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.10 Published 2021-10-15

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

Guidelines

	989	Radiotherapy guidelines for gastric cancer in China (2020ed)
		Radiooncologist Branch of Chinese Medical Doctor Association, Radiation Oncology Therapy Branch of the Chinese Medical Society, Cancer Radiotherapy Professional Committee of China Anti-Cancer Association
		Gastric cancer is one of the most common malignant tumors in China, and most of the patients are in the advanced stage when diagnosed. Radiotherapy plays an important role in the multidisciplinary treatment strategy. The panel of this guideline for gastric cancer in China included 34 experts from 22 leading hospitals and from treatment related departments as radiation oncology, surgical oncology, medical oncology and radiology. As the first guideline of radiotherapy for gastric cancer in China, it will provide important basis and reference for radiotherapy and comprehensive treatment of gastric cancer in China. Its continuous improvement and update in clinical practice will benefit the majority of gastric cancer patients and promote the development in this field.
		2021 Vol. 30 (10): 989-1001 [Abstract] ( 151 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	1002	Clinical efficacy of hypofractionated radiotherapy for patients with locally advanced or advanced non-small cell lung cancer
		Zhang Jiajia, Cao Yipeng, Chen Siying, Wang Jun, Zhao Lujun, Wang Ping, Liu Ningbo
		Objective To evaluate the survival outcome and toxicity of hypofractionated radiotherapy (45Gy/15f) in patients with locally advanced/advanced non-small cell lung cancer (NSCLC) who are ineligible for conventional fractionated radiotherapy. Methods The early efficacy, survival and toxicity of inoperable patients (n=64) with locally advanced/advanced NSCLC patients admitted to Cancer Hospital of Tianjin Medical University from 2014 to 2018 were retrospectively analyzed. Hypofractionated radiotherapy (45Gy/15f) were performed by using intensity-modulated radiotherapy or volumetric-modulated arc therapy technologies on Pinnacle 9 planning system. Results The median follow-up time was 26 months. The early efficacy was available in 58 patients:complete response for 2 cases (3%), partial response for 22(38%), stable disease for 28(44%) and progressive disease for 6(9%), respectively. The local control rate was 90%. The median time to progression (TTP) and the median overall survival (OS) for all patients was 8.2 months and 21.0 months, respectively. The 1-, 2-and 3-year TTP rate was 37%, 28%, 14% and the OS rate was 66%, 43% and 27%, respectively. The incidence of esophagitis was 17%(n=11), 19%(n=12) for radiation pneumonitis and 20%(n=13) for myelosuppression. No grade ≥3 esophagitis or pneumonia was found. Conclusion Hypofractionated radiotherapy (45Gy/15f) is efficacious and safe for patients with locally advanced/advanced NSCLC, which yields controllable adverse events.
		2021 Vol. 30 (10): 1002-1006 [Abstract] ( 121 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1007	Cohort study of changes in expression of three serum cytokines in patients with advanced non-small cell lung cancer after intensity-modulated radiotherapy combined with chemotherapy
		Tian Hanhan, Zhou Xilei, Chen Wei, Yu Changhua
		Objective To investigate the changes of the expression levels of serum proliferating cell nuclear antigen (PCNA), tumor-specific growth factor (TSGF), soluble E-cadherin (SE-CAD) and the relationship with clinical prognosis of advanced non-small cell lung cancer (NSCLC) patients treated with intensity-modulated radiotherapy combined with chemotherapy. Methods Eighty-four patients (29 cases of ⅢA, 30 ⅢB and 25 Ⅳ) with advanced NSCLC treated in our hospital from January 2016 to January 2018 were selected, and all patients were given with intensity-modulated radiotherapy combined with chemotherapy. The expression levels of serum PCNA, TSGF, and SE-CAD were compared among different TNM stages and before and after treatment. The serum PCNA, TSGF, SE-CAD levels were compared among patients with different clinical efficacy. The relationship between serum PCNA, TSGF and SE-CAD levels and clinical efficacy was assessed by Logistic regression analysis. The survival analysis was performed with Kaplan-Meier method. Results The expression levels of serum PCNA, TSGF and SE-CAD before treatment in stage Ⅳ patients were significantly higher than those in stage ⅢB and ⅢA patients (584.11±60.25 pg/ml vs. 531.06±51.37 pg/ml and 477.54±46.49 pg/ml, 96.13±7.54 U/ml vs. 8.52±5.91 U/ml and 82.41±5.0 U/ml, 3.02±0.26 ng/ml vs. 2.87±0.22 ng/ml and 2.71±0.15 ng/ml, all P<0.05), and the serum levels of three cytokines in ⅢB stage patients were significantly higher than those in their ⅢA stage counterparts (all P<0.05). After treatment, the serum levels of PCNA, TSGF and SE-CAD were significantly lower than those before treatment (396.11±50.23 pg/ml vs. 528.37±75.09 pg/ml, 74.81±4.72 U/ml vs. 88.68±6.13 U/ml, 1.92±0.24 ng/ml vs.2.86±0.31 ng/ml, all P<0.05). At 18 months after treatment, the serum levels of PCNA, TSGF and SE-CAD in surviving patients were significantly lower than those of dead patients (332.51±54.32 pg/ml vs. 444.92±60.07 pg/ml, 70.59±6.20 U/ml vs. 78.05±8.44 U/ml, 1.71±0.24 ng/ml vs. 2.08±0.27 ng/ml, all P<0.05). The serum levels of PCNA, TSGF and SE-CAD were significantly associated with clinical prognosis (all P<0.05). Among 84 NSCLC patients, the >Objective response rate after treatment was 29%(24/84). The survival curves in patients with high expression levels of serum PCNA, TSGF and SE-CAD were significantly lower than those in the low-expression group (all P<0.05). Conclusion Serum PCNA, TSGF and SE-CAD are highly expressed in patients with advanced NSCLC, which are closely correlated with clinical staging and prognosis and contribute to predicting survival status.
		2021 Vol. 30 (10): 1007-1012 [Abstract] ( 106 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1013	Preliminary analysis of the benefit groups of patients with locoregional recurrence of esophageal squamous cell carcinoma who received different patterns of irradiation
		Shen Wenbin, Gao Hongmei, Xu Jinrui, Li Shuguang, Li Youmei, Zhu Shuchai
		Objective To explore the benefit groups of patients with locoregional recurrence of esophageal thoracic squamous cell carcinoma who received radiotherapy or chemoradiotherapy with different patterns of irradiation. Methods Clinical data of 344 esophageal thoracic squamous cell carcinoma patients with postoperative recurrence who received intensity conformal radiotherapy or concurrent chemoradiotherapy in the Fourth Hospital of Hebei Medical University from 2009 to 2014 were retrospectively analyzed. The distribution of recurrence sites and prognostic factors were analyzed. A stratified analysis was carried out on the benefit groups of patients receiving the elective nodal irradiation (ENI) and involved field irradiation (IFI). Results 276 cases (80.2%) recurred at a single site and 68 cases (19.8%) recurred at more than two sites. The follow-up rate was 96.2%. The 1-, 3-and 5-year overall survival rates were 53.6%, 22.6% and 16.4%, respectively, with a median of 12.8 months (95%CI:11.3-14.3 months). The 1-, 3-and 5-year local recurrence-free survival rates were 46.5%, 16.9% and 12.0%, respectively, with a median of 11.0 months (95%CI:9.6-12.4 months). The 1-, 3-and 5-year progression-free survival rates were 39.8%, 11.3% and 6.7%, respectively, with a median of 7.9 months (95%CI:5.8-10.0 months). Multivariate analysis showed that gender, the log odds of metastatic lymph nodes (LODDS) and the number of chemotherapy cycles were the independent prognostic factors (P=0.003,<0.001,<0.001). Subgroup univariate analysis demonstrated that patients with an esophageal lesion length<5.0cm,N0stage, the number of surgically-dissected lymph nodes of ≤9,the number of postoperative positive lymph node metastasis site of 0, and LODDS≤0.030 obtained benefits from ENI (P=0.032,0.012,0.001,0.012 and 0.014). Patients with the number of surgically-dissected lymph nodes of ≥16 achieved benefits from IFI (P=0.035). Conclusions Radiotherapy is an effective treatment mode for patients with local recurrence after esophageal cancer surgery. For patients with preoperative esophagography showing shorter esophageal lesions, earlier postoperative pathological N stage, lower LODDS score, and fewer surgically-dissected lymph nodes probably obtain more benefits from ENI than IFI. However, patients with more surgically-dissected lymph nodes may obtain more benefit from IFI compared with ENI.
		2021 Vol. 30 (10): 1013-1018 [Abstract] ( 107 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1019	Value of CT radiomics for prediction of pathological response to neoadjuvant chemoradiotherapy in esophageal cancer
		Zhu Xiang, Zhu Chaonan, Zeng Jian, Sun Xiaojiang, Lin Qingren, Fang Jun, Chen Ming, Ji Yongling
		Objective To establish a radiomics-based biomarker for predicting pathological response after preoperative neoadjuvant chemoradiotherapy (nCRT) in locally advanced esophageal cancer. Methods From 2008 to 2018,112 patients with locally advanced esophageal cancer who received nCRT were enrolled. All patients were treated with preoperative nCRT combined with surgery. Enhanced CT images and clinical information before nCRT were collected. A lesion volume of interest was manually delineated. In total, 670 radiomics features (including tumor intensity, shape and size, texture and wavelet characteristics) were extracted using the pyradiomics package in PYTHON. The stepwise regression combined with the best subset were employed to select the features, and finally the Logistic regression model was adopted to establish the prediction model. The performance of the classifier was evaluated by the area under the ROC curve (AUC). Results The pathological complete remission (pCR) rate was 58.0%(65/112). 10 radiomics features were included in the final model, The most relevant radiomics feature was the gray feature (the texture information of the image), followed by the shape and voxel intensity-related features. In the training set, the AUC was 0.750 with a sensitivity of 0.711 and a specificity of 0.778, the corresponding values in the testing set were 0.870, 0.757 and 0.900, respectively. Conclusions Models based on radiomics features from CT images can be utilized to predict the pathological response to nCRT in esophageal cancer. As it is efficient, non-invasive and economic model, it could serve as a promising tool for individualized treatment when validated by further prospective trials in the future.
		2021 Vol. 30 (10): 1019-1024 [Abstract] ( 120 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	1025	Total neoadjuvant therapy for locally advanced gastric cancer:an interim study of phase Ⅱ clinical trial
		Shi Jinming, Li Ning, Zhao Dongbing, Jiang Liming, Yang Lin, Ren Hua, Wang Shulian, Song Yongwen, Liu Yueping, Fang Hui, Yang Yong, Lu Ningning, Tang Yu, Qi Shunan, Chen Bo, Jing Hao, Li Yexiong, Tang Yuan, Jin Jing
		Objective To evaluate the safety and preliminary efficacy of total neoadjuvant therapy (TNT) model of"neoadjuvant chemoradiotherapy plus consolidation neoadjuvant chemotherapy (CNCT) followed by surgery" for locally advanced gastric cancer. Methods From 2018 to 2020, 28 patients clinically diagnosed with locally advanced gastric adenocarcinoma or Siewert Ⅱ/Ⅲ adenocarcinoma gastroesophageal junction cancer were prospectively enrolled. The neoadjuvant chemoradiotherapy (NCRT) was delivered with a total dose of 45Gy,1.8Gy/f. Concurrent chemotherapy was S-1 at a dose of 40-60mg twice daily. Then, patients received four to six cycles of CNCT of SOX regimen at three weeks after neoadjuvant chemoradiotherapy. D2 lymphadenectomy was performed at 4-6 weeks after CNCT. Results A total of 28 patients completed the whole therapy. Grade 3 or above adverse events occurred in 3 cases (11%) during CCRT, including thrombocytopenia, leukopenia and anorexia;2 cases (7%) developed leukopenia and 3 cases (11%) of thrombocytopenia during CNCT. Twenty patients (71%) completed the surgery. The proportion of patients with pathological complete remission (pCR) was 50%. Three patients experienced surgical complications including anastomotic leak, anastomotic stenosis and intra-abdominal sepsis. All were recovered after symptomatic treatment. Conclusion Interim analysis results demonstrate that TNT can yield significant down-staging for patients with locally advanced gastric cancer, which causes tolerable adverse events and postoperative complications.
		2021 Vol. 30 (10): 1025-1029 [Abstract] ( 122 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1030	Radiotherapy and prognostic analysis of breast cancer patients with isolated regional recurrence after mastectomy
		Zhao Xuran, Xuan Liang, Yin Jun, Tang Yu, Sun Huiru, Wu Shikai, Jing Hao, Fang Hui, Song Yongwen, Jin Jing, Liu Yueping, Ren Hua, Chen Bo, Qi Shunan, Li Ning, Tang Yuan, Lu Ningning, Yang Yong, Li Yexiong, Sun Bing, Wang Shulian
		Objective To analyze the prognosis of patients with isolated regional recurrence (RR) after mastectomy, and evaluate the efficacy of radiotherapy and identify the optimal radiation target volumes. Methods Clinical data of 144 patients with first isolated RR after mastectomy between 2001 and 2018 were retrospectively analyzed. All patients had not received post-mastectomy radiotherapy. The primary endpoints consisted of the subsequent locoregional recurrence (sLRR), distant metastasis (DM), progression-free survival (PFS) and overall survival (OS). Results With a median follow-up of 82.5 months after RR, the 5-year sLRR, DM, PFS and OS rates for the entire group were 42.1%, 71.9%, 22.9% and 62.6%, respectively. Local plus systemic therapy was an independent favorable prognostic factor for sLRR (P<0.001) and PFS (P=0.013). The sLRR rate in the surgery plus radiotherapy group was the lowest (P<0.001). Surgery plus radiotherapy significantly reduced the 5-year risk of recurrence within the initially involved nodal regions (P<0.001). Patients with chest wall irradiation obtained the 5-year subsequent chest wall recurrence rate of 12.1% compared to 14.8%(P=0.873) for those without chest wall irradiation. The subsequent supraclavicular recurrence rate was lower in patients with prophylactic supraclavicular irradiation than that without prophylactic supraclavicular irradiation (9.9% vs. 23.8%, P=0.206). The incidence rates of initially uninvolved axillary and internal mammary nodal recurrence were below 10% regardless of prophylactic irradiation or not. Conclusions Patients with RR alone have an optimistic 5-year OS in the contemporary era. Comprehensive locoregional treatment including surgery and radiotherapy combined with systemic therapy is recommended. The chest wall, axillary and internal mammary nodal prophylactic irradiation should not be routinely performed for all patients with RR. The value of supraclavicular prophylactic irradiation remains to be evaluated.
		2021 Vol. 30 (10): 1030-1035 [Abstract] ( 100 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1036	Clinical application of 3D template-assisted brachytherapy in para-iliac lymph node metastasis
		Lu Hongling, Sun Yunchuan, Xiao Li, Yin Xiaoming, Guo Wei, Yang Hongjuan, Zhou Jianxi
		Objective To preliminarily evaluate the safety and efficacy of 3D printing template-assisted brachytherapy in the treatment of solitary metastatic lymph nodes adjacent to iliac vessels. Methods Clinical data of 12 cases of para-iliac lymph node metastasis after radiotherapy admitted to our hospital from October 2018 to April 2020 were retrospectively analyzed. All patients received 3D printing template-assisted brachytherapy at a prescription dose of 20-30Gy/fraction. CT scan was reviewed every 1 month in the first 3 months after treatment and every 3 months at 3 months after treatment.Local control rate, symptom relief rate and adverse events were evaluated. Results All the 12 patients successfully completed the treatment and follow-up. At 1,3 and 6 months after 3D printing template-assisted brachytherapy, 2, 2 and 3 patients obtained complete remission of lymph nodes, 9, 8 and 8 cases of partial remission, 1 case of stable disease and no case of disease progression. The symptoms were relieved in 10 patients. Acute radiation enteritis occurred in 2 patients and myelosuppression in 2 patients, which were mitigated after symptomatic treatment. Conclusion 3D printing template-assisted brachytherapy may be an efficacious and safe treatment of para-iliac lymph node metastasis, which yields tolerable adverse events.
		2021 Vol. 30 (10): 1036-1040 [Abstract] ( 90 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1041	Prediction model of local effect model-based rectal dose volume histogram in prostate cancer patients treated with carbon ion radiotherapy
		Yang Yifeng, Wang Weiwei, Li Ping, Zhao Jingfang, Zhang Qing
		Objective To establish a local effect model (LEM)-based rectal dose volume histogram (DVH) prediction model in prostate cancer patients treated with carbon ion therapy based on Japanese experience, aiming to provide reference for clinically reducing the incidence of rectal adverse reactions. Methods The planning CT data of 76 patients with prostate cancer were collected. The microdosimetric kinetic model (MKM) was used for initial planning, and the LEM was selected to recalculate the biological dose based on the same fields to MKM. Then, the geometric features and DVH of the rectum were extracted from the LEM plans. The planning data of 61 cases were used to establish the prediction model with linear regression and the other 15 cases were used for validation. Results The ratio of the overlapped volume between the rectum and the region of interest (ROI) expended from planning target volume by 1cm along the left and right directions of the rectum could be proved to be the characteristic parameters for linear regression. The mean goodness-of-fit R² of predicted and LEM plan-based DVH of 15 cases was 0.964. The results of predicted rectal adverse reactions based on predicted DVH were consistent with those of LEM plan-based DVH. Conclusions The linear regression method used in this study can establish an accurate prediction model of rectal DVH, which may provide certain reference for reducing the incidence of rectal adverse reactions. Nevertheless, the findings remain to be further verified by clinical trials with larger sample size.
		2021 Vol. 30 (10): 1041-1046 [Abstract] ( 119 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	1047	Study of sub-region segmentation of brain metastases based on magnetic resonance perfusion imaging
		Hou Chuanke, Gong Guanzhong, Wang Lizhen, Su Ya, Lu Jie, Yin Yong
		Objective To evaluate the feasibility of magnetic resonance (MR) perfusion imaging for sub-region segmentation of brain metastases (BMs), and to provide reference for individualized radiotherapy based on blood flow perfusion heterogeneity in BMs patients. Methods 96 BMs patients were selected, including 55 patients with necrosis and 41 without necrosis. Each patient was scanned with CT simulation and MR simulation before radiotherapy. MIM Maestro 6.8.8software was used to delineate the gross tumor volume (GTV) and necrosis GTV (GTVN) from enhanced T1W images and T2 Propeller images, respectively, and the solid GTV (GTVS) was obtained by the subtraction of the two. Then, the cerebral blood flow map of three dimensional arterial spin labeling (3D-ASL) was employed to determine the high perfused GTV (GTVH) and low perfused GTV (GTVL). The volume and proportion of sub-regions were counted and compared between two groups and the correlation of each sub-region was analyzed. Results The volume of GTV in the necrosis and non-necrosis groups was 19.56 and 7.34cm³, respectively. Besides, the AUC of the ROC between GTV volume and necrosis was 0.749. In the necrosis group, the ratio of GTVN, GTVS, GTVH and GTVL to GTV was 20.47%, 79.53%, 33.03% and 46.50%, respectively (all P<0.05). Among them, the r value between GTVS and GTV was 0.963, 0.849 for GTVL and GTV, and 0.840 for GTVL and GTVS, significantly higher than 0.683 for GTVH and GTV and 0.764 for GTVH and GTVS (all P<0.05). In the non-necrosis group, the ratio of GTVH to GTV was higher than that in the necrosis group (58.95% vs. 33.03%, P<0.05). In addition, the ratio of GTVL to GTV was slightly lower than that in the necrosis group (41.05% vs. 46.50%, P>0.05). The r value between GTVH and GTV was 0.776, significantly higher than 0.574 between GTVL and GTV (P<0.05). Conclusion MR-3D-ASL can quantitatively analyze the heterogeneous blood perfusion of BMs, which could guide the sub-region segmentation and local dose escalation of tumors.
		2021 Vol. 30 (10): 1047-1053 [Abstract] ( 100 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1054	Analysis of the influence of tracking error of Xsight lung tracking system caused by cardiac beating
		Xiao Feng, Chang Yu, Quan Hong, Yang Zhiyong
		Objective To analyze the influence of tracking error of Xsight lung tracking system caused by cardiac beating. Methods 48 patients with lung tumors adjacent to the heart were enrolled into this study. The tumor movement curves were collected by the Xsight lung tracking system and recorded in the treatment log files during the Cyberknife treatment process. The curves were subject to filtering analysis and the respiratory motion of < 1Hz and the cardiac beating motion of > 1Hz were separated. According to the filtering results, the patient treatment tracking data were divided into two groups based on whether the cardiac beating wave of >1Hz existed. The tracking errors were statistically compared between two groups based on the X-ray imaging data collected by Xsight lung tracking system during treatment. Results For the fractionation with cardiac beat information, the tracking errors of the patient′s related models were (1.45 ± 0.99),(0.46 ± 0.21) and (0.70 ± 0.54)mm in the left-right, superior-inferior and anterior-posterior direction, respectively. For the fractionation without cardiac beat information, the tracking errors of the patient′s related models were (1.52 ± 1.17),(0.63 ± 0.37) and (1.07 ± 0.62)mm in the left-right, superior-inferior and anterior-posterior direction, respectively. The tracking errors in the superior-inferior and anterior-posterior direction of patients with accurate cardiac beat models were 28.34% and 34.86% less than those of their counterparts without accurate cardiac beat models and there was significant difference (both P<0.05). Conclusion The tracking accuracy of Xsight lung tracking system will be significantly improved if the cardiac beat model is accurately established.
		2021 Vol. 30 (10): 1054-1058 [Abstract] ( 107 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1059	Study of setup error and dosimetry of postoperative intensity-modulated radiotherapy for breast cancer using skin lead marker and iSCOUT image-guided positioning system
		Dong Fangfen, Dai Liyan, Huang Miaoyun, Weng Xing, Jiang Liuqing, Xu Benhua, Li Xiaobo
		Objective To explore the application value of skin lead marker combined with iSCOUT image-guided positioning system in monitoring and correcting the setup error of intensity-modulated radiotherapy (IMRT) for breast cancer and calculate the PTV margin, aiming to provide reference for clinical practice. Methods 25 breast cancer patients treated with IMRT after modified radical mastectomy in Fujian Medical University Union Hospital from April to August 2019 were enrolled in this study. The skin lead marker combined with iSCOUT image-guided positioning system was employed for image-guided positioning based on the gold standard registration algorithm. Initial setup errors on the x (lateral), y (craniocaudal) and z (anteroposterior) axis and residual errors after the position correction were recorded and analyzed. The effect of the errors before and after image-guided correction upon the plan dose was compared and the reasonable PTV margin was calculated. Results 25 patients received 150 times of positioning verification using skin lead marker combined with iSCOUT image-guided positioning system. The absolute residual errors on the x-, y-and z-axis were (1.53±0.96),(1.30±0.99) and (1.34±0.92)mm, significantly smaller than the initial setup errors of (2.63±2.12),(2.41±2.45) and (3.07±2.77)mm (all P<0.001). The percentage of dose deviation due to residual errors was also smaller than that of the initial errors. Significant differences were observed in D98%, D2%, Dmax of PTV, Dmax of the heart, Dmax of the healthy breast, and Dmean of the affected lung and both lungs. The percentage deviation from the original plan was decreased from 2.18%, 3.19%, 10.66%, 8.75%, 48.21%, 10.50%, and 3.66% to 0.38%, 0.23%, 2.31%, 0.04%, 13.78%, 6.35% and 0.41%, respectively (all P<0.05). PTV margins on the x-, y-and z-axis after correction were calculated as 1.87, 1.75 and 1.69mm, respectively. Conclusion It is feasible and valuable to apply the skin lead marker combined with iSCOUT image-guided positioning system in the positioning verification and correction of breast cancer radiotherapy position, providing novel reference for clinical PTV margin.
		2021 Vol. 30 (10): 1059-1064 [Abstract] ( 127 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1065	Preliminary study of physical model test and clinical application based on EPID-based in-vivo dose verification system
		Mao Ronghu, Guo Wei, Li Bing, Zhang Yong, Wang Qingjie, Cheng Xiuyan, Ge Hong, Lei Hongchang
		Objective To validate the accuracy of physical model of in-vivo 3D dose verification based on electronic portal imaging device (EPID) using the phantom and preliminarily analyze the clinical application. Methods Two phantoms (uniform and non-uniform phantoms) were involved in this study. The system of in-vivo 3D dose verification based on EPID was employed to acquire the images of square fields (SF) and combined fields of intensity-modulated radiotherapy (CFIMRT). The physical model of different media was constructed using the system. The factor of γ passing rate under different dose/distance criteria was statistically compared. For clinical cases, the dose-volume histograms were adopted to analyze the dose distribution of target volume and organs at risk (OARs). Results For the SF in the uniform phantom, the average γ passing rate (3%/3mm) was (97.49±1.11)%, and (94.06±5.11)% for the SF in the non-uniform phantom (P>0.05). No statistical significance was noted in IMRT using different delivery methods (all P>0.05). For clinical cases, the average γ passing rate (3%/2mm) was (97.96±1.84)% in the pre-treatment dose verification, and (90.51±6.96)%(3%/3mm) for the in-vivo 3D dose verification. For clinical cases, significant dose deviation was observed in OARs with small size and large volume changes. Conclusion The in-vivo 3D dose verification model based on EPID can be effectively applied in inter-fraction dose verification, providing technical support for adaptive radiotherapy in clinical practice.
		2021 Vol. 30 (10): 1065-1070 [Abstract] ( 110 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1071	Effect of FAM83D silencing on radiosensitivity of esophageal squamous cell carcinoma cells by mediating epithelial-mesenchymaltransition
		Yang Xingxiao, Zou Naiyi, Zhang Xueyuan, Ma Ming, Zhu Shuchai
		Objective To examine the effect of FAM83D knockdown on proliferation, survival ability and invasion of human esophageal squamous cell carcinoma after X-ray radiation, and explore the mechanism. Methods The expression of FAM83D, E-cadherin and vimentin in tumor tissues was detected in 69 cases of esophageal squamous cell cancer by using immunohistochemical method. The siRNA based on the sequences of the FAM83D mRNA were synthesized to transfect into the cultured ECA109 cells as FAM83D shRNA group. The effect of silencing FAM83D gene was evaluated to determine the protein levels of FAM83D in the human oesophageal squamous cell carcinoma ECA109 and KYSE30 cells using western blotting. MTS, clone formation, and Transwell assay were employed to examine the proliferation, survival ability and invasion of ECA109 and KYSE30 cells in vitro, respectively. We used flow cytometry assay to analyze distribution of cell apoptosis in different groups. Western blotting was used to examine the expression of cell metastasis-related molecules and apoptosis-related protein. Results The strong expression rates of FAM83D, E-cadherin, and vimentin were 55%(38/69), 36%(25/69) and 61%(42/69) in the tumor tissues, respectively. FAM83D protein expression was significantly and negatively correlated with the expression of E-cadherin (r=-0.350, P<0.01), and positively with the expression of vimentin (r=0.470,P<0.01). Western blotting results demonstrated that silencing FAM83D gene significantly reduced the FAM83D protein expression (P<0.01). MTS data demonstrated that FAM83D knockdown after irradiation significantly inhibited the proliferation of esophageal squamous cell carcinoma ECA109 and KYSE30 cells (P<0.05). The data from the clone formation assay revealed that the radiosensitivity was increased after downragulation of FAM83D expression (P<0.01). In addition, the invasive abilities of oesophageal carcinoma cells transfected with FAM83D shRNA after irradiation were significantly inhibited compared with those of the NC group (P<0.01), followed by the downregulation of N-cadherin, vimentin, Snail, p-Akt and p-GSK-3β expression, and the upregulation of E-cadherin expression (P<0.01). The apoptosis rate of tumor cells in FAM83D shRNA group after irradiation was markedly increased (P<0.01), followed by a decrease of Bcl-2 and Mcl-1 expression and an increase of Cleaved caspase-3 expression (P<0.01). Conclusions FAM83D expressions was found to be closely related to the invasion and development of ESCC. Furthermore, siRNA interference technology inhibited the expression of FAM83D gene in oesophageal squamous cell carcinoma cells, reduced the proliferation, invasion of cells, induced cell apoptosis, and increased radiosensitivity, which may be associated with regulating the epithelial-mesenchymaltransition via Snail/Akt/GSK-3β signaling pathways.
		2021 Vol. 30 (10): 1071-1077 [Abstract] ( 106 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1078	Role of miR-133a in radiation-induced cardiac injury in mice
		Yan Rui, Song Jianbo, Guo Min, Cai Honghong, Xu Xianhai, Zhang Yarong, Yu Yang, Li Sijin
		Objective To investigate the regulatory role of microRNA in radiation-induced heart disease (RIHD) in mice and provide a new strategy for its treatment. Methods Based on the Gene Expression Omnibus database (GSE147241), which includes normal heart tissue and irradiation heart tissue, we conducted bioinformatics research and analysis to determine the differentially-expressed genes. Then, thirty male C57/BL6 mice were randomly divided into the control group, irradiation group and miR-133a overexpression intervention group. The heart received single dose of X-ray 20Gy in the irradiation group and miR-133a overexpression intervention group, but not in the control group, and then fed for 16 weeks. Cardiac function was assessed by echocardiography. Myocardial fibrosis was detected by Masson staining. The expression levels of miR-133a, CTGF, COL-1 and COL-3 mRNA were detected by qRT-PCR. The expression levels of CTGF, COL-1 and COL-3 proteins were detected by western blot. Results miR-133a was the differentially-expressed gene between the irradiation and control groups. Overexpression of miR-133a could mitigate the decrease in cardiac function and increase in myocardial collagen content (P<0.01). Meantime, overexpression of miR-133a could down-regulate the expression levels of CTGF, COL-1, COL-3 mRNA and protein (P<0.01). Conclusions Radiation increases the synthesis of collagen and leads to myocardial fibrosis remodeling. Overexpression of miR-133a can alleviate the radiation-induced myocardial fibrosis.
		2021 Vol. 30 (10): 1078-1083 [Abstract] ( 173 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	1084	Research progress on radiotherapy combined with chemotherapy for locally advanced nasopharyngeal carcinoma
		Wu Yanling, Chen Yupei, Ma Jun
		Nasopharyngeal carcinoma (NPC) is one of the common head and neck malignant tumors. Radiotherapy is the main treatment for NPC. The comprehensive application of chemotherapy strategies (induction, concurrent and adjuvant) in radiotherapy has improved the efficacy in the treatment of locally advanced NPC. Based on current evidence, concurrent chemoradiotherapy combined with adjuvant or induction chemotherapy has been recommended as the standard treatment for locally advanced NPC. However, there are still many deficiencies in the standard treatment, and the application of induction and adjuvant chemotherapy remains controversial. Establishing a more ideal and individualized chemoradiotherapy for locally advanced NPC is still the research direction in the future.
		2021 Vol. 30 (10): 1084-1088 [Abstract] ( 115 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1089	Research progress on postoperative application of vaginal brachytherapy in patients with early endometrial carcinoma
		Qin Xue, Yan Junfang, Yang Bo, Hou Xiaorong, Yu Lang, Qiu Jie
		Radiation therapy plays an important role in the adjuvant treatment of patients with early endometrial carcinoma. Vaginal stump is a common site of disease failure for early endometrial carcinoma patients with intermediate-high risk factors for recurrence. Compared with external beam radiotherapy, vaginal brachytherapy (VBT) can achieve comparable local control rate with fewer toxicities. In this article, research progresses upon the application of VBT in patients with early endometrial carcinoma after hysterectomy were investigated from multiple perspectives of the selection of patients, the selection of vaginal applicator, factors influencing dose distribution, image-guided adaptive brachytherapy, the design and implementation of radiotherapy regime. In addition, the application of intensity-modulated VBT and the usage of novel quality assurance equipment were also discussed.
		2021 Vol. 30 (10): 1089-1093 [Abstract] ( 134 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1094	Application of MRI segmentation in tumor radiotherapy
		Sun Jiawei, Bi Hui, Ni Xinye
		Magnetic resonance imaging (MRI) is a technology with no radiation and high resolution of soft tissues. Therefore, MRI-guided radiotherapy has become a hot spot in the field of radiotherapy. It is of great importance to accurately delineate the targets in radiation oncology. Currently, the delineation of targets is mostly completed by manual segmentation, which is time-consuming, subjective and inconsistent. Automatic segmentation can improve the efficiency and consistency without sacrificing the accuracy of segmentation. In this article, the automatic segmentation methods of MRI applied in radiotherapy were reviewed. The goals, challenges and methods of automatic segmentation for different radiotherapy sites including prostate, nasopharyngeal carcinoma, brain tumors and other organs were analyzed and discussed.
		2021 Vol. 30 (10): 1094-1098 [Abstract] ( 117 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1099	Research status of solutions for main problems in clinical application of cone-beam CT
		Zhang Bingxin, Fu Dongshan
		Since the application of image-guided radiotherapy in clinical practice, cone-beam CT (CBCT) has become the most widely employed image-guided device. However, some problems remain to be cautioned in the application of CBCT, such as certain errors in the setup errors before and after the correction of CBCT, the failure of CBCT to correct dynamic changes, whether the influence of application frequency of CBCT on patients’ boundary of clinical target volume can be reduced, imaging conditions of CBCT lack of a certain degree of flexibility, and the effect of clinical value and application cost on the practicality of CBCT. Only by fully understanding the problems in CBCT application can CBCT be applied more reasonably and scientifically.
		2021 Vol. 30 (10): 1099-1104 [Abstract] ( 105 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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