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.7 Published 2021-07-15

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

Head and Neck Tumors

	653	Analysis of long-term survival outcomes and late radiation toxicity of 132 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy
		Fang Zengyi, Wu Zifei, Wu Chuan, Luo Cheng, Gao Mingquan, Lai Xin, Luo Liping, Wang Weidong, Lang Jinyi
		Objective To retrospectively analyze the long-term survival (10-15 years) and late toxicity of nasopharyngeal carcinoma (NPC) patients after intensity-modulated radiotherapy (IMRT), aiming to provide reference for the optimal treatment of NPC. Methods 132 patients with NPC who were treated with IMRT in Sichuan Cancer Hospital from 2003 to 2009 were recruited. Among them, 3 patients were classified as stage Ⅰ, 22 cases of grade Ⅱ, 61 cases of grade Ⅲ, 43 cases of ⅣA and 3 cases of ⅣB, respectively. The median dose was 73.37Gy (66 to 85Gy), divided into 33 times. Twenty patients received radiotherapy alone, 112 cases of concurrent radiochemotherapy. The survival rate was calculated by Kaplan-Meier method and log-rank test. Univariate prognostic analysis was performed. Cox model was used to conduct multivariate prognostic analysis. The late radiation toxicity was evaluated by RTOG/EORTC criteria. Results The median follow-up duration was 128 months (range, 3 to 191 months). The 10-and 15-year local control rates of NPC patients were 86.0% and 79.9%. The disease-free survival rates were 72.5% and 63.2%, and the overall survival (OS) rates were 65.2% and 57.1%. The local recurrence rate was 12.1%, and the distant metastasis rate was 16.7%. A total of 53 patients died, of whom 15 patients died of local recurrence, 20 patients died of distant metastasis and 18 patients died of other diseases (pneumonia, intracranial hemorrhage and accident, etc.). The 10-and 15-year non-tumor-related mortality rates were 11.3% and 13.6%. Univariate analysis showed that age, smoking habit, lactate dehydrogenase (LDH), T stage and clinical stage were the independent prognostic factors of OS in NPC patients. Multivariate analysis demonstrated that LDH, T stage and synchronous chemotherapy were the prognostic factors of OS in NPC patients. The incidence of gradeⅠ-Ⅱ late radiation injury (hearing impairment, dysphagia, dental caries and xerostomia) was 90.4%,and 8.5% for grade Ⅲ-Ⅳ late radiation injury (skin fibrosis, hearing impairment and radiation brain injury). Conclusions The 10-and 15-year OS of NPC patients treated with IMRT is relatively high. With the prolongation of survival, the non-tumor-related mortality rate is increased. Distant metastasis is the main cause of treatment failure. The main late injuries include grade Ⅰ/Ⅱ hearing impairment, dysphagia, dental caries and xerostomia.
		2021 Vol. 30 (7): 653-658 [Abstract] ( 148 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	659	Prognosis evaluation of ameloblastoma—A study based on SEER database
		Jin Yi, Yang Pei, Jin Hekun, Han Yaqian, Wu Xiangwei, Wang Hui
		Objective Ameloblastoma (AM) is a rare tumor derived from dental epithelial tissues, which is prone to recurrence and infiltration. This study aims to identify the prognostic factors of AM. Methods 207 ameloblastoma patients were screened from the SEER database. A Cox regression model and nomogram were constructed to evaluate the factors on the overall survival. Clinical data of 61 patients admitted to Hunan Cancer Hospital were retrospectively analyzed. The independent factors of recurrence rate were analyzed by the Cox regression model. Results The results on the SEER database showed that age, tumor size, type of surgery, radiotherapy were important prognostic factors of the overall survival. The nomogram was constructed and the C-index was equaled to 0.821, indicating this model was moderately accurate. The receiver operating characteristic (ROC) curve demonstrated that the area under the ROC curve (AUC) at 1, 3, 5, and 10 years were 0.852, 0.869, 0.856, and 0.879, indicating this model had relatively high sensitivity and specificity. Kaplan-Meier survival analysis suggested that overall survival in the high-risk group was significantly lower than that in the low-risk group (P<0.001). Based on retrospective analysis, clinical symptoms and type of surgery were the independent factors of the local recurrence rate. Kaplan-Meier survival analysis found the recurrence rate of facial swelling and pain was lower compared to those of other symptoms. Compared with the palliative surgery, radical surgery could decrease the recurrence rate. Conclusions Age, tumor size, type of surgery, and radiotherapy may be important factors of the overall survival. Type of surgery and clinical symptoms are probably the independent factors of the recurrence rate.
		2021 Vol. 30 (7): 659-664 [Abstract] ( 197 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	665	Correlation between changes of oral bacterial flora and radiation-induced oral mucositis during radiotherapy for head and neck
		Shu Zekai, Wang Baikui, Wang Lei, Chen Ming, Li Weifen, Chen Yuanyuan
		Objective To investigate the correlation between the changes of oral bacterial flora during head and neck radiotherapy and radiation-induced oral mucositis (ROM). Methods The oral bacterial samples of patients with nasopharyngeal carcinoma and accompanying family members were obtained before and at the end of radiotherapy and subjected to high-throughput sequencing. C57BL/6 mice were used to establish the ROM models. On the 9^th day after radiotherapy, oral bacterial samples were collected in the radiotherapy group and the negative control group. On the 3^rd, 5^th, 7^th, and 9^th days post-radiotherapy, the tongue tissues were obtained from another batch of mice in the negative control and radiotherapy groups. Inflammatory factors were detected with PCR and HE staining was performed. Results The oral bacterial diversity of patients after radiotherapy significantly differed from that of patients before radiotherapy and their accompanying family members before and after radiotherapy in Observed species,Chao1, Simpson index (all P<0.05). There was a significant difference in Shannon index between the severe and mild ROM patients (P=0.036). LEfSe analysis showed that patients with severe ROM had higher levels of g_Streptococcus and f_Streptococcus, and lower levels of f_Familyxl, g_Gemini and o_Bacillus. The Simpson index and PCoA results in the oral bacterial samples significantly differed between the negative control and radiotherapy groups (all P<0.05). Conclusions Radiotherapy can disrupt the balance of bacterial flora. The dysregulated oral bacterial flora is closely associated with the aggravation of ROM.
		2021 Vol. 30 (7): 665-670 [Abstract] ( 158 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	671	Impact of the number of chemotherapy cycle of concurrent chemotherapy during radiotherapy on clinical prognosis of limited-stage small cell lung cancer
		Ge Xingping, Yu Hao, Zhang Jiaqi, Zhang Zhen, Wang Youyou, Wang Peng, Xu Liming, Liu Ningbo, Zhao Lujun
		Objective To investigate the role of concurrent chemoradiotherapy in the treatment of limited-stage small cell lung cancer (LS-SCLC) and the impact of the number of chemotherapy cycle during radiotherapy (RT) on clinical prognosis. Methods Patients with LS-SCLC treated with definitive radiotherapy from May, 2008 to September, 2016 were included in the study. The primary endpoint was overall survival (OS), which was calculated from the start of treatment to the date of death or last follow-up. The effect of the number of concurrent chemotherapy cycle and other clinical factors on clinical efficacy was analyzed. Survival analysis was performed with Kaplan-Meier method, and multivariate analysis was performed with Cox regression model. Results Three hundred and seventeen patients were eligible for the analysis. Among them, 129 patients received sequential chemoradiotherapy and 188 patients received concurrent chemoradiotherapy. Among patients receiving concurrent chemoradiotherapy, 86 patients received 1 cycle of concurrent chemotherapy and 102 cases of 2 cycles of concurrent chemotherapy. The median follow-up time was 22.47 months. Multivariate survival analysis showed that only clinical stage, timing of RT administration and prophylactic cranial irradiation (PCI) were the independent prognostic factor for OS. The median OS in patients who received 1 cycle and 2 cycles of concurrent chemotherapy during RT were 33.8 months and 30.4 months (P=0.400). No matter in elder patients or in younger patients, in early RT group or in late RT group and application of PCI or not, the number of concurrent chemotherapy cycle exerted no significant impact on OS. The incidence of grade 3 or above adverse events was 20% in the 1-cycle concurrent chemotherapy group, and 13.7% in the 2-cycle concurrent chemotherapy group. Conclusions Concurrent chemoradiotherapy is the standard treatment of LS-SCLC. Two cycles of concurrent chemotherapy during RT is not necessarily superior to 1 cycle of concurrent chemotherapy. The optimal number of concurrent chemotherapy cycle during RT need to be studied in a large prospective randomized clinical trial.
		Guide:
		2021 Vol. 30 (7): 671-675 [Abstract] ( 249 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	676	Value of MRI T2WI-TSE-BLADE sequence in accurately delineating the gross tumor volume of esophageal carcinoma based on pathological specimens
		Ge Hong, Wang Nan
		Objective To explore the value of BLADE sequence in determining the target range of esophageal cancer radiotherapy through the correlation and consistency between measured esophageal cancer length on the MRI-BLADE sequence and the surgical pathological specimens. Methods Clinical data of 36 patients who were pathologically diagnosed with esophageal carcinoma and received preoperative esophageal MRI in the Affiliated Cancer Hospital of Zhengzhou University between January 2016 to June 2019 were collected. The CT, DWI and BLADE sequence images of all participants were collected and imported into the Monaco system, by which the correlation and consistency between the tumor length measured based on these three imaging methods were statistically compared. Furthermore, the differences in gross tumor volume (GTV) delineated by different physicians in different images were compared. Results The correlation coefficients of the tumor length measured by CT, DWI and BLADE and pathological specimen length were 0.467, 0.723 and 0.896, respectively. The consistency analysis indicated that all the differences between the BLADE sequence and pathological specimen length were within the 95% consistency limit. The consistency and correlation between the BLADE sequence and actual tumor length were significantly better than those between the DWI sequence and CT images (both P<0.05). The volume of DWI and BLADE images obtained by four physicians was significantly smaller than that of CT images (both P<0.05). The differences in GTV delineated by different physicians by these three imaging methods were insignificant (all P>0.05), but the GTV delineated by the four physicians on the BLADE sequence were more similar (all P>0.05). Conclusions BLADE sequence can help physicians to determine the upper and lower boundaries of esophageal tumors more accurately and reduce the differences in GTV delineation among different physicians. And it can effectively improve the unity of individual′s understanding of the scope of target area delineation, and improve the objectivity of clinicians′ judgment of GTV. BLADE sequence can be used as an important imaging tool for accurate target delineation in radiotherapy.
		2021 Vol. 30 (7): 676-681 [Abstract] ( 161 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	682	Study of occult uterine perforation in brachytherapy of cervical cancer
		Zhao Xiujuan, Wu Haiyan, Zhong Mingsong, Guo Mingfang, Huang Yue, Chen Duke, Zhou Qi
		Objective To evaluate the difference of dosimetry between three-dimensional and two-dimensional plans based on CT images of occult perforation in brachytherapy of cervical cancer, aiming to provide clinical reference. Methods A total of 817 patients with cervical cancer received simple intrauterine (intrauterine tandem plus vaginal colpostats) three-dimensional brachytherapy in Chongqing University Cancer Hospital from January 2019 to December 2020 were retrospectively reviewed. Among them, 16 patients had occul uterine perforation. Based on Oncentra Brachy Therapy plan system, the single prescription dose was 6Gy. Three-dimensional (3D group) and two-dimensional (2D group) plans were designed on the perforated CT images The target volume, conformal index (CI), conformal index coformity index (COIN) and organs-at-risk (OAR) D2cm³ parameters were used to assess the plans between two groups. Results The incidence of pccult uterine perforation was 1.96%(16/817) during brachytherapy for cervical cancer. The volume of prescription dose curve in the 3D group was(40.74±14.98) cm³, significantly smaller compared with (91.46±19.71) cm³ in the 2D group (P<0.05), whereas the volume of the high-risk clinical target area wrapped by prescription dose curve did not significantly differ between two groups (P>0.05). The CI and COIN in the 3D group were 0.79±0.10 and 0.72±0.96, significantly higher compared with 0.38±0.09 and 0.37±0.18 in the 2D group (both P<0.05). The D2cm³ of bladder, rectum, sigmoid colon, small intestine in the 3D group were (306.06±77.57) cGy,(252.27±72.60) cGy,(127.25±62.84) cGy and (228.79±94.90) cGy, significantly lower than (548.03±164.21) cGy,(411.16±118.74) cGy,(227.45±94.48) cGy and (450.95±157.96) cGy in the 2D group (all P<0.05). Conclusions Application of image guidance in brachytherapy of cervical cancer is helpful to detect occult uterine perforation. When occult uterine perforation occurs, the use of three-dimensional plan can basically meet the clinical needs, which is significantly better than the two-dimensional plan.
		2021 Vol. 30 (7): 682-687 [Abstract] ( 182 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	688	Preliminary clinical practice of Elekta Unity MR-linac
		Qin Shirui, Cheng Bin, Tian Yuan, Zhang Ke, Huan Fukui
		Objective To summarize the experience of ELEKTA Unity MR-linac in clinical application in our hospital and analyze the positioning accuracy, process time and other related issues. Methods A total of 14 patients enrolled in the Unity MR-Linac study were reviewed. All treatment time (including positioning, scanning, replanning, and beam discharge) and setup errors in 3directions were statistically analyzed. 11 patients with conventional accelerators using the multifunctional immobilization system (MIS) were randomly selected to make statistical analysis of the setup errors, and the differences between the Unity group and the conventional accelerators using the MIS were compared using t-test. Results In the Unity group, the setup errors in X,Y and Z directions were (-0.15±0.30) cm,(0.02±0.57) cm and (-0.10±0.28) cm, respectively. The average treatment time was 36.87minutes. The average positioning time was 5.40minutes. The mean scan time was 7.48minutes, the mean adaptive plan time was 7.46minutes, and the mean beam time was 9.48minutes. In the conventional accelerator group, the setup errors were (0.05±0.25) cm,(-0.01±0.25) cm and (-0.03±0.23) cm, respectively. The results of the setup errors of patients fixed with MIS showed that there were significant differences in the left and right directions (P<0.001), while there were no significant differences in the Y and Z directions (P=0.061 and 0.374) between two groups. Conclusions Except in the X direction, there is no significant difference in setup errors between the Unity and conventional accelerator groups in the condition of laser-free system. Under smooth circumstances, the treatment time by using ATP (adapt to position) workflow will also be within the range of tolerance of the patients. Magnetic-guided radiotherapy has a promising application prospect, whereas the procedure needs to be optimized.
		2021 Vol. 30 (7): 688-691 [Abstract] ( 284 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	692	Study of scanning method of T1WI_Star_VIBE_FS in MRI simulation of neck radiotherapy
		Liu Weiwei, Li Tian, Hu Qiaoqiao, Zhao Dan, Zhang Yangzi, Yue Haizhen
		Objective To compare and analyze the image quality,signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of T1WI_Star_VIBE_FS sequence in MRI simulation of neck tumors with different scanning methods, aiming to determine the optimal scanning method. Methods A retrospective analysis of 78 patients receiving MRI contrast scan was performed. All patients were randomly divided into three groups according to three different scanning methods including bolus mode (group A,n=23), segmentation splicing mode (group B,n=18) and the combination mode (group C,n=37). The image quality, SNR and CNR of the anterior soft tissues of neck were statistically compared. Results A higher image quality score was obtained in group C. The mean SNR and CNR in three groups were calculated as 214.70±148.78,91.95±59.26,307.61±127.80, and 208.74±148.27,85.79±59.50,301.58±127.48, respectively. The image quality score,SNR and CNR in group C were significantly better compared with those in group A and B (all P<0.01). Conclusion Combination of bolus and segmentation splicing modes is a recommended approach in MRI simulation during radiotherapy of neck tumors.
		2021 Vol. 30 (7): 692-696 [Abstract] ( 196 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	697	Utilization of a scintillator detection system for quality assurance in carbon-ion and proton therapy
		Li Yongqiang, Wenchen Hsi, Zhao Jun, Chen Zhi, Sun Wei
		Objective A two-dimensional (2D) in-house-built scintillator detection system (SDS) was utilized for quality assurance of the active spot scanning proton and heavy ion accelerator, aiming to establish a rapid detection method and provide reference for the quality of proton and heavy ion beam (spot position, spot size, virtual source-to-axis distance, profile depth dose distribution and beam range). Methods The SDS consisted of a ceramic gadolinium-sulfoxylate phosphor-scintillating screen, a mirror and a commercial digital camera. The dose distribution image was obtained based on scintillator,mirror reflector and optical signal acquisition device to transform the proton and heavy ion beam into visible light through sulfur gadolinium oxide scintillator and collect visible light information to meet the clinical requirements for the quality of proton and heavy ion beam. Results The deviation of spot position measured by multifilament proportional chamber and the SDS was less than 1mm. The differences of beam spot size measured by multifilament proportional chamber and the SDS were (1.40±0.59)mm for protons, and (0.5±0.08)mm for carbon ions. For 429.25MeV/u carbon, the virtual source-to-axis distance (VSAD) at the x-and y-axes was 751.8cm and 805.6cm. And difference between physical distance and virtual source-to-axis distance was less than 1%. The range of 287.5MeV/u carbon measured by SDS was 160mm. Conclusions The in-house-built scintillator detector can measure beam spot position and size, virtual source, depth distribution curve and range, which can be used as an effective tool for quality assurance control of proton and heavy ion therapy.
		Guide:
		2021 Vol. 30 (7): 697-701 [Abstract] ( 184 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	702	Study of feasibility of exchanging intensity-modulated radiotherapy plans after beam matching on two Linacs
		Fang Chunfeng, Xu Shouping, Hou Jun, Song Yuanyuan, Xu Wei, Cao Lin, Yang Tao, Wang Zishen, Xie Dong, Zhu Longlin, Qu Baolin
		Objective To explore the feasibility of the clinical implementation of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans with 6MV photon on two Elekta Linacs (Versa HD and Synergy) after beam matching. Methods The images of 12 patients with nasopharyngeal carcinoma, central lung cancer and prostate cancer were randomly selected, and the IMRT and VMAT plans were designed. Two different dose tools of ionization chamber and three-dimensional detector ArcCheck were used to verify the individualized radiation treatment of 6MV photon beams on two Linacs and compare the differences. Results The deviations between the doses of two Linacs (Versa HD and Synergy) measured by the ion chamber and treatment planning system were (0.32±1.32)% and (0.54±1.29)%. The differences of all plans were within the range of ±3%, and the deviations of the point dose between two Linacs were within the range of ±2% with no statistical significance (both P>0.05). The γ analysis of verification using ArcCheck showed that the passing rates of all plans under the 2mm/3% and 3mm/3% with 10% threshold conditions were over 95%, respectively. The average differences between two Linacs were 0.19%(2mm/3%) and 0.09%(3mm/3%). Conclusions The results of performing IMRT/VMAT plans on two Linacs meet the clinical requirements and the differences between two Linacs are small. Hence, the same plans can be implemented interchangeably on different Linacs.
		2021 Vol. 30 (7): 702-706 [Abstract] ( 156 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	707	Realization of interactive assessment form of radiotherapy dose based on Eclipse Scripting API
		Huang Shixiong, Yang Songhua, Zeng Degao, Zeng Biao
		Objective To realize the interactive form evaluation of radiotherapy dose and the automatic calculation of conformity index (CI) and heterogeneity index (HI) in the Eclipse planning system. Methods The Eclipse Scripting API application development interface and C# programming language were employed to develop it with script plug-ins combined with independent programs. The visual interface programming and call the relevant dose query function in the API were utilized to realize the interactive table dose evaluation and the automatic calculation of HI. The functions of calling dosage structure creation and structure Boolean operation in the API were adopted to realize the automatic calculation of CI. Results 15 clinical radiotherapy cases of nasopharyngeal carcinoma were selected. The dose evaluation results were statistically compared between this method and the module equipped in the Eclipse system. The results showed that the accuracy was consistent between these two methods (P>0.05), whereas the evaluation efficiency of this method was significantly higher compared with that of the Eclipse system module (P<0.05). Conclusions The interactive evaluation form in this article has a friendly interface, which allows users to more conveniently perform dose assessment, multi-plan comparison, and calculation of CI and HI, which effectively improves work efficiency and can better serve the clinical and scientific research work of radiotherapy.
		2021 Vol. 30 (7): 707-711 [Abstract] ( 240 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	712	Installation product acceptance of Varian Halcyon accelerator
		Hu Qiaoqiao, Wu Hao, Jiang Fan, Wang Ruoxi, Wang Meijiao, Zhang Yibao
		Objective To understand the components, performance, acceptance test and quality assurance (QA) protocols of the new Varian Halcyon accelerator through the procedures of installation product acceptance (IPA). Methods Per Varian IPA protocol, TG-142 for LINAC and TG-148 for tomotherapy QA protocols, the software license, safety interlock, mechanical accuracy, dosimetric performance and imager system were checked thoroughly. Some parameters were benchmarked to the conventional TrueBeam system. Results The system has been fully licensed. Safety interlock was normal. Mechanical accuracy:The maximum deviation of beam stability per gantry rotation was 1.13%. The size of isocenter was>0.59mm. The offsets of MV imager, collimation rotation and absolute gantry rotation were 0.09mm,-0.21° and 0.11°, respectively. The maximum offsets of couch, virtual-to-isocenter were 0.15mm (vertical) and -0.04mm (vertical), respectively. Beam performance:The depth deviation of maximum dose was 0.1cm. The offset of percentage depth dose at 10cm was 0.5%. The maximum deviations of off-axis-intensity, symmetry, and repeatability were 0.9%, 0.94% and -0.44%, respectively. MV imager:The dark field mean pixel value, noise, corrected pixels, defective lines, sensitivity and linearity disparity of dose were 614, 4.4, 3626, 0, 19177, and 0.47%, respectively. All values were within the range of tolerance. Visual check of contrast resolution and small object detection was all satisfactory. Conclusions Without Halcyon-specific TG report or guidelines, manufacture-provided IPA manual can be helpful with the installation of acceptance and QA protocols. IPA has been successfully performed for Halcyon at Peking University Cancer Hospital. The automated workflow improves the clinical efficiency by simplifying the operations.
		2021 Vol. 30 (7): 712-716 [Abstract] ( 408 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	717	Preliminary comparative study of active breathing coordinator and free breathing combined with bodyfix fixation device in stereotactic radiotherapy of thoracic tumors
		Ying Wei, Zhang Dekang
		Objective To compare the difference between active breathing coordinator (ABC) technique and free breathing (FB) mode combined with bodyfix stereotactic radiotherapy (SBRT) for chest tumors. Methods 40 thoracic tumor patients receiving SBRT were randomly selected and divided into the ABC technique group and FB model group. After fixation with bodyfix fixing devices in two groups, cone-beam CT (CBCT) scan images before each SBRT were matched with the plan reference images. The setup errors in the left-right (LR), superior-inferior (SI) and anterior-post (AP) directions were obtained. Then, the setup errors were corrected. SBRT was performed and split intra-fraction CBCT was conducted simultaneously, which was repeated until the end of treatment. Results In the ABC technique group, the setup errors in the LR, SI and AP directions were (0.25±0.21) cm,(0.28±0.21) cm, and (0.21±0.24) cm, significantly less compared with (0.31±0.22) cm,(0.32±0.21) cm and (0.37±0.23) cm in the FB model group (all P<0.05). The V30Gy of the heart, the V20Gy and V30Gy of the lung in the ABC technique group were significantly less than those in the FB model group (0.31%∶7.35%;24.5%∶32.9%;19.5%∶25.8%, all P<0.05). Conclusions ABC technique combined with bodyfix fixation device may be superior to FB mode in SBRT for chest tumors, which remains to be validated by subsequent studies with large samples.
		2021 Vol. 30 (7): 717-720 [Abstract] ( 158 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	721	A longitudinal study of transcriptional profiling of carbon-ions exposure on the lung
		Zhou Cheng, Wen Lei, Su Shengfa, Lu Shun, Xu Zhiyuan, Cheng Hao, Shan Changguo, Lai Mingyao, Cai Linbo, Chen Longhua, Chen Ming, Zhou Zhaoming
		Objective To investigate the expression changes at the transcriptional level in normal lung tissues of mice after exposure to heavy ion radiation for different durations at different doses, aiming to provide evidence for exploring sensitive genes of heavy ion radiation, heavy ion radiation effect and the damage mechanism. Methods Experiments on the temporal kinetics:the whole thorax of mice was irradiated with 14.5Gy carbon-ions and the total RNA of lung tissue was extracted at 3days, 7days, 3 weeks and 24 weeks. In dose-dependent experiment, the total RNA of lung tissue was extracted at 1 week after irradiated with a growing thoracic dose of 0, 7.5, 10.5, 12.5, 14.5, 17.5 and 20Gy. Protein-to-protein interaction (PPI) analysis and gene-ontology biological process enrichment analysis were performed on significant differentially expressed genes (DEGs). Results A clearly differential expression patterns were observed at 3-day (acute stage), 1-week (subacute stage), 3-week (inflammatory stage) and 24-week (fibrosis stage) following 14.5Gy carbon-ions irradiation. Among those, the 3-day time point was found to be the mostly different from the other time points, whereas the 7-day time point had the highest uniformity with the other time points. Cellular apoptosis was the main type of cell death in normal lung tissues following carbon-ions exposure. The interactive genes of Phlda3, GDF15, Mgmt and Bax were identified as the radiosensitive genes, and Phlda3 was the center (R=0.76, P<0.001). Conclusion The findings in this study provide transcriptional insights into the biological mechanism underlying normal lung tissue toxicity induced by carbon-ions.
		2021 Vol. 30 (7): 721-727 [Abstract] ( 270 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	728	Study of sensitization effect of hydroxyurea on chemoradiotherapy of human glioma U251 cells
		Yang Yali, Yang Zhihua, Pan Wenyan, Lin Minghui, Zhang Zixin, Wang Yanyang, Shang Jun, Tang Jing, Bai Zhoulan, Zhe Hong
		Objective To investigate the effect of hydroxyurea (HU) combined with temozolomide (TMZ) and radiotherapy (RT) on the sensitivity of human glioma U251 cells to chemoradiotherapy (CRT). Methods Human glioma U251 cell line was cultured in vitro. CCK8 cell assay was used to detect the proliferation activity of U251 cells treated with different concentrations of HU/TMZ under different conditions. Flow cytometry was utilized to detect apoptosis rate and cell cycle distribution of U251 cells. Transwell chamber assay and scratch test were performed to evaluate the changes of cell invasion and migration. The expression levels of apoptosis proteins were determined by Western blot. Colony formation assay was adopted to detect the cell survival fraction . Results HU concentration at 50μmol/L and below did not affect the proliferation of human glioma U251 cells (P>0.05). Low-dose HU combined with CRT significantly inhibited cell proliferation (P<0.05), invasion (P<0.01) and migration (12h P<0.001,24h P<0.01), and promoted cell apoptosis (P<0.01) compared with the use of CRT alone. Application of 50μmol/L HU combined with RT increased the radiosensitivity of cells (SER=1.49), significantly prolonged the cell cycle of S phase and G2 phase (both P<0.05), considerably up-regulated the expression levels of the apoptosis-associated proteins of Caspase-3 and Bax and significantly down-regulated the expression level of anti-apoptosis protein of Bcl-2(all P<0.001). Conclusions Compared with CRT, HU combined with CRT can further inhibit the proliferation, invasion and migration of human glioma U251 cells, promote cell apoptosis, increase the radiosensitivity and prolong the cell cycle of S and G2 phases, thereby enhancing the sensitivity of human glioma U251 cells to CRT.
		2021 Vol. 30 (7): 728-734 [Abstract] ( 156 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	735	Research progress on hippocampal-avoidance whole brain radiotherapy
		Chen Mengyuan, Chen Yuanyuan, Chen Ming, Du Xianghui
		With the advancement of imaging diagnosis and the development of modern radiotherapy, the survival of cancer patients has been prolonged and the incidence rate of brain metastases (BM) has been significantly increased. The quality of life of patients and potential radiotherapy-induced neurocognitive impairment have gradually captivated widespread attention. Whole brain radiotherapy (WBRT) is one of the common local therapies for BM patients. However,the application of WBRT is controversial because it may lead to neurocognitive impairment. The incidence of metastatic tumors in hippocampus and radiation-induced neurocognitive impairment can accelerate the implementation of hippocampal-avoidance WBRT (HA-WBRT). In this article, the feasibility of HA-WBRT was discussed and research progress in recent years was reviewed.
		2021 Vol. 30 (7): 735-738 [Abstract] ( 130 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	739	Research progress on application of nimotuzumab in esophageal cancer
		Jin Xiaoqian, Wang Lan, Han Chun
		Esophageal cancer is a common malignant tumor of digestive system in China. Concurrent chemoradiotherapy has become the widely recognized method for the treatment of inoperable locally advanced esophageal carcinoma. Nevertheless, clinical efficacy of concurrent chemoradiotherapy remains to be enhanced. Nimotuzumab, the first human monoclonal antibody to treat malignant tumors in China, has been applied in the treatment of nasopharyngeal carcinoma, glioma, pancreatic cancer and other malignant tumors, which yields significant survival benefits and causes mild adverse events. Hence, more and more scholars are paying attention to its application value in the treatment of esophageal cancer. In this article, research progress on the application of nimotuzumab in esophageal cancer was reviewed, aiming to provide new ideas for the treatment of esophageal cancer.
		2021 Vol. 30 (7): 739-743 [Abstract] ( 140 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	744	Recent research progress on surgery combined with radiation therapy for primary liver cancer
		Yang Yongqiang, Chen Wei, Tian Ye
		Surgical resection is the main radical treatment of early and mid-stage primary liver cancer (PLC), but the high postoperative recurrence rate is the main factor affecting the curative effect. With recent advancement in techniques, the efficacy and safety of radiation therapy for PLC have been widely proven. In this review, we will investigate the combination of surgery and radiation therapy, covering the topics of preoperative or postoperative radiotherapy for PLC with portal vein tumor thrombus, postoperative adjuvant radiotherapy in PLC with narrow surgical margin or microvascular invasion, stereotactic body radiation therapy as a bridge to liver transplantation, radiotherapy in conversion to resectability for intrahepatic inoperable PLC. Despite radiation therapy is one of the effective therapeutic options for PLC, there is still a compelling need for prospective, randomized, controlled phase Ⅲ trials to acquire high-levelclinical evidence for confirming the role of radiation therapy in the treatment of PLC.
		2021 Vol. 30 (7): 744-747 [Abstract] ( 219 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	748	Clinical value of extramural vascular invasion in rectal cancer
		Chen Silin, Tang Yuan, Jin Jing
		Extramural vascular invasion (EMVI) is a prognostic factor in rectal cancer. The previous evaluation of EMVI relies on the analysis of postoperative pathological results. With the development of MRI, MRI can accurately assess the status of EMVI (mrEMVI).MrEMVI has become the important prognostic indicator for rectal cancer.The risk of local recurrence and distant metastasis in mrEMVI-positive patients will be significantly increased. The aim of this article is to review the diagnostic features, clinical significance, and impact on treatment patterns of EMVI, and project its future development trend of EMVI.
		2021 Vol. 30 (7): 748-752 [Abstract] ( 158 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	753	Research progress on the influencing factors and prognosis of radiation-induced lymphopenia
		Sun Guangyi, Wang Shulian
		Lymphocyte-led immunity plays an important role in the occurrence and development of tumors. It has been found that radiotherapy can induce lymphopenia in patients with solid tumors, and radiotherapy-induced lymphopenia (RIL) might be caused by the irradiation of circulating blood. The sensitivity to irradiation differs among different subtypes of lymphocytes. RIL can be affected by radiation fractionation, technique and volume. Meanwhile, it has been proven that RIL can significantly reduce the survival of patients with multiple solid tumors. In this article, relevant researches were reviewed, aiming to advance clinical treatment decisions and optimize radiotherapy protocols.
		2021 Vol. 30 (7): 753-756 [Abstract] ( 138 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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