Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2021 Vol.30 Issue.1 Published 2021-01-15

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

Investigation Research

	1	Radiation oncology residency training programs in China:investigation and comparison with western programs
		Qi Shunan, Yang Zhuanbo, Wang Hua, Cao Jianzhong, Zhang Ximei, Fan Chengcheng, Wang Qifeng, Wang Shulian, Li Yexiong
		Objective To summarize the experience of radiation oncology residency training programs in western coutries, and provide evidence to improve the present Phase-I Radiation Oncology Residency Training Programs in China. Methods An electronic questionnaire-based survey was conducted among residents and staffs in 6 top cancer centers in China and 5 centers from Europe and North America to collect their feedback regarding the description and comparison of different programs. Results , A total of 70 responses and 4 papers explaining relevant training programs from 26 residents and 23 teachers in Chinese hopsitals and 20 residents and 1 teacher from Europe and North America were received. The Radiation Oncology Residency Training Programs in China were designed into 2 phases, and the Results in the current study were involved with the first phase. Program designs were similar in the following aspects:goal, clinical practice-based training, rotation curriculum, interim and final assessment. However, the total timeframe in the investigated Chinese Phase-I programs was shorter than that in western hospitals (2 to 3 years vs. 4 to 5 years). Chinese programs covered major common diseases, whereas rotation design was performed based on each individual disease in western programs. In Chinese programs, the working hours were mainly 40-60 h every week. Although the working hours were commensurate with local workforce regulations, the residents from MSK program had an outstanding longer working time of 60-80 h every week and treated more patients compared with other programs. Conclusions The investigated Phase-I Radiation Oncology Residency Training Programs in 6 top cancer centers in China share common features in goals, training modes and assessments with western programs. However, our programs have shorter timeframe and less detailed requirements in individual disease than the western programs.
		2021 Vol. 30 (1): 1-6 [Abstract] ( 191 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Special Feature

	7	Diagnosis and treatment of radiation pneumonia
		Feng Qinfu, Zheng Miaoli, Zeng Qiang
		Radiation pneumonia is a part of radiation-induced lung injury, and its injury and repair is a complex pathophysiological process involving with the participation and interaction among numerous cells and cytokines. Early diagnosis and treatment of radiation pneumonia can alleviate lung injury and protect lung fuction. Compared with infectious pneumonia, there is no obvious difference in symptoms and physical signs. However, the symptoms are relatively mild, the total count of white blood cells is not significantly elevated or only the classification of neutrophils is relatively high. Hormone can stimulate the increase of white blood cells, which should be delivered prior to relevant examination. CT scan is a sensitive tool to make the diagnosis of radiation pneumonia, which can be utilized for staging, guiding treatment and prognosis evaluation. The lung injury changes of radiation pneumonia on CT scan can be observed 7-10 d later than relevant symptoms. Besides symptomatic treatment, such as cough relief and phlegm elimination, hormone is the key treatment of radiation pneumonia. It is recommended to deliver long-acting dexamethasone or prednisone with an initial small dose, adjusted to effective dose according to disease condition, maintained for 3-4 weeks, and gradually reduced to avoid the recurrence of radiation pneumonia. Pulse therapy for hormone is likely to lead to insufficient or excessive dose and affect the therapeutic effect. Insufficient dose can cause the occurrence of recurrent radiation pneumonia.
		2021 Vol. 30 (1): 7-10 [Abstract] ( 251 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	11	Study of related factors of radiation-induced hypothyroidism in nasopharyngeal carcinoma
		Zhou Ling, Chen Jia, Huang Shuang, Tao Changjuan, Shen Wei, Chen Ming, Yu Zhonghua, Chen Yuanyuan
		Objective To explore the main factors of hypothyroidism after radiotherapy and to identify the optimal thyroid dosimetric parameters by analyzing the dosimetric parameters of the thyroid. Methods The general clinical characteristics and dosimetric parameters of 206 patients with nasopharyngeal carcinoma treated in Cancer Hospital of University of Chinese Academy of Sciences were collected, and the correlation between them and the incidence of hypothyroidism was analyzed. Results The incidence of hypothyroidism in patients with nasopharyngeal carcinoma after radiotherapy was 50.49%(104/206). Univariate analysis showed that gender, N-stage, volume, mean dose, V20Gy, V25Gy, V30Gy, V35Gy, V40Gy, V45Gy of thyroid were associated with the incidence of hypothyroidism. Multivariate analysis demonstrated that volume (≤12.82cm³) and mean dose of thyroid were the independent risk factors of hypothyroidism. Mean dose of thyroid combined with volume could significantly predict the incidence of hypothyroidism after radiotherapy. Conclusion Mean dose of thyroid ≤ 47.21Gy is the optimal dosimetric parameter for radiation-induced hypothyroidism, especially the patients with thyroid volume ≤ 12.82 cm³ should pay more attention to the protection of thyroid gland during radiotherapy.
		2021 Vol. 30 (1): 11-15 [Abstract] ( 192 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	16	Relationship between monocytopenia and neutropenia during concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma and cervical cancer
		Dong Xiaohe, Yang Yongqiang, Zhao Peifeng, Qian Jianjun, Zhang Liyuan, Tian Ye
		Objective To evaluate whether the decrease in peripheral blood monocyte count was a potential predictor for neutropenia in patients with nasopharyngeal carcinoma and cervical cancer. Methods The medical records of 95 patients with nasopharyngeal carcinoma and cervical carcinoma who received intensity-modulated radiation therapy (IMRT) combined with paclitaxel liposomes and platinum (TP) synchronous chemotherapy and presented with neutropenia in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were retrospectively analyzed. Paired sample t-test was used to assess whether the number of days when the monocytes initially dropped/decreased to lowest level/eventually increased to normal value was significantly less than those of the neutrophils. In addition, the chi-square test was performed to determine the correlation between the degree of reduction in the absolute neutrophil count (ANC) and baseline absolute monocyte count (AMC). Results The change trend of AMC was consistent with that of ANC in the two cycles of concurrent chemotherapy. The number of days when AMC initially decreased/decreased to the lowest level/finally increased to normal value was significantly less than that of ANC (4 d vs. 6 d, 4 d vs. 10 d, P<0.001;5 d vs. 6 d, 6 d vs. 9 d, 7 d vs. 12 d, P<0.001). However, no correlation was found between the baseline level of monocytes and the degree of subsequent neutropenia [(AMC<0.4×10⁹ )vs.( AMC≥0.4×10⁹)=32 vs. 63,P=0.172]. Conclusions Decreased monocyte count is an important potential predictor for neutropenia and a significant indicator for guiding the next monitoring of neutrophil count and treatment with granulocyte colony-stimulating factor.
		2021 Vol. 30 (1): 16-22 [Abstract] ( 188 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	23	Multicenter 5-year survival analysis of weekly Endostar combined with concurrent chemoradiotherapy for unresectable locally advanced non-small cell lung cancer
		Ma Honglian, Peng Fang, Zhai Yirui, Bao Yong, Xu Yujin, Zhao Lujun, Li Dongming, Hui Zhouguang, Xu Liming, Hu Xiao, Wang Lyuhua, Chen Ming
		Objective To evaluate the 5-year survival outcome of patients with unresectable locally advanced non-small cell lung cancer (NSCLC) treated with Endostar in combination with platinum-based concurrent chemoradiotherapy. Methods From March 2009 to June 2015,115 patients with the unresectable locally advanced NSCLC from two prospective studies[Clinical trials 2009-2012(ClinicalTrials.gov NCT01894) and 2012-2015(ClinicalTrials.gov, NCT01733589)] were treated with Endostar in combination with platinum-based concurrent chemoradiotherapy. A total dose of 60-66 Gy was delivered in 30-33 fractions. Endostar was given 1 week prior to the beginning of radiotherapy, and repeated fortnightly during the concurrent chemoradiotherapy. After long-term follow up, survival outcome was evaluated in 104 patients treated with radiation dose of ≥60 Gy. Kaplan-Meier method was used for survival analysis. Univariate survival analysis was performed using the log-rank test. Results Of 104 eligible patients, 60.6% of them had squamous carcinoma and 65.4% were classified in stage ⅢB. All the patients received ≥2 cycles of Endostar and 93.3% of them received 4 cycles of Endostar. The median follow-up time was 68.3 months. The median overall survival (OS) and median progression-free survival (PFS) were 31.3 and 13.9 months, respectively. The 3-year and 5-year OS were 45.6% and 35.7%, respectively. The 3-year and 5-year PFS were 27.1% and 24.9%, respectively. Univariate analysis indicated that sex, ECOG, pathological type, clinical stage, radiotherapy technique, chemotherapy regimen, chemotherapy cycle and cycle of Endostar use were not associated with OS. Late radiation injury occurred in 14.4% of patients, and no grade 4-5 late injury was observed. Conclusion Patients with unresectable locally advanced NSCLC treated with Endostar fortnightly in combination with platinum-based concurrent chemoradiotherapy achieve better OS than historical data with tolerable toxicities.
		2021 Vol. 30 (1): 23-28 [Abstract] ( 170 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	29	Analysis of invasion characteristics and prognostic factors of patients with Masaoka-Koga stage Ⅲ thymoma
		Fan Chengcheng, Ge Hong, Zhang Yougai, Liu Meiling, Zhang Ruiyun, Ye Ke, Zheng Xiaoli, Sun Yanan
		Objective To analyze the invasion characteristics and prognostic factors of patients with Masaoka-Koga stage Ⅲ thymoma. Methods The tumor invasion characteristics of 179 patients who were diagnosed with Masaoka-Koga stage Ⅲ thymoma and treated in Affiliated Cancer Hospital of Zhengzhou University from January 2000 to June 2018 were analyzed retrospectively. According to the treatment methods, all patients were divided into the radical operation group (n=94), palliative operation group (n=39) and simple biopsy group (n=46). The χ² test was used to compare the classified variables, Kaplan-Meier method was utilized to calculate the cumulative survival rate, log-rank method was used for group comparison and univariate analysis, and Cox’s regression model was used for multivariate analysis. Results Mediastinal pleural invasion (86.0%) was the most common site, followed by pericardium (50.8%), great vessel (40.8%) and lung (36.3%). The proportion of macrovascular invasion in the radical operation group was 14.9%, significantly lower than 79.5% and 60.9% in the palliative surgery group and biopsy group (both P<0.001). Multivariate analysis showed that the nature of operation (P<0.001), age (P=0.011), radiotherapy (P=0.020) were the independent factors affecting overall survival (OS), while nature of operation (P<0.001), age (P=0.004), radiotherapy (P=0.020), number of invasive organs (P=0.023) and pathological type (P=0.016) were the independent factors affecting progress-free survival (PFS). Conclusions For patients with Masaoka-Koga stage Ⅲ thymoma, mediastinal pleura is the most common site of invasion, pericardium, lung and great vessels are also commonly invaded. The invasion of mediastinal pleura, pericardium and lung exerts slight effect on surgical resectability, whereas great vessel involvement can significantly affect surgical resectability. OS and PFS in patients undergoing radical resection are significantly better than those in patients treated with palliative resection and biopsy. Radical resection is the most important factor affecting prognosis.
		2021 Vol. 30 (1): 29-33 [Abstract] ( 183 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	34	Meta-analysis of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for advanced esophageal squamous cell carcinoma
		Cheng Liang, Gao Wei, Tian Dong, Yang Hao, Ran Xingqiang, Shi Guidong, Gui Yan, Fu Maoyong
		Objective To systematically evaluate the efficacy and safety of neoadjuvant chemoradiotherapy (NCRT) plus surgery versus neoadjuvant chemotherapy (NCT) plus surgery in the treatment of advanced esophageal squamous cell carcinoma. Methods Clinical controlled trials of comparing the treatment of NCRT plus surgery with NCT plus surgery for esophageal squamous cell carcinoma were electronically searched from the databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI, WanFang and VIP from the inception of databases to January, 2019. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And then, a meta-analysis was performed by using RevMan 5.3 software. Results A total of 8 clinical control studies were included, including 995 patients with esophageal squamous cell carcinoma. Meta-analysis Results showed that compared with the NCT group, the R0 resection rate was significantly higher(OR=2.14, 95%CI:1.03-4.45, P=0.040)and the pathological complete response (pCR) rate was significantly higher(OR=4.19, 95%CI:1.71-10.28, P=0.002)in the NCRT group. The incidence of postoperative complications (OR=1.37, 95%CI:0.76-2.48, P=0.300) and the risk of perioperative death (OR=1.28, 95%CI:0.58-2.83, P=0.54) were not significantly different between two groups. The long-term survival of patients with esophageal squamous cell carcinoma in the NCRT group was significantly better compared with that in the NCT group (HR=0.77, 95%CI:0.64-0.92, P=0.005). Conclusions Compared with NCT plus surgery for advanced esophageal squamous cell carcinoma, NCRT plus surgery has higher R0 resection rate and pCR rate,does not significantly increase the risk of perioperative complications or perioperative death, and significantly improves the long-term survival of esophageal squamous cell carcinoma patients.
		2021 Vol. 30 (1): 34-41 [Abstract] ( 188 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	42	Efficacy analysis of hypofractionated intensity-modulated radiation therapy combined with hormonal therapy for pelvic lymph node metastatic prostate cancer
		Yao Lihong, Liu Yueping, Li Yexiong, Wang Shulian, Jin Jing, Fang Hui, Song Yongwen, Tang Yu, Tang Yuan, Yang Yong, Qi Shunan, Chen Bo, Lu Ningning, Yu Zihao
		Objective To investigate the efficacy and prognosis of hypofractionated intensity-modulated radiation therapy combined with hormonal therapy in the treatment of pelvic lymph node metastatic prostate cancer. Methods Clinical data of 42 IVA prostate cancer patients who received hypofractionated intensity-modulated radiation therapy combined with hormonal therapy in Cancer Hospital of Chinese Academy of Medical Sciences between 2006 and 2018 were retrospectively analyzed. The total irradiation doses to the prostate and seminal vesicles were 67.5Gy/25f,2.7Gy/f. The prophylactic irradiation doses to the pelvic lymph nodes were 45-50Gy with a daily fraction dose of 1.8-2.0Gy. Thirty-three patients with residual lymph nodes were boosted to 60.0-67.5Gy for the residual area, 2.4-2.7Gy/f. Androgen deprivation therapy included surgical castration or luteinizing hormone-releasing hormone agonists combined with antiandrogens. Survival rate was calculated using Kaplan-Meier method. The differences between two groups were analyzed by log-rank test. Prognostic factors were identified by univariate and multivariate analyses. Results The median follow-up was 65.5 months (range, 5 to 150 months). The 5-year and 10-year failure-free survival (FFS) rates in the whole group were 67% and 45%, respectively. No clinical recurrence was observed in the irradiation field. The 5-year and 10-year prostate cancer-specific survival/overall survival (PCSS/OS) rates were 85% and 60%, respectively. Gleason score (≥8 and<8) and duration of hormonal therapy impacted the FFS (both P<0.05). The duration of hormonal therapy was an independent prognostic factor for PCSS/OS (P=0.003). Conclusions Hypofractionated intensity-modulated radiotherapy combined with hormonal therapy yields optimistic clinical efficacy in the treatment of pelvic lymph node metastatic prostate cancer. Gleason score (≥8 and <8) and duration of hormonal therapy are critical prognostic factors.
		2021 Vol. 30 (1): 42-46 [Abstract] ( 181 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	47	Predictive value of tumor deposit for the prognosis of patients with yp-stage Ⅲ rectal cancer
		Zhu Qiaoping, Li Anchuan, Xu Benhua
		Objective To analyze the predictive effect of tumor deposit(TD) on the prognosis of yp-stage Ⅲ rectal cancer patients,and its effect on postoperative adjuvant chemotherapy benefit. Methods Clinical data of 338 ypⅢ stage rectal cancer patients who received multidisciplinary treatment in Union Medical College Affiliated Hospital of Fujian Medical University from 2007 to 2017 were retrospectively analyzed. All patients were divided into the TD(-) group(n=301) and TD(+) group(n=37). Survival analysis was conducted by Kaplan-Meier method, log-rank test and univariate prognostic analysis. Multivariate prognostic analysis was performed by Cox’s regression model. Results The 5-year overall survival(OS), progress-free survival(PFS), and distant metastasis-free survival(DMFS) in the TD(-) group were significantly higher than those in the TD(+) group(59.3% vs. 42.0%,P=0.001, 79.1% vs. 55.0%,P<0.001, 55.6% vs. 38.0%,P<0.001),whereas no significant difference was observed in local recurrence-free survival(LRFS) between two groups(96.7% vs. 85.5%,P=0.679). Univariate prognostic analysis revealed that the number of TD was not correlated with the prognosis of patients(P=0.923), and postoperative adjuvant chemotherapy exerted no significant effect on the prognosis of patients in two groups(P=0.103). In multivariate analysis, TD was associated with worse OS(HR=2.343,95%CI:1.257-4.363, P=0.007). Conclusions For patients with ypⅢ stage rectal cancer undergoing multidisciplinary treatment, the prognosis of patients with TD is even worse. TD is an independent predictor for survival. No benefit can be obtained from postoperative adjuvant chemotherapy regardless of the presence or absence of TD.
		2021 Vol. 30 (1): 47-53 [Abstract] ( 174 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	54	Predictive value of absolute lymphocyte count and its related parameters before treatment in patients with locally advanced cervical cancer
		Wang Yuting, Qin Yonghui, Zhao Min, Wang Ruozheng
		Objective To investigate the prognostic value of absolute lymphocyte count (ALC) and neutrophil-lymphocyte ratio (NLR),macrophage-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) before treatment in patients with locally advanced cervical cancer (LACC). Methods A total of 175 patients newly-diagnosed with LACC admitted to Cancer Hospital affiliated to Xinjiang Medical University from August 2016 to October 2019 were enrolled in this study. Complete clinical data and ALC before treatment were recorded and NLR, MLR and PLR were calculated. Multivariate Cox′s proportional hazard regression model was used to analyze the prognostic factors of patients with LACC. Results The progress-free survival (PFS) of LACC patients in the NLR reduction group (<3.34) and MLR reduction group (<0.315) were significantly higher than those in the NLR and MLR elevation groups (both P<0.05). The overall survival (OS) of LACC patients in the ALC elevation group (≥1.375 × 10⁹/L) and the PLR reduction group (<160.575) were significantly higher compared with those in the ALC reduction group and PLR elevation group (both P<0.05). Univariate analysis showed that EQD2Gy, the equivalent dose of HR-CTV, was an important prognostic factor of PFS in patients with LACC (P=0.030). Multivariate Cox's regression analysis demonstrated that FIGO staging (HR=2.339, 95%CI 1.22-4.48, P=0.010) and concurrent chemoradiotherapy (HR=0.213, 95%CI 0.11-0.43, P<0.001) were the independent predicators of PFS in patients with LACC. However, concurrent chemoradiotherapy (HR=0.229, 95%CI 0.07-0.81, P=0.023) and MLR (HR=4.933, 95%CI 1.39-17.54, P=0.014) before treatment were the independent predictors of OS in patients with LACC. Conclusions Patients with locally advanced cervical cancer can benefit from concurrent chemoradiotherapy. HR-CTV EQD2Gy is a critical prognostic factor of PFS in patients with LACC. The increase of MLR before treatment is an independent prognostic factor of OS in LACC patients.
		2021 Vol. 30 (1): 54-60 [Abstract] ( 155 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	61	Study on the bladder filling consistency of pelvic tumors prior to the radiotherapy
		Wu Jiaying, Lu Shipei, Li Cunxiao, Li Yaning, Chang Hui, Wu Jianhua, Lin Chengguang, Yang Xin
		Objective Before the radiotherapy was performed, patients with pelvic tumors were analyzed for the consistency of bladder filling in the three steps of "Immobilization", "CT Simulation" and"X-ray Simulation". Methods In 2014, 105 patients (68 cases of cervical cancer, 32 cases of rectal cancer, 3 cases of vaginal cancer and 2 cases of prostate cancer) with pelvic tumor radiotherapy were randomly assigned to monitor bladder urine volume to a target urine volume of 400ml. First, patient were exhorted to empty the bladder, and the bladder volume meter BVI 9400 was used to measure the urine volume of the patient after emptying of the bladder. The patient immediately drank about 540ml of water and suppressed urine, measurements were taken every 0.5 h. At the same time, when the patient complained of "urgency of urine", bladder urine volume would be measured again and the time would also be recorded. Every other half an hour (emptying, 0.5 h after emptying, 1.0 h after emptying), when complaining of"urgency of urine", when actually performing urine volume and time were described as:U0 and t0, U0.5 and t0.5,U1.0 and t1.0,Ut and t,UT and T. Results There was a statistically significant difference in gender and age, and women had stronger ability to urinate than men U1.0(P=0.003), young people had stronger ability to urinate than middle-aged U1.0(P=0.002). In the three-step comparison, there was no statistically difference between 1 hour after emptying urine volume U1.0(P=0.177) and the actually performing urine volume UT (P=0.052). And the final urine volume was concentrated at 298-526ml. After the patient emptied the urine volume and complained of "urgency of urine", the time slot was t=(75.2±49.9) min, with the urine volume of Ut=(331.2±140.3)ml. And there was no statistically difference between Ut and UT (P=0.198) at X-ray Simulation. Conclusions The patient emptied the bladder and immediately drank 540ml of water. After 1 hour of suppressing urine, he complained of "urgency of urine" and achieved the target urine volume (400ml). At this time, the bladder urine volume U1.0 was consistency in the immobilization, CT Simulation, and X-ray Simulation.
		2021 Vol. 30 (1): 61-65 [Abstract] ( 198 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	66	Efficacy of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) therapy in the primary prevention of concurrent chemoradiotherapy-induced neutropenia
		Chen Yang, Wang Wei, Zhang Ruiping, Liu Ransheng, Zhang Aixu, Wang Zhizhen
		Objective To evaluate the efficacy and safety of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) therapy in the primary prevention of concurrent chemoradiotherapy-induced neutropenia. Methods In this single-center, open-label, single-arm clinical observation, the efficacy of PEG-rhG-CSF in the primary prevention of neutropenia after concurrent chemoradiotherapy in 58 patients admitted to Tianjin Medical University Cancer Institute and Hospital from June 2018 to June 2019 was evaluated. Results During the whole concurrent chemoradiotherapy, chemotherapy delay occurred in 6 patients (10%). Three patients (5%) had delayed concurrent chemotherapy due to leukopenia or neutropenia. The completion rate of chemotherapy cycle was 94.6%(106/112). Radiotherapy delay occurred in 10 patients (17%) including 2 patients (3%) of delayed radiotherapy due to leukopenia or neutropenia. No patient developed febrile neutropenia (FN). Subgroup analysis found that after completing 1 cycle of concurrent chemoradiotherapy, the incidence rates of grade 4 leukopenia and neutropenia were both 0. After completing 2 cycles of concurrent chemoradiotherapy, the incidence rates of grade 4 leukopenia and neutropenia were 0 and 2%. Conclusion During the chemoradiotherapy, application of PEG-rhG-CSF in the primary preventation can significantly reduce the incidence of FN, grade 4 leukopenia and neutropenia, which is beneficial to ensure the smooth progress of concurrent chemoradiotherapy.
		2021 Vol. 30 (1): 66-70 [Abstract] ( 189 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	71	Dermatofibrosarcoma Protuberans:a Systematic Evaluation and Meta-analysis of Efficacy of Postoperative Radiotherapy
		Lyu Anqi, Yin Zheng, Shan Shijun, Xie Liangxi, Wang Qiying
		Objective To evaluate the efficacy of postoperative radiotherapy (PRT) for dermatofibrosarcoma protuberans (DFSP). Methods A systematic review and meta-analysis of articles published before February 23, 2019 were conducted. A total of 655 studies were retrieved consisting of 195 DFSP patients. Among them, 50 cases were assigned into the PRT group and 145 cases in the surgery alone (SA) group. The recurrence rate was statistically compared between two group. Results Meta-analysis showed that the recurrence rate in the PRT group was significantly lower than that in the SA group (8% vs. 24.1%, OR=0.28, P=0.010). The recurrence rate of patients with positive margins in the PRT group was significantly lower compared with that in the SA group (8% vs. 61.5%, P=0.002). The recurrence rate of patients with negative margins in the PRT group had a decreasing trend than that in the SA group (6% vs. 21.6%, P=0.205). Conclusions The recurrence rate of surgery combined with PRT is lower than that of SA. The recurrence rate of patients with positive margins is higher than that of those with negative margins. For patients with positive margins, PRT can decrease the recurrence rate. The recurrence rate trends to decline in patients with negative margins after receiving PRT.
		2021 Vol. 30 (1): 71-75 [Abstract] ( 180 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	76	Evaluation the combined effect of three dose reconstruction systems on VMAT dosimetry verification of lung cancer
		Ma Yangguang, Mai Rizhen, Pei Yuntong, Hu Jinyan, Kong Fanyang, Wang Xuemin, Guo Yuexin
		Objective To evaluate the combined effect of an trajectory log field based(LBF)and two commercial dose reconstruction systems on volume-modulated arc therapy(VMAT)dose verification of lung cancer. Methods An in-house program was developed to introduce errors in trajectory log of TrueBeam to the origin plan and recalculate the dose of the error plan in treatment planning system(TPS). A total of 18 lung cancer cases treated by two-arc VMAT were selected to perform on LINAC and measured by ArcCheck simultaneously. Then, the reconstructed doses were obtained by 3DVH. The mode of reconstruction was calculated by LFB and Compass. Five of the 18 cases were performed on LINAC two times in four hours and measured by ArcCheck to evaluate the stability of the TrueBeam performance. The 18 plans were recalculated and performed on LINAC with a solid water phantom with 5 cm build-up, 4 cm back scattering thickness and a FC65-G detector in the center. The measured dose by detector was compared with the reconstructed dose by three systems. Results TheTruebeam performance was stable. For all of the 18 cases, the point dose measured by FC65-G and reconstructed by three systems had a deviation of less than 2% to the TPS calculated. For all of the organs reconstructed by LBF and most organs reconstructed by 3DVH and Compass, the γ pass rate between them and TPS all exceeded 90% under all criteria, as well as the ArcCheck measured Results. For all the organ dose difference between reconstructed and TPS, LBF system had the smallest difference, followed by the Compass system except the lung, and the 3DVH had the highest difference. Conclusions LBF, 3DVH and Compass can reflect the VMAT dose verification Results of lung cancer from different perspectives. The combined application of three systems can demonstrate the verification Results in an intuitive manner, which is beneficial for subsequent analysis.
		2021 Vol. 30 (1): 76-80 [Abstract] ( 181 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	81	The impact of image-guided radiation therapy on treatment of cervical cancer
		Lu Na, Zhang Zongkai, Wang Yadi, Zhang Fuli, Jiang Huayong, Chen Diandian
		Objective To evaluate the effect of radical image-guided radiotherapy (IGRT) on the target dose in cervical cancer and investigate the appropriate application mode. Methods Twenty patients with cervical cancer treated with helical tomotherapy (HT) in Seventh Medical Center of PLA General Hospital from 2012 to 2016 were selected. A megavoltage CT (MVCT) scan was performed before each treatment. The obtained MVCT images were used for dose parameter in the adaptive module of HT to obtain the actual dose (Plan 1) and the non-image-guided dose parameter was simulated (Plan 2). Each single dose distribution and the corresponding fused CT images were transferred to the software Mimvista 6.5 to obtain the total radiation dose parameter by dose superposition. Results The motion of CTV,uterus and GTV in Plan 2 was significantly larger than that of Plan 1(all P<0.05), and the largest changes were seen in the ventrodorsal and uterine direction. The V45Gy, V50Gy, D98% and Dmean of CTV and uterus and V50Gy of GTV in Plan 2 were significantly decreased compared with those in Plan 1(all P<0.05). The left-right motion of Plan 1 was negatively correlated with D2% and D98% of CTV and uterus (both P<0.05). The head-foot motion was negatively associated with V45Gy and V50Gy of GTV (both P<0.05). The ventrodorsal motion was negatively correlated with D98% of uterus (P<0.05). The left-right motion of Plan 2 was negatively correlated with D2% of CTV and V50Gy of uterus (both P<0.05). The head-foot motion was negatively associated with D98% of CTV, and D98%, Dmean, V45Gy and V50Gy of uterus (all P<0.05). The ventrodorsal motion was negatively correlated with D98% of CTV,D98%, Dmean, V45Gy and V50Gy of uterus, and Dmean and V45Gy of GTV (all P<0.05). Conclusions In intensity-modulated radiotherapy for cervical cancer, the uterine body displacement is large and the low CTV area is mainly located in the uterine body. IGRT can significantly reduce the dosimetric deviation induced by organ movement.
		2021 Vol. 30 (1): 81-85 [Abstract] ( 179 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	86	p21 gene knockout aggravates radiation-induced heart disease in vivo
		Du Haiyang, Zeng Zhimin, Xu Peng, Zhang Peng, Yi Yali, Huang Long, Liu Anwen
		Objective To investigate the role of p21 gene in the radiation-induced heart disease (RIHD) and to evaluate the effect on p21 gene knockout on RIHD phenotype in mouse models. Methods p21^-/-mice were utilized in the experimental group, and p21^+/-mice were allocated in the control group. RIHD mouse models were established by exposure to 10Gy whole heart irradiation by using a small animal radiation research platform. The heart samples were collected at 6 weeks after irradiation, the gross specimens were measured and subject to HE staining. The wall thickness and left ventricular ejection fraction of the mice were detected by the Vevo2100 ultrasound imaging system. The hypoxia in cardiac tissues was detected by the hypoxia probe method. The apoptosis of cardiac cells was determined by Tunel method. Results Compared with the p21^+/-mice, the survival of p21^-/-mice was significantly shortened (P=0.004), the interventricular septum was significantly thinned during the diastolic and systolic phases (P=0.049, P=0.006), the left ventricular posterior wall was remarkably thickened (P<0.001) and the left ventricular ejection fraction was significantly decreased (P=0.004). The gross heart tissue was enlarged in the p21^-/-mice. HE staining showed the aggregation of inflammatory cells in cardiac tissues and disordered arrangement of myocardial cells. Significant hypoxia and apoptosis could be observed in the p21^-/-mouse heart tissues. Conclusions p21^-/-mice are prone to more severe RIHD after irradiation, manifested with shortened cardiac survival, weakened cardiac function, abnormal cardiac structure, hypoxia and apoptosis of cardiac tissues. p21 plays an important role in the repair after cardiac irradiation.
		2021 Vol. 30 (1): 86-89 [Abstract] ( 194 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	90	Silencing lncRNA HOTAIR increases radiosensitivity of glioma cells by up-regulating miR-17-5p expression
		Yuan Gaoming, Meng Xiaofeng, Guo Xiaolong, Cheng Xiaobing, Hao Xiaowei, Shi Baozhong
		Objective To investigate the effect of lncRNA HOTAIR on the radiosensitivity of glioma cells and its underlying mechanism. Methods The negative control plasmid,HOTAIR silencing plasmid,miR-NC over expressing plasmid,miR-17-5p over expressing plasmid were transfected into U87R cells,and assigned intothe silencing control,HOTAIR silencing,miR-NC over expressing and miR-17-5 pover expressing groups. Cells in the the above groups were irradiated at a dose of 4Gy,and recorded as silencing control+4Gy group,HOTAIRsilencing+4Gy group,miR-NC over expressing+4Gy group and miR-17-5p over expressing+4Gy group. The HOTAIR silencing plasmid,miR-NC suppressing plasmid and miR-17-5p suppressing plasmid were co-transfected into U87R cells and recorded as the HOTAIR silencing+miR-NCsuppressing group and HOTAIR silencing+miR-17-5p suppressing group. All procedures were transfected by the liposome method. The expression of miR-17-5p and HOTAIR was detected by qRT-PCR. The radio sensitivity of glioma cells was evaluated by cell clone formation assay. The cell apoptosis was assessed by flow cytometry. The fluorescence activity was assessed by dual luciferase reporter assay.Results HOTAIR was highly expressed in the radiation-resistant glioma cells. Silencing HOTAIR and over-expressing miR-17-5p could increase the radiosensitivity of U87R cells and promote radiation-induced apoptosis of U87R cells. HOTAIR could target and regulate the miR-17-5p expression. Suppressing miR-17-5p reversed the effect of silencing HOTAIR on U87R cell sensitization and promoting radiation-induced U87R cell apoptosis. Conclusions Silencing lncRNA HOTAIR yields radiation sensitization and promotes radiation-induced apoptosis in glioma cells. The mechanism may be related to the regulation of miR-17-5p.
		2021 Vol. 30 (1): 90-94 [Abstract] ( 167 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	95	Research status of radiotherapy-induced taste disorders in head and neck malignant tumors
		Li Zhilin, Zhang Ye
		As one of the five senses of human beings, taste is inseparable from our lives. It is vulnerable to radiotherapy-induced injury for head and neck malignant tumors, which in turn affects the patients′ quality of life and clinical prognosis. In this article, the epidemiological characteristics, pathogenesis, influencing factors, evaluation and prevention and treatment of radiotherapy-related taste disorders were reviewed, aiming to explore the research progress on the radiotherapy-induced taste disorders and provide novel ideas to improve the quality of life in the whole process of radiotherapy for patients with head and neck malignant tumors.
		2021 Vol. 30 (1): 95-97 [Abstract] ( 191 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	98	Research progress on application of radiomics in radiotherapy of head and neck cancer
		Liu Xiaobin, Shen Wen
		Head and neck cancer presents with complex anatomy and high intratumoralheterogeneity. Radiotherapy is one of the main treatments. The therapeutic strategy and prognostic evaluation in head and neck cancer patients traditionally depend on TNM stage, lacking of individual information. Radiomics can extracts high-throughput image features relevant to the biology of tumors, which provides a non-invasive and quantitative method to evaluate the overall tumor heterogeneity and also offers a novel perspective for precision radiotherapy. The research progresses on the application and chanllenges of radiomics in the radiotherapy for head and neck cancer were summarized in this review.
		2021 Vol. 30 (1): 98-101 [Abstract] ( 177 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	102	Research status of hyperthermia and energy metabolism of tumor cells in hypoxic microenvironment
		Shi Fan, Sun Qiaozhen, Zhou Xuexiao, Xu Ting, Wang Shengzhi
		Metabolic reprogramming is a malignancy hallmark, which refers to the ability of cancer cells to alter metabolic and nutrient acquisition modes in order to support the energy demands for accomplishing the rapid growth, dissemination, metastasis and obtain the “building blocks” needed to maintain cell division. When solid tumors are exposed to low pH, low oxygen and tumor microenvironment with nutrient deficiencies,the hypoxia-inducible factor-1 can be activated, which mediates the remodeling of metabolic patterns in tumor cells, namely, energy is obtained by circulating intracellular components (removing substrates such as proteins and lipid) or by utilizing adaptive metabolic reprogramming (such as glycolysis, autophagy and lipid metabolism, etc.). As a treatment scheme based on local heating of tumors, hyperthermia has a variety of anticancer mechanisms and can be used in combination with radiotherapy, chemotherapy and biological immune therapy. In this review, we briefly discussed the metabolic remodeling model mediated by hypoxia-inducible factor 1 in a hypoxia microenvironment, described the possible regulatory mechanism of hyperthermia on hypoxia-inducible factor-1 and prospected the application of hyperthermia in oral and maxillofacial tumors.
		2021 Vol. 30 (1): 102-106 [Abstract] ( 175 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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		2021 Vol. 30 (1): 107-108 [Abstract] ( 118 ) [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
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Chinese Anti-Cancer
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Chinese Journal of Lung
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