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.8 Published 2021-08-15

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

Special Feature

	759	Discussion on current problems of neoadjuvant chemoradiotherapy for esophageal carcinoma
		Gong Heyi, Li Baosheng
		Neoadjuvant chemoradiotherapy is the preferred treatment mode for the diagnosis and treatment of locally advanced operable esophageal carcinoma recommended by many guidelines. However, some problems remain to be further explored. In this article, current problems perplexing clinical practice were sorted out, aiming to provide constructive suggestions for the smooth development of neoadjuvant chemoradiotherapy for esophageal carcinoma in the future.
		2021 Vol. 30 (8): 759-763 [Abstract] ( 127 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	764	Prognosis analysis of T1 stage nasopharyngeal cancer with different lymph node and metastasis stages in the era of precision radiotherapy
		Yan Li, Wang Shengzi, Zhu Yi, Zou Lifen, Li Ji, Li Ruichen
		Objective To evaluate the survival prognosis for T1 stage nasopharyngeal carcinoma patients complicated with different stages of cervical lymph node metastasis, aiming to provide reference for optimizing the treatment plan. Methods Clinical data of 413 patients in non-keratinizing carcinoma and undifferentiated locally early nasopharyngeal carcinoma (T1N0-3M0-1) undergoing radiotherapy alone or radiochemotherapy in Department of Radiation Oncology of our hospital from January 2014 to December 2019 were retrospectively analyzed. The survival analyses were performed with Kaplan-Meier method and statistically compared using the log-rank test. Results Of all patients, 291 were male, and 122 were female (aged from 9 to 78 years old) with a median age of 51 years old. All patients were diagnosed with T1N0-3M0-1 nasopharyngeal carcinoma. In the TNM stage grouping system, 48(11.6%) patients were classified as stage Ⅰ (T1N0M0), 158(38.2%) cases of stage Ⅱ(T1N1M0), 162(39.2%) cases of stage Ⅲ(T1N2M0), and 45(10.9%) cases of stage ⅣA to ⅣB(T1N3M0/T1NxM1). Eight patients (1.9%) with stage ⅣB had metastasis at presentation. The lymph node positivity rate of all patients reached up to 88.1%. Seven patients received three-dimensional conformal radiotherapy, 371 cases of intensity-modulated radiotherapy and 35 cases of volumetric-modulated arc therapy. The 5-year overall survival rate was (95.9±1.2)% and with 100% for T1N0M0 patients,(99.2±0.8)% for T1N1M0 patients,(95.1±2.2)% for T1N2M0 patients and (87.9±6.6)% for T1N3M0 patients, respectively. Primary distant metastasis and N3 stage were significantly correlated with poor prognosis (both P<0.05). The most common long-term side effect of radiotherapy was xerostomia with an incidence rate of 18.6%(17.9% for grade 1 toxicity), followed by hearing damage and tooth discomfort. Only 2 patients developed Grade Ⅲ toxic reactions, manifested as complete hearing loss. Conclusions Although T1 nasopharyngeal carcinoma patients have a high propensity of cervical node metastasis, favorable clinical prognosis can be obtained after radiotherapy alone. Moreover, the long-term side effects under precision radiation exert no severe effect upon the quality of life of patients.
		2021 Vol. 30 (8): 764-769 [Abstract] ( 116 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	770	Clinical efficacy and prognosis of adjuvant radiotherapy for adenoid cystic carcinoma of head and neck salivary gland
		Wang Xin, Dou Shengjin, Li Rongrong, Zhang Lin, Chen Gang, Zhu Guopei
		Objective To investigate the optimal treatment modalities and prognostic factors of adenoid cystic carcinoma of the head and neck salivary gland. Methods From January 2016 to December 2018, clinical data of 166 patients with adenoid cystic carcinoma of the head and neck salivary gland who received postoperative radiotherapy at Department of Radiation Oncology of the Ninth People′s Hospital of Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by log-rank test. Multivariate prognostic analysis was carried out by Cox proportional hazard regression model. Results Among 166 enrolled patients, 70 cases were male and 96 female with an average age of 53 years (18 to 71 years). The median follow-up time was 31.2 months (8.6-63.1 months). Sixty-six patients underwent radical surgery (extended resection across the anatomical areas outside the tumor bed, pursuing negative margins of various resections), and the remaining 100 patients underwent conservative surgery (only extended resection of lesions, not pursuing negative nerve resection margins). The median dose of postoperative radiotherapy was 66Gy (54-70Gy). Seventy-three patients were treated with TP regime due to positive or close margins and 9 cases of cervical lymph node metastasis. The 3-and 5-year overall survival (OS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) rates were 95% and 95%, 93% and 93%, 74% and 66%, 73% and 65%, respectively. Seven patients experienced primary lesion recurrence, 5 cases of regional lymph node recurrence and 38 cases of distant metastasis. T3-T4 stage,lymph nodes (+),stage IV, solid pathologic subtype, Ki-67≥10% and perineural invasion were associated with worse PFS and DMFS. Multivariate analysis demonstrated that only solid pathologic subtype was the independent prognostic factor of OS, LRRFS, PFS and DMFS. Conclusions The local control rate of salivary gland adenoid cystic carcinoma can be improved by postoperative intensity-modulated radiotherapy (IMRT) with a recommended dose of ≥66Gy. Solid pathologic subtype is the most important adverse prognostic factor.
		2021 Vol. 30 (8): 770-774 [Abstract] ( 123 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	775	Application of ¹⁹²Ir brachytherapy in locally recurrent non-small cell lung cancer
		Lu Hongling, Sun Yunchuan, Xiao Li, He Xinying, Bi Jianqiang, Huang Rujing;Hu Tingting, Yin Xiaoming, Guo Wei, Yang Hongjuan, Yang Wenbo, Wang Junjie
		Objective To evaluate the clinical efficacy and adverse events of ¹⁹²Ir high-dose rate brachytherapy (HDR-BT) in the treatment of locally recurrent non-small cell lung cancer (NSCLC). Methods Clinical data of 22 cases of recurrent NSCLC after radiotherapy admitted to our hospital from September 2013 to March 2018 were retrospectively analyzed. ¹⁹²Ir HDR-BT was adopted for reradiotherapy. The prescription dose was 30Gy for 1 fraction. CT scan was reviewed every 1 month in the first 3 months after treatment and every 3 months after 3 months. Local control rate and adverse events were evaluated. The 1-and 2-year overall survival (OS) rates of re-treatment after relapse were calculated. Results All the 22 patients completed the treatment successfully. The 1-, 3-and 6-month complete response (CR) rates were 9%, 14% and 14%, 82%, 82% and 82% for the partial response (PR) rates, 5%, 0% and 0% for the stable disease (SD) rates, 5%, 5% and 5% for the progressive disease (PD) rates, 91%, 96% and 96% for the Objective response rates (ORR), respectively. The 1-and 2-year OS rates of re-treatment after relapse were 59% and 27%. Five patients (23%) experienced acute radiation-induced pneumonitis (3 cases of grade 1 and 2 cases of grade Ⅱ), 4 cases (18%) of radiation-induced bone marrow suppression (3 cases of grade I leukopenia and 1 case of grade I thrombocytopenia) and 1 case of postoperative pneumothorax. All these adverse events were mitigated after symptomatic treatment.Conclusion ¹⁹²Ir HDR-BT is an efficacious and safe treatment of locally recurrent NSCLC.
		2021 Vol. 30 (8): 775-779 [Abstract] ( 144 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	780	Preliminary study of the dose of radiotherapy for patients with thoracic esophageal squamous cell carcinoma after local recurrence
		Shen Wenbin, Li Youmei, Xu Jinrui, Li Shuguang, Song Chunyang, Zhao Yan, Chen Junqiang, Zhu Shuchai
		Objective To evaluate the effects of different irradiation doses on postoperative local recurrence in patients with esophageal cancer after radio (chemo) therapy. Methods Clinical data of 331 esophageal cancer patients presenting with postoperative local recurrence admitted to our hospital from 2009 to 2014 were collected. The recurrence site, the effects of different radiotherapy doses on the prognosis of patients and the independent prognostic factors were retrospectively analyzed. The survival rate was calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox proportional hazard regression model. Results The 1-, 3-and 5-year overall survival rates were 54.3%,23.2% and 16.6%,respectively. The median overall survival was 13.4 months (95%CI:11.7-15.0). The median survival of patients with radiotherapy doses< 60Gy and ≥60Gy was 10.8 and 13.9 months (P=0.013). Stratified analysis showed that patients with age< 60 years, no smoking history, no drinking history, no family history, upper thoracic segment, left thoracotomy, N0 staging, log odds of positive lymph nodes (LODDS)< 0.030, recurrence time ≥ 13.1 months and recurrence site ≥ 2had better prognosis when receiving radiotherapy dose ≥ 60Gy (P=0.038, 0.033, 0.001, 0.003, 0.018, 0.010, 0.041, 0.039, 0.043 and 0.007). Moreover,the short-term clinical efficacy of patients treated with ≥60Gy dose was significantly better than that of those with<60Gy dose (P<0.001), which did not increase the incidence of ≥grade 2 radiation-induced gastritis (P=0.977) or radiation-induced pneumonitis (P=0.444). Cox multivariate analysis showed that the LODDS size, prescription dose and short-term efficacy were the independent factors affecting clinical prognosis of patients (P=0.006, 0.008 and<0.001). Conclusions The recommended dose for esophageal cancer patients with local recurrence after radiotherapy (chemotherapy) is greater than or equal to 60Gy. The results of this study need to be confirmed by prospective studies with a large sample size.
		2021 Vol. 30 (8): 780-785 [Abstract] ( 114 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	786	Survival after intraoperative or postoperative radiotherapy in early breast cancer:an analysis of the SEER database
		Xue Yu, Xu Xiaofan, Chen Yuqiu, Yin Xiaoling, Gu Jun
		Objective To compare the survival and prognostic factors of intraoperative radiotherapy (IORT) and postoperative radiotherapy (PORT) in female patients, aged≥50 years, diagnosed with node-negative breast cancer (≤ 3cm in size). Methods Clinical data of eligible early breast cancer patients between 2010 and 2015 were obtained from the SEER database. Patients were divided into the IORT and PORT groups according to the radiotherapy record and propensity score matching (PSM) was subsequently conducted. Kaplan-Meier curve was used to evaluate the overall survival (OS) and breast cancer-specific survival (BCSS) between two groups and Cox proportional hazard regression analysis was used to explore the risk factors of clinical prognosis. Results 7 068 patients were included after PSM. The median follow-up time was 32.0 months. The 5-year OS rates in the IORT and PORT groups were 96.8% and 93.8%, respectively. Univariate Cox analysis showed that radiotherapy, age, histological grade, T stage, estrogen receptor (ER) status and progesterone receptor (PR) status were the independent risk factors for OS, and histological grade, T stage, ER status, PR status and chemotherapy were the independent risk factors for BCSS. Multivariate Cox regression analysis demonstrated that patients who received IORT had better OS than PORT counterparts (P=0.020). Besides, patients aged≥60 years obtained worse OS than those aged<60 years (P=0.003). Patients with T2 stage or ER-negative tumors had worse OS than those with T1 stage tumors (P<0.001) or ER-positive tumors (P=0.001). Patients with grade Ⅲ-Ⅳ tumors achieved worse BCSS (P=0.004). Subgroup analysis showed that IORT yielded better OS for elderly patients (≥60 years), grade Ⅲ-Ⅳ tumors, infiltrating duct carcinoma, T2 stage tumors, ER-positive tumors, PR-positive tumors and patients without chemotherapy. Conclusions IORT may bring benefit for highly selected patients with low risk of recurrence, which is not inferior to PORT in terms of short-term survival. Prospective studies with longer follow-up time are needed to confirm the findings.
		2021 Vol. 30 (8): 786-791 [Abstract] ( 101 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	792	Relationship between gastric filling status and intra-or inter-fractional displacement of tumor in the preoperative radiotherapy of adenocarcinoma of the esophagogastric junction
		Shi Jinming, Liu Wenyang, Tang Yuan, Li Ning, Song Yongwen, Wang Shulian, Ren Hua, Liu Yueping, Fang Hui, Lu Ningning, Tang Yu, Qi Shunan, Yang Yong, Chen Bo, Li Yexiong, Jin Jing
		Objective To investigate the relationship between gastric filling status and intra-or inter-fractional tumor displacement in patients with adenocarcinoma of the esophagogastric junction (AEG) undergoing preoperative radiotherapy. Methods From October 2018 to June 2019, 10 patients with locally advanced AEG who received totally neoadjuvant therapy were enrolled in this prospective study. Patients received two markers implanted at the cranial and caudal borders of the tumors under gastroscope and a total of 20 fiducial markers were implanted finally. All patients underwent 4DCT scan under the gastric fasting and filling status. Ten images of 0% to 90% respiratory phase were automatically reconstructed by the system (Pinnacle³,version9.1,Philips Medical Systems,Eindhoven,The Netherland). Each patient obtained one hundred sets of images. Results In the tumors proximal to the chest, gastric filling did not significantly affect intrafractional or interfractional tumor displacements. Nevertheless, in the tumors distal to the chest, the interfractional displacement in the cranio-caudal (CC) direction under the gastric fasting status was significantly larger compared with that under the gastric filling status (6.22±4.67mm vs. 4.13±3.68mm,P=0.013). To ensure 95% of the prescribed dose irradiated to at least 90% of the tumor volume during the radiotherapy, the margins of tumors proximal to the chest in the left-right (LR), antero-posterior (AP) and CC directions were 9mm, 8.5mm, 12.1mm under gastric filling status with 300ml semi-fluid. Six patients diagnosed with gastric cancer with proximal thoracic fiducial markers treated by preoperative radiotherapy were included in the validation group, revealing that the fiducial markers of 93% patients were covered in this margin. Conclusion During the preoperative radiotherapy in AEG patient, the approach of quantitative gastric filling can be considered.
		2021 Vol. 30 (8): 792-796 [Abstract] ( 111 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	797	An automatic VMAT planning method for primary liver cancer radiotherapy based on predicting the feasibility DVH
		Han Fei, Xia Wenlong, Ma Pan, Ren Wenting, Chen Jiayun, Men Kuo, Chen Bo, Dai Jianrong
		Objective To establish an automatic planning method using volumetric-modulated arc therapy (VMAT) for primary liver cancer (PLC) radiotherapy based on predicting the feasibility dose-volume histogram (DVH) and evaluate its performance. Methods Ten patients with PLC were randomly chosen in this retrospective study. Pinnacle Auto-Planning was used to design the VMAT automatic plan, and the feasibility DVH curve was obtained through the PlanIQ dose prediction, and the initial optimization objectives of the automatic plan were set according to the displayed feasible objectives interval. The plans were accessed according to dosimetric parameters of the planning target volume and organs at risk as well as the monitor units. All patients′ automatic plans were compared with clinically accepted manual plans by using the paired t-test. Results There was no significant difference of the planning target volume D2%, D98%, Dmean or homogeneity index between the automatic and manual plans ((58.55±2.81) Gy vs.(57.98±4.17) Gy,(47.15±1.58) Gy vs.(47.82±1.38) Gy,(53.14±0.95) Gy vs.(53.44±1.67) Gy and 1.15±0.05 vs. 1.14±0.07, all P>0.05). The planning target volume conformity index of the manual plan was slightly higher than that of the automatic plan (0.77±0.08 vs. 0.69±0.06, P<0.05). The mean doses of normal liver, V30Gy, V20Gy, V10Gy, V5Gy and V<5Gy of the automatic plan were significantly better than those of the manual plan ((26.68±11.13)% vs.(28.00±10.95)%,(29.96±11.50)% vs.(31.89±11.51)%,(34.88±11.51)% vs.(38.66±11.67)%,(45.38±12.40)% vs.(50.74±13.56)%, and (628.52±191.80) cm³ vs.(563.15±188.39) cm³, all P<0.05). The mean doses of the small intestine, the duodenum, and the heart, as well as lung V10 of the automatic plan were significantly less than those of the manual plan ((1.83±2.17) Gy vs.(2.37±2.81) Gy,(9.15±9.36) Gy vs.(11.18±10.49) Gy,and (5.44±3.10) Gy vs.(6.25±3.26) Gy, as well as (12.70±7.08)% vs.(14.47±8.11)%, all P<0.05). Monitor units did not significantly differ between two plans ((710.67±163.72) MU vs.(707.53±155.89) MU, P>0.05). Conclusions The automatic planning method using VMAT for PLC radiotherapy based on predicting the feasibility DVH enhances the quality for PLC plans, especially in terms of normal liver sparing. Besides, it also has advantages for the protection of the intestine, whole lung and heart.
		2021 Vol. 30 (8): 797-802 [Abstract] ( 105 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	803	Study of standardizing nomenclatures for organs at risk of nasopharyngeal carcinoma via the contouring content-based image retrieval method
		Mai Xiuying, Huang Shen, Zhong Zhenfang, Zheng Wanjia, Chen Shuxian, Huang Guangsen, Zhou Su, Huang Sijuan, Xia Yunfei, Huang Xiaoyan, Yang Xin
		Objective Based on the AAPM TG-263, a Content-Based Standardizing Nomenclatures (CBSN) was proposed to explore the feasibility of its standardization verification for organs at risk (OAR) of nasopharyngeal carcinoma (NPC). Methods The radiotherapy structure files of 855 patients with nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT) from 2017 to 2019(15 of whom showed clinical anomalous structures) were retrospectively collected and processed. The Matlab self-developed software was used to obtain the image position, geometric features, first-order gray histogram, and the Gray-level Co-occurrence Matrix′s texture features of the OAR contour outlined by the doctor to establish the CBSN Location Verification model and CBSN Knowledge Library. Fisher discriminant analysis was employed to establish a CBSN OAR classification model, which was evaluated using self-validation, cross-validation, and external validation, respectively. Results 99%(69/70) of the simulated anomalous structures were outside the 90% reference range of the CBSN Knowledge Library and the characteristic parameters significantly differed among different OARs (all P<0.001). The accuracy rates of self-validation, cross-validation and external verification of the CBSN OAR classification model were 92.1%, 92.0% and 91.8%, respectively. Fourteen cases of clinical abnormal structures were successfully detected by CBSN with an accuracy rate of 93%(14/15). In the simulation test, the accuracy of the left and right location verification reached 100%, such as detecting the right eye lens named Len_L. Conclusion CBSN can be used for OAR verification of NPC, providing reference for multi-center cooperation and standardized radiotherapy of NPC patients.
		2021 Vol. 30 (8): 803-810 [Abstract] ( 101 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	811	Improving the accuracy of pencil beam dose calculation of intensity-modulated proton therapy for lung cancer patients using deep learning
		Wu Chao, Pu Yuehu, Shang Haijiao
		Objective Proton pencil beam (PB) dose calculation can achieve rapid dose calculation, whereas it is inaccurate due to the approximation in dealing with inhomogeneities. Monte Carlo (MC) dose calculation is recognized as the most accurate method, but it is extremely time consuming. The aim of this study was to apply deep-learning methods to improve the accuracy of PB dose calculation by learning the difference between the MC and PB dose distribution. Methods A model which could convert the PB dose into the MC dose in lung cancer patients treated with intensity-modulated proton therapy (IMPT) was established based on the Hierarchically Densely Connected U-Net (HD U-Net) network. PB dose and CT images were used as model input to predict the MC dose for IMPT. The beam dose and CT images of 27 non-small cell lung cancer patients were preprocessed to the same angle and normalized, and then used as model input. The accuracy of the model was evaluated by comparing the mean square error and γ passing rate (1mm/1%) results between the predicted dose and MC dose. Results The predicted dose showed good agreement with MC dose. Using the 1mm/1% criteria, the average γ passing rate (voxels receiving more than 10% of maximum MC dose) between the predicted and MC doses reached (92.8±3.4)% for the test patients. The average dose prediction time for test patients was (6.72±2.26) s. Conclusion A deep-learning model that can accurately predict the MC dose based on the PB dose and CT images is successfully developed, which can be used as an efficient and practical tool to improve the accuracy of PB dose calculation for IMPT in lung cancer patients.
		2021 Vol. 30 (8): 811-816 [Abstract] ( 124 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	817	Preliminary study of tolerance limits and action limits of IMRT plan dose verification based on AAPM-TG218 report
		Guo Wei, Mao Ronghu, Li Bing, Geng Dandan, Cheng Xiuyan, Lei Hongchang
		Objective Based on the AAPM-TG218 report, the dose verification of intensity-modulated radiotherapy (IMRT) plans were classified to understand the current status, establish the process and determine the limits of dose verification in our hospital. Methods Different combinations of tumor locations, accelerators, treatment planning systems and verification devices in our hospital were verified and compared to determine the tolerance limits and action limits of each combination. The measurement requirement was adopted according to the AAPM-TG218 report,and 80 cases were selected for each measurement. The measurement procedures were implemented based upon the AAPM-TG218 report and clinical experience of our hospital. Results The clinical action limits of IMRT plans in our hospital could meet the recommended range of the AAPM-TG218 report,and the tolerance limits were slightly lower than the AAPM-TG218 report′s recommendation (93.94% for 3%/2mm). The measurement of verification devices was related to the sensitivity. The tolerance limits measured by EPID were higher than ArcCHECK, especially when the dose/distance requirements were more stringent (94.12% and 92.03% for 3%/2mm, P=0.074;86.82% and 74.61% for 2%/2mm,P=0.017). Conclusion Through the AAPM-TG218 report, the work flow of IMRT dose verification and the limit range are established in our hospital, providing guidance for subsequent clinical dosimetric measurement.
		2021 Vol. 30 (8): 817-821 [Abstract] ( 173 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	822	Effect of inter-fractional positional uncertainty on cumulative dose of target volume in intensity-modulated radiotherapy of cervical cancer
		Ouyang Shuigen, Tao Na, Liu Tingting, Guo Qing, Cheng Jianqiang, Wei Xiyi, Tao Fali, Niu Ruijun, An Yongwei
		Objective To obtain the inter-fractional set-up errors of intensity-modulated radiotherapy (IMRT) of cervical cancer by cone-beam CT (CBCT), and to analyze the variations of the set-up errors on the cumulative dose deviation of the target volume. Methods A total of 48 patients with cervical cancer who underwent IMRT were enrolled in this study, and the set-up errors of 696 CBCTs were obtained. The set-up errors were input into the treatment planning system, and the cumulative set-up error dose was obtained by superposing the set-up errors dose. The deviation percentage was calculated by the deviation formula and the standard planning dose. Results The set-up errors caused the offset of isocenter distance by 0.58(0.36,0.80) cm. Different statistical differences were noted between the cumulative set-up error dose and the standard planning dose by WilCoxon test. All the dose deviations in the target volume were reduced, and the differential dose volume histogram (DVH) appeared negatively skewed, and the peak value was declined. The DVH diagram shifted to the left with an inverse S-curve and the slope was increased. The HIdeviation of the target volume from small to large were:CTV1,CTV2,GTV/CTV,CTV3,CTVn,CTVall,and GTVnd;The HIdeviation of the target volume were increased. Conclusions The effect of set-up errors in IMRT of cervical cancer upon the cumulative doses of the target volume significantly differs. The cumulative dose of the target volume is reduced, and the uniformity of the target volume dose becomes worse. The uncertainty of the inter-fractional position leads to an increase or decrease in the the fractional doses of the target volume. The biological effect on tumor cells and the tumor recurrence remains to be investigated. In IMRT of cervical cancer, the CBCT position calibration is required before each treatment to ensure the dose accuracy of each structure in the target volume.
		2021 Vol. 30 (8): 822-827 [Abstract] ( 136 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	828	First clinical application and dosimetric verification of total body irradiation with volumetric modulated arc therapy
		Jiang Xiaoqin, Su Baofeng, Chen Chunxiang, Xu Zhaoji, Zhang Jianwen
		Objective To investigate the implementation procedures and dosimetric verification of the first patient treated with total body irradiation (TBI) based on volumetric modulated arc therapy (VMAT). Methods Two sets of CT images were acquired under the head-in first and foot-in first to contour the planning target volume (PTV) of the cranial and caudal segments to accomplish the treatment of the whole body length, on which two interrelated plans of 5 subsequent isocenters with a total of 15 VMAT fields were performed to cover all PTVs. The plans were prescribed to ensure 90% PTV dose coverage with a total dose of 12Gy in 6 fractions. Firstly, a dose optimization was performed on the caudal CT images, then the cranial CT images were optimized based on the dose distribution of the caudal CT images. The evaluation of the final treatment plan was carried out based on a plan sum of both two sets of images. The parameters of PTV and organs at risk (OARs) were measured by dose volume histograms from the accumulated plan. The quality assurance comprised the verification of the VMAT plans for each individual isocenter via Delta4 phantom. The dose distribution in the overlapped region between two adjacent central fields was verified with EBT3 film. The absolute dose at the overlapped region between two images was measured via Pinpoint chamber. In vivo dosimetry on the patient′s skin was monitored by MOSFET dosimeters. The results of planning parameters and treatment duration were analyzed. Results The mean doses of two segments of PTVs were 12.45Gy and 12.37Gy. The mean dose for the lung was 10.8Gy. The machine unit (MU) and mean treatment delivery time were 2883 MU and 24.3min, and the mean total time per fraction was 121min. The mean 3%/3mmγ-analysis pass rate for each isocenter VMAT plan was (99.74±0.42)%, and the mean 5%/5mmγ-analysis pass rate for the overlapped region was (90.11±2.72)%. The average deviation of absolute dose in the overlap region of the caudal and cranial images was (3.6±0.4)%.In vivo measurement of 8 points on the patient showed that the dose of each region was ranged from 1.57Gy to 2.04Gy. Conclusion According to the results of dosimetric verification, TBI based on multi-isocenter VMAT can be applied in clinical practice, which remains to be improved in terms of dose distribution, measurement results and clinical efficiency.
		2021 Vol. 30 (8): 828-834 [Abstract] ( 123 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	835	Analysis of setup errors of postoperative intensity-modulated radiotherapy immobilized with integrated cervicothoracic board (mask) system in breast cancer patients
		Zhang Yanxin, Huan Fukui, Zhu Gengqiang, Zhou Ke, Feng Xin, Wan Bao, Tang Yu, Jing Hao, Wang Shulian, Dai Jianrong
		Objective To investigate the setup errors of postoperative radiotherapy immobilized with integrated cervicothoracic board (mask) system in breast cancer patients. Methods Thirty-two breast cancer patients treated with postoperative radiotherapy immobilized with integrated cervicothoracic board (mask) system were prospectively recruited in this study. Breast/chest wall (cw) and supra/infraclavicular nodal region (sc) were irradiated with intensity-modulated radiotherapy. CBCT location verification in radiotherapy and target areas of the breast/chest wall and upper and lower collarbone were carried out, respectively. The consistency between setup errors and the position of the upper and lower target areas of 239 CBCT images was analyzed. Results The translational setup errors of the breast/chest wall in the X-cw (left-right), Y-cw (superior-inferior), Z-cw (anterior-posterior) directions were (1.84±2.36)mm,(1.99±2.48) mm, and (1.75±1.86) mm, respectively. The translational setup errors of the supra/infraclavicular nodal region in the X-sc (left-right), Y-sc (superior-inferior), Z-sc (anterior-posterior) directions were (1.98±2.44) mm,(1.98±2.48) mm, and (1.71±1.79) mm, respectively. The differences of translational setup errors between the breast/chest wall and supra/infraclavicular nodal region in the X, Y, Z directions were (0.38±0.66) mm,(0.07±0.41) mm, and (0.45±0.92) mm, respectively. Conclusion For the breast cancer patients treated with postoperative radiotherapy covering breast/chest wall and supra/infraclavicular nodal region, the integrated cervicothoracic board (mask) immobilization system provides good reproducibility and yields Sfew setup errors.
		2021 Vol. 30 (8): 835-840 [Abstract] ( 108 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	841	Radiosensitivity enhancement effect of FePd@CNTs nanocomposites on MCF-7 cells
		Kong Xiangyue, Lyu Meng, Peng Xiaoqing, Xiang Yicong, Quan Hong
		Objective To evaluate the radiosensitivity enhancement effect of FePd@CNTs nanocomposites on human breast cancer MCF-7 cells. Methods FePd@CNTs nanocomposites were synthesized by chemical reduction method. Transmission electron microscope and energy dispersive spectrometer were utilized to characterize the surface morphology and chemical composition of FePd@CNTs nanocomposites. The compatibility of FePd@CNTs nanocomposites with human normal breast epithelial MCF-10A cells was determined by CCK-8 assay. The radiosensitivity enhancement effect of FePd@CNTs nanocomposites on MCF-7 cells was assessed by CCK-8 assay, flow cytometry and clony formation assay. Results FePd nanospheres were successfully modified on the surface of CNTs by chemical reduction method. FePd@CNTs nanocomposites showed a low toxicity to MCF-10A cells (IC50=738.3μg/m), and effectively enhanced the effect of X-ray radiation on MCF-7 cells (sensibilization ratio=1.22). Conclusion FePd@CNTs nanocomposites exhibit a promising potential for treating breast cancer and enhancing radiosensitivity effect.
		2021 Vol. 30 (8): 841-845 [Abstract] ( 95 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	846	Silencing lncRNA UCA1 affects radiosensitivity of glioma cells by up-regulating miR-873-5p expression
		Yuan Jinjin, Liu Zongwen, Song Rui, Liu Junqi, Fan Ruitai
		Objective To investigate the effect of lncRNA UCA1 on the radiosensitivity of in vitro cultured glioma cell lines SHG-44, U87 and U251 by regulating the miR-873-5p expression. Methods The survival of glioma cells SHG-44, U87 and U251 treated with different radiation intensities (0, 2, 4, 6 and 8Gy) was detected by colony formation assay. The expression levels of UCA1 in glioma cells SHG-44, U87 and U251 were measured by qRT-PCR. The radiation-resistant glioma cells U87 and U251 were selected for subsequent study. After silencing UCA1 expression and/or over-expressing miR-873-5p, the cell survival rate was detected by colony formation assay, and the cell apoptosis rate was determined by flow cytometry. The dual luciferase reporter gene assay and qRT-PCR were employed to verify the targeting relationship between UCA1 and miR-873-5p. Results UCA1 was up-regulated in the radiation-resistant U87 and U251 cells. Silencing UCA1 or over-expressing miR-873-5p inhibited the survival of U87 and U251 cells, and promoted the cell apoptosis induced by radiation exposure. miR-873-5p was a target gene of UCA1, and UCA1 negatively regulated the expression of miR-873-5p. The inhibition of miR-873-5p could reverse the effect of silencing UCA1 on the radiosensitivity of glioma cells. Silencing UCA1 increased the inhibitory effect of radiation on the glioma cell U251 xenografts. Conclusion Silencing UCA1 inhibits the survival of glioma cells and promotes the cell apoptosis by up-regulating the expression of miR-873-5p, thereby increasing the radiosensitivity of glioma cells.
		2021 Vol. 30 (8): 846-852 [Abstract] ( 100 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	853	Research progress on prediction methods for esophageal cancer response to neoadjuvant chemoradiotherapy
		Li Yue, Yu Wen, Fu Xiaolong
		The incidence of esophageal cancer ranks third among all malignant tumors in China. Neoadjuvant chemoradiotherapy followed by radical surgery is the standard treatment for locally advanced esophageal cancer. Whether the tumor lesions can achieve complete pathological remission after neoadjuvant chemoradiotherapy provide profound guidance for subsequent treatment. In this article, research progresses on the application of pathological, radiological and biological approaches to evaluate and predict the tumor response to neoadjuvant chemoradiotherapy were reviewed.
		2021 Vol. 30 (8): 853-857 [Abstract] ( 109 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	858	Research progress on multimodality treatment for primary tracheal adenoid cystic carcinoma
		Qu Guofeng, Ran Juntao
		Primary tracheal adenoid cystic carcinoma (TACC) is exceedingly rare. Surgical resection is the main treatment for TACC. Whether the operation is radical or not is a key prognostic factor. Postoperative radiotherapy may be suitable to improve the local control rate and long-term survival for patients with positive surgical margin. For unresectable, recurrent and metastatic TACC patients, definitive radiotherapy, chemotherapy and molecular targeted therapies have yielded certain clinical efficacy. The aim of this review is to summarize the research progress on multimodality treatment for TACC.
		2021 Vol. 30 (8): 858-861 [Abstract] ( 90 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	862	Research progress on tumor hyperthermia
		Zhao Yanyan, Xu Yasi, Wu Qiong, Ma Shenglin, Zhang Shirong
		In recent years, increasing evidence has shown that hyperthermia is safe, effective and causes low toxicity. Hyperthermia can exert synergistic effect with other treatments, such as radiotherapy and chemotherapy. It has become an important adjuvant anti-tumor treatment secondary to surgery, chemotherapy, radiotherapy and biological treatment. Hyperthermia can improve the efficacy of radiotherapy and chemotherapy by directly inhibiting tumor cells and heat-induced radiosensitizing effect. Hence, hyperthermia is gradually applied in the multimodality treatment of tumors. In this article, we intend to review the research progress on the application of tumor hyperthermia in conventional radiotherapy, chemotherapy, immunotherapy and new biomaterials.
		2021 Vol. 30 (8): 862-866 [Abstract] ( 112 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	867	Basic research progress on the combination of heavy ion beam and immunotherapy in the treatment of malignant neoplasm
		Geng Yichao, Zhang Qiuning, Lu Bing, Wang Xiaohu
		In recent years,heavy ion beams have received great attention in the field of malignant tumor radiotherapy due to their radiation physics and biological characteristics. The high rate of local tumor control is one of its advantages, but the control rate of metastatic lesions is still crucial in the treatment of most malignant tumors. Clinical studies on the combined conventional radiotherapy and immunotherapy suggest that the combination of the two can not only control the primary lesions, but may also reduce or completely eliminate distant metastatic lesions. High linear energy transfer radiation, especially heavy ion beams, may have stronger potential in combined immunotherapy. Therefore, this article focuses on the basic research progress of heavy ion beams regulating anti-tumor immune effects and their combined application with immunotherapy.
		2021 Vol. 30 (8): 867-870 [Abstract] ( 130 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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Cancer Hospital of Chinese
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