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.6 Published 2020-06-15

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

Investigation Research

	401	Research status and development trend of global radiotherapy for lung cancer in recent 10 years——bibliometric analysis based on Web of Science
		Duan Hexin, Xiang Zhibi, Peng Haiqin, Zhou Rongrong
		Objective To investigate the research status and development trend of radiotherapy for lung cancer in recent 10 years through the bibliometric analysis of relevant literature. Methods Taking the core collection of Web of Science as the data source,combined with the visualization function of Cite Space software,bibliometric methods were adopted to analyze the literature publication,distribution of journals,authors,institutions and countries,the literature co-citation,keyword co-occurrence and clustering of the lung cancer radiotherapy research from 2010 to 2019. Results In recent 10 years,the amount of literature published in this field has been on the rise year by year. International Journal of Radiation Oncology Biology Physics was the journal with the largest number of publications. The authors and organizations with the most articles were all from the United States. Stereotactic radiotherapy has become a research hot spot in this field,and the combination of immunotherapy and stereotactic radiotherapy may become a novel development trend in the future. Conclusions In the past 10 years,the research on radiotherapy has been developing steadily at home and abroad,forming a certain research direction and development trend. Some core institutions and core authors have appeared. However, international exchange and cooperation remain to be strengthened probably due to the unbalanced development of global radiotherapy technology.
		2020 Vol. 29 (6): 401-406 [Abstract] ( 209 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	407	Investigation and analysis of diagnosis and treatment of cancer patients in prefectural hospitals from Sichuan province during 2019 novel coronavirus disease (COVID-19) epidemic
		Fan Yixin, Li Zhihui, Chen Ailin, Huang Rui, Yin Li, Zhang Peng
		Objective To investigate the diagnosis and treatment of cancer patients in the prefectural and municipal hospitals in Sichuan province during the outbreak of 2019 novel coronavirus disease (COVID-19) epidemic, and analyze the impact of the epidemic on the hospitalization and treatment of cancer patients, aiming to provide reference for the diagnosis and treatment of cancer patients by medical institutions in different provinces. Methods The prefectural and municipal hospitals in Sichuan province were investigated in the form of questionnaire. Results A survey was conducted in 37 prefecture-level large and medium-sized hospitals in Sichuan province, of which Grade 3A hospitals accounted for 78.4%. Among the investigated hospitals, the hospitals whose hospitalization index of oncology patients and radiotherapy index of radiotherapy patients were< 1 after the first-class response were 83.7% and 93.1%, respectively. Hospitals with normal or delayed chemotherapy within one-week consisted of 54.1%, and 89.7% of the hospitals received normal radiotherapy or delayed radiotherapy within one-week after the Spring Festival. After the second-class response, the proportion of hospitals with oncology patients and radiotherapy patients that increased after the first-class response was 78.4% and 79.3%, respectively. Conclusions Under the guidance of the State Council, the Sichuan Provincial Party Committee and the Provincial Government, Health Commission of Sichuan Province, and the municipal health commissions at various levels and under the joint efforts of medical institutions and front-line medical staff from Department of Oncology, a majority of cancer patients admitted to prefectural and municipal hospitals in Sichuan province can receive active and effective treatment during the outbreak of COVID-19 epidemic.
		2020 Vol. 29 (6): 407-410 [Abstract] ( 210 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	411	Analysis of long-term efficacy of re-irradiation for recurrent glioma
		Lyu Shuang, Zhang Haibo, Xu Ying, Ren Xue, Jiang Tong, Yan Ying
		Objective To analyze the long-term efficacy and safety of re-irradiation for recurrent glioma. Methods The data of 52 patients with recurrent gliomas were collected from 2009 to 2019. The median planned targetvolume (PTV) was 73.5 cm³(49.9-102.7 cm³) and the median dose was 45.0 Gy (43.0-48.8 Gy). Kaplan-Meier method was used for survival assessment,log-rank test for difference assessment,and Cox's regression model for multivariate prognostic analysis. Results The median follow-up time was 32.6 months. The median overall survival (OS) and progression-free survival (PFS) time were 16.1 months (95%CI,4.1-28.1) and 8.0 months (95%CI,4.0-12.0). The 1-, 2-and 3-year survival rates were 67%,43% and 29%, respectively. The 6-month,1-year and 2-year PFS rates were 67%,40%,26%, respectively. Multivariate analysis showed that KPS score and recurrence time significantly affected the OS (P=0.012,P=0.001). KPS score and time interval between two radiotherapies significantly impacted the PFS (P=0.003,P=0.018). Stratified analysis showed that KPS score was the independent prognostic factor of OS and PFS in patients with WHO grade Ⅱ initial pathology and reoperation after recurrence (P<0.001,P=0.012);clinical manifestation was the independent prognostic factor of OS and PFS in patients with WHO grade Ⅲ and Ⅳ initial pathology (P=0.006,P=0.044). The overall incidence of adverse reactions was 30.8%. Grade 1 adverse reactions accounted for 25.0%,and 5.8% for grade 2. Conclusions Re-irradiation for recurrent glioma yields good long-term clinical efficacy and tolerable adverse reactions.
		2020 Vol. 29 (6): 411-415 [Abstract] ( 185 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	416	Experience and efficacy of SBRT for lung cancer:an analysis of 142 patients
		Dong Baiqiang, Wang Jin, Xu Yujin, Hu Xiao, Du Xianghui, Shan Guoping, Shao Kainan, Bai Xue, Chen Ming
		Objective To evaluate the clinical efficacy and safety of stereotactic body radiation therapy (SBRT) for stage Ⅰ-Ⅱ non-small cell lung cancer. Methods Retrospective analysis of patients with early stage lung cancer who received SBRT in Zhejiang Cancer Hospital from 2012 to 2018 was conducted. The Kaplan-Meier method was used for survival analysis. The main endpoints of the study were locoregional control (LRC) and cancer specific survival (CSS). Results A total of 142 eligible cases were included,with a median BED10100Gy (100-132Gy). The median age was 75.6 years (47.2-89.0 years),among which 75 patients were aged (greater than or equal to 75 years old). The median follow-up time was 31.0 months,for patients< 75 years old and patients ≥ 75 years old. The 5-year LRC were 84.5% and 95.8% respectively,5-year CSS were 72.4% and 78.6% respectively,for patients< 75 years old and elderly patients. The systemic response was mild during treatment,no grade 4-5 adverse events occurred in all patients. The main acute side effect was radiation pneumonitis (RP) below grade 3. Grade 2 RP appeared in 14 patients (9.9%) after SBRT where grade 3 RP occurred in 2(1.4%). There was no treatment-related mortality in the SBRT group. Conclusions SBRT is a safe and effective treatment for early primary lung cancer with satisfactory rates of LRC and CSS in 5 years and mild complication,which is similar to previous reports.
		2020 Vol. 29 (6): 416-420 [Abstract] ( 189 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	421	Application of 24-hour dynamic electrocardiogram combined with cardiac troponin I in evaluating radiation-induced cardiac injury
		Wu Xia, Yang Qinghua, Liu Xuejian, Qiao Hanyong
		Objective To investigate the value of 24-hour dynamic electrocardiogram combined with cardiac troponin I (cTnI) in evaluating the radiation-induced heart disease (RIHD) in chest tumor radiotherapy. Methods From 2015 to 2018, 128 patients with chest tumor who received radiation therapy with/without chemotherapy in the Third People′s Hospital of Linyi were selected to undergo routine ECG examination, 24-hour dynamic ECG examination, cTnI and cardiac color Doppler ultrasound before radiotherapy, 30Gy radiotherapy, 50Gy radiotherapy, after radiotherapy and 3 months after radiotherapy, respectively. The detection rates of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI, cardiac color Doppler ultrasound and 24-hour dynamic electrocardiogram combined with cTnI for RIHD were statistically compared. The correlation between glucose level, hypertension and coronary heart disease, combined with chemotherapy, radiation dose and the irradiated area of the heart and the incidence of RIHD was analyzed. Results The detection rates for RIHD did not significantly differ between 24-hour dynamic electrocardiogram and routine electrocardiogram (P>0.05), whereas the detection rates for arrhythmia, atrioventricular block, bundle branch block and ST-T changes of 24-hour dynamic electrocardiogram were significantly higher than those of routine electrocardiogram (all P<0.05). The detection rate of 24-hour dynamic electrocardiogram combined with cTnI was significantly higher compared with that of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI or cardiac color Doppler ultrasound alone (all P<0.05). There was a significant difference in RIHD before and after radiotherapy (P<0.05). The incidence rate of RIHD in the radiation therapy combined with chemotherapy group was significantly higher than those in the cisplatin chemotherapy and radiotherapy alone groups, especially in the epirubicin+ cyclophosphamide group (45%, all P<0.05). The incidence rate of RIHD was similar between radiotherapy alone and radiotherapy combined with cisplatin chemotherapy (both P>0.05). After radiation therapy, the grade of RIHD was elevated in 40 cases (31.2%). Diabetes mellitus, hypertension, coronary heart disease, radiotherapy combined with chemotherapy, cardiac Dmean and cardiac V40Gy were the independent factors for the occurrence of grade 1-4 RIHD (all P<0.05). Conclusion The 24-hour dynamic electrocardiogram combined with cTnI is of great value in the detection of RIHD induced by radiotherapy for chest tumors with high detection rate, simple operation and low cost, which is worthy of application in clinical practice.
		2020 Vol. 29 (6): 421-426 [Abstract] ( 230 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	427	Preliminary study of predicting radiation pneumonitis based on radiomics technology
		Zhang Zhen, Zhao Lujun, Wang Wei, Cui Jingjing, Wang Qi, Liu Ying, Wang Qingxin, Zhang Daguang
		Objective To identify the radiomics features related to the occurrence of radiation pneumonitis based on localized CT images of the chest in lung cancer patients, establish a machine learning model and investigate the value of radiomics technology in predicting the incidence of radiation pneumonitis. Methods Clinical data of 86 patients with stage Ⅲ non-small cell lung cancer who received radical intensity-modulated radiation therapy (IMRT) were retrospectively analyzed. The radiation pneumonitis was graded by follow-up imaging data and clinical information. The planning CT images were collected. The lung was used as the volume of interest for extraction of radiomics features. The radiomics features,clinical and dosimetric parameters associated with the incidence of radiation pneumonitis were analyzed. Using the support vector machine to construct the model,the prediction performance of the model was evaluated by the five-fold verification method. Results A total of 1029 radiomics features were extracted from CT images and 5 features were selected by ANOVA and LASSO. Two validation sets showed differences between adopting radiomics features alone and incorporating clinical and dosimetric parameters and radiomics features (AUC=0.67 and 0.71,respectively). Conclusions The radiomics model constructed by planning CT images of lung cancer patients has the potential to predict the occurrence of radiation pneumonitis. Addition of clinical and dosimetric parameters can further improve the prediction performance of the model.
		2020 Vol. 29 (6): 427-431 [Abstract] ( 227 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	432	Interobserver variability in the delineation of the target volume based on supine and prone simulation 3DCT for external-beam partial breast irradiation after breast-conserving surgery
		Yu Ting, Li Yankang, Li Fengxiang, Wang Jinzhi, Wang Wei, Xu Min, Zhang Yingjie, Li Jianbin
		Objective To explore the interobserver variabilities in the delineation of the target volume using simulation three-dimensional computed tomography (3DCT) between the supine and prone positions for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS). Methods Twenty-seven breast cancer patients who were scheduled to receive EB-PBI after BCS from July 2016 to April 2017 were enrolled in this study. All patients underwent axial 3DCT simulation scanning in the supine and prone positions during free breathing. Based on two different simulation 3DCT acquired, the gross target volume (TB) formed by using surgical clips and the clinical target volume (CTV) were delineated by five radiologists using specific guidelines. The following parameters including the target volume, coefficient of variations (COV) and matching degree (MD) were calculated to analyze the interobserver variability. Twenty-seven breast cancer patients who were scheduled to receive EB-PBI after BCS from July 2016 to April 2017 were enrolled in this study. Results Whether in the supine or prone position, the interobserver variabilities for TB and CTV were statistically significant (P<0.001,P=0.001,P<0.001,P=0.001). And the intersection of CTV in the prone position was 5.79 cm³ greater than that in the supine position (P=0.011). The interobserver variability of COVCTV in the prone positionwas significantly lower than that in the supine position (P=0.014). And the interobserver variabilities of MDTBTB and MDTBCTV in the prone positionwere statistically greater than those in the supine position, respectively (P<0.001,P= 0.001). Conclusions When delineating the target volume of EB-PBI in the prone position, the interobsever variability can be reduced compared with that in the supine position. Hence, it is more reasonable to carry out EB-PBI in the prone position in free breathing.
		2020 Vol. 29 (6): 432-436 [Abstract] ( 183 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	437	Preliminary observation of the results of external irradiation combined with brachytherapy for inoperable locally advanced rectal cancer
		Zhao Zhipeng, Li Dan, Guan Wei, He Mingyuan, Cheng Guanghui, Wu Ning
		Objective To explore the clinical efficacy and adverse reactions of the combination of external beam radiotherapy followed by three-dimensional intracavitary brachytherapy in patients with inoperable locally advanced rectal cancer. Methods Clinical data of 11 patients with inoperable locally advanced rectal cancer, 7 male and 4 female, admitted to China-Japan Union Hospital of Jilin University from 2013 to 2015 were retrospectively analyzed. All patients received pelvic external irradiation (50 Gy in 25 fractions), followed by a three-dimensional intracavitary brachytherapy boost (15-20 Gy in 3-4 fractions,1 fraction/week). External beam radiotherapy was used to boost the dose to the perirectal lymph nodes (60-66 Gy in 30-33 fractions). All patients received concurrent chemotherapy with Capecitabine during external beam radiotherapy. Efficacy evaluation was performed using the RECIST standard. Survival and local control rates were calculated using the Kaplan-Meier method. Early and late radiotherapy responses were assessed using the RTOG lesion grading criteria. Results The CTV D90% EQD2 Gy of HDR 3D-ICBT among 11 patients was (21.3±1.60) Gy. The complete response (CR) and partial response (PR) rates were 64% and 27%,respectively, yielding an objective response rate (CR+PR) of 91%. With a median follow-up time of 36 months, the 1-,2-,and 3-year overall survival rates were 82%,64% and 46%,respectively. The 1-,2-,3-year disease-free survival rates were 64%,45% and 27%,respectively. The 3-year local control rate was 46%. One patient presented with lung metastases after 8 months, 7 patients experienced grade 1-2 acute intestinal reactions and 5 patients developed grade 1-2 acute bladder reactions, only one patient had grade 2 myelosuppression;long-term grade 1-2 intestinal reactions occurred in 5 patients, and 1 patient had long-term grade 1-2 bladder reaction. All the radiation-induced toxicities were alleviated by medication administration. Conclusions External beam radiotherapy followed by three-dimensional intracavitary brachytherapy can be a safe and effective surrogate in patients with inoperable locally advanced rectal cancer,which yields reliable clinical efficacy and tolerable adverse reactions.
		2020 Vol. 29 (6): 437-440 [Abstract] ( 180 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	441	Prediction of deep learning-based radiomic features for neoadjuvant radiochemotherapy response in locally advanced rectal cancer
		Li Ning, Sharon Qi, Feng Lingling, Tang Yuan, Li Yexiong, Ren Ye, Fang Hui, Tang Yu, Chen Bo, Lu Ningning, Jing Hao, Qi Shunan, Wang Shulian, Liu Yueping, Song Yongwen, Jin Jing
		Objective To evaluate the effectiveness of deep learning (DL)-based radiomic features extracted from pre-treatment diffusion-weighted magnetic resonance images (DWI) for predicting neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC). Methods Forty-three patients receiving nCRT from 2016 to 2017 were included. All patients received DWI before nCRT and total mesorectal excision surgery 6-12 weeks after completion of nCRT. The patient-cohort was split into the responder group (n=22) and the non-responder group (n=21) based on the post-nCRT response assessed by postoperative pathology, MRI or colonoscopy. DL-based radiomic features were extracted from the apparent diffusion coefficient map of the DWI using a pre-trained convolution neural network, respectively. Least absolute shrinkage and selection operator-Logistic regression models were constructed using extracted radiomic features for predicting treatment response. The model performance was evaluated with repeated 20 times stratified 4-fold cross-validation using receiver operating characteristic (ROC) curves.Results The model established with DL-based radiomic features achieved the mean area under the ROC curve of 0.73(SE, 0.58-0.80). Conclusion DL-based radiomic features extracted from pre-treatment DWI achieve high accuracy for predicting nCRT response in patients with LARC.
		2020 Vol. 29 (6): 441-445 [Abstract] ( 185 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	446	Clinical efficacy of concurrent chemoradiotherapy in cervical cancer patients with pelvic and/or para-aortic lymph node metastasis treated with radical surgery
		Tu Yeqiang, Tang Qiu, Yan Dingding, Lyu Xiaojuan, Chen Jianhong, Wang fangfang
		Objective To determine whether postoperative concurrent chemoradiotherapy (CCRT) improves the survival outcomes of cervical cancer patients with pelvic and/or para-aortic lymph node metastasis after radical surgery. Methods Clinical data of 188 cervical cancer patients presenting with pelvic and/or para-aortic lymph node metastasis after radical surgery between February 2008 and November 2011 were retrospectively analyzed. The incidence of pelvic and/or para-aortic lymph node metastasis was confirmed by postoperative pathology. The clinical efficacy of CCRT was evaluated. Results Recurrence/metastasis occurred in 46 patients. In the radiotherapy alone group, 4(57.1%) patients had recurrence/metastasis in the posterior peritoneum subgroup, 5(55.6%) in the iliac subgroup and 11(28.2%) in the pelvic non-iliac subgroup, respectively. In the CCRT group, there were 5(62.5%) cases of recurrence/metastasis in the posterior peritoneum subgroup, 5(25%) in the iliac subgroup and 16(15.2%) in the pelvic non-iliac subgroup, respectively. Compared with the radiotherapy alone, CCRT could significantly improve the 5-year overall survival (OS) rate of patients with pelvic without iliac lymph node metastasis or iliac lymph node metastasis (pelvic without iliac:88.6% vs.76.9%, P=0.003;iliac:80.0% vs.44.4%, P=0.041), whereas failed to improve the 5-year OS of patients with para-aortic lymph node metastasis (50.0% vs.42.9%, P=0.973). The location of lymph node metastasis and CCRT were the independent prognostic factors for OS (para-aortic vs. pelvic without iliac:hazard ratio[HR]=4.259,95%CI=1.700-10.671, P=0.002;iliac vs. pelvic without iliac:HR=2.985,95%CI=1.290-6.907, P=0.011;concurrent chemotherapy vs. radiotherapy alone:HR=0.439,95%CI=0.218-0.885,P=0.021). Conclusions CCRT can improve the survival of patients with pelvic lymph node metastasis, but it fails to enhance the survival rate of patients with para-aortic lymph node metastasis.
		2020 Vol. 29 (6): 446-450 [Abstract] ( 188 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	451	Cumulative dosimetric investigation based on image deformable registration in radiotherapy for cervical cancer
		Peng Qinghe, Zhang Shili, Peng Yinglin, Liu Hui, Ye Weijun
		Objective To evaluate the differences in the cumulative doses for cervical cancer between two different methods, and analyze the correlation between the severity of radiation proctitis and the cumulative dose of the rectum. Methods. Clinical data of 278 patients with cervical cancer treated with radiotherapy were retrospectively analyzed. The total dose of radiotherapy was calculated by simple dose volume histogram parameter accumulation method (S-DVH group) and dose accumulation by deformation image registration (DIR group) in 49 patients with radiation proctitis. The rectal cumulative dose of the 278 patients with S-DVH was counted(D2.0cm³/D1.0cm³/D0.1cm³). The correlation analysis was performed by Spearman’s correlation analysis. Results The average cumulative dose(D90%) difference of high-risk clinical target volume (HRCTV) between the S-DVH and DIR groups was 2 Gy (EQD2Gy)[(88.66±5.75) vs. (86.66±5.54) Gy, P<0.05], and the average cumulative dose difference(D2.0cm³ and D1.0cm³) of bladder was 2.13 Gy[(82.46±6.91) vs.(80.33±6.86) Gy, P<0.05] and 2.35 Gy[(88.46±4.37) vs.(86.11±3.93) Gy, P<0.05], and the average cumulative dose difference(D2.0cm³ and D1.0cm³) of rectum was 1.99 Gy[(72.49±5.17) vs.(70.50±5.03) Gy, P<0.05] and 2.71 Gy[(78.87±4.50) vs.(76.16±4.14) Gy, P<0.05]. The rectal cumulative dose(D2.0cm³/D1.0cm³/D0.1cm³) was positively associated with the grade of radiation proctitis. Conclusions The cumulative doses differ between two groups, and are equally in an acceptable range. S-DVH method is a relatively simple method to evaluate the cumulative exposure dose. The cumulative doses of the rectum(D2.0cm³/D1.0cm³/D0.1cm³) can be used to predict the incidence of radiation proctitis.
		2020 Vol. 29 (6): 451-454 [Abstract] ( 194 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	455	Auto-analysis intrafraction prostate movement patterns based on transperineal ultrasound real-time tracking system and linear discriminant model
		Gao Yan, Zhao Bo, Gao Xianshu, Qi Xin
		Objective To qualitatively analyze and auto-discriminate intrafraction prostate movement patterns based on transperineal ultrasound (TPUS) technique and linear discriminant analysis (LDA) method, which lays a solid foundation for individualized precise radiotherapy. Methods A total of 1265 intrafraction motion trajectories and millions of monitoring data were recorded by TPUS from 61 prostate cancer patients. Seven typical patterns were considered:stable at baseline, slight transient excursion, persistent excursion and continuous drift, as well as obvious transient excursion, persistent excursion and continuous drift. Motion trajectory diagrams associated with the displacement-time function were generated by MATLAB programming. Valuable features were selected and different patterns were identified. Discriminant accuracy and receiver operating characteristic (ROC) curve were utilized to evaluate the performance of LDA model. Results Four movement patterns were found per patient during the whole treatment process, and unstable type was occupied at (35.00±21.49)%. With the increase of treatment times, motion trajectories did not show an increasingly stable trend, and the appearance of different patterns was extremely irregular. After quantitative analysis, discriminant accuracy of LDA method was 90.4% for the training set and 89.5% for the testing set, with a sensitivity of 84.9% and a specificity of 91.1%. Conclusion Intrafraction movement patterns are characterized by diversity and randomness. The LDA method can be used to discriminate different movement patterns effectively, and the unknown samples can be identified by discriminant equations and centroid coordinates.
		2020 Vol. 29 (6): 455-460 [Abstract] ( 189 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics · Biology · Technique

	461	A study on fast cone beam CT
		Li Minghui, Niu Chuanmeng, Zhang Ke, Tian Yuan, Men Kuo, Dai Jianrong
		Objective To evaluate the effect of fast cone beam CT (CBCT) scan mode on image quality and registration results, and to establish the scanning pre-settings for fast CBCT. Methods Three scanning modes were utilized to the CBCT phantom, and the registration accuracy and image quality were quantitatively evaluated. The correlation and consistency of measurement results under different scanning modes were further verified by 278 sets of CBCT data from 33 clinical tumor patients. Results The maximum deviation between the measurement results of three scanning models and the actual value was 0.70 mm (0.51 mm on average). The measurement results of the same location were consistent among three scanning modes (0.00 mm). For the uniformity, the results of the normal mode were the best (3.62% on average), followed by the fast 1 mode (3.90% on average) and the fast 2 mode (4.84% on average). For the noise, the results of the normal mode were the best (15.69 on average), followed by the fast 2 mode (17.23 on average) and the fast 1 mode (21.74 on average). Regarding the high contrast resolution, the measurement results of three scanning modes were consistent (at least 3 pairs could be distinguished). For the low contrast resolution, the results of the fast 1 mode were the best (1.69 on average), followed by the normal mode (2.10 on average), and the fast 2 mode (2.31 on average). For the geometric accuracy, the measurement results of the three scanning modes were basically consistent with a mean deviation of 0.05 mm. The correlation of the measurement results between normal mode and fast 1 mode was the highest in clinical cases (R²>0.90, P<0.01) with a high degree of consistency (95% consistency limit of the above two scanning modes< 1 mm threshold). Conclusion Compared with the normal mode, the fast 1 mode can yield equivalent image quality, consistent registration results, faster scanning speed and lower scanning dose. Therefore, the fast 1 mode is recommended as the scan mode in clinical practice.
		2020 Vol. 29 (6): 461-465 [Abstract] ( 179 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	466	Dosimetric comparison between volumetric-modulated arc radiotherapy and intensity-modulated proton therapy in patients with ventricular tachycardia using stereotactic ablative radiotherapy
		Ren Xueying, Gao Xianshu, He Pengkang, Zhao Zhilei, Zhao Bo, Bai Yun, Ma Mingwei, Qin Shangbin, Zhang Min, Zhou Jing
		Objective To evaluate the dosimetric properties of intensity-modulated proton therapy (IMPT) plans for simulated treatment planning in patients with ventricular tachycardia (VT) using stereotactic ablative body radiotherapy (SABR), in comparison with the volumetric-modulated arc therapy (VMAT).Methods A total of 25 gross target volume (GTV) of the apical, anterior, septal, inferior and lateral wall of the left ventricle (LV) were delineated on the CT simulation images of 5 patients with complete data. An additional 5 mm GTV margin was added to the internal target volume (ITV), and an additional 3 mm ITV margin was added to the planning target volume (PTV). VMAT and IMPT plans were designed in each target area. Dose prescription was 25 Gy (RBE) in a single fraction. The dosimetric differences of ITV and organ at risk (OAR) were compared between VMAT and IMPT.Results The median volume of ITV was 45.40 cm³(26.72-67.59 cm³). All plans had adequate target coverage(V95%Rx≥99%). Compared with the VMAT plans, IMPT reduced the Dmean of whole heart, pericardium and non-target cardiac tissues (relative difference) by 44.52%, 44.91% and 60.16%, respectively, which also reduced D0.03 cm³ of the left anterior descending artery by 17.58%(P<0.05). After stratified analysis according to the lesion sites, IMPT could still reduce the dose of most OAR. However, the D0.03 cm³ of LAD and LCX for the lesions in the anterior wall of LV, the D0.03 cm³ of LCX in the inferior wall and D0.03 cm³ of LAD in the apical wall did not significantly differ (both P>0.05).Conclusions Both VMAT and IMPT plans can meet the clinical dosimetric requirements when SABR is simulated in patients with VT. However, IMPT can lower the dose of normal heart tissues, which has the potential benefit of reducing the risk of complications, such as ischemic heart disease, pericarditis/pericardial effusion, etc.
		2020 Vol. 29 (6): 466-471 [Abstract] ( 171 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	472	Establishment and verification of a displacement model for the solitary pulmonary lesion based on 4D-CT technology
		Shang Dongping, Wang Min, Duan Jinghao, Yu Jinming, Yin Yong
		Objective To measure the displacement of the solitary pulmonary lesion (SPL) located in different pulmonary segments based on 4D-CT technology (4DCT) and to establish and verify a relevant mathematical model of tumor displacement. Methods The modeling samples of 290 SPLs were subject to both 4DCT and active breath control (ABC) spiral CT scans. The tumor displacement in different pulmonary segments was measured based on 4DCT images. The tumor volume was obtained by contouring the gross tumor volume (GTV) on ABC spiral CT images. The diaphragm movement was measured by X-ray simulator. The vital capacity and tidal volume were gained by pneumatometer. The baseline data, such as gender, age, height, weight, respiratory rate, and tumor lobe and segment where tumors were located, were collected. Multivariate linear regression was used to analyze the correlation between the 3D-tumor displacement and gender, age, height, weight, respiratory rate, tumor location, volume and diaphragm movement. The displacement model was established based on the modeling sample of 290 cases. Then,it was verified by comparing the tumor displacement derived from the model with that of 4DCT technology based on the randomly selected 17 SPLs. Results The displacement model for tumors located in the upper lobe was established as Xup=-0.267+0.002TV+0.446DM, Yup=-1.704+0.004TV+0.725DM+2.250SII+1.349SIII and Zup=0.043+0.626DM+0.599SII+0.519SIII. The displacement model of the middle lobe tumors was Xmid=0.539+0.758DM, Ymid=-2.316+2.707DM+0.009TV and Zmid=0.717＋1.112DM. The displacement model for tumors located in the lower lobe was Xlow=-0.425+0.004TV+0.857DM,Ylow=4.691+4.817DM+0.005TV-0.307RR+3.148SIX+2.655SX and Zlow=0.177+0.003TV+0.908DM.(DM:diaphragm movement, TV:tidal volume, RR:respiratory rate, SII:posterior segment, SIII:anterior segment, SIX:lateral basal segment, SX:posterior basal segment). There was no significant difference between two results derived from the displacement model and 4DCT technology.(P>0.05). Conclusions The diaphragm movement and tidal volume are the main influencing factors of 3D lung tumor displacement. The tumor displacement in the superior-inferior direction is correlated with different pulmonary segments of the upper and lower lobes. The displacement of tumors located in different segments of middle lobes is similar. The displacement model can predict the displacement of SPLs located in different lobes, providing reference for individualized delineation of PTV.
		2020 Vol. 29 (6): 472-476 [Abstract] ( 223 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	477	Research progress on radiotherapy combined with immune checkpoint inhibitor in the treatment of non-small cell lung cancer
		Jin Jianan, Xu Yujin, Chen Mengyuan, Chen Ming
		The emergence of immune checkpoint inhibitors (ICI) provides a novel method for the treatment of non-small cell lung cancer (NSCLC). However, the limitation of ICI alone prompts clinicians to explore the feasibility of radiotherapy combined with ICI. Recent studies on this combined therapy have preliminarily revealed its significant prospects for changing the treatment system of NSCLC. From the perspective of the mechanism of combined therapy, this study reviewed the basic research on this combined therapy and the clinical progress on different radiotherapy combined with ICI.
		2020 Vol. 29 (6): 477-481 [Abstract] ( 191 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	482	Research progress on stereotactic radiation therapy for early non-small cell lung cancer
		Yu Hongfang, Yu Zhilong
		Stereotactic body radiation therapy (SBRT) refers to the use of stereotactic isocentric rotation technology, which concent rates high-energy radiation in the target area for a large dose of irradiation, causing irreversible biological damage, while the normal tissue is not or less exposed. Currently, SBRT is the standard treatment for inoperable patients with early non-small cell lung cancer (NSCLC). The efficacy of SBRT in the treatment of peripheral and central lung cancer has been validated, whereas there is no consensus on the dose and fractionation, which remains to be further explored. The clinical efficacy of SBRT combined with immunotherapy needs to be further studied. Therefore, the optimal dose and fractionation of SBRT for early peripheral and central NSCLC were discussed, the difference in the clinical efficacy among SBRT, lobectomy and thoracoscopic surgery was analyzed and the clinical efficacy of SBRT combined with immunotherapy was assessed, aiming to provide theoretical basis for the application of SBRT in clinical practice.
		2020 Vol. 29 (6): 482-485 [Abstract] ( 186 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	486	Research progress on prophylactic cranial irradiation in non-small cell lung cancer
		Zhang Yang, Li Hongwei, Liu Jianhui, Song Yipeng
		Brain metastasis has become a major failure pattern with the prolonged survival of patients with non-small cell lung cancer (NSCLC). Prophylactic cranial irradiation (PCI) has been proven to play a significant role in small cell lung cancer, whereas its value in NSCLC is still controversial. Therefore, this article reviewed the role of PCI in NSCLC, high-risk factors of brain metastasis, timing, dose fraction and toxicity of PCI, etc.
		2020 Vol. 29 (6): 486-490 [Abstract] ( 186 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	491	Research progress on magnetic resonance imaging-guided proton therapy for tumors
		Shang Haijiao, Pu Yuehu, Wang Xuetao
		With the application of magnetic resonance imaging (MRI)-guided photon therapy, the concept of combining real-time MRI guidance with proton therapy, namely, MRI-guided proton therapy (MRPT), has attracted widespread attention. It is expected that MRPT canmitigate the uncertaintiesduring the treatment of proton therapy to make full use of the physical advantages of protons. However, multiple electromagnetic interactions between proton therapy and MRI-guided systems may lead to mutual interference between the two systems. This article review the research progress on the MRPT system, aiming to provide certain reference for the design of MRPT system.
		2020 Vol. 29 (6): 491-493 [Abstract] ( 180 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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China Association for
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Chinese Medical Association

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

Chinese Anti-Cancer
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Chinese Journal of Lung
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