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.6 Published 2021-06-15

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

Consensus

	535	Chinese Expert Consensus on Clinical Operation Guidelines of CT Simulation Positioning Technology (2021 edition)
		Radiotherapy Technology Group of Radiation Oncology Branch of Chinese Medical Association, Medical Technician Professional Committee of Chinese Medical Doctor Association
		CT-simulation positioning is a radiotherapy simulation positioning technology based on CT images, which can establish a three-dimensional coordinate system, accurately display tumor size, scope of invasion and lymph node metastasis, precisely display the contour of surrounding vital organs and the relationship between tumor and vital organs, providing electron density for the design of radiotherapy plan, which is one of the basic conditions of precise radiotherapy. Chinese Expert Consensus on Clinical Operation Guidelines of CT Simulation Positioning Technology was formulated to standardize clinical operation technology of CT simulation positioning and provide quality assurance for precise tumor target delineation and planning design. This consensus includes overview of application of CT simulation,consensus on CT simulation positioning of common tumors, common post-processing of CT simulation positioning technology, respiratory movement management technology, adverse reactions and processing of CT simulation, prospect of CT simulation, aiming to guide clinical practice of radiation therapists and radiation oncologists and bring survival benefits to patients.
		2021 Vol. 30 (6): 535-542 [Abstract] ( 166 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	543	Radiotherapy is beneficial for long-term survival of patients with stage ⅣB thoracic esophageal squamous cell carcinoma at initial diagnosis
		Wang Xuefeng, Cao Feng, Jing Shaowu, Wang Jianing, Shi Hongyun, Wang Jun
		Objective To investigate the value of radiotherapy in patients with stage ⅣB thoracic esophageal squamous cell carcinoma (ESCC) at initial diagnosis. Methods A total of 199 patients with stage ⅣB thoracic ESCC at initial diagnosis (according to UICC/AJCC Eighth Edition Esophageal and Esophagogastric Junction Cancer TNM Staging) who were treated in the Fourth Hospital of Hebei Medical University between January 2010 to December 2016 were recruited. Winthin the whole group,130 patients (65.3%) had distant lymph node metastases alone, 51 cases (25.6%) of solid organ metastases alone and 18 cases (9.0%) of solid organ complicated with distant lymph node metastases. Among them, 16 patients (8.0%) were treated with chemotherapy alone, 50 cases (25.1%) of radiotherapy alone, 133 cases (66.8%) of radiochemotherapy (81 patients treated with concurrent radiochemotherapy and 52 patients treated with sequential radiochemotherapy). The survival rate was calculated by Kaplan-Meier method and the difference was analyzed by log-rank test. Clinical prognosis was assessed by multivariate Cox regression model. Results The median overall survival (OS) of the entire cohort was 12.3 months (95%CI:10.6-15.4m), and the 1-, 2-, 3-and 5-year OS rates were 52.1%, 25.2%, 19.1%, and 11.5%, respectively. Multivariate analysis showed that tumor length, the number of metastatic organs, and treatment modalities were the independent prognostic factors for OS. There was no significant difference in OS between concurrent radiochemotherapy and sequential radiochemotherapy (P=0.955). The OS of patients in the radiotherapy dose of ≥6000 cGy group was significantly longer than that of their counterparts in the 4500-5039 cGy and 5040-6000 cGy groups (both P<0.001). Conclusions For stage ⅣB thoracic ESCC patients at initial diagnosis, tumor length ≤3cm, single organ metastasis, and radiochemotherapy strategy are significantly correlated with longer OS. For stage Ⅳ ESCC patients with good physical status, radiotherapy can be supplemented on the basis of systemic chemotherapy. Concurrent or sequential radiochemotherapy needs to be individualized. If patients are tolerable, radiochemotherapy is recommended to the primary tumor or non-regional metastatic lymph nodes, aiming to prolong the OS of patients.
		2021 Vol. 30 (6): 543-548 [Abstract] ( 199 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	549	A nomogram model based on cone beam CT radiomics combined with clinical features and dosimetric parameters predicting radiation pneumonitis in patients with esophageal cancer receiving radiotherapy
		Du Feng, Wang Qiang, Wang Wei, Zhang Yingjie, Li Zhenxiang, Li Jianbin
		Objective To develop and validate a nomogram model for predicting radiation-induced pneumonitis in esophageal cancer based on CBCT radiomics characteristics combined with clinical characteristics and lung dosimetric parameters. Methods Clinical data, dosimetric parameters and CBCT images of 96 patients with thoracic middle esophageal squamous cell carcinoma treated by intensity-modulated radiation therapy (IMRT) from 2017 to 2019 were analyzed retrospectively. The CBCT images of each patient in three different time periods were obtained. All patients were assigned randomly into the primary cohort (n=67) and validation cohort (n=29). Double lungs were selected as the region of interest (ROI), and 3D-slicer software was used for image segmentation and feature extraction. The LASSO regression were applied to identify candidate radiomic features and construct the Rad-score. The optimal time period, clinical and dosimetric parameters were selected to construct the nomogram model, and then the area under the receiver operating characteristic curve (AUC) was used to evaluate the prediction effect of the model. Results The predictive capacity of the model in the first time period was the highest. In the primary cohort,the AUC was 0.700(95%CI:0.568-0.832), the sensitivity was 61.5%, and the specificity was 75.0%. In the validation cohort, the AUC was 0.765(95%CI:0.588-0.941),the sensitivity was 84.6% and the specificity was 64.7%,respectively. In the combined nomogram model,the AUC in the primary cohort was 0.836(95%CI:0.700-0.918), the sensitivity was 96.0% and the specificity was 54.8%. In the validation cohort,the AUC was 0.905(95%CI:0.799-1.000), the sensitivity was 92.9% and the specificity was 73.3%,respectively. The diagnostic efficiency of combined nomogram model was the best. Conclusions The nomogram model based on early lung CBCT radiomics has certain predictive efficiency for RP. The model of lung CBCT radiomics in early stage of radiotherapy can predict RP of esophageal cancer. The nomogram model based on Rad-score combined with V5Gy, MLD and tumor stage yields better predictive accuracy, which can be used as a quantitative prediction model for RP.
		2021 Vol. 30 (6): 549-555 [Abstract] ( 181 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	556	Meta-analysis of the incidence of radiation pneumonitis between European,American and Asian populations
		Wei Jia, Zhang Zhen, Yu Jiaqi, Jia Huijun, Tian Jia, Meng Chunliu, Ren Kai, Zhao Lujun
		Objective To compare the incidence of radiation pneumonitis (RP) between lung cancer patients from the European, American and Asian regions. Methods The studies related to lung cancer and RP were searched from PubMed, Embase, and Cochrane library. According to the different places where the studies were conducted, the searched studies were divided into two types:Asian studies and European, American and Australian studies. The incidence of RP between two regions was summarized. Studies related to dosimetry parameters were searched from PubMed database. Results A total of 3,190 patients from 14studies were included. Meta-analysis results showed that the incidence of ≥ grade 3 RP was similar in patients from Asia and Europe, America and Australia (4.9% vs. 4.6%, P=0.895), whereas the incidence of grade 5 RP in Asia was significantly higher than that in Europe, America and Australia (1.5% vs. 0.2%, P=0.002). Moreover, the lung irradiation dose received by the patients in the Asian group was relatively low. Lung V20Gy dose limitation standard was reported in 21studies. Further analysis found no statistical significance in lung V20Gy dose limitation standard between two regions (P=0.440), and the standard in Asian studies is likely to be even stricter. Conclusions The incidence of RP after chemoradiotherapy in lung cancer patients in Asia is relatively higher compared with those in Europe, America and Australia. The differences in dose limitation standard should be noted when the thoracic radiation regimen based solely on the data from foreign studies is applied to the patients in Asia.
		2021 Vol. 30 (6): 556-562 [Abstract] ( 191 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	563	Comparison of the value of two scores for predicting prognosis in patients with locally advanced rectal cancer undergoing concurrent chemoradiotherapy plus surgery
		Chen Silin, Tang Yuan, Li Ning, Jiang Liming, Jiang Jun, Wang Shulian, Song Yongwen, Liu Yueping, Fang Hui, Lu Ningning, Qi Shunan, Chen Bo, Li Yexiong, Jin Jing
		Objective To evaluate the prognostic significance of neoadjuvant rectal (NAR) score and downstaging depth score (DDS) after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC). Methods Retrospective analysis was performed for 200 patients with LARC (T3-T4 and/or N1-N2,M0), who were initially treated in the Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2018. All patients had baseline MRI data and received preoperative nCRT and radical resection. All patients received preoperative radiotherapy with a dose of 45-50Gy combined with concurrent capecitabine. The effect of NAR and DDS scores on clinical prognosis was statistically compared. The 3-year disease-free survival (DFS) was calculated using the Kaplan-Meier method and compared by the log-rank test. Cox proportional hazards model was used to perform multivariate survival analysis. The predictive performance for 3-year DFS was calculated using the receiver operating characteristic (ROC) curve. Results The median follow-up time was 30.5(10.6-54.0) months. In terms of DDS, the 3-year DFS rate was 56.4% in the DDS ≤0 group, significantly lower than 83.0% in the DDS >0 group (P=0.002). In terms of NAR score, the 3-year DFS rates were 90.1%, 73.8% and 53.6% in NAR score ≤8, 8-16 and>16 groups, respectively (P<0.001). In the whole cohort, the area under the ROC curve (AUC) of DDS and NAR scores for predicting 3-year DFS were 0.683 and 0.756(P=0.037). In yp0-I stage patients (n=72), the AUC of DDS and NAR scores for predicting 3-year DFS were 0.762 and 0.569(P=0.032). Conclusions High DDS and low NAR scores after nCRT indicate good prognosis for patients with LARC. NAR score yields better accuracy than DDS in predicting clinical prognosis, but DDS is significantly better than NAR score in yp0-I stage population.
		2021 Vol. 30 (6): 563-568 [Abstract] ( 204 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	569	Clinical efficacy and prognosis of 85 patients with extracranial metastatic breast cancer receiving radiotherapy
		Song Yuchun, Fang Hui, Wang Shulian, Xiao Jianping, Tang Yu, Liu Yueping, Song Yongwen, Chen Bo, Qi Shunan, Li Ning, Tang Yuan, Jing Hao, Yang Yong, Ren Hua, Zhao Ruizhi, Lu Ningning, Jin Jing, Li Yexiong
		Objective To evaluate the clinical efficacy of radiotherapy in the treatment of extracranial metastatic breast cancer, and to investigate the significance and prognostic factors of whole-lesion radiotherapy (WLRT). Methods Clinical data of 85 patients with extracranial metastatic breast cancer treated with radiotherapy between 2014 and 2019 were retrospectively analyzed. Thirty-six patients were assigned into the WLRT group and 49 in the non-WLRT group. The local control (LC), progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method, log-rank test and univariate prognostic analysis. Cox proportional hazards model was used for multivariate prognostic analysis. Results The median follow-up time was 26.7 months. The 2-year LC, PFS, OS rates were 77%, 26%, 77%, respectively. The 2-year LC (91% vs. 67%, P=0.001), PFS (47% vs. 8%,P<0.001), OS rates (84% vs. 71%, P=0.010) in the WLRT group were significantly higher than those in the non-WLRT group, respectively. Multivariate analysis demonstrated that WLRT was an independent favorable prognostic factor for the LC, PFS and OS. Furthermore, bone metastasis alone was associated with improved LC and positive hormone receptor status was correlated with improved OS. Conclusions WLRT has the potential to prolong the survival of patients with extracranial metastatic breast cancer. The patients with bone metastases alone obtain better LC, whereas those with negative hormone receptor status has worse OS.
		2021 Vol. 30 (6): 569-574 [Abstract] ( 178 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	575	Comparison of efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer:a Meta-analysis
		Wang Sheng, Zhao Xue, Zhang Yiqing, Sun Kaiguo, Qin Zhaohui, Yao Yuanhu
		Objective To systematically evaluate the efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer. Methods Literature review was performed from PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang, CNKI and VIP from the inception date to February, 2020 using the key words including “pancreatic neoplasm, pancreatic cancer, surgery, preoperative chemoradiotherapy, neoadjuvant chemoradiotherapy”in both English and Chinese. The randomized controlled clinical trials (RCTs) of neoadjuvant chemoradiotherapy followed by surgery versus immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer were searches. Literature screening, data extraction and estimation of the risk of bias were independently conducted by two researchers. The HR and 95%CI were used for estimating the overall survival time. The R0 resection rate, overall incidence of postoperative complications, and mortality rate throughout treatment were assessed by the RR and 95%CI. The heterogeneity of the studies was analyzed using the I² test. Results A total of 4 RCTs were included. Among 400 patients, 197 cases were assigned into the neoadjuvant chemoradiotherapy combined with surgery group and 203 in the immediate surgery group. The results of Meta-analysis showed that patients in the neoadjuvant chemoradiotherapy followed by surgery group obtained longer overall survival (HR=0.76, 95%CI:0.60-0.97, P=0.03) and higher R0 resection rate (RR=1.72, 95%CI:1.40-2.13, P<0.01). Besides, the overall incidence of postoperative complications (RR=1.02, 95%CI:0.73-1.43, P=0.90) and mortality rate throughout treatment (RR=1.19, 95%CI:0.48-2.93, P=0.71) did not significantly differ between two groups. Conclusions During the treatment of resectable or borderline resectable pancreatic cancer, neoadjuvant chemoradiotherapy followed by surgery may bring more survival benefits than immediate surgery and does not increase the incidence of postoperative complications and mortality rate throughout treatment. Therefore, neoadjuvant chemoradiotherapy followed by surgery can be used as a recommended treatment for patients with resectable or borderline resectable pancreatic cancer.
		2021 Vol. 30 (6): 575-581 [Abstract] ( 188 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	582	Objective clinical outcome and patient satisfaction in self-assessment of postoperative electronic radiation for refractory keloids
		Sun Shuai, Sun Xiansong, Wang Yijun, Zhang Yu, He Lei, Zhang Fuquan
		Objective Objective To investigate the role of radiotherapy in the treatment of refractory keloids, evaluate the self-assessment degree of satisfaction of patients and compare with the objective outcomes. Methods A total of 144 patients (290 lesions) with refractory keloids admitted to Peking Union Medical College Hospital from 2013 to 2018 were included in this study. The median age was 28 years old (range:15-81 years old).All lesions were subjected to electronic radiation at postoperative 24h. The regime of 5 to 7MeV electron beam radiation therapy was adopted. The total dose was ranged from 16 to 18Gy/2f (at 1-week interval). The median follow-up time was 48 months (range:35-91 months).Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the degree of satisfaction. Multivariate analysis was performed by Cox proportional hazards model. Results Among 290 keloids, 52keloids (17.9%) relapsed in 3 to 42 months from the end of radiotherapy (median 12 months). The main side effects were hyperpigmentation and local incisional extension. Univariate analysis showed that local incisional color darker than skin, pruritus, pain and young age were associated with recurrence. Multivariate analysis indicated that local incisional color darker than skin and pain were the independent prognostic factors for scar recurrence. Recurrence, hyperpigmentation and local incisional extension were the main reasons for patients' dissatisfaction. Conclusions Postoperative electronic radiation can achieve satisfactory efficacy in the treatment of refractory keloids. Local incisional color darker than skin and pain are the independent prognostic factors of keloid recurrence. Patient self-assessment results are not fully consistent with the objective clinical outcomes and recurrence status.
		2021 Vol. 30 (6): 582-586 [Abstract] ( 200 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	587	Design of a drum-shaped applicator through Monte Carlo simulation for breast intraoperative radiotherapy
		Ma Pan, Li Minghui, Niu Chuanmeng, Xie Xin, Ma Min, Dai Jianrong
		Objective To design a drum-shaped applicator through Monte Carlo simulation for breast intraoperative radiotherapy. Methods Applicator designing process is as follows:first, determined the shape of the applicator based on the geometric characteristics of the breast tumor bed closed to the chest wall;second, calculated the scattering angle and dose rate of the electron beam after passing through a series of scattering foils of different thicknesses to determine the thickness of the scattering foil;thrid, modeled the layer according to the applicator's geometric characteristics where modulator located, and designed the modulator through the relationship between the geometric characteristics of the layer and the surface dose of the applicator. EGSnrc/BEAMnrc and EGS4/DOSXYZ were employed to model the head of the Mobetron, the layer, the applicator, and to calculate the dose distributions. Results The applicator has two components. The upper component is a 3cm-diametre cylindrical collimator with 0.5cm wall made of 0.3cm steel and 0.2cm water equivalent material (WEM), a 0.13cm-foil made of tansgen. The lower component is a 4cm-diametre drum made of 0.2cm WEM and a 0.14cm maximum thickness hill-shaped modulator made of steel. When the energy of electron beam was 12MeV, the dose rate was about 90.44 cGy/min, and the depth of the 50% isodose curve was 1cm. Conclusion The applicator is successfully designed, and can obtain a drum-shaped dose distribution.
		2021 Vol. 30 (6): 587-591 [Abstract] ( 194 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	592	The setup errors of thermoplastic head and shoulder molds with or without vacuum pad in HFSRT for brain metastases in the lung cancer
		Li An, Liu Jia, Lai Jialu, Wang Qiang, Xu Qingfeng, Zhong Renming, He Yinbo, Bai Sen, Zhou Lin
		Objective To retrospectively analyze the setup errors of thermoplastic head and shoulder molds alone or combined with vacuum pad in hypofractionated stereotactic radiotherapy (HFSRT) for non-small cell lung cancer (NSCLC) with brain metastases. Methods Fifty-four NSCLC patients with brain metastases who received HFSRT from 2017 to 2019 were enrolled in this study. Twenty-four patients were fixed with thermoplastic head and shoulder molds (group A),and 30 patients were fixed with thermoplastic head and shoulder molds plus vacuum pad (group B). The interfraction and intrafraction setup errors were acquired from cone-beam CT online image registration before and after the HFSRT. Optical surface system was applied in monitoring the intrafraction setup errors. The setup errors in each direction between two groups were analyzed by independent samples t-test. Results For the interfraction setup errors of the whole group, the proportion of the horizontal setup errors of ≥3mm was 7.0% to 15.4% and 7.0% to 12.6% for the rotation setup errors of ≥2°. In group A, the anteroposterior setup error was (1.035±1.180)mm, significantly less than (1.512±0.955)mm in group B (P=0.009). In group A, the sagittal rotation setup error was 0.665°±0.582°, significantly less than 0.921°±0.682° in group B (P=0.021). For the intrafraction setup errors of the whole group, the proportion of horizontal setup errors of ≥1mm was 0% to 0.7%, whereas no rotation setup error of ≥1° were observed. In group B, bilateral, anteroposterior and sagittal rotation setup errors were (0.047±0.212)mm,(0.023±0.152)mm and 0.091°±0.090°, significantly less compared with (0.246±0.474)mm,(0.140±0.350)mm and 0.181°±0.210° in group A (P=0.004, P=0.020, P=0.001), respectively. Optical surface monitoring data were consistent with the obtained results. Conclusions Thermoplastic head and shoulder molds (with or without vacuum pad) combined with online image registration and six-dimensional robotic couch correction can be applied in HFSRT for brain metastases from NSCLC. The intrafraction setup errors in group B are smaller than those in group A. Optical surface system has certain value in monitoring the intrafractional movement.
		2021 Vol. 30 (6): 592-597 [Abstract] ( 199 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	598	Evaluation of machine performance check (MPC) system in accelerator
		Xiao Yang, Huang Shunping, Li Heng, Wu Yan, Zhang Yaqian, Chen Xingqiang
		Objective To verify the reliability, accuracy and stability of the machine performance check (MPC) system of Varian's TrueBeam series accelerator.Methods After the installation was completed, the acceptance data were compared with the results of the first MPC operation to verify the reliability of the MPC results;the accuracy of the MPC results in the image-guided radiotherapy (IGRT) application was verified by the method of artificially introducing errors. The mechanical performance results of 60 groups of MPC from March 2019 to March 2020 were collected to calculate the mean value and standard deviation and compare the stability differences of each index. Results The equipment error parameters obtained by MPC were all lower than those obtained by acceptance. The maximum difference between two sets of data was only 2mm and the threshold ratio was less than 20%. MPC had a high sensing accuracy for radiation and imaging position shift, and the r values were more than 90%. The vertical direction of the couch had a poor sense of displacement accuracy, and the r value was less than 73.7%. For this verification project, the angle of the treatment bed was the most stable, and the standard deviation did not exceed 0.01. The stability of other indexes did not significantly differ. Conclusions MPC can be used as a verification tool for routine quality assurance of IGRT. The verification accuracy of radiation and imaging centers are better than the mechanical accuracy of gantry, collimator and couch.
		2021 Vol. 30 (6): 598-601 [Abstract] ( 200 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	602	Establishment of radiation-induced heart damage rat model and its early detection indicators
		Feng Zhangxin, Lu Bing, Ouyang Weiwei, Su Shengfa, Zhang Dingwen, Wang Wei, Wan Yan, Li Qingsong, Geng Yichao, Ma Zhu, Cao Dongdong, Fu Shimei
		Objective To explore the establishment of radiation-induced heart damage (RIDH) SD rat models caused by irradiation of 15Gy/3f and the changes in early detection indicators, and evaluate the effect of irradiation combined with recombinant human endostatin (Endostar). Methods 75 adult male SD rats were randomly divided into the blank control group (C group), Endostar group (E group), 25Gy irradiation group (MHD25 group), 15Gy irradiation group (MHD15 group) and 15Gy irradiation combined with Endostar group (MHD15+E group), respectively. Blood sample was taken to measure the CK, CK-MB, LDH and CRP at 24h, 48h and 15d after corresponding interventions. After cardiac echocardiography at 1, 3 and 6 months, 5 rats in each group were randomly sacrificed and myocardial tissues were collected for HE and Masson staining. Two-way ANOVA was employed for statistical analysis. Results Compared with group C, myocardial fibrosis were observed in the MHD15 group at 6 months (P<0.05), which occurred later than that in the MHD25 group. Ejection fraction (EF) and fractional shortening (FS) were significantly decreased after 3 months in each irradiation group (all P<0.05), whereas the degree of decrease was similar among all groups (all P>0.05). The expression levels of myocardial enzymes and inflammatory cytokines did not significantly differ among different groups (all P>0.05). Conclusions In the early stage, exposure to 15Gy/3f irradiation can cause cardiac function damage in SD rat hearts, such as the reduction of EF and FS, and even lead to myocardial fibrosis in the late stage, which is delayed and less severe than high-dose irradiation. Irradiation combined with Endostar has no significant effect on radiation myocardial injury in rats.
		2021 Vol. 30 (6): 602-607 [Abstract] ( 171 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	608	Screening of differentially expressed miRNAs in A549 cells induced by 17-AAG-M and its effect on radio-sensitivity
		Zhang Nan, Xue Lian, Yu Dong
		Objective To screen 17-AAG-M-induced differentially expressed miRNAs in human non-small cell lung cancer (NSCLC) A549 cells under X-ray and evaluate its effect on radio-sensitivity. Methods A549 cells were treated with 17-AAG-M and 4Gy. Total RNA was extracted for microarray screening. The expression of the miRNAs of interest in the tumor was observed by public database. The target miRNAs were analyzed by using GO and KEGG pathways, and verified by qPCR. The effect of target miRNAs on the survival rate and proliferation of A549 cells under X-ray was evaluated by MTT and clone formation assays. The radio-sensitivity of the target miRNAs was analyzed by the single-hit multi-target model formula. Results 20 differentially expressed miRNAs were screened. The down-regulated hsa-miR-30a-3p showed a close correlation with lung cancer in the database. It was involved with 50 biological processes including cell proliferation and affected the MAPK signaling pathway, cancer-related pathways and cell cycle, etc. Compared with the 17-AAG-M group, the relative expression level of hsa-miR-30a-3p under the action of 17-AAG-M and X-ray was down-regulated from 2.42 to 0.16. hsa-miR-30a-3p inhibited the survival rate of A549 cells (survival rate:78.52%) and further decreased to 69.00% under X-ray. Up-regulation of hsa-miR-30a-3p expression inhibited the proliferation of tumor cells and increased the radio-sensitivity of A549 cells. The radio-sensitization ratio was 1.18. The above performance became more obvious under the action of 17-AAG-M. Conclusions In A549 cells, hsa-miR-30a-3p is differentially expressed under the action of 17-AAG-M and X-ray. Moreover, up-regulation of the expression level of hsa-miR-30a-3p in A549 cells can reduce the viability and proliferation of tumor cells, and increase the radio-sensitivity of tumor cells. The inhibition effect of X-ray combined with 17-AAG-M upon tumors can be strengthened.
		2021 Vol. 30 (6): 608-613 [Abstract] ( 189 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	614	Correlation between classic Wnt signaling pathway and radioresistance of esophageal cancer cells
		Zhan Hui, An Yuan, Ren Minzhu, Zhao Bing, Hou Xiabao
		Objective To clarify the role of classic Wnt signaling pathway in the radioresistance of esophageal cancer cells (ECC), and investigate the underlying mechanism, aiming to identify critical molecular targets for clinically enhancing the radiosensitivity of esophageal cancer. Methods The radiosensitivity of four types of ECCs (EC9706, ECA109, KYSE70 and KYSE150) were assessed by colony formation assay. Western blot and RT-PCR were used to detect the activation of classical Wnt signaling pathway after irradiation. Classic Wnt signaling pathway activator (AZD2858) and inhibitor (XAV-939) were utilized to comprehensively evaluate the effect of classic Wnt signaling pathway on the radiosensitivity of ECCs. Cellular immunofluorescence staining was performed to detect the production and repair of DNA double-strand breaks (DSB), as well as the foci formation of DSB repair proteins after irradiation. Results The results of colony formation assay showed that the radiosensitivity of four types of ECCs from high to low was EC9706, ECA109, KYSE70 and KYSE150. In KYSE150, a radioresistant cell type, the level of nuclear β-catenin and the transcription of c-Myc gene were significantly increased after irradiation (both P<0.05). However, in EC9706, a radiosensitive cell type, the level of nuclear β-catenin and c-Myc gene transcription were not affected by irradiation (both P>0.05). Moreover, EC9706 cells showed enhanced radioresistance in the presence of AZD2858(P<0.05), whereas XAV-939 treatment decreased the radioresistance in KYSE150 cells (P<0.05). AZD2858 accelerated the DSB repair in EC9706 cells (P<0.05), whereas XAV-939 delayed the DSB repair in KYSE150 cells (P<0.05). Furthermore, the results of immunofluorescence staining showed that XAV-939 reduced the DSB repair capacity by inhibiting homologous recombination repair-related proteins (BRCA1 and RAD51) rather than non-homologous end junction repair-related proteins (Ku80 and XRCC4). Conclusions The classic Wnt signaling pathway participates in the regulation of radiosensitivity in ECCs by regulating the homologous recombination repair of DSB after irradiation. Inhibition of the classic Wnt signaling pathway can counteract the radioresistance of ECCs and enhance the killing effect of irradiation on ECCs.
		2021 Vol. 30 (6): 614-618 [Abstract] ( 185 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	619	Low-glucose combined with palmitic acid enhances the radiosensitivity of colorectal cancer through inducing reactive oxygen species generation and DNA damage
		Kuang Hao, Kang Jinlin, Wang Fen, Zhou Fuxiang
		Objective To investigate the mechanism underlying the inhibiting effect of low-glucose combined with palmitic acid on human colon cancer cells and its influence on the radiosensitivity. Methods Under the treatment of low-glucose, palmitic acid and low-glucose combined with palmitic acid, the treatment condition that significantly inhibited the proliferation of SW480 was screened by CCK-8 assay. The reactive oxygen species (ROS) level, mitochondrial membrane potentialand apoptosis rate were detected by flow cytometry. The changes in the radiosensitivity were detected by immunofluorescence-based γ-H2AX quantification and colony formation assay. The protein expression level was detected by Western blot. Results Compared with the control group, the condition of low-glucose combined with 120μmol/L palmitic acid significantly inhibited the proliferation of SW480 cells (P<0.01). The expression levels of CPT1a, PFKFB3 and PKM were significantly up-regulated, the expression levels of NDUFV1, NDUFV2 and NDUFS1 were remarkably down-regulated, the ROS level was significantly increased and the ATP level was considerably reduced in the cells under metabolic stress (all P<0.01). After irradiation, the number of γ-H2AX foci was significantly increased (P<0.05), and the D0 value was significantly reduced (P<0.01),the ROS level was considerably increased (P<0.001), the apoptosis rate was significantly increased (P<0.001) and the expression level of γ-H2AX protein was remarkably up-regulated (P<0.01) in the low-glucose combined with 120μmol/L palmitic acid group. Pretreatment with NAC could reverse the changes of ROS, apoptosis and γ-H2AX protein expression. Conclusions The combination of low-glucose and palmitic acid can induce metabolic stress in SW480 cells, inhibit tumor proliferation and increase the radiosensitization when combined with radiotherapy by inducing the generation of ROS and DNA damage.
		2021 Vol. 30 (6): 619-624 [Abstract] ( 206 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	625	Effect of RNaseH-1 on inhibition of telomerase-negative osteosarcoma and enhancement of radiosensitivity
		Yu Xiaoyan, Wang Qingqing, Wang Yuan, Zhou Yunfeng
		Objective To investigate the effect and mechanism of RNaseH-1 on the radiosensitivity of the osteosarcoma cells via the alternative lengthening of telomeres (ALT) mechanism to maintain the telomere length. Methods ALT osteosarcoma cell U2OS and telomerase-positive osteosarcoma cell 143B over-expressing RNaseH-1 were constructed by lentiviral transfection. After cell transfection, cell proliferation and cell cycle were determined using CCK-8 assay and flow cytometry. The effect of RNaseH-1 on the radiosensitivity of osteosarcoma cells was examined by colony formation assay. DNA injury (γ-H2AX foci) was assessed by immunofluorescent assay. The expression levels of related proteins were detected by Western blot. Results The proliferation abilities of U2OS cells were significantly declined following the over-expression of RNaseH-1, and G1 cell cycle arrest was noted (all P<0.05). Over-expression of RNaseH-1 in U2OS cells increased the phosphorylated levels of ATM and Chk², down-regulated the expression of homologous recombination (HR)-related proteins RAD51 and BRCA1significantly aggravated DNA damage and remarkably enhanced the radiosensitivity (all P<0.05). Over-expression of RNaseH-1 exerted no inhibitory effect upon the telomerase-positive 143B cells (P>0.05). Conclusion RNaseH-1 over-expression suppresses telomerase-negative osteosarcoma cells and enhances the radiosensitivity probably via the role of RNaseH-1 in inhibiting the homologous recombination repair and activating the ATM signaling pathway.
		2021 Vol. 30 (6): 625-630 [Abstract] ( 192 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	631	Research progress on early stage extranodal natural killer/T cell lymphoma
		Xu Tian, Yin Li, Zhan Mengna, Hu Xinyu, Xue Ke, Pei Shuai, He Xia
		Extranodal natural killer/T-cell lymphoma (ENKTCL) is the subtype of non-Hodgkin lymphoma with high heterogeneity and invasiveness. Though most ENKTCL patients are present as early-stage at diagnosis, clinical prognosis significantly differs due to the limitations of clinical staging. Radiotherapy (RT) and chemotherapy (CT) are the first-line treatments for early ENKTCL patients. However, there is no consensus on the combined modalities of RT and CT, and their optimal strategy. With the continuous renewal of clinical staging and prognostic models, early-stage ENKTCL patients tend to accept risk-adapted treatment with proper stratification. In this review, the latest research progresses on clinical staging, prognostic models and treatment were retrospectively analyzed, aiming to provide references for clinical decision-making.
		2021 Vol. 30 (6): 631-636 [Abstract] ( 175 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	637	Research status of radiotherapy combined with EGFR-TKI for brain metastases in patients with EGFR-mutant NSCLC
		Xiang Xing, Yang Wengang, Chen Xiaxia, Geng Yichao, Ma Zhu, Su Shengfa, Ouyang Weiwei, Lu Bing
		The prognosis of patients with brain metastases from non-small cell lung cancer (NSCLC) is poor. Tyrosine kinase inhibitor (TKI) significantly improves the prognosis of patients with epidermal growth factor receptor (EGFR) sensitive mutation. EGFR sensitive mutations are associated with the incidence of brain metastases in NSCLC and may affect the efficacy of radiotherapy and TKI therapy. Both EGFR-TKI and radiotherapy are effective for EGFR-mutant NSCLC with brain metastases. Whether the combination of EGFR-TKI and radiotherapy may improve the prognosis compared with EGFR-TKI or radiotherapy alone has been studied. Retrospective studies have indicated that upfront radiotherapy, especially upfront stereotaxic radiosurgery combined with EGFR-TKI may be more advantageous in improving the prognosis, but it is still controversial. Therefore, clinical research progresses on the radiotherapy for EGFR-mutant NSCLC patients with brain metastases were reviewed.
		2021 Vol. 30 (6): 637-642 [Abstract] ( 195 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	643	Research progress on real-time tumor monitoring and tracking technology in radiotherapy
		Zhan Mengna, Guo Chang, Yin Li, Mou Zhongde, Zhai Zhenyu, He Xia
		The motion of the tumor limits further improvement in the accuracy of radiotherapy. Real-time monitoring and tracking of tumor location is an emerging technology to improve the accuracy of tumor radiotherapy. According to the adopted methods, it can be broadly divided into non-radiation-based and radiation-based systems. The former system includes ultrasound guidance, nuclear magnetic resonance guidance, electromagnetic tracking, optical image guidance, artificial intelligence-based technologies, and the latter system consists of KV, MV-grade X-ray imaging system and CT-based guidance system. In this review, research progresses on real-time tumor monitoring and tracking technology in radiotherapy, respective advantages and disadvantages and current clinical application were summarized.
		2021 Vol. 30 (6): 643-647 [Abstract] ( 189 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	648	Clinical application of surface guided radiotherapy
		Li Tantan, Huan Fukui, Dai Jianrong
		By using optical surface guided radiotherapy technology, the principle of three-dimensional body surface imaging is employed to obtain body surface images in a real-time manner. By comparing with reference images, it can verify the position before treatment, and realize real-time monitoring and gated treatment during treatment. It is a non-invasive and non-radiation technology, which is mainly applied in the treatment of intracranial, head and neck, chest and abdomen, breast, extremities and pediatric tumors. The research progresses consist of four aspects including less body surface markers, less restraint fixation, safer collision prediction and more accurate real-time tracking.
		2021 Vol. 30 (6): 648-652 [Abstract] ( 197 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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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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