Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

中华放射肿瘤学杂志

Office

Journal

Archive

RSS

Download

Instruction

Template

Quick Search

Advanced Search

Chinese Journal of Radiation Oncology

	2020 Vol.29 Issue.4 Published 2020-04-15

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

Guideline

	241	Quality control guidelines for medical electronic linear accelerators
		National Cancer Center/National Cancer Quality Control Center
		With the development of radiotherapy technology,China has entered the era of precision radiotherapy. Medical electronic linear accelerators quality control is very important. This guide provides guidance for domestic medical institutions to develop their own quality control methods. The scope covers mechanical performance,safety interlock,dosimetric performance,imaging performance,and other special techniques. The aim of this guide is to unify the quality control protocol from different institutions. Taking into account the different brand models of equipment,the reference values and test methods are not unique. The quality control guidelines are for reference only,and the reference values need to refer to the measurement results during machine acceptance. It is recommended that each accelerator should have at least one medical physicist. For daily QA items,the therapist or medical physicist is in charge of the work;for monthly and annual QA items,medical physicist completes the work. Those who participate in quality control must be certified and trained,and the measurement results should be reviewed and archived by senior medical physicists.
		2020 Vol. 29 (4): 241-258 [Abstract] ( 230 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	259	The diagnostic value of HPV detection in squamous cell carcinoma of cervical lymph node metastasis from an unknown primary site (with report of 6 cases)
		Jiang Chenxue, Xu Tingting, Wang Cuihong, Sun Guohua, Wang Qifeng, Shen Chunying, Hu Chaosu, Lu Xueguan
		Objective To evaluate the diagnostic value of HPV detection in squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site. Methods Clinical data of 6 patients who were initially diagnosed with squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site and eventually diagnosed with HPV-related oropharyngeal squamous cell carcinoma were collected,and the process of diagnosis was analyzed. Results Upon the initial admission,all patients were diagnosed with squamous cell carcinoma of the cervical lymph node metastasis with positive p16 expression,positive HPV-16 subtype and negative EBER expression. No obvious primary lesion was found after comprehensive examination. Subsequently,four of them underwent ipsilateral tonsollar blind biopsy (n=2) and ipsilateral tonsillectomy (n=2). All these four patients were pathologically diagnosed with tonsillar squamous cell carcinoma. For the other two cases,MRI detected the thickening complicated with enhancement of ipsilateral wall of oropharynx and tongue root after follow-up for D149 and D545,respectively. Biopsy confirmed the diagnosis of squamous cell carcinoma of the tonsil and tongue root,respectively. Conclusion For patients with HPV-positive squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site,the possibility that the primary lesion originates from the oropharyngeal site,especially the tonsil and tongue root,should be highly suspected.
		2020 Vol. 29 (4): 259-261 [Abstract] ( 187 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	262	Clinical application of SIOPE guidelines in target definition for craniospinal irradiation in children
		Xing Pengfei, Yang Yongqiang, Qian Jianjun, Tian Ye
		Objective According to the SIOPE (2018) guidelines,the whole brain target of patients undergoing craniospinal irradiation was delineated and the underdose of sub-structures which were not delineated in original plan was verified, aiming to provide evidence for the risk of whole brain recurrence of craniospinal irradiation and accumulate experience for the clinical application of SIOPE guidelines. Methods Twelve children who underwent craniospinal irradiation were selected. As per the SIOPE guidelines in 2018, the CTVsub (including the superior orbital fissure,foramen rotundum,foramen ovale,jugular foramen,hypoglossal canal,internal auditory meatus and optic nerve) were delineated based on the original CTVold (whole brain plus sieve plate) to form PTVnew. A rough PTV (PTVrough) was formed by giving a margin of 15 mm forward-downward (skull base) and 3 mm in the other directions. CRTold and IMRTold plans were designed based on PTVold. CRTnew and IMRTnew plans were designed based on PTVnew. CRTrough plan was designed based on PTVrough. The omission of sub-structures based on CTVold and the underdose of CTVsub in each plan were evaluated. Results A total of 78.6% of superior orbital fissure,71.99% of foramen rotundum,96.76% of foramen ovale,88.5% of jugular foramen,97.71% of hypoglossal canal,99.48% of internal auditory meatus and 100% of optic nerve volume were missed based on CTVold. The target dose coverage of CTVsub based on CRTold and IMRTold was only 91.70% and 89.83%, respectively. The underdose was observed in 16.66%,3.57%,20.83%,1.78% and 1.19% of sub-structures in CRTold,CRTnew,IMRTold,IMRTnew and CRTrough plans, respectively. Of the underdose of all sub-structures,38.36% and 46.58% occurred in CRTold and IMRTold plans, respectively. Among them,the least and the most significant underdose occurred in foramen rotundum (0%) and foramen ovale (36.66%),respectively. Conclusions As per the SIOPE guidelines, traditional brain tissue delineation (including sieve plate) is likely to omit part of the target during the cranial target definition of craniospinal irradiation. The most significant underdose occurs in foramen ovale,and more obvious in the IMRT plan. The plan based on the delineation of sub-structures can significantly improve the underdose. When AP-PA irradiation is adopted,a rough PTV is recommended to obtain approximate target dose coverage and organ of risk sparing,whereas it requires further clinical verification.
		2020 Vol. 29 (4): 262-266 [Abstract] ( 212 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	267	Generative Adversarial Networks based synthetic-CT generation for patients with nasopharyngeal carcinoma
		Qi Mengke, Li Yongbao, Wu Aiqian, Guo Futong, Jia Qiyuan, Song Ting, Zhou Linghong
		Objective To establish a correlation model between MRI and CT images to generatesynthetic-CT (sCT) of head and neck cancer during MRI-guided radiotherapy by using generative adversarial networks (GAN). Methods Images and IMRT plans of 45 patients with nasopharyngeal carcinoma were collected before treatment. Firstly, the MRI (T1) and CT images were preprocessed, including rigid registration, clipping, background removal and data enhancement, etc. Secondly, the cases were trained by GAN, of which 30 cases were randomly selected and put into the network as training set images for modeling and learning, and the other 15 cases were used for testing. The image quality of predicted sCT and real CT were statistically compared, and the dose distribution recalculated upon predicted sCT was statistically compared with that of real planned dose distribution. Results The mean absolute error of the predicted sCT of the testing set was (79.15±11.37) HU, and the SSIM value was 0.83±0.03. The MAE values of dose distribution difference at different regional levels were less than 1% compared to the prescription dose. The gamma passing rate of the sCT dose distribution was higher than 92% and 98% under the 2mm/2% and 3mm/3% criteria. Conclusions We have successfully proposed and realized the generation of sCT for head and neck cancer using GAN, which lays a foundation for the implementation of MRI-guided radiotherapy. The comparison of image quality and dosimetry shows the feasibility and accuracy of this method.
		2020 Vol. 29 (4): 267-272 [Abstract] ( 217 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	273	Application of ArcCHECK system in the verification of tomotherapy plan for esophageal cancer
		Wang Zhenli, Zheng Anping, Zhu Jian, Du Hongling, Sun Xiaodong, Wang Dong, Wang Huitao, Zhang Yaowen, Zhu Qingshan, Cui Zhenhua
		Objective To explore the application of ArcCheck system in the validation of Helical and Direct tomotherapy plans for esophageal cancer and summarize relevant experience. Methods The Helical and Direct tomotherapy verification plans were established for 32 patients with esophageal cancer at different positions according to the doctor′s instructions, which were verified by the ArcCHECK system to compare the passing rate of the results.The correlation between the volume of the target area and the passing rate of the planned verification was analyzed. The therapeutic verification plan with a small target volume was made. The target area was placed at the center of ArcCHECK phantom and the area of detectors to statistically compare the verification passing rates. Results Helical plan showed a significantly higher passing rate than the Direct plan (P<0.01). The correlation coefficients between the target volume and the passing rate of the Helical and Direct plans were -0.364 and -0.042, and the P values were 0.041 and 0.819, respectively. For the Helical plan, when the 3%/2mm criterion was adopted, there was significant difference between placing the high-dose area at the center of the phantom and the area of detectors (P=0.005), and the passing rate of the latter was higher. There was no significant difference in the other cases (all P>0.05). Conclusions The passing rate of the Helical plan is generally higher than that of the Direct plan, which may be related to the angular response of the ArcCHECK detector and the fact that more reference points are not included for calculation due to low-dose radiation. In addition, it may also be related to the higher requirements of Direct plan for tomotherapy dose control system. In the Helical verification plan, when the 3%/3mm criterion is adopted, the larger the target volume, the higher the possibility of lower passing rate, whereas the correlation coefficient between them is relatively low. The high-dose area can be verified by the plans at the center of the phantom or the detection point. With the comprehensive consideration, we suggest putting it at the center of the phantom.
		2020 Vol. 29 (4): 273-277 [Abstract] ( 206 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	278	Comparison of the performance of two methods to determine set-up errors for DIBH patients with left sided breast cancer in radiotherapy
		Li Tantan, Zhang Jianghu, Song Yongwen, Tang Yu, Qi Shunan, Lu Fengyu, Zhang Wei, Wang Zengzhou, Feng Xin, Qin Shirui, Cheng Bin, Liu Bofei, Fu Guishan, Wang Shulian, Dai Jianrong
		Objective To establish the basic procedures of the application of optical surface monitoring system (OSMS) in the deep inspiration breath hold (DIBH) radiotherapy for patients with left sided breast cancer and compare the performance of OSMS and cone-beam CT (CBCT) in the determination of the set-up errors of DIBH radiotherapy for patients with left sided breast cancer. Methods Twenty patients with left sided breast cancer received DIBH radiotherapy. Through the registration of CBCT images with the planning CT images,and the registration of OSMS radiography images with the outer contour of the body surface,translational set-up errors and rotational errors were determined along the lateral-medial (Rx), superior-inferior (Ry) and anterior-posterior (Rz) directions. Pearson correlation analysis was performed to evaluate the correlation of the set-up errors determined by two methods,and Bland-Altman plot analysis was used to assess the coincidence of these two methods. Results Two methods were positively correlated. The Rz volume was 0.84,0.74 and 0.84 in the x,y and z directions,and 0.65,0.41 and 0.54 in the Rx,Ry and Rz directions,respectively (all P<0.01). The 95%CI of agreement were within preset 5 mm tolerance (-0.37-0.42cm,-0.39-0.41cm,-0.29-0.49cm) in x,y and z directions for two methods. The 95%CI of agreement were within preset 3 ° tolerance -2.9°-1.4°,-2.6°-1.4°,-2.4°-2.5°in Rx,Ry and Rz directions for two methods. The system errors of 20 patients with left sided breast cancer receiving DIBH radiotherapy were <0.18cm and the random errors were <0.24cm. Conclusions OSMS is equivalent to CBCT in the determination and stimulation of set-up errors for patients with left sided breast cancer receiving DIBH radiotherapy. The combination of CBCT and OSMS is a safe and reliable method.
		2020 Vol. 29 (4): 278-282 [Abstract] ( 236 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	283	Application value of individualized 3D-printed vaginal template for cervical cancer brachytherapy
		Wang Binbing, Zheng Guanghao, Zhang Xiang, Liu Jiping
		Objective To introduce the workflow of individualized 3D-printed intracavitary/interstitial vaginal template design. Dosimetric parameters and operation safety were investigated to evaluate the performance of 3D-printed template and freehand implantation. Methods Forty patients previously treated with intracavitary/interstitial Ir-192 HDR brachytherapy were enrolled in this study. All patients were randomly divided into the treatment (n=20) and control groups (n=20). In the treatment group, twenty patients were treated with individualized 3D-printed template. CT-based preplan was carried out to determine the needle implantation cannels. Template with customized shape and implantation cannels was then produced by a 3D printer. Finally,the template was inserted under CT guidance. In the control group, twenty patients received freehand implantation. Needle insertion was decided empirically without the preplan process. Results The difference of D90 for high risk CTV was found to be minor,while the D2cm³ in the rectum,bladder and sigmoid was significantly improved in the treatment group. Meanwhile,the high dose region and conformal index were also improved in the treatment group. A total of 273 needles were inserted and one (0.3%) not-used needle was found. No normal tissues were penetrated during needle insertion in the treatment group. In the control group,a total of 203 needles were inserted and 4(2.0%) not-used needles were observed,and normal tissue penetration occurred in 3(1.5%) needle insertion. Conclusions The individualized 3D-printed template implantation approach has advantages in terms of dosimetry and safety compared with freehand implantation. The actual treatment can achieve the dosimetric design requirements of the preplan.
		2020 Vol. 29 (4): 283-288 [Abstract] ( 208 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	289	Effect of LncRNA UCA1 on radiosensitivity of lung cancer cells and its mechanism
		Wang Cheng, Liu Zongwen, Hou Ge, Yang Jun, Huang Yangyang
		Objective To evaluate the effect of long-chain non-coding RNA (LncRNA) UCA1 on the proliferation,apoptosis and radiosensitivity of lung cancer cell and to explore the underlying mechanism. Methods qRT-PCR was used to detect the expression of UCA1 and miR-513a-5p in lung cancer cell A549,H1299 and normal human lung cell HBE. The si-con group (transfected si-con),si-UCA1 group (transfected si-UCA1),miR-513a-5p group (transfected miR-513a-5p mimics),miR-NC group (transfected miR-NC),IR+si-con group (transfected si-con,and irradiated),IR+si-UCA1 group (transfected miR-NC and irradiated),IR+miR-513a-5p group (transfected miR-513a-5p mimics and irradiated),IR+miR-NC group (transfected miR-NC and irradiated),IR+si-UCA1+anti-miR-513a-5p group (co-transfected si-UCA1, anti-miR-513a-5p and irradiated) were transfected into the A549 and H1299 cells by liposome method,and then the cells in certain groups were subject to 4Gy irradiation. The cell proliferation of each group was detected by MTT assay. The sensitivity enhancement ratio was assessed by clone formation assay. The cell apoptosis of each group was detected by flow cytometry. The fluorescence activity of each group was detected by dual-fluorescein gene detection assay. Results Compared with human normal lung cell HBE,the expression levels of UCA1 were significantly up-regulated in the lung cancer cell A549 and H1299(both P<0.05),whereas those of miR-513a-5p were significantly down-regulated (both P<0.05). Inhibition of UCA1 and overexpression of miR-513a-5p significantly inhibited cell proliferation,promoted cell apoptosis and increased the sensitivity of radiation exposure of A549 and H1299(sensitivity enhancement ratio=1.897, 2.146 and 1.615,1.872). miR-513a-5p could suppress the fluorescence activity of wild-type UCA1 cells,and UCA1 could negatively regulate the expression of miR-513a-5p. Inhibition of miR-513a-5p could reverse the enhancement effect of inhibiting UCA1 upon the radiosensitivity of lung cancer cells. Conclusions Inhibition of LncRNA UCA1 can enhance the sensitivity of radiation exposure to lung cancer cells. The mechanism may be related to the targeted inhibition of miR-513a-5p.
		2020 Vol. 29 (4): 289-293 [Abstract] ( 199 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	294	Mechanism of radiation combined with recombinant human endostatin in inducing myocardial fibrosis
		Wan Yan, Ouyang Weiwei, Su Shengfa, Zhang Jun, Xu Shilin, Ma Zhu, Li Qingsong, Geng Yichao, Lu Bing
		Objective The experimental animal model was established to unravel the mechanism of radiation-induced myocardial fibrosis and validate the role of recombinant human endostatin in aggravating the process of radiation-induced myocardial fibrosis via the TGF-β 1, Smad2 and Smad3 signaling pathways. Methods Sixty male adult Sprague-Dawley rats were randomly divided into the following groups:radiotherapy (RT)25 Gy,recombinant human endostatin (RE) 6 mg/kg,RE 12 mg/kg,RT 25 Gy+RE 6 mg/kg,RT 25 Gy+RE 12 mg/kg and blank control groups. Five rats were sacrificed in each group at 1 and 3 months after interventions. The myocardial tissues were collected. The pathological changes were observed by Hematoxylin and eosin staining. The degree of fibrosis was assessed by Masson trichrome staining. The expression levels of TGF-β1,Smad2, Smad3 and Collagen-I mRNA and protein were quantitatively measured by real-time PCR and Western blotting. Results At 3 months after intervention, Masson trichrome staining revealed that the collagen deposition in the RT 25Gy and RT 25Gy+RE (6 and 12 mg/kg) groups was more significant than that in the control group. In addition, The expression levels of TGF-β1,Smad2, Smad3 and Collagen-I mRNA and protein in these groups were significantly up-regulated compared with those in the control group. Conclusions Radiation with a total physical dose of 25 Gy can induce myocardial fibrosis in the SD rat models. TGF-β 1 and Smad2 signaling pathways are the common signaling pathways of myocardial fibrosis induced by radiation combined with recombinant human endostatin.
		2020 Vol. 29 (4): 294-299 [Abstract] ( 188 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	300	Design and implementation of quality management system for tumor radiotherapy
		Yang Shuirong, Ye Xiaoyan, Li Xiaobo, Xu Benhua, Tang Liyu, Lin Zhixiong
		Objective To design and implement a network-based quality management system for tumor radiotherapy. Methods The system consists of B/S framework-based three-layer structures including the application layer, system service layer and data layer. It utilizes Nutz as the development framework to develop web applications,MySQL as the system database,Java programming language for system development,Tomcat as a system application server for project release and IE,Google and other mainstream browsers to achieve client access server functions. Results The system can support integrated information management and service of quality control institutions at the provincial, municipal and county levels. The functions include procedure management,case management,quality control management,notification announcement,data management and system management, etc. The system has been set up and tested in the cooperation units,and the operation and function are in good condition. Conclusion The system can support the assessment of online quality control,which is conducive to information analysis and sharing,promotes the standardization and normalization of quality control and improves work efficiency. Case management function can monitor the diagnosis and treatment processes of patients, establish continuous electronic record, deliver rational treatment and rehabilitation guidance plan, which play a pivotal role in the evaluation of tumor radiotherapy.
		2020 Vol. 29 (4): 300-303 [Abstract] ( 210 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	304	Current situation of clinical research of buccal mucosa squamous cell carcinoma
		Liu Xiaoyang, Liu Xuewen, Wang Hui
		Treatment approaches for buccal mucosa carcinoma include surgery,radiotherapy,chemotherapy,targeted therapy,immunotherapy and various combinations of these modalities, whereas the clinical efficacy is not satisfactory. In this article, literature review was conducted to summarize the current situation of the diagnosis,lymph node metastasis,treatments of buccal mucosa carcinoma, aiming to provide reference for clinical practice.
		2020 Vol. 29 (4): 304-307 [Abstract] ( 176 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	308	Current situation and research progress on postoperative adjuvant radiotherapy for thymoma
		Zeng Qiang, Zhai Yirui, Wang Xiaodan, Feng Qinfu
		Surgical resection is the most important treatment of thymoma. However,the role of postoperative adjuvant radiotherapy (PORT) has been controversial. The survival benefits of two-dimensional radiotherapy are not significant. However,precision radiotherapy has significantly changed tumor radiotherapy. The value of PORT for thymoma may also be altered. At present,the effect of radiotherapy in patients with positive surgical margins or inoperable resection is confirmed. For patients with complete surgical resection,Masaoka-Koga stage Ⅰ patients do not require PORT. Whether PORT should be given for stage Ⅱ patients remains debated if stage Ⅱ b, large volume and B2/B3 type were considered during radiotherapy. The role of PORT for stage Ⅲ patients is also in disputed, whereas a majority of findings support the application of PORT. Precision technology is recommended during PORT.The clinical target volume suggests that the three-dimensional expansion of the tumor bed is 0.5 cm, including the mediastinal pleura involved by the tumor and 0.5-1.0 cm along the anterior and posterior direction of the mediastinal pleura, the cranial and caudal direction, the lung side is expanded within the 0.5 cm, and the vascular wall around the tumor and part of the vascular space, so as to avoid including too much normal tissue.The dose for complete resection is 45-50 Gy and 54-60 Gy or slightly higher for incomplete resection,which may increase the benefits and reduce the risk of PORT.The application of new radiotherapy techniques such as particle therapy can gain the advantage of dosimetric distribution, and whether it can be transformed into clinical benefits needs to be further explored.
		2020 Vol. 29 (4): 308-312 [Abstract] ( 216 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	313	Research progress on the prevention and treatment of radiation-induced intestinal injury by the genus Lactobacillus
		Zhao Tianshu, Yang Yongqiang, Cai Shang, Tian Ye
		Acute radiation-induced intestinal injury is the common complication in patients following abdominal and pelvic radiotherapy. However, no effective clinical prevention and treatment interventions are available. As the probiotics and symbiotic bacteria, many species of the genus Lactobacillus are normally present in the gastrointestinal tract and beneficial for the intestinal health. Preclinical studies have reported that the genus Lactobacillus can prevent and treat acute radiation-induced intestinal injury by protecting crypt stem cells,maintaining intestinal barrier and exerting the antioxidant effect, etc. Clinical trials have prompted that oral administration of adequate complex probiotics containing Lactobacillus spp.at one week before radiotherapy contributes to preventing radiation-induced diarrhea. In addition, oral intake of the genus Lactobacillus has the tendency to treat radiation-induced diarrhea and mitigate acute radiation proctitis. At present,no relevant adverse events have been reported.
		2020 Vol. 29 (4): 313-316 [Abstract] ( 176 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	317	Research status of ultrasound-guided radiotherapy for tumors
		Sun Hongfei, Ni Xinye, Yang Jianhua
		Image-guided techniques are critical to improving the accuracy of radiotherapy for tumors. Ultrasound images have been gradually applied in the set-up verification of clinical radiotherapy and adaptive radiotherapy because of the real-time,reproducible and non-radiative characteristics. In this paper,the application of ultrasound image-guided technology in radiotherapy was classified and analyzed,and the latest research progress was introduced.
		2020 Vol. 29 (4): 317-320 [Abstract] ( 212 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

News

More.....

Cooperation unit

友情链接

China Association for
　Science and Technology

Chinese Medical Association

Cancer Hospital of Chinese
　Academy of Medical
　Sciences Department of
　Radiation Oncology

Chinese Anti-Cancer
　Association

Chinese Journal of Lung
　Cancer

Cqvp

CNKI

Wanfang Data

More....