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.5 Published 2020-05-15

	Abdominal Tumors Review Articles Consensus Thoracic Tumirs Physics Bionlogy Technique

	321	Strategies of adjuvant radiotherapy for patients with breast cancer in COVID-19 disease outbreak
		Fang Hui, Wang Shulian, Li Yexiong
		Breast cancer is the most common malignancy in women in China, and adjuvant radiotherapy is an important component of multidisciplinary treatment. The 2019 novel coronavirusdisease(COVID-19) poses a significant challenge for patients to complete radiotherapy, because of a high hospital-related transmission rate of COVID-19 and a high risk of severe events for cancer patients. In this comment, we propose three major strategies for adjuvant radiotherapy in this COVID-19 outbreak:omission of radiotherapy, postponing of radiotherapy, and hypofractionated radiotherapy.
		2020 Vol. 29 (5): 321-323 [Abstract] ( 179 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Consensus

	324	Expert consensus on standardized management of radiotherapy nutrition
		Branch of Radiation Oncology of Chinese Medical Association
		About 40%-80% of patients with malignant tumors have nutrition-related problems, and malnutrition produces adverse effects on the treatment and prognoses of patients receiving radiotherapy. Medical nutrition therapy aims to help solve the malnutrition of tumor patients undergoing radiotherapy, which is of great significance to improve the nutritional status of patients and promote the comprehensive treatment effect of cancer. Patients receiving radiotherapy should be offered whole-course nutrition management during the peri-radiation period. Before, during, and after radiotherapy, NRS-2002 is utilized for nutritional risk screening;PG-SGA is employed for nutritional assessment when necessary;and standardized individualized nutritional support is provided in combination with RTOG acute and late radiation injury grading. This consensus supplemented and refined the nutritional support process for patients receiving radiotherapy, further discussed the standardized management process and standards of nutrition for radiotherapy in combination with guidelines on nutrition in cancer patients, so as to provided standards and reference for clinicians of oncology radiotherapy to develop standardized nutritional support.
		2020 Vol. 29 (5): 324-331 [Abstract] ( 191 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumirs

	332	The role of salvage radiotherapy in re-treatment of esophageal squamous cell carcinoma with regional lymph node oligo-recurrence after surgery
		Fan Chengcheng, Ge Hong, Ye Ke, Sun Yanan, Zheng Xiaoli, Feng Zhuo, Ni Peizan, Song Shuai, Zhang Yougai
		Objective To evaluate the role of salvage radiotherapy in the re-treatment of patients with regional lymph node oligo-recurrence after radical surgery for esophageal squamous cell carcinoma. Methods Clinical data of patients diagnosed with thoracic esophageal squamous cell carcinoma treated with radical surgery and developed regional lymph node oligo-recurrence (n=1-3) from January 2013 to January 2016 were retrospectively analyzed. A total of 74 cases with intact clinical data were extracted for analysis. The survival analysis was performed by Kaplan-Meier method. Group comparison was conducted by Log-rank method. Results The median overall survival (OS) after recurrence was 9(2.5-43) months, and the median progression-free survival time (PFS) was 4(1-33) months. There were 47 cases in the salvage radiotherapy group and 27 cases in the non-radiotherapy group, and the Objective response rates were 77%(36/47) and 30%(8/27), respectively. Patients in the salvage radiotherapy group had better OS (P=0.042) and PFS (P=0.01) compared with their counterparts in the non-radiotherapy group. Among the patients who received salvage radiotherapy, involved field irradiation and elective nodal irradiation yielded similar OS (P=0.963) and PFS (P=0.599), and patients treated an irradiation dose ≥ 60Gy had better OS (P=0.001) and PFS (P=0.001) compared with those with dose< 60Gy. Conclusions Local salvage radiotherapy is an effective treatment of esophageal squamous cell carcinoma with regional lymph node oligo-recurrence after radical surgery. Salvage radiotherapy has better OS and PFS compared with non-radiotherapy. Prospective clinical studies should be carried out to standardize the target and dose of radiotherapy, and to further clarify the effect of radiotherapy.
		2020 Vol. 29 (5): 332-336 [Abstract] ( 179 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	337	Analysis of the therapeutic effects and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma
		Wu Xiaoyuan, Yang Yuanyuan, Xing Wenqun, Li Xue, He Chunyu, Jiang Qiong, Liu Jinsong, Wang Jianhua
		Objective To evaluate the therapeutic effects and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. Methods The clinical data of a total of 148 patients with locally advanced esophageal squamous cell carcinoma enrolled in the Affiliated Cancer Hospital of Zhengzhou University from 2007 to 2017 were retrospectively analyzed. The patients received 5-Fu/Cisplatin or Paclitaxel/Cisplatin for chemotherapies. The total treatment dose for the radiotherapy was delivered at 36-40Gy under conventional fractionation. Kaplan-Meier method was used to calculate survival rates, and Log-rank test and Cox model were performed for univariate analysis and multivariate analysis, respectively. Results The overall survival (OS) rates of 1-, 3-and 5-year were 74%, 51% and 51%, respectively, with a median survival time (MST) of 72.4 months. The carcinoma/disease-free survival (DFS) rates for 1, 3, 5 years were 60%, 51%, 45%, respectively, with a median time of 60.1 months. The 1-, 3-and 5-year OS rates of the pCR group were 86%, 70%, 70%, the ones of which in the non-pCR group were 70%, 44%, 43%, respectively (P=0.002). The 1-, 3-and 5-year DFS rates were 76%, 71%, 68% for the pCR group, and 53%, 43%, 37% for the non-pCR group, respectively (P=0.002). In pN(-) group and pN(+) group, the 1-, 3-and 5-year OS rates were 83%, 56%, 55% and 50%, 38%, 38%(P=0.004), respectively. Further, the 1-, 3-and 5-year DFS rates were 66%, 56%, 51% for the pN(-) group, and 43%, 38%, 31% for the pN(+) group (P=0.006), respectively. Multivariate analysis revealed that pCR and pN status were independent prognostic factors for OS and DFS (P=0.012, 0.011 and P=0.025, 0.033). Conclusion Neoadjuvant chemoradiotherapy demonstrated significant therapeutic effects in the treatment of locally advanced esophageal squamous cell carcinoma, while pCR and pN status served as independent prognostic factors.
		2020 Vol. 29 (5): 337-341 [Abstract] ( 210 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	342	Efficacy and prognostic analysis of chest wall boost radiotherapy in stage T4 breast cancer patients after modified radical mastectomy
		Song Yuchun, Deng Yanbo, Wang Shulian, Song Yongwen, Tang Yu, Yang Yong, Fang Hui, Wang Jianyang, Jing Hao, Zhang Jianghu, Sun Guangyi, Chen Siye, Zhao Xuran, Jin Jing, Liu Yueping, Chen Bo, Qi Shunan, Li Ning, Tang Yuan, Lu Ningning, Li Yexiong
		Objective To analyze the efficacy of chest wall boost radiotherapy in stage T4 breast cancer patients after modified radical mastectomy. Methods A retrospective analysis was performed on the data of 148 stage T4 breast cancer patients who were admitted from 2000 to 2016 and received radiotherapy after modified radical mastectomy. There were 57 cases in the chest wall boost radiotherapy group and 91 cases in the conventional dose group. Radiotherapy was performed by conventional+ chest wall electron beam, three-dimensional conformal+ chest wall electron beam, intensity modulated radiotherapy+ chest wall electron beam irradiation. EQD2 at the boost group was >50Gy. All patients received neoadjuvant chemotherapy. Kaplan-Meier method was used to analyze survival;Logrank was used to test differences;and Cox model was used to do multivariate prognostic analysis. Results The median follow-up time was 67.2 months. The 5-year rates of chest wall recurrence (CWR), locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS) were 9.9%, 16.2%, 58.0%, and 71.4%, respectively. The 5-year rates of CWR, LRR, DFS, and OS with and without chest wall boost radiotherapy were 14% vs. 7%, 18% vs. 15%, 57% vs. 58%, 82% vs. 65%(P>0.05), respectively. Multivariate analysis showed that chest wall boost radiotherapy had no significant effect on prognosis (P>0.05). Among 45 patients in the recurrent high-risk group, boost radiotherapy seemed to have higher OS rate (P=0.058), DFS rate (P=0.084), and lower LRR rate (P=0.059). Conclusions Stage T4 breast cancer patients had strong heterogeneity. Chest wall boost radiotherapy did not apparently benefit all patients. For patients with 2-3 high risk factors including positive vascular tumor embolus, pN2-N3, and hormone receptor negative, chest wall boost radiotherapy showed a trend of improving efficacy.
		2020 Vol. 29 (5): 342-348 [Abstract] ( 203 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	349	The relationship between Lauren classification and pathological response after preoperative chemoradiotherapy for locally advanced gastric cancer
		Fang Yi, Zhang Yujing, Li Nai, Ling Yihong, Zhou Zhiwei
		Objective To investigate the correlation between Lauren classification and pathological response after preoperative chemoradiotherapy in patients with locally advanced gastric cancer. Methods From 2013 to 2019,98 patients with definite Lauren classification who were enrolled in Sun Yat-sen University Cancer Center 5010 Phase Ⅲ clinical trials. Among them, 46 patients received preoperative chemoradiotherapy (CRT), and the remaining 52 cases received preoperative chemotherapy (ChT) and radical surgery. After preoperative therapy, the correlation between pathological responseincluding the tumor regression grade (NCCN-TRG0-3) and the lymph node stage (ypN0-3) and Lauren classification was analyzed. A favorable pathological response (FPR) was defined as TRG0-2 and ypN0. Results In the CRT group, patients with intestinal type (IT) tumors had a higher rate of ypN0(OR=6.8,95%CI:1.8-25.0,P=0.004) and FPR (OR=8.0,95%CI:2.2-29.9,P=0.002) than their counterparts with diffuse or mixed type tumors. However, Lauren classification was not significantly correlated withpathological responsein the ChT group (P>0.05). For patients with IT tumors, those receiving CRT had a higher likelihood of achieving a TRG0-2 response (P=0.033), an ypN0 nodal regression (P<0.001), and a FPR (P<0.001) than their counterparts receiving ChT, whereas pathological response was not significantly associated with preoperative therapeutic method in patients with diffuse or mixed tumors (P>0.05). Conclusion Lauren classification may be a reliable predictor of the clinical efficacy of preoperative chemoradiotherapy for locally advanced gastric cancer, which can be utilized to select and optimize preoperative treatment.
		2020 Vol. 29 (5): 349-353 [Abstract] ( 159 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics Bionlogy Technique

	354	Impacts of different registration ranges on the accuracy of multiple metastases treated with tomotherapy
		Liu Hui, Peng Yinglin, Sun Wenzhao, He Huilang, Zhou Linghong
		Objective To analyze the impacts of different registration ranges on the accuracy of multiple metastases treated with helical tomotherapy. Methods According to the locations of target volumes, 28 patients with multiple metastases were divided into the head/chest group (n= 15) and the chest/pelvis group (n= 13). The CT and MVCT images acquired in first fraction were studied and compared in two groups, which were captured and matched with different registration ranges (all targets/the targets in proximity to the head/ the targets in proximity to the foot). The CTV_MVCT volume coverage rate (CR) under the matched target volumes,the dice similarity coefficient (DSC) between the CTV_CT and CTV_MVCT, and the position deviation of the CTV geometric center were compared. Results We observed similar results in the head/chest group and chest/pelvis group. Specifically, there was no significant difference in the CR, DSC and geometric center deviation between the two target regions when registered with all targets (P>0.05). Regarding single target region registration, the DSC and geometric center deviation of this target were significantly superior to the other non-registered target (P< 0.05). To a single target, the CR, DSC, and geometric center deviation obtained with registration presented the best performance, which was significantly greater than these parameters obtained with all targets registration, while the other side target area obtained the worst results (P< 0.05). Conclusions Registration of one target region may reduce the accuracy of other non-registered targets. We recommend that the image guidance ranges for multiple metastases treated with tomotherapy should include all target regions or independent registrations for different targets.
		2020 Vol. 29 (5): 354-357 [Abstract] ( 225 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	358	Development of an automatic analysis system for radiotherapy planning
		Yang Chengwen, Feng Yuanming, Wang Ping, Guo Lu, Wang Wei
		Objective An automatic analysis system for radiotherapy planning was developed to realize the automatic analysis of dose parameters of radiotherapy planning through the intelligent analysis of the underlying data of Pinnacle³ treatment planning system (TPS). Methods The radiotherapy plans of 12 patients with esophagus cancer were analyzed.The automatic analysis system automatically retrieved the Pinnacle³ TPS database, obtained the raw data of 12 cases of treatment plan, and automatically analyzed the underlying raw data, reconstructed contours, radiation fields, and dose parameters, and recalculated dose distribution and dose-volume histograms. The accuracy of the recalculation of the volume and dose data of the new system was evaluated by comparing with volume and dose data from the original plans of online TPS. Results The automatic analysis system successfully parsed the underlying data of the treatment plan and reconstructed the parameters of the treatment plan. The volume deviation between the contour calculated by the new system and the original plans was ≤0.1%;Compared with the reference dose of the original plans, the deviations of dose parameters (Dmax, Dmean, D95, and D50 for GTV,PGTV,CTV, and PTV) recalculated by the new analysis system were ≤1.0%;The deviations of Dmax and Dmean of recalculated ROIs from the original plans were <5%. Conclusions The automatic analysis system can directly analyze the underlying data of the Pinnacle³ TPS treatment plan, reconstruct the treatment plan, calculate the contour volume and dose parameters, and the dose deviations from the original plans meet clinical requirements
		2020 Vol. 29 (5): 358-362 [Abstract] ( 190 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	363	Evaluation of three predictive models of knowledge-based treatment strategies for radiotherapy
		Wu Aiqian, Li Yongbao, Qi Mengke, Jia Qiyuan, Guo Futong, Lu Xingyu, Liu Yuliang, Zhou Linghong, Song Ting, Chen Chaomin
		Objective To compare the accuracy and generalized robustness of three predictive models of knowledge-based treatment strategies for radiotherapy for optimized model selection. Methods The clinical radiotherapy plans of 45 prostate cancer (PC) cases and 25 nasopharyngeal cancer (NPC) cases were collected, and analyzed using three models (Z,L and S model),proposed by Zhu et al, Appenzoller et al and Shiraishi et al, respectively, to predict the dose-volume histogram (DVH) of bladder and rectum on PC cases and that of left and right parotid on NPC cases. The prediction error was measured by the difference of area under the predicted DVH and the clinical DVH curves (\|V(pre_DVH)-V(clin_DVH)\|),where a smaller prediction error implies a greater prediction accuracy. The accuracies of these three models were compared on the single organ at risk (OAR), and the generalized robustness of models was evaluated and compared by calculating the standard deviation of the prediction accuracy on different OAR. Results For bladder and rectum, the prediction error of L model (0.114 and 0.163,respectively) was significantly higher than those values of Z and S models (≤0.071,P<0.05);for left parotid gland, the predicted error of S model (0.033) did not present significant difference from those values of Z and L models (≤0.025,P>0.05);for right parotid gland, S model (0.033) demonstrated significantly higher prediction error than those of Z and L models (≤0.028,P<0.05). Regarding different OAR,S model showed a lower standard deviation of prediction accuracy when comparing to Z and L models (0.016,0.018 and 0.060,respectively). Conclusions In the prediction of DVH in bladder and rectum of PC,Z and S models were more accurate than L model. In contrast, Z and L models demonstrated higher accuracy than S model in the prediction of left and right parotid glands of NPC. In respect to different OAR, the generalized robustness of S model was superior than the other two models.
		2020 Vol. 29 (5): 363-373 [Abstract] ( 226 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	369	The value of MRI enhanced scan sequence in the radiotherapy target volume delineation in lung cancer with obstructive pneumonia/atelectasis
		He Tianyu, Li Sihan, Li Guang
		Objective To explore the feasibility and advantages of different MRI sequences in delineating target volumes in lung cancer with obstructive pneumonia or atelectasis (OC). Methods Fourteen patients with OC underwent CT localization and MRI scan. CT, T1WI, fat suppression T2WI, LAVA, LAVA+C images were collected respectively. CT and MRI images were fused in the treatment planning system, and GTV-p was target delineated on CT and MRI respectively. Results CT showed tumor and OC boundaries in 2 patients, fat suppression T2WI showed tumor and OC boundaries in 10 patients, LAVA showed tumor and OC boundaries in 12 patients, and LAVA+C showed tumor and OC boundaries in 10 patients. Fat suppression T2WI, LAVA, and LAVA+C sequences showed similar resolving ability (P>0.05). The GTV of T2WI, LAVA, and LAVA+C sequences decreased significantly compared with ST-GTV (P<0.05), and T2WI_GTV and LAVA_GTV were similar (P>0.05). The GTV value of LAVA+C was the smallest among all sequences. Conclusions The application of MRI fat compression T2WI, LAVA, and LAVA+C sequences to the radiotherapy target volume delineation in lung cancer patients with OC improved the accuracy, among which the boundary resolution of LAVA was better than that of fat compression T2WI, and LAVA+C showed the best effect on tiny blood vessels.
		2020 Vol. 29 (5): 369-377 [Abstract] ( 192 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	374	Automatic delineation of rectal cancer target volume and organs at risk based on convolutional neural network
		Xia Xiang, Wang Jiazhou, Yang Lifeng, Zhang Zhen, Hu Weigang
		Objective To realize automatic delineation of rectal cancer target volume and normal tissues and improve clinical work efficiency. Methods The deep learning method based on convolutional neural network was adopted to construct neural network, learn and realize automatic delineation, and compare the differences between automatic delineation and manual delineation. Results Two hundred and ten caseswith rectal cancer were randomly assigned to a training set of 190 and a validation set of 20. The complete delineation of a single case took about 10s;the average Dice of CTV was 0.87±0.04;the average Dice of other normal tissues was bigger than 0.8;the Hausdorff distance (HD) index of CTV was 25.33±16.05;the mean distance to agreement (MDA) index was 3.07±1.49, and the Jaccard similarity coefficient (JSC) index was 0.77±0.07. Conclusion The deep learning method based on full convolutional neural network can realize the automatic delineation of rectal cancer target volume and improve work efficiency.
		2020 Vol. 29 (5): 374-368 [Abstract] ( 232 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	378	Study of improving IMRT dose accuracy in patients with metal implants by density filling and artifact reduction
		Zhao Peifeng, Zhou Gang, Sun Yanze, Yang Yongqiang, Xing Pengfei
		Objective To explore the method of improving the accuracy of dose calculation of treatment plan in radiotherapy for patients with metal implants. Methods A CT simulator with metal artifact reduction technique (MAR) was utilized to scan the CIRS intensity-modulated phantom with metal rods and 8 patients with steel nails implanted in the centrum for radiotherapy. Radiotherapy plans were designed using conventional CT images, MAR images and density-filled images. The dose calculation errors between single field and intensity-modulated radiotherapy (IMRT) plan were compared. The effect of mental implants and their artifacts on the irradiation dose of IMRT plan was evaluated. Results In the conventional CT images of the phantom, when the incident path of the field failed to pass through the metal region, the dose calculation error for a single field was 3.85%, and the range of dose error for the field was 4.46%-74.11% when passing through the metal region. IMRT planning errors might exceed the clinically acceptable range when the incident path of the field passed through the metal region, and the errors tended to increase with the increase of dose weight of this field. After processing the images with density filling and artifact reduction techniques, the errors of the single field were 1.23% and 0.89%-4.73%, respectively, and the dose error of IMRT was 1.84%. The error of IMRT plan was 1.88% if density filling technique alone was employed to process the metal region. Due to the influence of metal implants and their artifacts, the minimum dose, average dose and prescription dose coverage actually received in the tumor target area were lower than IMRT plan results based on conventional CT images. The dosimetric difference of organs at risk was not statistically significant. Conclusions In the radiotherapy plan based on conventional CT images, there may be a large dose calculation error when the incident path of field passes through the metal region. If the metal material is known, density filling of the metal region in the planning system can effectively improve the accuracy of dose calculation. Metal artifact reduction technique can significantly improve the image quality and further reduce dose calculation error, which should be a routine technique for CT machines equipped with this function to perform simulated localization of patients with metal implants.
		2020 Vol. 29 (5): 378-382 [Abstract] ( 175 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	383	Radiosensitivity of connexin 43(CX43) on S24-GBMSCs based brain tumor in nude mice
		Huang Lulu, Liu Shengwen, Zhang Mengxian, Yu Shiying, Qiu Hong, Hu Guoqing
		Objective Toinvestigate the impact of connexin 43(CX43) on the connection of S24glioblastoma multiforme (S24-GBM) cellular network and to explore its role on radio-resistance. Methods Specific lentiviral vectors were used to knockout CX43 in S24-GBM stem cells (S24-GBMSCs). Alternatively, carbenoxolone (CBX) was used to block transmission of CX43. Subsequently, the animal subjects grafted with S24-GBMSCs were monitored under a multiphoton laser scanning microscope (MPLSM). Dynamic changes of tumor microtubes (TMs) and transmission of Ca²⁺ and SR101 in the cellular network were recorded. To study the radiosenstivity of S24-GBM before and after CX43 inhibition, MRI scanning of the brains was taken before and after radiation to assess the tumor sizes. Survival time of each subject was also recorded. Results In comparison with control group, knockout of CX43 in S24-GBMSCs led to shorter TMs, less TM connected cells, lower Ca²⁺ synchronicity and SR101 fluorescence, as well as decreased tumor sizes and prolonged survival time (all P<0.01), which were independent from radiation. However, CBX only demonstrated inhibition on the growth of tumors and the diffussion of Ca²⁺ and SR101, without affecting TMs formation. These above-mentioned alterations could be enhanced by the combination of gap43 knockout in S24-GBMSCs with blockage of CX43 by CBX (all P<0.05). Conclusion CX43 plays a critical role in the radioresistance of S24-GBM by influencing the formation of S24-GBM cellular network and the transmission of important signaling molecules including Ca²⁺ and SR101.
		2020 Vol. 29 (5): 383-387 [Abstract] ( 204 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	388	Research progress in the effect of non-neoplastic complications on adverse reactions to radiotherapy
		Yang Yongqiang, Cai Shang, Tian Ye
		Radiotherapy is an important component of multidisciplinary comprehensive treatment of malignant tumors. However, the existence of non-neoplastic complications may increase the acute and late adverse reactions of radiotherapy and affect the smooth implementation of radiotherapy. This paper reviews the effects of various common non-neoplastic complications (including diabetes, HIV infection, and inflammatory bowel disease) on radioactive normal tissue damage in tumor patients.
		2020 Vol. 29 (5): 388-391 [Abstract] ( 168 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	392	Research progress in the effect of radiotherapy and its timing on tissue expander/prosthesis implantation-based breast reconstruction
		Qi Yihang, Kong Xiangyi, Wang Xiangyu, Wang Jing
		As indications of radiotherapy in the treatment of breast cancer continue to expand, more and more patients need radiotherapy after mastectomy. With the development of breast reconstruction, radiotherapy and its timing will affect breast reconstruction while patients benefit from tumor treatment and may lead to different postoperative complications and cosmetic effects. How to optimize the comprehensive therapeutic strategies of postoperative breast reconstruction and radiotherapy for breast cancer, especially the techniques of breast reconstruction and the choices of radiotherapy timing, has become an issue of common concerns of multidisciplinary treatment involving radiotherapy, breast surgery, and plastic surgery. This paper aims to review and summarize the latest high-quality research in this field including the impact of radiotherapy and its timing on tissue expander/prosthetic breast reconstruction, rate of prosthetic reconstruction, and postoperative patient satisfaction so that scholars can understand the latest research progress of radiotherapy and breast reconstruction and clinicians can optimize therapeutic regimens.
		2020 Vol. 29 (5): 392-395 [Abstract] ( 189 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	396	Research progress in dosimetry with MRI-Linac
		Fu Jiaqi, Ni Cheng, Fu Jie
		The integration of MRI and linac has realized real-time MRI-guided radiotherapy and accelerated the progress of precision radiotherapy. Electrons are subjected to Lorentz force in the magnetic field, especially the electron cyclotron effect occurs at the tissue-air interface, which changes the original electron equilibrium state and brings challenges to dosimetry with MRI-Linac. In recent years, a series of studies carried out through Monte Carlo simulation and experimental measurement have suggested that the conventional dosimetry devices can be used for the dosimetry with MRI-Linac after replacing the magnetic materials, but corresponding correction factors should be introduced according to the magnetic field intensity, placement angle of the measuring device, type of the measuring device. The standardization, streamlining, and real-time dosimetry with MRI-Linac need to be further studied.
		2020 Vol. 29 (5): 396-400 [Abstract] ( 204 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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