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.12 Published 2020-12-15

	Abdominal Tumors Thoracic Tumors Physics·Biology·Technique Review Articles Guidelines

Guidelines

	1021	Practice guideline of patient-specific dosimetric verification for intensity-modulated radiotherapy
		National Cancer Center/National Cancer Quality Control Center
		Patient-specific dosimetric verification is an important component of quality assurance processes for intensity-modulated radiotherapy (IMRT), which plays a critical role in ensuring the safety and quality of IMRT. There has been no national practice guideline or explicit recommendations for tools and methods for patient-specific IMRT dosimetric verification in China. Interpretation and clinical significance of verification results, causes and management interventions for IMRT dosimetric verification failure, tools and methods and implementation details significantly differ among different institutions. Under the guidance and organization of Radiation Oncology Quality Control Committee, National Quality Control Center of Cancer Theranostics, this guideline was formulated based on the results of national survey, multi-center validation test, expert discussion, consultation and review. This guideline specifies the requirement of institution, organization, personnel, tools and device, technical workflow, and documentation,aiming to improve the standardized implementation of IMRT dosimetric verification procedures.
		2020 Vol. 29 (12): 1021-1024 [Abstract] ( 310 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	1025	Application of radiotherapy with the extension of spinal cord for esophageal cancer
		Wei Shengtao, Liu Yang, Wang xiang, Zhang Haisan, Li Dingjie
		Objective To analyze the setup and residual errors of spinal cord during online CT-guided radiotherapy for patients with esophageal cancer, and to discuss the necessity of segmental extension of spinal cord. Methods According to the radiotherapy site, 60 cases of esophageal cancer were divided into the neck, chest and abdomen groups, 20 cases in each group. Cervical pleura or vacuum bag was fixed, IMRT technology was adopted, and pre-treatment CT images were obtained by CTVision, and 20 consecutive CT scans were collected for each case. CT images were imported into MIM software. The parameters of the setup errors were processed and extracted. The CT spinal cord was delineated for verification and planning, and the Dice coefficient, Hausdorff maximum distance and centroid coordinate of the delineated spinal cord were processed and extracted. Compatibility anova data were adopted. The calculation formula of the extension margin is MPRV= 1.3 ∑total+0.5 σtotal. Results Residual centroid method was employed. Non-on-line and on-line CT-guided radiotherapy, the extension margins of neck,chest, abdominal spinal cord in the x-, y-and z-axis were 3.86,5.37,6.36 mm;3.45,3.83,4.51 mm;4.05,4.83,7.06 mm,vs,2.85,2.19,2.83 mm;2.32,2.20,2.16 mm;2.86,2.21,2.83 mm, respectively. During residual Hausdorff distance method,non-on-line and on-line CT guided radiotherapy,the extension margins of neck, chest, abdominal spinal cord in the x-, y-and z-axis were 3.10, 5.33,6.15 mm;3.30,3.77,4.61 mm;3.35,4.76,6.87mm,vs,2.12,2.06,2.32 mm;2.12,2.06,2.32 mm;2.12,2.06,2.32 mm,respectively. Conclusion The setup errors and residual errors are different in each segment of spinal cord. Henc, different extension margins should be given.
		2020 Vol. 29 (12): 1025-1029 [Abstract] ( 251 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1031	Analysis of clinical outcomes and prognostic factors in 109 patients with early-stage non-small cell lung cancer treated with stereotactic ablation radiotherapy
		Zheng Xiaoli, Liu Meiling, Wang Xiaohui, Sun Yanan, Song Shuai, Yang Yang, Jiao Ruidi, Ye Ke, Fan Chengcheng, Ge Hong
		Objective To evaluate the long-term survival and identify prognostic factors of patients diagnosed with early-stage non-small cell lung cancer (ES-NSCLC) receiving stereotactic ablation radiotherapy (SABR). Methods Clinical data of 109 ES-NSCLC patients treated with SABR in Henan Cancer Hospital from 2011 to 2018 were retrospectively analyzed. The overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) were calculated by Kaplan-Meier method and log-rank test. Multivariate prognostic analysis was performed by Cox regression model. Results The median follow-up time was 44 months (2-93 months). The median OS, CSS and PFS were 78 months, 78 months and 44 months, respectively. The 1-year OS, CSS and PFS were 95.4%, 97.2% and 84.1%, and 75.6%, 79.1% and 56.6% for the 3-year OS, CSS and PFS, and 55.6%, 60.7% and 37.3% for the 5-year OS, CSS and PFS, respectively. Univariate analysis showed that ECOG score, age, smoking history and derived-neutrophil/lymphocyte ratio (dNLR) were the influencing factors of OS (P=0.03, 0.02, 0.04, 0.001). Age, smoking history and dNLR were the influencing factors of CSS (P=0.02, 0.03, 0.001). Multivariate analysis demonstrated that dNLR was an independent prognostic factor for OS and CSS (P=0.001, 0.001). Conclusions ES-NSCLC patients treated with SABR can achieve favorable survival. The dNLR is an independent prognostic factor of OS and CSS, which can be considered in clinical application.
		2020 Vol. 29 (12): 1031-1036 [Abstract] ( 251 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1030


		2020 Vol. 29 (12): 1030-1030 [Abstract] ( 171 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	1037	Retrospective analysis of toxicities and clinical efficacy of postoperative radiotherapy for pediatric nephroblastoma
		Lu Ningning, Yu Zihao, Wang Shulian, Yang Yong, Tang Yu, Tang Yuan, Song Yongwen, Jin Jing, Fang Hui, Liu Yueping, Li Ning, Ren Hua, Chen Bo, Qi Shunan, Jing Hao, Li Yexiong
		Objective To evaluate the toxicities and clinical efficacy of postoperative radiotherapy for children with nephroblastoma (Wilms’ tumor). Methods In total, 116 WT Children (≤14-year-old) treated with radiotherapy (RT) in our center from 2005 to 2018 were recruited in this retrospective analysis. RT-induced toxicities and clinical efficacy were analyzed. RT was performed guided by Children's Oncology Group (COG) protocol. The overall survival (OS), flank-field control (LC), abdominal control (AC), and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meiermethod. pathologically proved. Results From January, 2005 to August, 2018, 116 pathologically proved WT patients were enrolled. Most of them were diagnosed with favorable WT (94.8%) and stage Ⅲ WT (87.1%). With a median follow-up time of 30.4(0.7-185.7) months, the 3-year OS, LC, AC and DMFS were 83.9%, 78.2%,75.2% and 82.8%, respectively. Sixty-four (55.2%) patients suffered from Grade I to Ⅱ gastrointestinal toxicities and Grade I to IV hematological toxicities. Only 5 patients (4.3%) had Grade Ⅱ late toxicities. For 96 patients who received adjuvant RT, the median surgery-RT interval time was 1.2(0.5 to 7.1) months. The 3-year OS, LC, AC and DMFS were 88.1%, 96.7%, 92.7% and 86.9%, respectively. Patients with tumor rupture without whole abdomen irradiation (WAI) tended to have lower AC, DMFS and OS.Twenty children received salvage RT when they had disease relapse. The 3-year OS and DMFS of patients with salvage RT were significantly worse than those receiving adjuvant RT (OS:68.2% vs. 88%, P=0.012;DMFS:64.3% vs. 86.9%, P=0.032). Conclusions Tumor bed irradiation for WT patients as per COG protocol can be well tolerated and achieve high efficacy. Salvage RT yields poor efficacy for tumor bed recurrence. Furthermore, tumor rupture without WAI possibly increases the abdominal and distant recurrence and the risk of death.
		2020 Vol. 29 (12): 1037-1042 [Abstract] ( 229 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1043	Influencing factors and prognostic values of hemoglobin changes in prostate cancer patient during radiotherapy combined with androgen-deprivation therapy
		Li Xiaoying, Gao Xianshu, Li Hongzhen, Qin Shangbin, Li Xiaomei, Zhang Min, Ma Mingwei, Qi Xin, Bai Yun
		Objective To analyze the influencing factors of hemoglobin changes in prostate cancer patients during radiotherapy combined with androgen-deprivation therapy (ADT) and analyze the relationship between the hemoglobin changes and long-term prognosis. Methods The changes of hemoglobin levels in 145 prostate cancer patients treated with radiotherapy combined with ADT in Department of Radiation Oncology of Peking University First Hospital from November 2011 to May 2015 were retrospectively analyzed. Intensity-modulated radiotherapy (IMRT) was employed for conventionally fractionated radiotherapy. Luteinizing hormone-releasing hormone agonist was utilized for endocrine therapy. Results The median hemoglobin reduction during radiotherapy combined with ADT was 8 g/L. The higher the baseline level of hemoglobin, pelvic irradiation and GS score before radiotherapy, the more obvious the decrease of hemoglobin during treatment (all P<0.001). Pelvic radiotherapy significantly increased the decline tendency of hemoglobin throughout the combined treatment (86.8% vs. 72.8%, P=0.05). The duration of endocrine therapy before radiotherapy and the hemoglobin changes during endocrine therapy alone were not significantly correlated with the degree of hemoglobin decline during subsequent radiotherapy (P=0.53 and 0.837). The biochemical failure-free survival did not significantly differ between patients with significant and mild hemoglobin reduction (P=0.686). Conclusions The baseline level of hemoglobin before radiotherapy is negatively correlated with the decrease of hemoglobin during combined therapy. Pelvic radiotherapy is positively correlated with hemoglobin reduction during combined therapy. Hemoglobin reduction during combined therapy is not associated with the long-term biochemical failure-free survival of patients.
		2020 Vol. 29 (12): 1043-1047 [Abstract] ( 235 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1048	Dosimetric study of cardioulmonary volume dose of internal mammary node irradiation under inverse-planned intensity-modulated radiation therapy
		Wu Hualing, Cao Lu, Cai Gang, Cai Rong, Xu Cheng, Chen Jiayi
		Objective To explore whether internal mammary node irradiation (IMNI) can control the normal tissue volume dose within a reasonable range under inverse-planned intensity-modulated radiation therapy (IP-IMRT). Methods The patients with breast cancer received postmastectomy combined with radiotherapy from January 2015 to July 2016 in Department of Radiation Oncology in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively screened and sampled. The prescription dose was 50Gy/25 times. The whole heart and ipsilateral lung were outlined on CT scan, and the dose-volume histogram parameters were quantified in the RT planning system (ADAC Pinnacle). Results For the left breast cancer patients (n=67) who received IMNI, the total heart dose-volume histogram parameters in 2016 were significantly decreased compared with those in 2015. The D_mean in 2015 was (976.65±411.16) cGy, significantly larger than (687.47±134.65) cGy in 2016(P=0.008). Among the same sampled population, the percentage of whole heart D_mean at the doses of 12Gy, 10Gy, 8Gy was 33.3%, 33.3%, and 66.7% in 2015, and 0%, 3.8%, and 11.5% in 2016, respectively. For the right breast cancer patients (n=65) , D_mean, V2Gy, V10Gy, V15Gy and V20Gy of the heart in the IMNI group were significantly higher than those in the non-IMNI group in 2016(all P<0.05). For the ipsilateral lung, D_mean, V10Gy, V20Gy, and V30Gy in the IMNI group were remarkably higher than those in the non-IMNI group (all P<0.05). Conclusions IMNⅡs found to be associated with increased cardiopulmonary dose volume with IP-IMRT technique. Nevertheless, with the practical experience of IMRT and the increasing awareness of cardiac dose limitation, it is feasible to control the cardiac dose increment within a limited range.
		2020 Vol. 29 (12): 1048-1053 [Abstract] ( 235 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1054	Application of delayed-enhancement MRI in lumpectomy cavity delineation for patients after breast-conserving surgery in prone radiotherapy using deformable image registration
		Zhao Changhui, Li Jianbin, Wang Wei, Gong Guanzhong, Xu Liang, Zhang Yingjie, Li Fengxiang, Shao Qian, Wang Jinzhi, Liu Xijun, Xu Min
		Objective To assess the feasibility of delayed-enhancement MRI in contouring the lumpectomy cavity (LC) for patients with invisible seroma or a low cavity visualization score (CVS≤2) in the excision cavity after breast-conserving surgery (BCS). Methods Twenty-six patients with stageT1-2N0M0 who underwent prone radiotherapy after BCS were recruited. The LC delineated on CT simulation images was denoted as LCCT. The LCs delineated on T2WI, as well as on different delayed phases (2-, 5-and 10-minute) of delayed-enhancement T1WI were defined as LCT2, LC2T1, LC5T1 and LC10T1, respectively. Subsequently, the volumes and locations of the LCs were compared between CT simulation images and different sequences of MR simulation images using deformable image registration. Results The volumes of LCT2, LC2T1, LC5T1 and LC10T1 were all larger than that of LCCT. A statistical significance was found between the volume of LCCT and those of LC2T1 or LC5T1, respectively (both P<0.05). The conformal index (CI), degree of inclusion (DI), dice similarity coefficient (DSC) and the distance between the center of mass of the targets (COM) of LCCT-LC10T1 were better than those of LCCT-LCT2, LCCT-LC2T1 and LCCT-LC5T1, however, there was no statistical difference among them (all P>0.05). Conclusions It is feasible to delineate the LC based on prone delayed-enhancement MR simulation images in patients with low CVS after BCS. Meanwhile, the LCs derived from prone delayed-enhancement T1WI of 10-minute are the most similar with those derived from prone CT simulation scans using titanium clips, regardless of the volumes and locations of LCs.
		2020 Vol. 29 (12): 1054-1058 [Abstract] ( 256 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1059	Analysis of complications and BREAST-Q score after radiotherapy in breast cancer patients treated with different reconstruction methods
		Li Jiahui, Zinati·Nuertai, Cheng Fang
		Objective To compare the complications, degree of satisfaction and quality of life among breast cancer patients treated with different reconstruction methods after postoperative radiotherapy, aiming to explore the optimal combination of reconstruction and radiotherapy. Methods 105 breast cancer patients treated with postoperative radiotherapy after reconstruction surgery in Tumor Hospital from 2014 to 2019 were enrolled. According to the type of reconstruction, all patients were divided into group A (autologous reconstruction group, n=54) and group B (implant reconstruction group, n=51). Patients in group B were further divided into group B1(one-stage reconstruction group, n=30) and group B2(two-stage reconstruction group, n=21) according to the timing of reconstruction. The incidence of complications and BREAST-Q score were statistically compared between groups A and B, groups B1 and B2, respectively. The influencing factors of BREAST-Q score were identified by multiple linear regression analysis. Results The incidence of long-term complications and the total incidence of complications in group A were significantly lower than those in group B (1.9% vs. 37.3%, P<0.001 and 9.3% vs.43.1%, P<0.001), and the scores of psychosocial well-being and degree of satisfaction with breasts in group A were significantly higher than those in group B (71(15) vs. 66(22), P=0.027 and 53(8) vs. 53(8), P=0.032)). There was no significant difference in the incidence of complications and BREAST-Q scores between groups B1 and B2(both P>0.05). Breast volume and complications were the predictors of BREAST-Q score (both P<0.001). Conclusions Radiotherapy after autologous reconstruction of breast cancer yields fewer complications and better BREAST-Q score than the implantation reconstruction. The incidence of postoperative radiotherapy complications and BREAST-Q scores are equivalent between one-stage and two-stage reconstruction. The BREAST-Q score is lower in patients with large breasts or complications.
		2020 Vol. 29 (12): 1059-1063 [Abstract] ( 239 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1064	Relationship between T cell subsets in peripheral blood and clinical characteristics and prognosis of Uygur women with advanced cervical squamous cell carcinoma
		Guo Yuping, Gulina·Kulban, Wang Ruozheng
		Objective To observe the relationship between peripheral blood T cell subsets and clinical characteristics and prognosis of Uygur women with advanced cervical squamous cell carcinoma in Xinjiang. Methods A total of 185 patients pathologically diagnosed with stage ⅡB-IVA cervical squamous cell carcinoma admitted to Cancer Hospital Affiliated to Xinjiang Medical University from January 2015 to December 2018 were selected. The relationship between T cell subsets in peripheral venous blood and clinical characteristics and prognosis was analyzed. Results CD⁺₄ T cells, CD⁺₈ T cells and CD⁺₄/CD⁺₈ T cell ratio were significantly correlated with clinical stage, tumor diameter and body mass index (BMI)(all P<0.05). The later Federation International Association of Gynecology and Obstetrics (FIGO) tumor stage, the larger the tumor diameter, the higher the BMI, and the higher the CD⁺₈ T cells and the lower the CD⁺₄ T cell and CD⁺₄/CD⁺₈ T cell ratio. The count of CD⁺₄ T cells was decreased in patients with lymph node metastasis. Cox’s univariate analysis showed that FIGO stage, age, lymph node metastasis, tumor diameter, BMI, CD⁺₄ T cells, CD⁺₈ T cells, CD⁺₄/CD⁺₈ T cell ratio and treatment methods were the important factors affecting the overall survival (OS). Multivariate analysis showed that BMI, treatment method, CD⁺₄T cells and tumor diameter were the independent prognostic factors affecting OS (all P<0.05). Conclusions The level of T cell subsets in peripheral blood of Uygur cervical cancer patients is out of balance. CD⁺₄T cells, CD⁺₈ T cells and CD⁺₄/CD⁺₈ T cell ratio are associated with FIGO stage, tumor diameter and BMI, and CD⁺₄T cells are correlated with lymph node metastasis. BMI, treatment method, tumor diameter and CD⁺₄ T cell are the independent prognostic factors affecting the OS of patients with cervical cancer.
		2020 Vol. 29 (12): 1064-1069 [Abstract] ( 242 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Biology·Technique

	1070	Research and development of remote training system for radiotherapy CT simulation based on virtual reality technology
		Zheng Fen, Xu Benhua, Huang Miaoyun, Jiang Liuqing, Dong Fangfen, Guo Lanyan, Yao Jianmin, Chen Yuangui, Li Xiaobo
		Objective To develop a remote training system for CT simulation positioning of radiotherapy using virtual reality technology, and to explore a new method of medical training. Methods The 3DMax and Maya were employed to establish the 3D model. The unity3D engine was adopted to develop 3D virtual operation and interaction system. Java spring MVC architecture was utilized as the system background service. MySQL was used as the background database system. The users were assigned into two roles:teacher and student, and the modes were divided into teaching and assessment modes. Results The function of the system covered the whole process of CT simulation positioning, mainly including modules of patient information management, CT simulation positioning machine cognition, body position fixation technology, CT positioning scanning, and emergency handling, etc. Since it was put into use in 2018, the system has been running stably, with 14920 pages views and an 86.66% pass rate. Compared with the traditional training, the training efficiency has been significantly improved and has received unanimous recognition. Conclusions The remote training system can effectively improve the clinical practice ability and humanistic care ability of the trainees, which has good autonomy, sharing, and innovation. At present, the system has been put online and has strong popularization with prospects for broad application.
		2020 Vol. 29 (12): 1070-1074 [Abstract] ( 285 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1075	Acceptance tests of beam performance for pencil beam scanning (PBS) proton system of IBA
		Yang Tao, Qu Baolin, Xu Shouping, Xie Chuanbin, Xu Wei, Gong Xuan, Cao Lin
		Objective To explore the beam performance of GTR 360° PBS dedicated nozzle for IBA Proteus Plus proton system and evaluate the beam characteristics of PBS during acceptance test procedure (ATP) to meet the precision and safety requirements of clinical treatment. Methods According to the requirements of acceptance tests, the beam tests of PBS mainly included:test of integrated depth dose (IDD), test of maximum field size at the maximum and minimum ranges, field uniformity and informative PBS tests for the GTR 360°, test of lateral dose uniformity in a single field uniform dose in a cube, test of longitudinal dose uniformity in a single field uniform dose in a cube, and test of monitor unit reproducibility and proportionality. Results The maximum deviation measured of range, fall back accuracy and distal fall-off was 0.03g/m², 0.01g/m² and 0.078g/m², respectively. Maximum field size at the maximum and minimum ranges was 30.2cm×40.2 cm and 30.1cm×40.1 cm, respectively. During the different gantry angles and ranges, the lowest γ passing rate of a pattern plan was 97%, the maximum deviation of the centrical beam spot size at the X and Y axes was -0.16 mm and -0.21 mm, and the worst symmetry was 0.80%. Compared with the centrical beam spot, the maximum size deviation of the other beam spots was 0.11 mm and 0.14 mm at the X and Y axes, and the maximum position accuracy deviation of the beam spot was 0.60 mm and 0.43 mm at the X and Y axes. The maximum deviation of lateral dose uniformity at at the X and Y axes was 0.55% and 0.80% in the high energy region, and 0.6% and 0.75% in the low energy region. The maximum deviation of longitudinal dose uniformity was 0.79% in the high energy region, and 2.22% in the low energy region. The monitor unit (MU) reproducibility factor was 0.106% and the maximum proportionality deviation was 0.67%. Conclusion The dedicated nozzle of PBS has passed all the beam performance acceptance tests, which meet the requirements of all parameters, and the whole system yields relatively high accuracy, repeatability and good stability.
		2020 Vol. 29 (12): 1075-1079 [Abstract] ( 288 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1080	Evaluation of multi-leaf collimator performance of TrueBeam accelerator using high-resolution trajectory log files
		Ma Yangguang, Mai Rizhen, Hu Jinyan, Han Bin, Jia Fei, Xu Dandan, Liu Shuaipeng, Guo Yuexin
		Objective To evaluate the multi-leaf collimator (MLC) performance of TrueBeam accelerator using trajectory log files. Methods All tests were performed 5 times under different gantry-collimator angle combination. The 1 mm picket fences were constructed by static or dynamic MLC. The control ability for small-field accuracy of accelerator was evaluated. Repeatability was assessed by MLC repeat motion. The movement performance of difference velocities along one direction and the opposite direction were evaluated via a 1 cm picket fences which slipped from -7 cm to 7 cm with a uniform velocity and stopped or immediately back at 7 cm. The MLC performance in a complex program was evaluated by a cross movement test. Results Both the static and the dynamic picket fences yielded high accuracy. The deviation spectrums of MLC in different gantry angle were consistent, however, an absolute difference of 0.0011 mm was found. For uniform velocity movement tests with 0°gantry, the RMSE of MLC was increased from 0.0150 mm to 0.0598 mm when the speed was accelerated from 5 mm/s to 25 mm/s. Similar results were obtained in non-zero gantry angle. The “overspeed” effect caused by the direction change movement of MLC was less obvious than that caused by speed changed from zero to a uniform velocity movement state. There was no significant change in speed before and after the MLC crossing. The MLC speed fluctuated around the set value, which was independent of the gantry angle. Conclusion A method for evaluating the performance of MLC using trajectory log files is established, which can evaluate the MLC performance of TrueBeam accelerator and be used for MLC rapid quality control in clinical practice.
		2020 Vol. 29 (12): 1080-1085 [Abstract] ( 289 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1086	Protection design of Halcyon accelerator room
		Yu Lang, Yang Bo, Sun Xiansong, Zhang Yue, Wang Bei, Wang Zhiqun, Zhang Jie, Qiu Jie
		Objective To discuss the design details of accelerator room for a novel enclosed O-ring linac Halcyon, and to optimize its protection and layout. Methods According to the optimization principle of radiation protection and the requirements of national radiation protection standards, and the structural characteristics of Halcyon accelerator, the differences between conventional and this novel accelerator rooms were analyzed by discussing the space layout of the machine room, shielding calculation, electrical facilities, purifying ventilation, temperature and humidity control and other factors. Results The Halcyon machine had a compact structure, a closed ring frame design and a main beam shielding device, which could greatly reduce the radiation protection pressure while improving the space utilization rate of the machine room. The optimized design layout of the machine room could eliminate hidden dangers, avoid design defects, and prevent adverse consequences caused by design errors. Conclusions The overall structure of Halcyon accelerator is different from that of conventional accelerators. The design details should be taken into full consideration to ensure the optimization of radiation protection, lay a good foundation for subsequent installation, debugging and operation of the equipment and create a good treatment environment for patients and medical staff.
		2020 Vol. 29 (12): 1086-1090 [Abstract] ( 527 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1091	Application of adjuvant skin-marker positioning in overweight patients with thoracic and abdominal tumors
		Wu Jiandong, Chen Xiuying, Hong Jinsheng, Wu Yinghui, Chen Longjian, Huang Weikang, Xue Wangui, Wu Bin
		Objective To investigate whether adjuvant skin-marker positioning can decrease the set-up errors in overweight patients with thoracic and abdominal tumors. Methods A total of 60 overweight patients with thoracic and abdominal tumors treated with radiotherapy in the First Affiliated of Fujian Medical University between January 2018 and December 2018 were randomly divided into two groups. In group A, conventional skin-marker positioning was adopted. In group B, conventional skin-marker positioning combined with adjuvant skin-marker position was employed. All patients were immobilized with thermoplastic positioning body membrane with head-body plate fixation. The set-up errors in the right-left, head-foot and dorsoventral directions were obtained from cone-beam CT (CBCT) scan system before radiation delivery. The set-up errors were statistically compared between two groups by using t-test. Results In group A, the set-up errors in the right-left, head-foot and dorsoventral directions were (4.47±2.91) mm,(5.43±2.61) mm and (3.87±2.40) mm, significantly higher compared with (2.97±1.68) mm,(3.21±1.62) mm and (2.59±1.57) mm, respectively (all P<0.001). Conclusion Adjuvant skin-marker positioning method can reduce the set-up errors and enhance the positioning repeatability in overweight patients with thoracic and abdominal tumors receiving radiotherapy.
		2020 Vol. 29 (12): 1091-1095 [Abstract] ( 260 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1096	miR-377-5p enhances radiosensitivity of esophageal cancer cell line TE-1 by inhibiting AKT1/GSK-3β signaling pathway
		Ba Yuntao, Wang Quan
		Objective To investigate the effect and mechanism of miR-377-5p on the radiosensitivity of esophageal cancer cell line TE-1. Methods Esophageal cancer cell line TE-1 was transfected with miR-377-5p mimic and miR-377-5p mimic NC to construct the TE-1 cells overexpressing miR-377-5p. After the transfected TE-1 cells were exposed to ionizing radiation, radiobiological parameters(D0,Dq,SF2) were detected by plate colony formation assay. Cell invasion ability was assessed by Transwell chamber assay, Cell migration ability was evaluated by cell scratch assay, Cell viability was assessed by CCK8 assay. Cell apoptosis and cell cycle were detected by flow cytometry, Western blot. The phosphorylation levels of AKT1 and GSK-3βwere measured by Western blot. Results At the doses of 2, 4, 6, and 8 Gy, the colony formation rate in each group was significantly decreased (all P<0.05), and the colony formation rate at the same irradiation dose in the miR-377-5p mimic group was significantly lower than that in the miR-377-5p mimic NC group (P<0.05). Compared with the miR-377-5pmimic NC group, the D0, Dq and SF2 at 2Gy were decreased significantly in the miR-377-5pmimic group (all P<0.05), and the radiosensitization ratio(D0 ratio) was 1.34. After 0 Gy ionizing radiation, the invasion, migration and proliferation abilities of TE-1 cells were significantly decreased, the level of cell apoptosis was significantly increased, the cell cycle was arrested in G1 phase, and the phosphorylation levels of AKT1 and GSK-3β were significantly decreased in the miR-377-5pmimic group (all P<0.05). Following 4 Gy irradiation, cell invasion, migration, proliferation abilities were decreased, the level of cell apoptosis was increased significantly, the G1 phase was significantly extended and the phosphorylation levels of AKT1 and GSK-3β were also decreased significantly in the miR-377-5pmimic group (all P<0.001). Conclusion miR-377-5p can increase the radiosensitivity of esophageal cancer cell line TE-1, which may be due to the inhibition of the AKT1/GSK-3β signaling pathway.
		2020 Vol. 29 (12): 1096-1101 [Abstract] ( 265 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1102	The role of lung type Ⅱ epithelial stem cell differentiation in radiation-induced pulmonary fibrosis
		Xiao Ziting, Tian Jian, Zhu Yanyan, Wang Chaojie, Ma Ning, Zhang Xingnan,Zhou Yun, Zhou Jianwei
		Objective To determine the role of type Ⅱ alveolar epithelial stem cells (AEC Ⅱ) in radiation-induced pulmonary injury and investigate the potential mechanism by observing the dynamic changes in the expression levels of anti-prosurfactant protein C (proSP-C) proSP-C (AEC Ⅱ biomarker), homeobox only protein X (HOPX, type I alveolar epithelial cell biomarker) or vimentin (a mesenchymal marker) and transforming growth factor β1(TGF-β1), a profibrotic cytokine. Methods Eight-week old C57BL/6j female mice were exposed to X-ray thoracic irradiation. Mouse lungs were collected at 8 different time points of 24 h, 1 week, 1 to 6 months after irradiation. The histopathological changes of the lungs at different time points were observed with H& E staining to determine the time of formation of pulmonary fibrosis. In addition, the co-expression of proSP-C with HOPX or vimentin in AEC Ⅱ was confirmed by immunofluorescence staining to track AEC Ⅱ phenotypes at different injury phases following thoracic irradiation. The expression levels of those proteins and TGF-β1 were quantitatively detected by Western blot. Results After thoracic exposure to a single dose of 20 Gy X-ray for 3 months, the fibrotic lesions in the lungs could be noted. The co-expression of proSP-C with vimentin or HOPX could be observed in AEC Ⅱ. Western blot demonstrated that the expression levels of TGF-β1 and those proteins were also changed along with the lung injury. Conclusion AEC Ⅱ can be differentiated into mesenchymal-like cells after X-ray irradiation due to the up-regulated expression of TGF-β1, which is a potential cause of radiation-induced pulmonary fibrosis.
		2020 Vol. 29 (12): 1102-1109 [Abstract] ( 233 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1110	Radiosensitivity of lncrna linc00909 targeting mir-548-3p on colorectal cancer cells
		Hou Ge, Xiao Chenhu, Chen Xiaojuan, Huang Yangyang, Wang Cheng, Chai Ting, Song Rui, Yuan Jinjin, Liu Zongwen
		Objective To investigate whether lncRNA LINC00909 affected the radiosensitivity of colorectal cancer cells by targeting miR-548-3p. Methods The expression levels of LINC00909 and miR-584-3p in colorectal cancer and adjacent tissues were detected by qRT-PCR. The colorectal cancer cells SW480 and SW620 were cultured in vitro, and transfected with si-NC, si-LINC00909, miR-NC, miR-584-3p mimics, si-LINC00909, and anti-miR-NC and si-LINC00909, and anti-miR-584-3p, respectively. The cells were irradiated with a dose of 4 Gy. The cell survival fraction and sensitization enhancement ratio (SER) were detected by clone formation assay. Cell proliferation was detected by MTT assay. Cell migration and invasion were assessed by Trans well chamber assay. The targeting relationship between LINC00909 and miR-584-3p was confirmed by dual luciferase reporter assay. The effect of interfering with the expression of LINC00909 or inhibiting the expression of miR-584-3p on the weight of the xenograft tumor after irradiation was evaluated by subcutaneous xenograft experiment in nude mice. Results The expression level of LINC00909 in colorectal cancer tissues was significantly up-regulated (P<0.05), whereas the expression level of miR-584-3p was significantly down-regulated (P<0.05). After interfering with the expression of LINC00909 or miR-584-3p overexpression, the cell survival fraction score was significantly reduced (P<0.05), the SERs were 2.017 and 1.762, and cell proliferation, migration and invasion were suppressed (all P<0.05). Dual luciferase reporter assay confirmed that LINC00909 could target and bind to miR-584-3p. After interfering with the expression of LINC00909, the weight of the transplanted tumor was significantly reduced (P<0.05), whereas the weight of the transplanted tumor was significantly increased after co-transfection with anti-miR-584-3p (P<0.05). Conclusion Interfering with the expression of LINC00909 can inhibit the proliferation, migration and invasion ability of colorectal cancer cells by up-regulating the expression of miR-548-3p, thereby enhancing the cell radiosensitivity.
		2020 Vol. 29 (12): 1110-1117 [Abstract] ( 264 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1118	Inhibiting lncRNA LINC00958 expression promotes apoptosis of colorectal cancer cells and increases the radiosensitivity throuth targeting miR-422a
		Liang Hong, Zhang Hui, Zhang Hui
		Objective To investigate the effect of lncRNA LINC00958 on the apoptosis and radiosensitivity of colorectal cancer cells and its underlying mechanism. Methods The pcDNA, pcDNA-LINC00958, si-NC, si-LINC00958, miR-NC, and miR-422a plasmids were transfected into SW480 cells and assigned into the pcDNA group, pcDNA-LINC00958 group, si-NC group, si-LINC00958 group, miR-NC group, miR-422a group, respectively. Anti-miR-NC and anti-miR-422a plasmids were co-transfected into SW480 cells with si-LINC00958, and assigned into the si-LINC00958+anti-miR-NC group and si-LINC00958+anti-miR-422a group. miR-NC and miR-422a were transfected into the WT-LINC00958 and MUT-LINC00958 cells, respectively. The fluorescence activity was detected. Cell transfection was performed by liposome method. The expression levels of miR-422a and LINC00958 were measured by qRT-PCR. The expression levels of proteins were detected by Western Blot. Cell apoptosis was assessed by flow cytometry. The radiosensitivity of colorectal cancer cells was evaluated by cell clone formation assay. The fluorescence activity was detected by dual luciferase reporter assay. Results High expression of LINC00958 and low expression of miR-422a were observed in colorectal cancer cells. Inhibition of LINC00958 expression and overexpression of miR-422a could promote cell apoptosis and increase cell radiosensitivity of colorectal cancer cells. LINC00958 could target the regulation of miR-422a expression. Inhibition of miR-422a reversed the effect of inhibiting the expression of LINC00958 on increasing the radiosensitization and promoting cell apoptosis of colorectal cancer cells. Conclusions Inhibition of LINC00958 expression increases the radiosensitivity and promotes the apoptosis of colorectal cancer cells. The mechanism may be related to the regulation of miR-422a, which will provide new targets and new ideas for the treatment of colorectal cancer.
		2020 Vol. 29 (12): 1118-1123 [Abstract] ( 240 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1124	RIP3-mediated necroptosis induced by radiation injury in neuronal cells
		Yang Songhua, Huang Shixiong, Zeng Biao, Dong Qian, Zhu Xiaocong, Zeng Na, Li Bin, Zhou Guanzhi, Chen Yifang, Yang Huiting, Li Jian, Shi Yingrui
		Objective To observe the presence or absence of necroptosis in PC12 cells after radiation injury, and to detect the expression of receptor-interacting protein 3(RIP3) and evaluate its regulatory effect on necroptosis. Methods PC12 cells were treated with different doses of irradiation and their necroptosis was detected by lactate dehydrogenase (LDH) release at different time points. After pretreatment with necroptosis inhibitor Necrostatin-1(Nec-1), the changes of cell necroptosis were detected by LDH. The expression level of RIP3 after irradiation intervention was detected by Western blot (WB). After pretreatment with the RIP3-specific inhibitor GSK'872, the changes of cell necroptosis were detected by LDH. The best transfection sequence of RIP3 knockout was screened by WB. The cells were divided into the control group, irradiation group, solvent control group, no-load control group and pretreatment group. WB, immunofluorescence staining, MTT, LDH and Annex V-fluorescein Isothiocyanate/Propidium Iodide (AnnexV-FITC/PI) flow cytometry were used for detection and analysis. Results After 4 Gy irradiation, the degree of cell necrosis was the highest after 3 hours of culture, and the expression level of RIP3 protein was up-regulated. The cell necrosis was decreased after Nec-1,GSK'872 and RIP3 gene knockdown pretreatment. Conclusions The radiation injury of 4Gy can induce the necroptosis of PC12 cells, and the most significant effect can be observed when cultured for 3 hours after irradiation. RIP3 is involved in the process of necroptosis of PC12 cells induced by radiation injury, and plays a pivotal positive regulatory role.
		2020 Vol. 29 (12): 1124-1129 [Abstract] ( 248 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	1130	Effect of hyperthermia on immune cells and immune-related cytokines in tumor immune microenvironment
		Zhou Xuexiao, Shen Pei, Wang Shengzhi, Shi Fan, Sun Qiaozhen, Xu Ting
		With the in-depth study of tumor hyperthermia and tumor immune microenvironment (TIME), the role of hyperthermia in TIME has captivated increasing attention from scholars in recent years. Based upon recent research progress at home and abroad, the effect and mechanism of hyperthermia on several major immune cells and immune-related cytokines in the TIME were reviewed in this article. Comprehensive and deep understanding of the regulation of hyperthermia on the TIME could provide new ideas and methods for tumor treatment.
		2020 Vol. 29 (12): 1130-1134 [Abstract] ( 266 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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