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.3 Published 2021-03-15

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

Special Feature

	221	Physics issues on plan design and evaluation for stereotactic radiotherapy based on linear accelerator
		Wang Xuetao, Wang Xin, Bai Sen, Zhong Renming
		Stereotactic radiotherapy (SRT), also known as stereotactic ablative radiotherapy (SABR), includes stereotactic radiosurgery and stereotactic body radiotherapy (SBRT). This technique has the characteristics of large single fractional dose, few fractions, high equivalent biological doses, and rapid fall off-target doses. It can be implemented by relatively special equipment such as Gamma knife, Cyberknife, Tomotherapy and Vero 4D RT system, etc. In many cases, SBRT technique is employed based on linear accelerators. SRT differs from conventional radiotherapy in terms of the plan design and plan evaluation. Consequently, it is necessary to discuss the differences and provide guidance for clinical application and research.
		2021 Vol. 30 (3): 221-229 [Abstract] ( 161 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	230	Analysis of the factors influencing the efficacy of concurrent chemoradiotherapy for locally advanced head and neck squamous cell carcinoma:based on a phase Ⅲ clinical randomized controlled study
		Wang Kai, Qu Yuan, Yi Junlin, Chen Xuesong, Wang Xiaolei, Liu Shaoyan, Xu Zhengang, Zhang Shiping, Wu Runye, Zhang Ye, Li Suyan, Luo Jingwei, Xiao Jianping, Gao Li, Xu Guozhen, Li Yexiong, Huang Xiaodong
		Objective To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups. Methods All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96Gy (27.56-76.00Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250mg (100-570mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan-Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup (P=0.009), and there was an increasing trend in patients aged≤55 years and female patients (P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T4(P=0.048), N3(P=0.005), non-IMRT treatment (P=0.001) and hypopharyngeal carcinoma (P=0.004) subgroups, there was an increasing trend in male (P=0.064), high-and moderate-grade squamous cell carcinoma (P=0.076) and non-surgical treatment subgroups (P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years (P=0.017 and 0.039), women (P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma (P=0.006 and 0.022), N3stage (P=0.001 and 0.017), non-surgical treatment (P=0.007 and 0.033) and non-IMRT treatment subgroups (P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma (P=0.022). Conclusion Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N3stage, non-surgical treatment and non-IMRT treatment patients.
		2021 Vol. 30 (3): 230-234 [Abstract] ( 184 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	235	Preliminary results of SBRT treatment of pulmonary oligometastasis from head and neck tumors
		Hua Yonghong, Dong Ruizeng, Piao Yongfeng, Wang Lei, Wang Qiong, Tao Changjuan, Chen Yuanyuan, Chen Xiaozhong, Hu Qiaoying, Chen Ming
		Objective To preliminarily evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic tumors from head and neck carcinoma. Methods Clinical data of 24 patients with pulmonary oligometastasis from head and neck carcinoma undergoing SBRT in Zhejiang Cancer Hospital from January 2014 to May 2019 were retrospectively analyzed. Survival analysis was performed by Kaplan-Meier method. Results Among the 24 patients, 12 cases were diagnosed with nasopharyngeal origin and 12 cases of non-nasopharyngeal origin. A total of 34 pulmonary metastatic lesions were treated with SBRT. The median follow-up time was 19.5 months. Thirteen cases developed new lesions after SBRT, and 9 of them occurred within 1 year after SBRT treatment. The actual 1-year local control rate was 95%. The median progression-free survival was 15.2 months, and the 1-and 2-year progression-free survival were 59% and 46%, respectively. The 2-and 3-years overall survival rate at were 71% and 51% fter lung metastasis, respectively. Univariate analysis showed that the patients with primary lesions located in nasopharynx and disease-free interval of more than 1 year had survival advantage. No more than grade 3 radiation-induced injury was observed in the whole cohort after SBRT, and the incidence of mild radiation-induced injury was 13%. Conclusions SBRT is safe and effective in the treatment of pulmonary oligometastatsis from head and neck carcinoma, and it may be more effective for patients with primary tumors located in nasopharynx.
		2021 Vol. 30 (3): 235-238 [Abstract] ( 179 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	239	Preliminary study of values of failure mode and postoperative radiotherapy in 69 non-small cell lung cancer patients with chest wall invasion
		Muyasha·Abulimiti, Liang Jun
		Objective: To preliminarily investigate the values of failure mode and postoperative radiotherapy in non-small cell lung cancer (NSCLC) patients with chest wall invasion. Methods A total of 69 T3 stage NSCLC patients who underwent thoracic surgery in our hospital from 2010 to 2018 and presented with postoperative pathological findings of chest wall invasion were recruited. The outcomes between the post-operative radiotherapy and non-radiotherapy groups were assessed by propsensity matching analysis. Kaplan-Meier survival analysis and Cox’s model prognostic factors analysis were performed. Results The median survival time of 69 patients was 25 months and the median progression-free survival was 8 months. Thirty-six cases were diagnosed with primary stage M0 including 28 cases (78%) of R0 resection and 33 cases (48%) were diagnosed with stage M1a and received non-R0 resection because of pleural metastases. In total, 53 cases (77%) suffered from disease progression, and 26 cases (38%) experienced local recurrence including 58% of mediastinal lymph node recurrence and 36% of chest wall tumor bed recurrence. Distant metastases were observed in 50 cases (73%) including 43% of pleural metastases. Univariate analysis showed that age, pathological staging, range of primary lesion invasion, postoperative radiotherapy and postoperative targeted therapy were significantly associated with overall survival (all P<0.05). The overall survival in the postoperative radiotherapy group was better than that in the non-radiotherapy group. No statistical difference was observed in the progression-free survival, local recurrence-free survival and distant metastasis-free survival between two groups (all P>0.05). Conclusions For NSCLC patients with chest wall invasion, distal metastasis failure is the main cause, while local failure mainly consists of mediastinal lymph node andchest wall recurrence. Postoperative radiotherapy may improve survival. Nevertheless, the combination and benefit degree of postoperative comprehensive treatment need to be further confirmed by prospective studies.
		2021 Vol. 30 (3): 239-243 [Abstract] ( 162 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	244	Comparison of MRI and CT for target volume delineation and dose coverage for partial breast irradiation in patients with breast cancer
		Song Yuchun, Xie Xin, Che Shunan, Sun Guangyi, Tang Yu, Zhang Jianghu, Wang Jianyang, Fang Hui, Chen Bo, Song Yongwen, Jin Jing, Liu Yueping, Qi Shunan, Tang Yuan, Lu Ningning, Jing Hao, Yang Yong, Li Ning, Li Jing, Wang Shulian, Li Yexiong
		Objective To compare magnetic resonance imaging (MRI)-based and computed tomography (CT)-based target volume delineation and dose coverage in partial breast irradiation (PBI) for patients with breast cancer, aiming to explore the application value of MRI localization in PBI after breast-conserving surgery. Methods Twenty-nine patients with early breast cancer underwent simulating CT and MRI scans in a supine position. The cavity visualization score (CVS) of tumor bed (TB) was evaluated. The TB, clinical target volume (CTV), planning target volume (PTV) were delineated on CT and MRI images, and then statistically compared. Conformity indices (CI) between CT- and MRI-defined target volumes were calculated. PBI treatment plan of 40Gy in 10 fractions was designed based on PTV-CT, and the dose coverage for PTV-MRI was evaluated. Results The CVS on CT and MRI images was 2.97±1.40 vs. 3.10±1.40(P=0.408). The volumes of TB, CTV, PTV on MRI were significantly larger than those on CT,(24.48±16.60) cm³ vs. (38.00±19.77) cm³,(126.76±56.81) cm³ vs. (168.42±70.54) cm³,(216.63±81.99) cm³ vs. (279.24±101.55) cm³, respectively,whereas the increasing percentage of CTV and PTV were significantly smaller than those of TB. The CI between CT-based and MRI-based TB, CTV, PTV were 0.43±0.13,0.66±0.11,0.70±0.09(P<0.001), respectively. The median percentage of PTV-MRI receiving 40Gy dose was 81.9%(62.3% to 92.4%),significantly lower than 95.6%(95.0%~97.5%) of PTV-CT. Conclusions The CVS between CT and MRI is not significantly different, but the MRI-based TB, CTV, PTV are significantly larger than CT-based values. The PTV-MRI is of underdose if PBI treatment plan is designed for PTV-CT. As a supplement of CT scan, MRI can enhance the accuracy of TB delineation after breast-onserving surgery.
		2021 Vol. 30 (3): 244-248 [Abstract] ( 199 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	249	Application IPSA combined with increasing cervical center dose in intracavitary and interstitial brachytherapy for locally advanced cervical cancer
		Lin Xia, Wang Tiejun, Wang Jiapeng, Liu Zhongshan, Guo Jie, Jiang Siwen
		Objective To analyze the advantages of IPSA combined with increasing cervical center dose in intracavitary and interstitial brachytherapy (IC/IS) for locally advanced cervical cancer. Methods A total of 46stage ⅡB cervical cancer patients with, local lesion size≥5cm after 45Gy/25f external intensity-modulated radiotherapy (IMRT) were recruited. Uterine tandem and needles were implanted, CT was performed, and then HR-CTV, rectum, bladder, sigmoid colon and the area of cervix increased dose (HR-cervix) were delineated, IPSA was used for optimization. According to whether the dose of HR-cervix was increased or not, all patients were divided into IC/IS+HR-cervix group (group A) and IC/IS group (group B). The differences in dosimetric parameters were compared between two groups. Results The relative uterine tandem dwell time was significantly extended in group A (P<0.001). In group B, the V150% and V200% volumes of HR-cervix were increased from 63.94% and 30.80% to 91.54% and 64.06%. The D90% and D100% in group A were significantly lower than those in group B (both P<0.05). There was no statistical difference in organ at risk (OAR) dose. Conclusion IPSA combined with increasing cervical center dose can meet the HR-CTV D90% dose requirement, normal tissue dose limits, and can escalate the doses to local areas of the cervix.
		2021 Vol. 30 (3): 249-252 [Abstract] ( 181 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	253	Evaluation of clinical efficacy of microwave ablation in situ for thoracic, lumbar and sacral spinal metastases
		Yu Zhe, Zhang Minghua, Gao Tongshuan, Ding Rui, Fan Qingyu
		Objective To evaluate the clinical outcomes of patients with single spinal metastasis of thoracic, lumbar or sacral vertebra treated with microwave ablation in situ. Methods For 28 patients with single spinal metastasis of thoracic, lumbar or sacral vertebra, detailed and personal surgical plans were carried out. Instead of en bloc resection, hyperthermia ablation in situ was performed followed by strengthening procedures under the guidance of G-arm fluoroscopy machine. Intraoperatively, spinal cord and nerve root were properly protected. The bone defects were reconstructed by bone cement after the diseased lesions were revomed. All patients were followed up for almost 1 year postoperatively. During follow-up, X-ray and MRI images were obtained, and the level of pain and neurologic outcomes were also examined. Results All 28 patients successfully received microwave ablation in situ. The average ablation time was approximately 8 minutes and the average amount of bone cement implanted was approximately 10.5ml. The pain scores of digital pain classification before and 3 months after operation were 7.86±1.58 and 3.07±1.89(P<0.05). The postoperative neurological function of 22 patients was improved than that before operation. No significant changes were observed in 5 patients. The neurological function of the affected limb was relieved, whereas the symptoms of the healthy limb were slightly worse in the remaining case. Conclusions Microwave ablation in situ is a feasible and effective surgical method for single spinal metastasis of thoracic, lumbar or sacral vertebra. It might possess many advantages, such as clear surgical field, smaller incisions, less bleeding, and safe margins during the operations. Further more, it could significantly relieve pain, restrict tumor growth, and improve the quality of life of patients. It is an innovative and distinctive therapeutic alternative for single spinal metastasis, which deserves widespread application.
		2021 Vol. 30 (3): 253-257 [Abstract] ( 180 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	258	Application of visual feedback coaching bar in deep inspiration breath holding during left breast cancer radiotherapy
		Li Tantan, Zhang Jianghu, Wang Shulian, Song Yongwen, Tang Yu, Lu Fengyu, Zhang Wei, Wang Zengzhou, Qin Shirui, Zhu Ji, Huan Fukui, Dai Jianrong
		Objective To evaluate the application of visual feedback coaching method, which is embedded in an optical surface monitoring system, in deep inspiration breath holding during the radiotherapy in left breast cancer patients after breast-conserving surgery. Methods Thirty patients with left breast cancer, who were scheduled to receive the whole breast radiotherapy after breast-conserving surgery, met the requirements of deep inspiration breath holding after respiratory coaching with the visual feedback coaching module in the optical surface monitoring system. Active breathing control equipment was used to control breath-holding state and CT simulation was performed. During treatment, optical surface monitoring system was used to guide radiotherapy. All patients were randomly divided into two groups. In group A (n=15), visual feedback respiratory training method was utilized and not employed in group B (n=15). In group A, the visual feedback coaching bar of the optical surface monitoring system was implemented, while audio interactive method was employed to guide patients to hold their breath. Real-time data of optical body surface monitoring were used to compare the interfraction reproducibility and intrafraction stability of breath holding fraction between two groups. Besides, the number of breath holding and treatment time per fraction were also compared. GraphPad prism 6.0 software was used for data processing and mapping, and SPSS 21.0 software was used for analyzing mean value and normality testing. Results Compared with the control group, the reproducibility in the experiment group was reduced from 1.5 mm to 0.7 mm, the stability was reduced from 1.1 mm to 0.8 mm, the mean number of breath holding required per fraction was decreased from 4.6 to 2.4, the mean beam-on time per fraction from 336s to 235s, and the treatment time per fraction was shortened from 847s to 602s (all P<0.05), respectively. Conclusions The application of visual feedback coaching method can improve the reproducibility and stability of breath holding during radiotherapy for left breast cancer, and it can also effectively reduce the number of breath holding and shorten the treatment time per fraction.
		2021 Vol. 30 (3): 258-261 [Abstract] ( 180 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	262	Application of kernel density estimation in predicting bone marrow dose of radiation therapy for gynecological tumors
		Cong Xiufeng, Chen Jun, Zhang Jingchao, Zhang Xiaoting, Lu Zaiming
		Objective To predict the dose of lumbosacral spine (LS) and pelvic bone marrow (PBM) based on kernel density estimation (KDE) in patients with gynecological tumors. Methods Fifteen patients with gynecological tumors receiving radiotherapy plans with dose limitation for LS and PBM in our hospital were selected as training data for machine learning. Another 10 cases were selected as the data for model validation. The minimum directional distance between the dose point in the organs and the edge of the planned target volume for the LS and PBM was calculated. Model training was performed by KDE. The accuracy of the model prediction was evaluated by the root mean square error. The model was utilized to predict the actual planned doses of the LS and PBM, and a linear fitting was performed on the predicted dose volume histogram (DVH) and actual results. The prediction effect was assessed by the goodness of fit R2. Results In terms of the DVH parameters required by the planner, the prediction doses from the model were similar to those of the verification plans:the difference of PBM V40Gy was 2.0%, the difference of the mean dose was 1.6Gy, and the difference of LS V10Gy was -0.4%. In the unrequired DVH parameters, except for the PBM V10Gy, the predicted values of the model were significantly high. The difference between the DVH predicted by the model and the actual plan was small, and the R2of the LS and PBM were 0.988 and 0.995, respectively. Conclusions The model based on KDE method can accurately predict the doses of the LS and PBM. This model can also be used as a method to ensure the quality of the plan, and improve the consistency and quality of the plan.
		2021 Vol. 30 (3): 262-265 [Abstract] ( 184 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	266	Application of failure mode and effect analysis in low-energy X-ray radiotherapy
		Yang Yining, Wang Song, Liu Qingfeng, Gong Xinyuan, Li Mu, Li Nana, Jiang Bo, Peng Yuna, Shen Ping, Zhu Yu, Yuan Guangjie, Shen Wen
		Objective To explore the application of failure mode and effects analysis (FMEA) in low-energy X-ray intraoperative radiotherapy (IORT), analyze its potential risks in IORT, and preliminarily explore the feasibility of FMEA in optimizing IORT management and reducing the occurrence of potential risks. Methods An FMEA working group was established by the IORT team (1 radiologist, 1 radiology physicist, 2 surgeons, and 2 nurses) to apply the FMEA methodology to conduct a systematic risk assessment. The process modules were established, the potential failure modes and causes for each module were analyzed, the severity (SR), frequency of occurrence (OR) and likelihood of detection (DR) of failure modes were scored and the risk priority number (RPN) was calculated:RPN= SR × OR × DR. The possible errors and potential clinical impact of each part of the radiotherapy process were prospectively analyzed and understood, the causes and current measures were analyzed for each failure mode and preventive measures were proposed and risk management measures were taken accordingly. Results The IORT process was divided into 8 modules with 14 failure modes. The highest OR value was unsatisfactory target area confirmation (7 points), the highest SR value was equipment failure to discharge the beam (10 points), the highest DR value was wrong key entry after dose calculation (7 points), the highest RPN values were unsatisfactory target area confirmation (210 points) and ineffective protection of endangered organs (180 points). Weaknesses were corrected according to priorities, workflows were optimized and more effective management methods were developed. Conclusion FMEA is an effective method of IORT management and contributes to reducing the occurrence of potential risks.
		2021 Vol. 30 (3): 266-271 [Abstract] ( 154 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	272	A phantom study of three-dimensional conformal radiation therapy and sliding window intensity-modulated radiation therapy based on 4D dose distribution
		Mao Ronghu, Zhang You, Tian Lingling, Gao Renqi, Ren Lei, Li Dingjie, Wang Jianhua, Yin Fangfang, Ge Hong
		Objective In this paper, based on the 4D dose distribution of the treatment plan, the effects of respiratory movement on the dose distribution of three-dimensional conformal radiation therapy (3DCRT) and sliding window intensity-modulated radiation therapy (SW-IMRT) techniques were analyzed, and the dose errors caused by respiratory movement based on the 4D dose distribution were evaluated. Methods In this study, the dynamic thoracic phantom (CIRS-008A) was used to simulate the patient with a 3cm spherical insert as the tumor. Four motion patterns were simulated with cos⁴(x) and sin (x) wave forms of 10 mm and 5 mm amplitudes. The 4DCT scans with the phantom were performed in different breathing modes, and the maximum intensity projection (MIP), average intensity projection (AIP) and 10separate 4DCT phase images were transferred to the Eclipse treatment planning system. The targets were contoured on MIP, with corresponding 3DCRT and SW-IMRT plans designed and dose calculated on AIP. By copying the plan designed on the AIP to each phase image of the 4DCT set, the MATLAB software package was employed to register and superimpose all the phase-specific doses onto one of the reference phase to create a 4D-accumulated dose distribution. Both films (EBT2) and optically stimulated luminescence (OSLD) detectors were inserted in and around the target area of the phantom to measure the delivered doses. The calculated 4D-accumulated doses were compared to the measured doses and their differences were evaluated using Gamma analysis. Results Under different respiration modes, the average Gamma index (3%/3mm) passing rates between the 4D-accumulated doses and EBT2-measured doses for 3DCRT and SW-IMRT plans were (98.8±0.78)% and (96.4±1.89)%, respectively. The absolute measurements of OSLDs both inside and outside of the target area well matched the 4D-accumulated doses. Conclusions 4DCT can be effectively applied to evaluate the treatment plan dose distribution through 4D dose accumulation, which can potentially avoid cold spots and target under-coverage. Under different respiration modes, both 3DCRT and SW-IMRT plans provide dose measurements consistent with those predicted by the 4D-accumulated dose of treatment plan.
		2021 Vol. 30 (3): 272-277 [Abstract] ( 162 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	278	Study of the verification of the source positioning and dwelling time based on the well-chamber
		Zhao Qiang, Wu Xiangyang, Chang Xiaobin, Feng Tao, Zhang Kun, Qu Ximei, Wang Xuemin, Yang Di, Deng Jia
		Objective To establish a dosimetric method based on the well-chamber to verify the accuracy of the source positioning and dwelling time for the afterloading machine, aiming to provide a new method for the quality control of afterloading machine. Methods The principle of this method was explained according to the hardware structure of the well-chamber. Then, the precision of this method was analyzed by the simulation test and data fitting. The feasibility test was also performed. And the advantages and disadvantages of this method were compared with those of the traditional method. Results The precision of this method for detecting the source positioning was 0.07mm and the dwelling time was 0.09s, respectively. In the feasibility test, the standard deviation of the measure value was below 3%. Conclusions The well-chamber method has high precision and convenient operation. It can be applied in the rapid verification of the relative accuracy of the source positioning and dwelling time of well-chamber.
		2021 Vol. 30 (3): 278-282 [Abstract] ( 156 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	283	Hyperthermia combined with chemotherapy induce tongue squamous cell carcinoma cell apoptosis by down-regulating HIF-1α and CYPJ expression
		Shi Fan, Sun Qiaozhen, Zhou Xuexiao, Xu Ting, Song Yipeng, Wang Shengzhi
		Objective The investigate the roles and significance of HIF-1α and CYPJ in tongue squamous cell carcinoma cell (TSCC), and further evaluate the regulatory effect of hyperthermia (HT) on HIF-1α and CYPJ in TSCC cells. Methods Eighty samples of cancer tissues and adjacent normal tissues from TSCC patients were collected. The expression levels of HIF-1α and CYPJ were detected by immunohistochemistry, Western blotting (WB) and fluorescence quantitative PCR, and the relationship between the expression levels of HIF-1α and CYPJ and clinicopathological characteristics was further analyzed. The expression levels of HIF-1α and CYPJ in Cal-27 cells under normoxic and hypoxic conditions for 24h when combined with HT (42℃), chemotherapy and both were detected by qPCR and WB. Cell migration was detected by cell scratch test and cell apoptosis was measured by flow cytometry. Results The expression levels of HIF-1α and CYPJ proteins in the tumor tissues of TSCC patients were higher than those in the adjacent normal tissues, which were significantly correlated with tumor size, TNM stage, differentiation degree and lymph node metastasis in TSCC patients (all P<0.05), whereas they were not correlated with gender or age (all P>0.05). The expression levels of HIF-1α and CYPJ in Cal-27 cells were significantly up-regulated in the hypoxic microenvironment (both P<0.05), which were also significantly enhanced by hyperthermia alone (both P<0.05). Compared with hyperthermia or chemotherapy alone, hyperthermia combined with chemotherapy significantly inhibited the expression of HIF-1α and CYPJ, suppressed cell migration and promoted cell apoptosis (all P<0.05). Conclusion s HIF-1α and CYPJ may be potential biomarkers for TSCC tumorigenicity and prognosis. In addition, tumor recurrence after hyperthermia may be due to the role of hyperthermia in triggering HIF-1α expression, which promotes the growth and survival of tumor cells adaptive to hyperthermia treatment by activating the downstream target genes, while hyperthermia combined with chemotherapy may be a promising treatment for TSCC.
		2021 Vol. 30 (3): 283-288 [Abstract] ( 146 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	289	miR-424-5p improves radiation sensitivity of cervical cancer by targeted inhibition of HMGA1 expression
		Li Yanyun, Sun Guixia, Wang Ning, Wu Dapeng, Jiang Huijuan
		Objective To investigate the effect of miR-424-5p on radiosensitivity and its mechanism in cervical cancer patients. Methods The expression levels of miR-424-5p in the cervical cancer tissues and Hela cells were detected by RT-qPCR. The apoptosis rate of Hela cells was determined by flow cytometry. The proliferation activity of Hela cells was detected by CCK-8 assay. The protein expression levels in Hela cells were measured by Western blot. Results Compared with normal tissues and cells, the expression level of miR-424-5p was significantly down-regulated in the cervical cancer tissues and Hela cells (1.03 vs. 0.88,P<0.01;1.00 vs. 0.75, P<0.01). Overexpression of miR-424-5p significantly inhibited the proliferation activity of Hela cells after radiation treatment (P<0.01), and significantly increased the apoptosis rate of Hela cells after radiation treatment (24.82% vs. 49.94%,P<0.001). Overexpression of miR-424-5p inhibited HMGA1 expression (1.01 vs. 0.63,P<0.01). miR-424-5p directly affected HMGA1, thereby impacting the radiosensitivity of cervical cancer radiotherapy. Conclusion miR-424-5p can improve the radiosensitivity of cervical cancer radiotherapy by directly targeting HMGA1.
		2021 Vol. 30 (3): 289-293 [Abstract] ( 281 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Symposium

	294	Principle and troubleshooting for the irregular case of UDRS interlock for Varian CLINAC-IX linear accelerator
		Zhang Qingzhao, Liu Lingxiang, Yi Lan
		The UDRS interlocking fault is a common dose interlocking of Varian high-energy linear accelerator. Due to the complexity of the system, this fault has brought challenges to the engineers for a long time. Hence, an effective solution is urgently required. In this article, the circuit and principle for UFRS interlocking fault for Varian CLINAC-IX linear accelerator were explicitly analyzed and the maintenance methods were summarized. The management methods of such rare fault were shared, aiming to provide reference for subsequent management of similar interlocking faults.
		2021 Vol. 30 (3): 294-296 [Abstract] ( 344 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	297	Research progress on brachytherapy for recurrent cervical cancer
		Liu Yanhao, Wang Junjie
		Cervical cancer is a common malignancy in women. Surgery and radiotherapy are the main therapeutic approaches. The recurrence rate of cervical cancer is high and the prognosis is relatively poor. Recurrent cervical cancer can be classified into the central pelvic, lateral pelvic and extra-pelvic recurrence. The management of recurrent cervical cancer mainly depends on previous therapeutic approaches and the recurrence site. Surgical resection is the optimal option for patients who have no history of radiotherapy, if feasible, chemoradiotherapy±brachytherapy can be considered. Patients with central pelvic recurrence after radiotherapy are suitable candidates for pelvic exenteration±intraoperative radiotherapy. However, the indications are highly selective, the incidence of postoperative complications is high and the quality of life is poor. Patients with lateral pelvic recurrence after radiotherapy could be treated by re-radiotherapy or chemotherapy. However, the incidence of serious side effects of re-radiotherapy is higher than that of the initial radiotherapy. The indications for stereotactic body radiotherapy are limited and the surgical skill of the surgeons is demanding. In recent years, radiotherapy technology has become more precise. Image-guided brachytherapy, such as high-dose-rate interstitial brachytherapy and radioactive ¹²⁵I seed implantation, has achieved high efficacy and safety, which may provide new treatment options for recurrent cervical cancer. In this article, research progress on brachytherapy for recurrent cervical cancer was summarized and reviewed.
		2021 Vol. 30 (3): 297-300 [Abstract] ( 201 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	301	Research progress on immunological mechanisms of radiation-induced brain injury
		Fu Min, Li Xiaoyu, Luo Na, Zhu Wenjun, Hu Guangyuan
		Radiation-induced brain injury is a neurological injury caused by radiation therapy of head and neck tumors. The pathogenesis is still unclear. It is hypothesized that immune cells play an important role in radiation-induced brain injury. The excessive activation of microglia in the central nervous system and the migration of peripheral immune cells into the brain collectively promote the incidence and development of radiation-induced brain injury. In this article, the immunological mechanism underlying the radiation-induced brain injury was reviewed.
		2021 Vol. 30 (3): 301-304 [Abstract] ( 229 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	305	Research progress on clinical factors for predicting radiation pneumonitis
		Wang Sheng, Wang Cailian
		Radiation pneumonitis (RP) is the most common adverse event of thoracic radiotherapy, which primarily occurs within the 3 months after the beginning of radiotherapy. RP can not only negatively affect the pulmonary function and quality of life of patients, but also limit the prescribed dose and the implementation of radiotherapy plan, lower the radiotherapy efficacy and even lead to death. Currently, multiple studies have been conducted to explore the predictive factors of RP. In this article, clinical predictive factors including dosimetric parameters, peripheral blood cells along with cytokines and pulmonary function parameters were classified and illustrated, aiming to provide valuable predictive indicators for clinical use and reduce the incidence of RP.
		2021 Vol. 30 (3): 305-310 [Abstract] ( 171 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	311	Research progress on acute radiation dermatitis in patients with nasopharyngeal carcinoma
		He Jian, Gao Jin, Qian Liting
		Acute radiation dermatitis is one of the most common toxicities of radiotherapy in patients with nasopharyngeal carcinoma. It leads to a series of symptoms such as erythema, desquamation and necrosis, which severely affect the quality of life. No concensus has been achieved on the standard prevention and treatment. In this article, literature review was performed in the prevention and treatment of acute radiation dermatitis in patients with nasopharyngeal carcinoma and relevant problems and prospects were proposed, aiming to provide certain reference for clinical trial and scientific research.
		2021 Vol. 30 (3): 311-315 [Abstract] ( 164 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	316	Research progress on automatic treatment planning methods for radiotherapy
		Zhang Qilin, Zhang Shuming, Wang Mingqing, Yang Ruijie
		The design of a conventional radiotherapy plan is a time-consuming and labor-intensive process, and relevant parameters need to be continuously adjusted in the plan optimization to identify the optimal plan. In addition, experience differences between planners, time invested in plan design, and institutional standards all affect the quality of the plan, which in turn influences clinical outcomes and patient prognosis. In recent years, automatic planning has developed rapidly, which can improve the efficiency of planning design while ensuring the quality of the plan. At present, there are several methods dedicated to the automation of radiotherapy planning design, such as the Rapid Plan and Auto-Planning functions in Eclipse and Pinnacle commercial treatment planning systems, and there are also studies applying artificial intelligence technology in dose prediction to achieve automatic planning. In this article, the research progress on automatic radiotherapy planning was reviewed, and the realization principles, clinical efficacy and existing problems of various automatic planning methods were illustrated.
		2021 Vol. 30 (3): 316-320 [Abstract] ( 216 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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