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.8 Published 2020-08-15

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

Guidelines

	599	Clinical practice guideline for radiation therapy of non-small cell lung cancer (2020 version)
		Radiation Oncology Branch of Chinese Medical Association, Radiation Oncologist Branch of Chinese Medical Doctor Association Professional Committee on Radiation Oncology, China AntiCancer Association Experts Committee on Radiation Oncology, Radiation Oncologist Branch of Chinese Society of Clinical Oncology
		With the rapid development of advanced technology, it has entered the era of precise radiotherapy, which significantly improves tumor control and reduces treatment-related toxicities. Currently, radiotherapy plays a critical role in different stages of non-small cell lung cancer (NSCLC). Additionaly, targeted therapy, immunotherapy, and other new drug therapies have made breakthrough progress, bringing survival benefits to patients with NSCLC in recent years. Based on the existing medical evidence of NSCLC in combination with the expert opinions, clinical practice guidelines for radiation therapy of non-small cell lung cancer in China (2020) has been formulated by Chinese Society for Radiation Oncology, Radiation Oncologist Branch of Chinese Medical Doctor Association Professional Committee on Radiation Oncology, China Anti-Cancer Association and Experts Committee on Radiation Oncology, Chinese Society of Clinical Oncology. The main contents include overview, diagnosis, treatment principles for early-, middle-and advanced-stage NSCLC, radiotherapy and follow-up, etc. The purpose of this paper is to provide NSCLC evidence-based medical guidance for clinicians and patients in China and guide clinical practice.
		2020 Vol. 29 (8): 599-607 [Abstract] ( 335 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	608	Clinical practice guideline for radiation therapy in small cell lung cancer (2020 version)
		Radiation Oncology Branch of Chinese Medical Association, Radiation Oncologist Branch of Chinese Medical Doctor Association Professional Committee on Radiation Oncology, China Anti-Cancer Association Experts Committee on Radiation Oncology, Radiation Oncologist Branch of Chinese Society of Clinical Oncology
		Small cell lung cancer (SCLC) is one of the most common malignancies that seriously threaten the lives of patients. In order to give full play to the important role of radiotherapy in the comprehensive treatment of SCLC and bring survival benefits to patients, Chinese Society for Radiation Oncology, Radiation Oncologist Branch of Chinese Medical Doctor Association Professional Committee on Radiation Oncology, China Anti-Cancer Association and Experts Committee on Radiation Oncology, Chinese Society of Clinical Oncology formulated the clinical practice guidelines for radiotherapy of small cell lung cancer in China (2020) on the basis of the existing clinical evidence combined with experts’ opinions, which mainly include the overview, diagnosis, radiotherapy and comprehensive treatment principles of different stages of SCLC and radiotherapy,techniquesaiming to provide evidence-based guidelines for clinicians and patients in China and guide clinical practice.
		2020 Vol. 29 (8): 608-614 [Abstract] ( 352 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Investigation Research

	615	Analysis of anxiety and depression in patients undergoing radiotherapy during COVID-19 epidemic period
		Ma Jiabin, Zhen Hongnan, Guan Hui, Liu Zhikai, Shen Jing, Wang Wenhui, Miao Zheng, Yan Junfang, Meng Qingyu, Hu Ke, Zhang Fuquan
		Objective To investigate the anxiety and depression of cancer patients undergoing radiotherapy during the epidemic of COVID-19. Methods By using self-rating anxiety scale and self-rating depression scale, a cross-sectional survey was conducted during the COVID-19 epidemic period. Results During the COVID-19 epidemic period, the incidence of anxiety and depression in cancer patients undergoing radiotherapy was 15.8% and 27.7% respectively, of which 12.9% suffered from both anxiety and depression. The average scores of anxiety and depression were 49.4(25/76) and 46.4(25/83), respectively,which were higher than those of the domestic norm. Age is a contributing factor for anxiety, and patients living in urban are more likely to experience depression. Conclusions The prevalence of anxiety and depression of cancer patients undergoing radiotherapy are higher than healthy people during the COVID-19 outbreak. We should pay more attention to the psychological states of the cancer patients.
		2020 Vol. 29 (8): 615-618 [Abstract] ( 357 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	619	Homogenization and optimization strategy for standard process of intensity-modulated radiotherapy for nasopharyngeal carcinoma
		Yang Guangrong, Luo Bangyu, Wu Yi, Wu Yajun, Qian Jindong, Zhao Lirong, Zhao Xianlan, Zhu Ying, Cui Tianxiang, Zhong Liangzhi, Zhou Yibing, Li Xiaoping, Liu Enqiang, Sun Jianguo
		Radiotherapy is the most common treatment for nasopharyngeal carcinoma, and the radiotherapy technique is essential for the prognosis of nasopharyngeal carcinoma. Due to the complexity of the structure of the intensity-modulated device and the accuracy of the clinical requirements of radiotherapy, it is inevitable that higher requirements will be imposed on the process of intensity-modulated radiotherapy. Currently, gaps exist in the radiotherapy equipment and personnel qualification among radiotherapy units, and thus the homogenization in the radiotherapy remains to be strengthened in China. With the application of radiotherapy information management system, digital medicine and artificial intelligence technologies in the field of radiotherapy, the original process fails to meet the application needs of the new precise radiotherapy technology. Therefore, this process is designed based on the existing radiotherapy procedures for nasopharyngeal carcinoma in combination with the latest developments in the field of radiotherapy, aiming to establish a novel standard process recommendation, ensuring the standardization and homogenization of radiotherapy and achieve the individualized intensity-modulated radiotherapy for nasopharyngeal carcinoma patients.
		2020 Vol. 29 (8): 619-624 [Abstract] ( 325 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	625	High-risk factors of retropharyngeal lymph node metastasis in patients with hypopharyngeal carcinoma based on magnetic resonance imaging
		Wang Huili, Qu Yuan, Wang Kai, Wu Runye, Liu Qingfeng, Zhang Ye, Zhang Shiping, Xiao Jianping, Yi Junlin, Gao Li, Xu Guozhen, Luo Jingwei, Huang Xiaodong
		Objective To analyze the incidence and high-risk factors of lymph node metastasis in the retropharyngeal region of hypopharyngeal squamous cell carcinoma based on magnetic resonance imaging (MRI), aiming to guide the delineation of clinical target area. Methods Clinical data of patients who were pathologically diagnosed with hypopharyngeal carcinoma from January 2012 to September 2018 in our center were retrospectively analyzed. All patients received head and neck MRI before treatment. The diagnosis of lymph node metastasis and the delineation of primary gross target volume (GTVp) and lymph nodes target volume (GTVnd) were determined by all the radiation oncologists in head and neck group through twice weekly general round discussion. The cut-off points of GTVp and GTVnd were defined by establishing the receiver operating characteristic curve. All patients were divided into the high GTVp, low GTVp and high GTVnd and low GTVnd groups. Chi-square test was used for univariate analysis and logistic regression was utilized for multivariate analysis to analyze the high-risk factors of patients with retropharyngeal lymph node metastasis. Results A total of 326 patients were included in this study, 295 of whom were diagnosed with cervical lymph node metastasis, accounting for 90.5%. The most common involved area was Level Ⅱ a, followed by Level Ⅲ, Level Ⅱ b, Level IV, Level Ⅶ a (retropharyngeal), Level V a, and Level V b. The incidence of retropharyngeal lymph node metastasis was 21.5%, and the incidence was 53.1% in patients with primary tumor located in the posterior pharyngeal wall. Univariate and multivariate analyses showed that patients with tumor originated from the posterior pharyngeal wall (P=0.002), bilateral cervical lymph node metastasis (P=0.020), larger GTVp (greater than 47 cm³,P=0.003), and larger GTVnd (greater than 22 cm³, P=0.023) were significantly associated with the occurrence of retropharyngeal lymph node metastasis. Conclusions The incidence of retropharyngeal lymph node metastasis is high in hypopharyngeal carcinoma, especially in patients with primary tumors in the posterior pharyngeal wall, bilateral cervical lymph node metastasis and larger primary burden. Therefore, for patients with these risk factors, it is highly recommended that the clinical target area should be delineated to include the retropharyngeal lymph node drainage area.
		2020 Vol. 29 (8): 625-628 [Abstract] ( 325 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	629	A prospective study of hippocampal-avoidance prophylactic cranial irradiation in small cell lung cancer patients with limited stage
		Kong Yue, Xie Tieming, Shi Lei, Du Fenglei, Hu Xiao, Gu Qing, Wang Jin, Fang Min, Chen Mengyuan, Xu Yujin, Ma Honglian, Chen Ming, Chen Yuanyuan
		Objective To analyze the feasibility of hippocampal-avoidance (HA) prophylactic cranial irradiation (PCI) in small cell lung cancer patients (SCLC)(limited stage) after chemotherapy and thoracic radiation. Methods From June 2016 to March 2019, 40 eligible SCLC patients were recruited and randomly divided into the routine PCI (n=22) and hippocampal-avoidance PCI (HA-PCI) groups (n=18). The HA zone was contoured according to the criteria of RTOG 0933. Volumetric-modulated arc therapy (VMAT) was adopted in the HA-PCI group. After radiotherapy, Hopkins verbal learning test (HVLT) and MRI were performed. Results The average hippocampus volume was (4.01±1.57) cm³, the average HA volume was (20.13±4.14) cm³, HA D100% was (7.19±0.38) Gy and HA Dmax was (14.38±1.18) Gy. During HVLT, 1-month-after-PCI vs. before-PCI (trial3, trial4, learning, percent retained), 1-month-after-PCI vs. after-PCI (trial3, learning), HA-PCI cohort showed advantages over PCI in HVLT scores. The average follow-up time was (17.00±8.47) months. Two patients with brain metastases which were out of the HAZ received routine PCI. Conclusions PCI using VMAT technology to protect hippocampus is feasible in dosimetry. The test results indicate that the protective effect of hippocampus protection on memory is worthy of further promotion in clinical practice.
		2020 Vol. 29 (8): 629-632 [Abstract] ( 340 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	633	Study of volume change and radioherapy timing in patients with stage Ⅳ non-small cell lung cancer by targeted therapy
		Zhang Xia, Zhang Yi, Ouyang Weiwei, Ma Zhu, Li Qingsong, Hu Yinxiang, Geng Yichao, Chen Xiaxia, Li Xiaoyang, Su Shengfa, Lu Bing
		Objective To investigate the primary tumor volume change and timing of radiotherapy for patients with stage Ⅳ non-small cell lung cancer with EGFR mutation during molecular targeted therapy. Methods Simulated CT scanning measurement and analysis were performed to observe the volume changes of primary tumors before and after treatment with a time interval of 10 days in this prospective study. Positioning and volume measurement were terminated when the volume change was 5% or less between two time points before and after treatment or 90 days after treatment. Primary tumor radiation therapy was then performed, acute radiation-induced injury was recorded, and the implementation and simulation of related parameters of radiotherapy plans were compared. Results Twenty-nine of 30 cases were included in the analysis (1 case dropped off). After EGFR-TKIs treatment, the volume of all primary tumors was decreased, but the shrinking rate was inconsistent with the speed. Until the last simulated CT scanning, the maximum and minimum shrinking rates were 90% and 28%, respectively. There was no case of termination within 30 days of treatment, and the average tumor volume was significantly decreased within 40 days and the average tumor volume significantly differed every 10 days (P<0.001). After 40 days, the volume shrinking rate of primary tumors ≤5% gradually appeared, and one patient presented with a volume shrinking rate of >5% on 90 days. During this time, the average volume shrinking rate slowed down and became stable, ranging from 49.15% to 54.77%. Moreover, the average volume continued to gradually shrink after slight increase at 70 days. There was no significant difference in the average volume every 10 days (P>0.05). After the termination of simulated CT scanning, the dose of primary tumor was (69±7) Gy for patients receiving radiotherapy. Two patients had grade 2 acute radiation-induced pneumonitis and 3 patients had grade 3 acute radiation-induced pneumonitis. In addition, 1 patient had grade 2 radiation-induced esophagitis. According to the technology and dose parameters of radiotherapy plan, simulated radiotherapy plans before and 40 days after EGFR-TKIs treatment were designed. The timing of implementation plan was significantly better than that before EGFR-TKIs treatment (all P<0.05), whereas it was similar to that at 40 days after EGFR-TKI treatment (P>0.05). Conclusions The primary tumor shrinking rate is gradually slowed down over time after EGFR-TKIs treatment in patients with stage Ⅳ non-small cell lung cancer. The average tumor volume is significantly decreased within 40 days and then the shrinking rate becomes slow. The tumor shrinking rate of each case is inconsistent. Radiotherapy at 40 days after treatment is probably the optimal timing to obtain high dose and control radiation-induced injury.
		2020 Vol. 29 (8): 633-638 [Abstract] ( 316 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	639	Analysis of clinical efficacy of hypofractionated precision radiotherapy for lung metastases
		Zhao Ruizhi, Luo Jingwei, Xiao Jianping, Liu Qingfeng, Zhang Ye, Bi Nan, Zhang Hongmei, Chen Xuesong, Wang Kai, Ma Yuchao, Yang Siran, Yi Junlin, Li Yexiong
		Objective To evaluate the efficacy and safety of hypofractionated radiotherapy for lung metastases (LMs). Methods From March 2007 to April 2019, 193 patients with 317 LMs including 124 male and 69 female admitted to our hospital were enrolled. The median age was 58 years old and the median KPS was 80. The primary tumors were mainly distributed in the lung (33.7%), colorectum (21.2%), head and neck (13.5%) and breast (10.9%), respectively. The clinical efficacy and side effects of hypofractionated radiotherapy for LMs were evaluated. Results The median follow-up time was 59.9 months (95%CI:55.1-64.6 months). Among 193 patients with 317 LMs, 90.7% of them were treated with 4D-CT, 69.4% for intensity-modulated radiation therapy (IMRT), 28.0% for volumetric-modulated arc therapy (VMAT) and 2.6% for tomotherapy (TOMO), respectively. The median gross tumor volume (GTV) and planning target volume (PTV) were 5.0cm³(0.2-142.3cm³) and12.0cm³(1.0-200.1cm³). The prescription dose regimen was 60Gy in 4 to 15 fractions. The median dose for PTV was 60Gy (45-70Gy) and biological effective dose was 96Gy (60-150Gy), respectively. The 1-, 3-and 5-year local control rates (LCR) were 95.7%, 91.3% and 89.9%, respectively. The median time from primary cancer diagnosis to lung metastases was a prognostic factor for LCR (P=0.027). The overall survival (OS) and progression-free survival (PFS) rates were 90.1%, 60.8%, 46.2%, and 54.3%, 30.3%, 19.9%, respectively. The median time from primary cancer diagnosis to lung metastases and extrapulmonary metastases was the prognostic factor for OS and PFS. No Grade 3 toxicities were seen. Conclusion Image-guided hypofractionated precision radiotherapy is an efficacious and safe treatment for LMs.
		2020 Vol. 29 (8): 639-643 [Abstract] ( 360 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	644	Relationship between adjuvant radiotherapy dose and pathologic complete response in patients with locally advanced esophageal squamous cell cancer
		Zeng Xiaoxiao, Sun Hongna, Wei Hao, Xu Yong, Zhou Xiaojuan, Ding Zhenyu, Gong Youling, Wang Jin, Zhou Lin, Lu You, Yuan Yong, Hu Yang, Liu Yongmei
		Objective To investigate the relationship between the dose of preoperative neoadjuvant radiotherapy and the pathologic complete response (pCR) rate in patients with locally advanced squamous cell esophageal cancer (ESCC). Methods Clinical data of 116 patients with ESCC who received neoadjuvant chemoradiotherapy followed by esophagectomy in our cancer center from July 2017 to December 2019 were retrospectively analyzed. The radiation doses were divided into 2 ranges based on Grays (Gy) received:40-45 Gy and 45 Gy or more. Results The overall pCR rate was 38. 8%(45/116). pCR was observed in 35 out of 80(44%) patients treated with 40-45 Gy and 10 of 36(28%) patients treated with 45 Gy or more. The pCR rate did not significantly differ between two groups [(40-45 Gy) vs.( ≥ 45 Gy), P=0.105)]. Conclusions Preoperative neoadjuvant radiotherapy with a higher dose (≥ 45 Gy) fails to increase the pCR rate in patients with locally advanced ESCC. Prospective randomized trials are required to determine the optimal dose of preoperative adjuvant radiotherapy.
		2020 Vol. 29 (8): 644-648 [Abstract] ( 351 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	649	Preliminary study of SII-N scoring model in predicting the prognosis of elderly patients with esophageal cancer
		Chen Qingqing, Cui Hongxia, Tian Ye, Guo Xinwei, Xu Yingying, Zhou Jundong, Ji Shengjun
		Objective To investigate whether TNM staging combined with systemic immune inflammation index (SII) has a high predictive value for the clinical prognosis of elderly patients with esophageal cancer. Methods Clinical data of 118 elderly patients with esophageal cancer who received radiotherapy and chemotherapy were retrospectively analyzed, and the SII was calculated. SII and clinicopathological features were included in the Cox proportional risk model, and the prognostic index (PI) equation was obtained. Kaplan-Meier survival analysis was adopted. According to PI, the survival of patients was predicted and the predictive values of PI and TNM were statistically compared. Results Univariate analysis showed that SII, N staging and TNM staging were closely correlated with the overall survival (all P<0.01). Cox multivariate analysis revealed that SII and N staging were the independent risk factors for overall survival. According to the results of Cox analysis, the equation of PI=0.961 × SII grouping+ 0.523 × N staging was obtained. The receiver operating characteristic (ROC) curve was drawn according to PI and overall survival, and the critical value was obtained and divided into different groups. The 1-, 2-and 3-year survival rates in the low-risk group were significantly higher than those in the high-risk group (HR=0.365, 95%CI:0.221-0.604, P<0.001). The prediction of overall survival by SII-N[area under curve (AUC)=0.707] was significantly better than that by TNM staging (AUC=0.560, P<0.001). Conclusion This study preliminarily proves that the SII-N prognosis score model is better than the traditional TNM staging, which may have guiding significance for the selection of therapeutic strategies for elderly patients with esophageal cancer, and is worthy of further study.
		2020 Vol. 29 (8): 649-653 [Abstract] ( 330 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	654	Predictive value of IVIM-DWI and DCE-MRI quantitative parameters on the early efficacy of concurrent chemoradiotherapy for cervical squamous cell carcinoma
		Zheng Xiaomin, Qian Liting, Dong Jiangning, Liu Yunqin, Fang Xin, Li Cuiping
		Objective To evaluate the application value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and dynamic contrast enhancement MRI (DCE-MRI) in the prediction of the early efficacy of concurrent chemoradiotherapy (CCRT) for cervical squamous cell carcinoma. Methods Fifty patients with cervical squamous cell carcinoma confirmed by pathology were included. Before CCRT, IVIM-DWI and DCE-MRI were scanned, and the values of quantitative parameters including ADC, D, D^* and f of IVIM-DWI and K^trans, Kep, Ve and Vp of DCE-MRI before treatment were measured for all patients. MRI reexamination was performed 1 month after the end of CCRT, and all patients were divided into the cure group and the residual group according to the tumor remission. The parameters of IVIM-DWI and DCE-MRI before treatment were statistically compared between two groups. The optimal predictive parameters and predictive thresholds were determined by drawing the receiver operating characteristic (ROC) curve. Results Twenty-four patients were assigned into the cure group and twenty-six patients in the residual group. The ADC, D and Ve values before treatment in the cure group were significantly lower than those in the residual group (all P<0.05), whereas the f and K^trans values were significantly higher than those in the residual group (both P<0.05). The other parameters did not significantly differ between two groups (all P>0.05). The area under ROC curve (AUC=0.823) of D value was the largest, followed by K^transvalue (AUC=0.754). The combined prediction efficacy of D and K^trans (AUC=0.867) was higher than that of either D or K^trans alone. The sensitivity was 88.5%, 85.8% and 88.8%, and the specificity was 70.8%, 66.7% and 79.2%, respectively. Conclusions Quantitative parameters of IVIM-DWI and DCE-MRI before treatment have certain predictive value for the early efficacy of CCRT in cervical squamous cell carcinoma, among which the predictive efficacy of D value is the highest, and the combined application of D and K^trans can improve the predictive efficacy.
		2020 Vol. 29 (8): 654-660 [Abstract] ( 333 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	661	Application of 3D printing technology-assisted standardized applicator in image-guided adaptive brachytherapy of stage ⅢB cervical cancer
		Zhao Zhipeng, Guan Wei, Zhao Hongfu, Mao Zhuang, Cheng Guanghui
		Objective To explore the application of 3D printing technology-assisted standardized applicator in the image-guided adaptive brachytherapy (IGABT) for cervical cancer. Methods Twenty-three patients with stage ⅢB cervical cancer with extensive paracervical invasion after external irradiation (45Gy/25f) were treated with IGABT, and the prescription dose was 7Gy/f×4f. According to the regression of tumor on MRI before and after external irradiation, the range of brachytherapy was determined, and the under dose area of standard intracavitary/interstitial applicator (IC+IS) was estimated. The virtual transperineal needle channel was inserted in the under dose area, the angle, spacing and depth of implantation were optimized. The auxiliary templates were designed with graphic design software, and 3D printing technology was utilized to print the auxiliary templates. The auxiliary templates were closely combined with the standardized applicator. Under the anesthesia condition, ultrasound-guided applicator was completed, and patients were scanned with MRI image after operation. The MRI images were introduced into treatment planning system (TPS) to delineate the target area and organs at risk, and the treatment plans were optimized to complete the plan evaluation and treatment. Results The average printing time of templates was (3.5±1.0) h, 382 implant needles were inserted guided by auxiliary templates,(4.2±1.5) template-guided implant needles were used in each fraction and the weight ratio was (16.49±9.50)%. The total dose of HR-CTV D90% EQD2Gy,α/β=10 was (90.45±3.03) Gy, and IR-CTV D90% EQD2Gy,α/β=10 was (66.46±3.68) Gy. The D2cm³EQD2Gy,α/β=3of the bladder, rectum, small intestine and sigmoid colon were (82.69±2.60) Gy,(73.20±2.52) Gy,(69.35±3.32) Gy and (69.39±3.27) Gy, respectively, all of which met the clinical dose requirements. The 1-and 2-year local control rates were 96% and 87%, 87% and 70% for the distant metastasis-free survival rates, and 96% and 78% for thea overall survival rates, respectively. Conclusion The auxiliary applicators made by 3D printing technology can effectively compensate for the dose insufficiency of the standard applicator in the paracervical and other areas during the clinical brachytherapy in patients with stage ⅢB cervical cancer, providing an effective method for the brachytherapy of advanced cervical cancer.
		2020 Vol. 29 (8): 661-665 [Abstract] ( 357 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	666	Study of three-dimensional dose distribution prediction model in radiotherapy planning based on full convolution network
		Bai Xue, Wang Shengye, Wang Binbing, Zhang Jie, Shao Kainan, Yang Yiwei, Shan Guoping, Chen Ming
		Objective To explore a three-dimensional dose distribution prediction method for the left breast cancer radiotherapy planning based on full convolution network (FCN), and to evaluate the accuracy of the prediction model. Methods FCN was utilized to achieve three-dimensional dose distribution prediction. First, a volumetric modulated arc therapy (VMAT) plan dataset with 60 cases of left breast cancer was built. Ten cases were randomly chosen from the dataset as the test set, and the remaining 50 cases were used as the training set. Then, a U-Net model was built with the organ structure matrix as inputs and dose distribution matrix as outputs. Finally, the model was adopted to predict the dose distribution of the cases in the test set, and the predicted 3D doses were compared with actual planned results. Results The mean absolute differences of PTV, ipsilateral lung, heart, whole lung and spinal cord for 10 cases were (119.95±9.04) cGy,(214.02±9.04) cGy,(116.23±30.96) cGy,(127.67±69.19) cGy, and (37.28±18.66) cGy, respectively. The Dice similarity coefficient (DSC) of the prediction dose and the planned dose in the 80% and 100% prescription dose range were 0.92±0.01 and 0.92±0.01. The γ rate of 3mm/3% in the area of 80% and 10% prescription dose range were 0.85±0.03 and 0.84±0.02. Conclusion FCN can be used to predict the three-dimensional dose distribution of left breast cancer patients undergoing VMAT.
		2020 Vol. 29 (8): 666-670 [Abstract] ( 427 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	671	Study of automatic treatment planning of intensity-modulated radiotherapy based on deep learning technique for breast cancer patients
		Fan Jiawei, Chen Zhi, Wang Jiazhou, Hu Weigang
		Objective To develop a deep learning-based approach for predicting the dose distribution of intensity-modulated radiotherapy (IMRT) for breast cancer patients, and evaluate the feasibility of applying the predicted dose distribution in the automatic treatment planning. Methods A total of 240 patients with left breast cancer admitted to Fudan University Shanghai Cancer Center were enrolled in this study:200 cases in the training dataset, 20 cases in the validation dataset and 20 cases in the testing dataset. A modified deep residual neural network was trained to establish the relationship between CT image, the contouring images of target area and organs at risk (OARs) and the dose distribution, aiming to predict the dose distribution. The predicted dose distribution was utilized as the optimization objective function to optimize and generate a high-quality plan. Results Compared with the dose distribution of clinical treatment plan, the predicted dose distribution for target areas and OARs showed no statistical significance except for a simultaneous boost target PTV48Gy. And the treatment plan generated based on the predicted dose distribution was basically consistent with the predicted outcomes. Conclusion Our results demonstrate that the deep learning-based approach for predicting the dose distribution of IMRT for breast cancer contributes to further achieving the goal of automatic treatment planning.
		2020 Vol. 29 (8): 671-675 [Abstract] ( 403 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	676	An inverse dose optimization algorithm for three-dimensional brachytherapy
		Wang Xianliang, Wang Pei, Li Churong, Li Jie, Kang Shengwei, Liu Min, Tang Ting, Yang Feng, Hou Qing
		Objective To explore an implementation method and results of an inverse dose optimization algorithm (gradient-based planning optimization, GBPO) in three-dimensional brachytherapy. Methods A standard quadratic objective function was used in the GBPO. The optimization code of GBPO was performed based on LBFGS (Limited memory Broyden Fletcher Goldberg Shanno). Seven cervical cancer patients using different applicators and 15 cervical cancer patients using the Fletcher applicator (Nucletron part#189.730) were retrospectively analyzed. The plan quality of GBPO was firstly assessed by isodose lines, then dose-volume histogram (DVH) parameters of CTV(D100%,V150%) and organs at risk(D0.1cm³,D1.0cm³,D2.0cm³) were used to evaluate the difference among the GBPO, IPSA and Graphic plans. Results For the 7 patients using different applicators, GBPO could optimize the conformal dose distribution, and the DVH parameters of the target and organs at risk were basically the same among the GBPO, IPSA and Graphic plans. For 15 patients using the Fletcher applicator, the difference in DVH parameters between the GBPO and IPSA plans was not statistically significant. There was no remarkable difference in the DVH parameters between the GBPO and Graphic plans, but the D100% of the GBPO plan was significantly higher (P<0.01), and the V150% was significantly lower (P<0.01) than that of the Graphic plan. Conclusions The quality of the GBPO plan is similar to that of the IPSA plan in terms of target coverage and organ protection. The inverse dose optimization algorithm GBPO can be integrated into a three-dimensional brachytherapy treatment planning system.
		2020 Vol. 29 (8): 676-681 [Abstract] ( 315 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	682	Mechanism of radiosensitization of erlotinib to non-small cell lung cancer cell line H1299
		Liu Dahai, Luo Jie, Liu Chunmei, Liu Xiaoxi, Shen Shasha, Li Xinjuan, Li Peijie, Ma Hu
		Objective To investigate the effect of epidermal growth factor receptor tyrosine kinase inhibitor on the radiosensitivity of human non-small cell lung cancer cells and its possible mechanism. Methods Human non-small cell lung cancer cells H1299 were cultured in vitro. CCK-8 was used to detect the toxic effects of erlotinib on H1299 cells, IC50 and IC20 were calculated, and IC20 was utilized as the drug concentration for subsequent experiments. The colony formation assay was performed to identifiy the effect of X-ray combined with erlotinib on H1299 cells,the radiosensitivity parameters were calculated, and the cell survival curves were delineated. Flow cytometry was conducted to detect the cell cycle distribution and apoptosis. Western blot analysis was used to detect the expression of EGFR/PI3K/AKT pathway and apoptosis-related proteins. Results Erlotinib exerted inhibitory effect upon the proliferation of H1299 cells, IC50 was calculated as 27.3μmol/L, and 3.3μmol/L for IC20. X-ray combined with IC20 concentration of erlotinib could reduce the cloning ability of H1299, increased the proportion of G0/G1 phase and G2/M phase, decreased the proportion of S phase, aggravated cell apoptosis, down-regulated the expression of pEGFR and pAKT proteins, and up-regulated the expression of apoptosis-related proteins including Active Caspase 3 and Cleaved PARP. Conclusions Erlotinib exerts a radiosensitizing effect on H1299. The possible mechanism is that erlotinib combined with radiation can suppress the EGFR/PI3K/AKT pathway, reduce the ability of repairing cell damage, change cell growth cycle and induce cell apoptosis.
		2020 Vol. 29 (8): 682-686 [Abstract] ( 314 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	687	Clinical progress on body gamma knife in the treatment of various types of metastases
		Wang Yuzhe, Yu Zhilong, Bao Yingna
		With the extension of human life expectancy,the threat of cancer to human beings has become increasingly prominent. Cancer has become the first cause of death for urban and rural residents in China. As the disease progresses, many patients have metastases in other sites besides the primary malignant tumors. Hence, it is of significance to choose effective treatment methods. Body gamma knife treatment is an accurate stereotactic radiotherapy that can render higher doses to the tumors and better protect surrounding normal tissues. A large number of clinical trials have demonstrated that body gamma knife treatment of lung metastases, liver metastases and adrenal metastases can obtain relatively high local control rates. In this article, the application of body gamma knife in the treatment of metastatic tumors was reviewed.
		2020 Vol. 29 (8): 687-690 [Abstract] ( 323 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	691	Research progress on hyperthermia in the treatment of glioma
		Lu Peng, Liu Jia, He Zhengwen, Wu Minghua
		Glioma is a highly common malignant brain tumor. Current mainstream treatments include surgery, radiotherapy and chemotherapy, but the low survival rate and poor prognosis of patients have led scientists to explore new therapies. Hyperthermia is a method of local or whole body heating that utilizes high temperature to kill tumor cells to achieve a therapeutic effect, which has multiple advantages in the treatment of glioma, such as minimal invasiveness and high precision, etc. Studies have shown that hyperthermia combined with radiotherapy and chemotherapy can improve the clinical prognosis of patients. Currently, it serves as a therapeutic tool for glioma with huge potential advantages. In this review, the hyperthermia methods applied to treat glioma were introduced. The application prospects and current status of hyperthermia in treating glioma were summarized. In addition, the mature equipment and operation methods that have been applied in the hyperthermia treatment of glioma were illustrated.
		2020 Vol. 29 (8): 691-694 [Abstract] ( 325 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	695	Research progress on the role of microorganisms in radiation-induced oral mucositis
		Shu Zekai, Lai Shuzhen, Chen Yuanyuan, Chen Ming
		Radiation-induced oral mucositis (ROM) is one of the most common adverse events after radiotherapy for head and neck cancer, which may result in oral pain, dysphagia, poor nutrition or even radiotherapy interruption. Recently, increasing attention has been paid to the role of microorganisms in ROM. In this review, the pathogenesis and clinical manifestations of ROM, the role of microorganism in ROM and its mechanism and probiotic therapy were summarized.
		2020 Vol. 29 (8): 695-698 [Abstract] ( 338 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	699	The role of long non-coding RNAs in radiation tolerance of cancer stem cells
		Yao Zhifeng, Yao Jianxin
		Cancer stem cells (CSCs) refer to a kind of cells with self-renewal ability and multi-directional differentiation potential inside the tumor. Although only occupying a small part of the whole cancer cells, they are the "original cells" that cause tumorigenesis, spread and recurrence, which is also the root cause of radiotherapy failure. CSCs are virtually resistant to radiotherapy and promote tumor metastasis either in a direct or indirect manner, which are therefore believed to serve as the basis of tumor metastasis. Moreover, the heterogeneity of CSCs may be responsible for the complexity of organ-specific metastasis. Long non-coding RNAs (lncRNAs) are a class of RNA molecules with over 200 nucleotides in length without protein coding potential, which are involved in the initiation and progression of several cancer types and closely related to the radiation tolerance. Recently, lncRNAs related to tumor radiation tolerance and its relationship with CSCs have attracted widespread attention. In this review, lncRNA-mediated regulation of CSCs following radiotherapy and the role of lncRNA in radiation tolerance were summarized.
		2020 Vol. 29 (8): 699-703 [Abstract] ( 308 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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Chinese Medical Association

Cancer Hospital of Chinese
　Academy of Medical
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Chinese Anti-Cancer
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Chinese Journal of Lung
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