectively. The voxels with a size of 0.2 mm, 0.5 mm and 0.5 mm were established along the x-, y-and z-axis. The influence of the magnetic field on the Kerma (kinetic energy released to matter) distribution and dose distribution within the 10.0mm region from the source center was evaluated. Furthermore,the ratio of the Kerma to dose as a function of the distance to the center source was acquired. Results The 1.5T magnetic field exerted no effect on the dose distribution adjacent to ⁶⁰Co HDR brachytherapy source, whereas3.0T magnetic field caused significant increase in the dose distribution within r<6 mm from the source center. The dose distribution was increased by 40% at r=5.4 mm from the source center. The ratio of Kerma to dose was less than 1 within the region of 1.2 mm<r<6.0 mm, suggesting that 3.0T magnetic field can lead to electronic disequilibrium within a larger region from the source center.Conclusions For Bebig ⁶⁰Co HDR brachytherapy source,it is safe and reliable to apply1.5T external magnetic field. Nevertheless, 3.0T magnetic field can cause high dose risk. Consequently, safety assessment and verification should be delivered prior to clinical application.
		2020 Vol. 29 (3): 193-196 [Abstract] ( 169 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	197	Clinical application and evaluation of automatic segmentation model based on deep learning for breast cancer radiotherapy
		Chen Xinyuan, Men Kuo, Tang Yu, Wang Shulian, Dai Jianrong
		Objective In this study,the deep learning algorithm and the commercial planning system were integrated to establish and validate an automatic segmentation platform for clinical target volume (CTV) and organs at risk (OARs) in breast cancer patients. Methods A total of 400 patients with left and right breast cancer receiving radiotherapy after breast-conserving surgery in Cancer Hospital CAMS were enrolled in this study. A deep residual convolutional neural network was used to train CTV and OARs segmentation models. An end-to-end deep learning-based automatic segmentation platform (DLAS) was established. The accuracy of the DLAS platform delineation was verified using 42 left breast cancer and 40 right breast cancer patients. The overall Dice Similarity Coefficient (DSC) and the average Hausdorff Distance (AHD) were calculated. The relationship between the relative layer position and the DSC value of each layer (DSC_s) was calculated and analyzed layer-by-layer. Results The mean overall DSC and AHD of global CTV in left/right breast cancer patients were 0.87/0.88 and 9.38/8.71 mm. The average overall DSC and AHD range for all OARs in left/right breast cancer patients were ranged from 0.86 to 0.97 and 0.89 to 9.38 mm. The layer-by-layer analysis of CTV and OARs reached 0.90 or above,indicating that the doctors were only required to make slight or no modification, and the DSC_s ≥ 0.9 of CTV automatic delineation accounted for approximately 44.7% of the layers. The automatic delineation range for OARs was 50.9%-89.6%. For DSC_s< 0.7,the DSC_s values of CTV and the regions of interest other than the spinal cord were significantly decreased in the boundary regions on both sides (layer positions 0-0.2,and 0.8-1.0),and the level of decrease toward the edge was more pronounced. The spinal cord was delineated in a full-scale manner,and no significant decrease in DSC_s was observed in a particular area.Conclusions The end-to-end automatic segmentation platform based on deep learning can integrate the breast cancer segmentation model and achieve excellent automatic segmentation effect. In the boundary areas on both sides of the superior and inferior directions,the consistency of the delineation decreases more obviously, which needs to be further improved.
		2020 Vol. 29 (3): 197-202 [Abstract] ( 186 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	203	Study of the mechanism of anti-tumor effect of Metformin-enhanced radiotherapy in CT26WT cell lines or mouse models with transplanted tumors
		Dai Xichao, Tao Leilei, Fang Tingting, Chen Ping, Sun Haijun, Wu Zhifeng, Dai Xichun
		Objective To investigate the inhibitory effect and mechanism of Metformin (Met) combined with irradiation in CT26WT cell lines or mouse models with transplanted tumors. Methods CT26WT cell line was treated with 0.5μmol/L,1.0μmol/L,5.0μmol/L and 10.0μmol/L Met,and CellTiter Glo kit was used to detect the inhibitory effect of Met at different concentrations on the viability of CT26WT cells. CT26WT cell line was treated with the control,Met (10μmol/L),15Gy irradiation and 15Gy irradiation+Met (10μmol/L). Clone formation assay was employed to detect the cell proliferation activity. Bablc mouse models of transplanted tumors (tumor size>150 mm³) were established and randomly divided into the control, 15Gy irradiation, Met and 15Gy irradiation+Met groups. Mice were given with 750 mg/kg Met at 24 h before irradiation. Transplanted tumor volume was measured regularly to delineate the growth curve of transplanted tumors and survival curve. The expression levels of P-H2AX and Sting proteins in CT26WT cells and transplanted tumors were detected by Western blot. The infiltration of CD8a (+) T cells in transplanted tumor tissues was detected by immunohistochemistry. Results The relative cell survival rate was 100%,87.9%,87.8%,87.3% and 76.5% in the 0, 0.5,1.0,5.0 and 10.0μmol/L Met groups,respectively (all P<0.05). The inhibitory effect of 10.0μmol/L was significantly stronger than that of 5.0μmol/L (P<0.001). The colone formation rate 34.0%,24.0%,22.3% and 14.0% in the control,Met,15Gy irradiation,Met+15Gy irradiation groups, respectively (all P<0.001). Western blot showed that compared with the control group,the expression of Sting protein was increased by 2.99-fold after Met treatment (P<0.001),and increased by 1.37-fold and 4.41-fold in the 15Gy irradiation and 15Gy irradiation+Met groups (both P<0.01). Compared with the 15Gy irradiation group,the expression of P-H2AX protein was significantly increased by 1.43 times after treatment with 15Gy+Met (P<0.001). The transplanted tumor growth curve showed that the transplanted tumor growth in the 15Gy+Met group was slower than that in the control group[(1007.0±388.5) mm³ vs. (2639.0±242.9) mm³,P<0.05)]. The overall survival time in the 15Gy irradiation+Met group was 48 d, significantly longer than 32 d in the control group (P<0.001). Compared with the control group,the expression of P-H2AX and Sting proteins in the 15Gy+Met group was increased by 8.8-fold and 1.6-fold (both P<0.001). Immunohistochemical staining showed that the infiltration of CD8a (+) T cells in the 15Gy irradiation+Met group was significantly higher than that in the control group (P<0.01). Conclusions Met combined with radiotherapy can inhibit the proliferation and clone formation of colon cancer cells, probably by aggravating DNA damage and activating the Sting signaling pathway, eventually leading to the increase of CD8a (+) T cells in tumor tissues and enhancing the killing effect upon transplanted tumor cells.
		2020 Vol. 29 (3): 203-206 [Abstract] ( 173 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	207	Effect of lncRNA MEG3 on radiosensitivity of nasopharyngeal carcinoma cells by down-regulating miR-7-5p expression
		Sun Xu, Sun Lifang, Yu Min, Li Ying, Li Mingyan, Yang Ke, Li Yujie, Xing Guochen, Han Quanxiang
		Objective To investigate the effect and underlying mechanism of lncRNA MEG3 on the radiosensitivity of nasopharyngeal carcinoma cells.Methods this experiment, overexpression control group,MEG3 overexpression group,miR-NC inhibition group,miR-7-5p inhibition group,overexpression control+4 Gy group, MEG3 overexpression+4 Gygroup,miR-NC inhibition+4 Gy group, miR-7-5p inhibition+4 Gy group, MEG3 overexpression+miR-NC overexpression group,MEG3 overexpression+ miR-7-5p overexpression group were established. The expression of miR-7-5p and MEG3 was detected by qRT-PCR. The radiosensitivity of nasopharyngeal carcinoma cells was measured by clone formation assay. Cell apoptosis was assessed by flow cytometry. The fluorescence activity was evaluated by dual luciferase reporter assay.Results MEG3 was lowly expressed in nasopharyngeal carcinoma tissues and cells. Overexpression of MEG3 and inhibition of miR-7-5p expression increased the radiosensitivity of nasopharyngeal carcinoma cells and promoted radiation-induced cell apoptosis. MEG3 could targetedly regulate the miR-7-5p expression. Overexpression of miR-7-5p reversed the effect of overexpression of MEG3 on the sensitization of nasopharyngeal carcinoma cells and the promotion of apoptosis induced by radiation exposure.Conclusions Overexpression of MEG3 increases the radiosensitivity of nasopharyngeal carcinoma cells and promotes radiation-induced cell apoptosis. The mechanism may be related to the down-regulation of miR-7-5p expression.
		2020 Vol. 29 (3): 207-210 [Abstract] ( 200 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	211	Preliminary exploration of 3D printed individualized applicator for 3D-image-guided intracavitary HDR-brachytherapy for nasopharyngeal carcinoma
		Tang Yiqiang, Zeng Lei, Ao Fan, Liao Yulu, Huang Min, Chen Shulan, Rao Xiaowei, Li Jingao
		Objective To explore the feasibility of 3D printed individualized applicator for the intracavitary HDR-brachytherapy for nasopharyngeal carcinoma. Methods CT scan was performed in 1 case of recurrent rT1 nasopharyngeal carcinoma and 1 case of T2 residual nasopharyngeal carcinoma and the obtained images were transmitted to 3D image processing software. The geometric contour parameters of the nasopharyngeal cavity were obtained and a pipeline was designed to make it close to the recurrent gross tumor volume (rGTV). Individualized cavity applicators were created by using 3D printer. The applicator was inserted into the patient′s nasopharyngeal cavity through oral cavity. The source tube and false source were inserted into the preset pipe of the applicator. CT scan was performed again and the images were transmitted to the 3D brachytherapy planning system. After delineating the target volume and organ at risk, treatment plan was optimized. After completing the first treatment, the applicator was removed. Before second treatment in a few days, CT scan was reviewed to confirm whether the position was correct. Results When the applicator was inserted into the nasopharyngeal cavity, it could be fully aligned with the nasopharyngeal wall and self-fixed without additional fixation measures. Comparing the location of false source in multiple reviews of CT scan, the error was ≤1 mm. No significant discomfort was reported throughout the treatment. In optimized three-dimensional treatment,100% prescription dose curve included the full rGTV, maximum dose of the brain stem and spinal cord was<30% prescription dose. Recurrent patients were given with a prescription dose of DT 40Gy/8 fractions/4 weeks and patients with residual tumors were given with 12Gy/2 fractions/1 week. No tumor recurrence was observed at postoperative 3 months in two cases. Conclusions The 3D printed individualized nasopharyngeal intracavitary applicator has the advantages of self-fixation, accurate location, good repeatability and good patient tolerance. The short-term outcome is effective, whereas its long-term clinical effect and adverse reactions need to be further observed.
		2020 Vol. 29 (3): 211-214 [Abstract] ( 162 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	215	Study of the feasibility of needle path optimization in 3D brachytherapy for cervical cancer
		Chen Xiang, Zhou Jianliang, Zhang Xiang, Wang Binbing
		Objective To compare the dosimetric differences between free-hand method and virtually optimized method for implanting needles in intracavitary and interstitial combined brachytherapy (IC/IS BT) of cervical cancer, and to explore the improvement space of the existing interstitial brahcytherapy plan. Methods High-dose-rate cervical cancer IC/IS BT plans (short for Treatment-Plan) of 18 cases were retrospectively analyzed. For each treatment plan, Nucletron Oncentra 3D brachytherapy planning system was utilized to redesign the virtually optimized insertion method IC/IS BT plan (short for Optimized-Plan). Dose volume histogram was adopted to evaluate the dose distribution in high-risk clinical target areas and exposure dose to organ at risk (OAR). The plan execution efficiency between two plans was also assessed. Results Comparing these two plans, the differences in conformity and uniformity of dose distribution of the target area were statistically significant (P=0.000,0.008). The differences of D0.01 cm³, D1 cm³, D2 cm³ and D5 cm³ in bladder, rectum, sigmoid and small bowel were all statistically significant (all P<0.05). Optimized-Plan could reduce the D2 cm³ of bladder, rectum, sigmoid and small bowel by 60.41, 36.43, 27.53 and 12.43 cGy, respectively. The execution time for the Treatment-Plan and Optimized-Plan were (857.92±243.39) s and (804.53±239.13) s with statistical significance (P<0.001). Conclusions Compared with the free-hand method, virtually optimized method yields more conformable coverage of the target area and more uniform dose distribution. At the same time, the doses of each OAR are reduced to different degrees and the execution time of the plan is also shortened.
		2020 Vol. 29 (3): 215-219 [Abstract] ( 148 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	220	Daily quality control data analysis and process evaluation of linear accelerator
		Jin Xiaoli, Lu Ying, Shi Qinying, Hao Lin, Xing Xiaofen
		Objective To analyze the quality control data of linear accelerator detected by Daily QA3 and to evaluate this quality control process using statistical process control.Methods After the calibrations of the accelerator and Daily QA3,Daily QA3 device was used to perform daily quality control by technicians and physicists and 100 groups and 30 groups of daily quality control data were collected. After the accelerator and Daily QA3 were re-calibrated,Daily QA3 device was utilized to perform daily quality control by technicians and 100 groups of the daily quality control data were repeatedly collected. The variations of normalized signal-to-noise ratio of quality control data collected after two calibrations were analyzed. The first 30 groups of daily quality control data measured by technicians and physicists were adopted to calculate the I-MR control chartsand compare the location of CL and the range of UCL and LCL. The process capability indices were calculated for three different quality control processes bytechnicians and physicists, respectively.Results For twice calibrations,normalized signal-to-noise ratio of quality control data significantly changed before 6 weeks, became stable between 6 and 8 weeks,and the changes became smaller after 8 weeks. For dose output measured by physicists,the rang of UCL and LCL was more narrow. In terms of flatness and symmetry,the location of CL was closer to zero. Regarding dose output and flatness,the process capability indices of three different quality control process were all satisfied ≥1,whereas unsatisfied for transverse symmetry. Conclusions The first 30–40 data points should be adopted to delineate I-MR control chart of the linear accelerator in daily quality control process. The quality control process should be completed by a fixed and small group of personnel and an optimal tolerance level should be customized.
		2020 Vol. 29 (3): 220-224 [Abstract] ( 151 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	225	Research progresson neoadjuvant chemoradiotherapy for locally advanced rectal cancer
		Wang Yiru, Zhang Yong, Wu Tong, Shen Meizhu
		Preoperative neoadjuvant chemoradiotherapy (NCR) combined with total mesorectal excision (TME) is the standard treatment mode for locally advanced rectal cancer. Compared with postoperative NCR, preoperative NCR increases the tumor down-staging, sphincter-preserving rate and local control rate. Patients who attain pathological complete response (pCR) after preoperative NCR have better prognosis compared with their counterparts. This article reviews the research progress on preoperative NCR in recent years.
		2020 Vol. 29 (3): 225-228 [Abstract] ( 168 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	229	Role of microRNA in predictingclinical efficacy of neoadjuvant chemoradiotherapy for rectal cancer
		Yao Wenyan, Peng Qiliang, Zhu Yaqun, Tian Ye
		Neoadjuvant chemoradiotherapy (NCRT) has become the standard treatment for patients with locally advanced rectal cancer (LARC). However,the response to NCRT varies among LARC patients and a subset of patients show resistance to NCRT. NCRT may delay the timing of surgery and even reduce the overall survival. Therefore,it is of significance to identify biomarkers for predicting the clinical efficacy of NCRT, screen patients who are resistant to NCRT and perform surgery as early as possible, eventually establishing an individualized therapeutic strategy. MicroRNAs are a class of small non-coding RNAs that post-transcriptionally regulate gene expression, which areinvolved in multiple signaling pathways and DNA damage repair process and affect the radiosensitivity of rectal cancer cells. Many recent studies have evaluated the role of microRNA in predicting the response to NCRT. The purpose of this article is to review the research progress and validate the role of microRNA in predicting the clinical efficacy of NCRT for rectal cancer.
		2020 Vol. 29 (3): 229-232 [Abstract] ( 167 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	233	Partial research progress on precision hyperthermia for malignant tumors
		Qian Jianing, Wu Zhibing
		Since the 21^st century,with the changes of people′s living habits and the aggravation ofenvironmental pollution,the incidence of tumors has been increasing day by day,which has become the main deathcauseof human diseases. Atpresent,in addition to the three major conventional treatments of tumors,the emergence of hyperthermia provides a safer and more effective solution for the prevention and treatment of tumors. Attributed to the rapid development of mechanical manufacturing,computertechnology,molecularbiology,materials science and other disciplines,precision hyperthermia presented by radiofrequency and ultrasonic focusing hyperthermia guided by magnetic resonance imaging (MRI) non-invasive temperature measure technology,as well as molecular level targeted hyperthermia have provided a broader perspective for the treatment of tumors. This article reviews the partial research progress on precision hyperthermia to understand the current general situation of precision hyperthermia for tumors.
		2020 Vol. 29 (3): 233-236 [Abstract] ( 193 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	237	Research progress on biomarkers for radiation-induced intestinal injury based on intestinal flora
		Zhang Junjun, Cai Shang, Yang Yongqiang, Li Junyan, Tian Ye
		Recently,the relationship between intestinal flora and its metabolites and tumorigenesis,inflammatory bowel diseasesas well as radiation-induced intestinal injury has captivated widespread attention from researchers. Accumulated evidence derived from nuclear accident investigation,animal model experiment and clinical research has proven the role of intestinal flora and its metabolites as the biomarkers to evaluate the radiation dose and severity of radiation-induced intestinal injury. This article reviews the relationship between intestinal flora and its metabolites and radiation-induced intestinal injury, aiming to provide theoretical reference for assessing the risk of radiation-induced intestinal injury.
		2020 Vol. 29 (3): 237-240 [Abstract] ( 180 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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