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.12 Published 2021-12-15

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

Head and Neck Tumors

	1227	Role of intensity-modulated radiation therapy combined with chemotherapy in patients with stage T1-2N1M0 nasopharyngeal carcinoma:a retrospective study
		Li Peijing, Jin Ting, Chen Yuanyuan, Chen Ming, Tian Ye
		Objective To evaluate the efficacy of intensity-modulated radiation therapy (IMRT) combined with chemotherapy for treating patients with T1-2N1M0 nasopharyngeal carcinoma (NPC). Methods 343 patients diagnosed with T1-2N1M0 NPC in Zhejiang Cancer Hospital and Sun Yat-sen University Cancer Center from January 2008 to December 2016 were recruited in this study. All patients received IMRT and divided into the radiotherapy (RT) and chemoradiotherapy (CRT) groups. Patients in the CRT group were further assigned into the concurrent chemoradiotherapy (CCRT), induction chemotherapy+ CCRT (IC+CCRT) and CCRT+ adjuvant chemotherapy (AC) groups. Locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) were estimated by Kaplan-Meier method. Multivariate prognostic analysis was performed by Cox models. Results The median follow-up time for surviving patients (303/343) was 91(range:49-138) months. The 5-year OS, CSS, PFS, LRFFS, and DMFS rates in the CRT group were not superior to those of the RT group (93.7%:93.9%,93.7%:93.9%,89.0%:87.7%,93.8%:92.8%,93.8%:91.2%, all P>0.05). No significant difference was found in treatment outcomes of patients with T1N1 or T2N1 NPC between two groups (all P>0.05). In multivariable analyses, only age was an independent prognostic factor for OS, PFS, CSS and DMFS, and negative correlation was found between them. No survival benefits were achieved in the CCRT, IC+CCRT, CCRT+AC and RT groups, and no significant differences were found in clinical efficacy among the three combined (all P>0.05). Conclusions IMRT alone yields comparable clinical efficacy to CRT in treating patients with T1-2N1M0 NPC. However, whether CT can be eliminated in the T1-2N1M0 population still needs further confirmation by prospective, randomized and controlled clinical trials.
		2021 Vol. 30 (12): 1227-1232 [Abstract] ( 89 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1233	The role of Glasgow prognostic score in prognostic evaluation of nasopharyngeal carcinoma
		Wu Ping, Du Renjia, Yu Yun, Wu Jia, Chen Ying, Zhang Li, Huang Jianfeng
		Objective To assess the role of Glasgow prognostic score (GPS) in the prognostic evaluation of nasopharyngeal carcinoma patients. Methods Clinical data of 129 nasopharyngeal carcinoma patients who received radical radiotherapy in Affiliated Hospital of Jiangnan University from January 2012 to December 2013 were retrospectively analyzed. Clinicopathological characteristics of the patients were collected, including gender, age, TNM staging, pathological type and treatment regimen, etc. The GPS before and at 3 months after radiotherapy were calculated. The survival curve was drawn by the Kaplan-Meier method. Cox regression model was used for analysis of prognostic factors. The area under the receiver operating characteristic (ROC) curve (AUC) was utilized to evaluate the predictive capability of clinical parameters on prognosis. Results With a median follow-up of 89.0 months (range:5.1-104.6 months), the 5-year progression-free survival (PFS) of 129 patients was 79.8% and 84.5% for the 5-year overall survival (OS). At 3 months after radiotherapy, the 5-year PFS were 85.6%, 61.1% and 33.3% in the GPS 0, 1 and 2 groups, and 90.4%, 66.7% and 33.3% for the 5-year OS, respectively (all P<0.01). At 3 months after radiotherapy,the GPS, clinical staging (Ⅰ-Ⅲ vs. ⅣA) and concurrent chemotherapy were significantly correlated with PFS and OS (all P<0.01). ROC curve showed that at 3 months after radiotherapy, the AUC values of GPS, clinical staging and two combined in predicting OS were 0.694, 0.815 and 0.860, respectively. Conclusions At 3 months after radiotherapy, higher GPS is an independent poor prognostic factor for nasopharyngeal carcinoma patients. The combination of GPS and clinical staging yields high accuracy in the prognostic evaluation of nasopharyngeal carcinoma patients.
		2021 Vol. 30 (12): 1233-1237 [Abstract] ( 105 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	1238	Comparison of spatial location and dynamic changes of functional parameters of primary tumors of thoracic esophageal cancer based on DWI and ¹⁸F-FDG PET-CT before and during radiotherapy
		Li Huimin, Li Jianbin, Li Fengxiang, Zhang Yingjie, Li Yankang, Guo Yanluan, Xu Liang
		Objective To evaluate the spatial position and functional parameters of¹⁸F-FDG PET-CT and diffusion-weighted imaging (DWI) before and during radiotherapy (RT) based on the medium of 3DCT in patients with esophageal cancer and to explore whether the high-signal area derived from DWI can be used for individualized definition of the volume in need of dose-escalation for esophageal cancer. Methods Thirty-two patients with esophageal cancer treated with concurrent chemoradiotherapy or neoadjuvant chemoradiation sequentially underwent repeated 3DCT,¹⁸F-FDG PET-CT and enhanced MRI scans before RT and at the 15^th time of RT. All images were fused with the 3DCT images by deformable registration. The gross tumor volume (GTV) was delineated based on PET Edge on the first and second 3DCT, PET-CT and DWI and corresponding T2-weighted MRI (T2W-MRI) fused images, and defined as GTVCTpre and GTVCTdur, GTVPETpre, GTVPETdur, GTVDWIpre and GTVDWIdur,respectively. SUV (SUVmax, SUVmean,SUVpeak), MTV, TLG, ADC (ADCmin and ADCmean) values and △SUV (△SUVmax, △SUVmean, △SUVpeak), △MTV, △TLG,△ADC (△ADCmean and △ADCmin) of lesions were measured before and during RT. Results The differences in SUV (SUVmax, SUVmean, SUVpeak), MTV, TLG, ADCmean and ADCmin of the GTV before and during RT were statistically significant (all P<0.001). The tumor ADC and SUV values before and during RT showed no significant correlation, and there was no correlation between △ADC and △SUV (both P>0.05). The conformity index (CI) of GTVPETpre to GTVDWIpre was significantly higher than that of GTVPETdur to GTVDWIdur (P<0.001). The shrinkage rate of maximum diameter (△LDDWI)(24%) and the shrinkage rate of tumor volume (VRRDWI)(60%) based on DWI during RT were significantly greater than the corresponding PET-based △LDPET (14%) and VRRPET (41%)(P=0.017 and P<0.001). Conclusions The location of high residual FDG uptake based on PET-CT yields poor spatial matching compared with the area with residual high signal based on DWI during RT. Tumor ADC and SUV values may play complementary roles as imaging markers for prediction of patterns of failure and for definition of the volume in need of dose-escalation. In addition, the shrinkage rates of tumor maximum diameter/volume based on DWI during RT are significantly faster than those based on PET-CT. Therefore, the feasibility of selecting boosting of the high signal area derived from DWI for individualized definition of the volume for esophageal cancer is not clear.
		Guide:
		2021 Vol. 30 (12): 1238-1243 [Abstract] ( 79 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1244	Correlation of short diameter of residual lymph nodes with efficacy and prognosis in esophageal squamous cell carcinoma patients undergoing chemoradiotherapy and establishment of a Nomogram model
		Ma Yuanyuan, Xia Jianhong, Li Hongliang, Su Xinyu, Zhou Liqing
		Objective To analyze the correlation of the short diameter of residual lymph nodes with the efficacy and prognosis of patients with esophageal squamous cell carcinoma (ESCC) undergoing chemoradiotherapy (CRT), and establish a Nomogram prediction model to predict the prognosis of ESCC patients. Methods Clinical data of 143 ESCC patients who underwent CRT in Second People's Hospital of Huai'an from August 2018 to September 2020 were collected. The survival analysis was conducted with Kaplan-Meier method, log-rank test and univariate prognostic analysis. Multivariate prognostic analysis was performed with Cox models. Finally, a Nomogram prediction model was established to predict the 1-year and 2-year progression-free survival (PFS) of patients, and the C-index, AUC, and calibration curve were used to evaluate the performance of the model. Results Logistic regression analysis results showed that differentiation, TNM staging, PG-SGA scores before and after radiotherapy (RT) and short diameter of residual lymph nodes were the independent predictors of clinical efficacy of ESCC patients treated with CRT. Cox regression analysis demonstrated that differentiation, TNM staging, PG-SGA scores before and after RT and short diameter of residual lymph nodes were the independent prognostic predictors of ESCC patients undergoing CRT. Conclusions The short diameter of residual lymph nodes is significantly correlated with the efficacy and prognosis of ESCC patients undergoing CRT. The Nomogram prediction model established after comprehensive clinical baseline characteristics is a practical and reliable tool for predicting clinical prognosis of ESCC patients.
		2021 Vol. 30 (12): 1244-1249 [Abstract] ( 94 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	1250	Prognostic analysis of early stage extranodal natural-killer/T cell lymphoma treated with induced chemotherapy combined with radiotherapy
		Wu Tao, Li Huan, Liu Qiulin, Zhang Jing, Hu Yunfei, Chen Mengxiang, Huang Yunhong
		Objective To analyze the efficacy and prognostic factors of induced chemotherapy combined with radiotherapy in the treatment of early stage extranodal natural-killer/T cell lymphoma (ENKTCL). Methods Two hundred and eighty-seven early stage NKTCL patients were treated in Affiliated Cancer Hospital of Guizhou Medical University from October 2003 to October 2021. All patients were aDministrated with short courses of induced chemotherapy combined with radiotherapy. Clinical prognostic factors of early stage NKTCL were analyzed. The overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method, log-rank test was conducted for univariate analysis and Cox models were performed for multivariate analysis. Results The 5-year OS and PFS were 72.8% and 68.9% in all patients. According to Nomogram risk index (NRI) prognostic model, 286 patients were divided into the low risk (NRI=0), intermediate low risk (NRI=1), intermediate high risk (NRI=2), high risk (NRI=3) and very high risk (NRI≥4) groups. In these 5 groups, the 5-year OS were 95.6%,76.3%,69.5%,61.0% and 23.3%(all P<0.001), and the 5-year PFS were 93,2%, 69.8%, 64.6%, 60.2% and 23.3%(all P<0.001), respectively. In the radiotherapy with a dose of ≥50Gy and<50Gy groups, the 5-year OS were 73.8% and 65.9%(P=0.123) and the 5-year PFS were 72.8% and 45.3%(P=0.001). According to the response to induced chemotherapy of complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD), the 5-year OS were 85.4%,74.0%,61.8% and 28.5%(all P<0.001), and the 5-year PFS were 83.7%,66.8%,65.7% and 27.4%(all P<0.001), respectively. Univariate analyses showed that stage Ⅱ, ECOG≥2, primary tumor invasion, radiotherapy dose<50Gy and short-term efficacy of induced chemotherapy were poor prognostic factors for the 5-year OS and PFS (all P<0.05). Multivariate analyses demonstrated that primary tumor invasion, ECOG≥2 and stage Ⅱ were poor prognostic factors for OS (all P<0.05), and primary tumor invasion and ECOG≥2 were poor prognostic factors for PFS (all P<0.05). Conclusions Early stage NKTCL patients can obtain high efficacy after induced chemotherapy combined with radiotherapy.complete response to induced chemotherapy is associated with favorable prognosis.
		2021 Vol. 30 (12): 1250-1255 [Abstract] ( 101 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1256	Correlation analysis between Naples prognostic score and treatment outcomes for locally advanced rectal cancer
		Zhu Jiahao, Gao Qizhong, Guo Xinwei, Liu Zhengcao, Yang Bo, Ji Shengjun, Zhao Yutian
		Objective To analyze the correlation between the Naples prognostic score (NPS) after preoperative neoadjuvant chemoradiotherapy in locally advanced rectal cancer (LARC) and evaluate the prognostic value of NPS in LARC. Methods 136 patients with LARC meeting the recruitment criteria from 2015 to 2020 were selected. Serum albumin, total cholesterol (TC) were collected and neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio were calculated. All patients were scored and graded according to the NPS rule. The survival rate was calculated with Kaplan-Meier method. Multivariate prognostic analysis was performed by Cox models. Results There was no significant correlation between NPS score and tumor regression or pathological complete response (pCR) of LARC patients after neoadjuvant therapy (P=0.192, P=0.163). However, Cox multivariate analysis showed that NPS was an independent risk factor for overall survival (OS) and disease-free survival (DFS) of LARC (P=0.009, P=0.003), and hierarchical analysis suggested that LARC patients with lower NPS score obtained better prognosis. Besides NPS, tumor size was also an independent risk factor for OS, and tumor size and N stage were the independent risk factors for DFS. Conclusion NPS has no correlation with tumor regression or pCR for LARC after neoadjuvant chemoradiotherapy, whereas it could serve as an effective predictor for long-term prognosis of LARC.
		Guide:
		2021 Vol. 30 (12): 1256-1261 [Abstract] ( 102 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1262	Prognostic analysis of patients with ⅣB stage hematogenous metastatic cervical squamous cell carcinoma
		Yin Zhuomin, Tang Huarong, Yuan Shuhui, Liu Shan, Chen Ming, Lou Hanmei
		Objective To evaluate the prognostic factors and the value of definitive pelvic radiotherapy in patients with stage ⅣB hematogenous metastatic cervical squamous cell carcinoma. Methods Clinical data of 80 patients with ⅣB stage squamous cell carcinoma admitted to Zhejiang Cancer Hospital from 2006 to 2016 were retrospectively analyzed. The survival analysis was conducted by Kaplan-Meier method. Prognostic factors were analyzed by Cox models. Results The 1-, 2-and 5-year overall survival (OS) and progression-free survival (PFS) rates were 52.5%, 26.3%, 16.8% and 25%, 13.8%, 8.8%, with a median OS of 13.8 months and a median PFS of 5.6 months, respectively. The most common site of metastasis was bone (51.3%), followed by lung (36.3%) and liver (26.3%). Univariate analysis revealed that chemotherapy combined with definitive pelvic radiotherapy and ≥6 cycles of chemotherapy were positively correlated with OS and PFS, whereas ECOG performance status score of 3-4 and liver metastasis were negatively correlated with OS and PFS. In multivariate analysis, liver metastasis (HR=2.23, 95%CI:1.01-4.91, P=0.048) and ECOG performance status score of 3-4(HR=2.01, 95%CI:1.03-3.91, P=0 0.040) were significantly correlated with poor OS. Subgroup multivariate analysis showed that compared with chemotherapy±palliative radiotherapy, systemic chemotherapy combined with definitive pelvic radiotherapy significantly improved OS (HR=0.39, 95%CI:0.18-0.84,P=0.016).compared with double drugs combined with<4 cycles of chemotherapy, double drugs in combination with ≥4 cycles of chemotherapy significantly improved OS (HR=0.32, 95%CI:0.15-0.68, P=0.003). Conclusions Patients with low ECOG performance status score or liver metastasis obtain poor prognosis. Definitive pelvic radiotherapy combined with chemotherapy can enhance clinical prognosis of patients with ⅣB stage hematogenous metastatic cervical squamous cell carcinoma.
		2021 Vol. 30 (12): 1262-1267 [Abstract] ( 97 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1268	Genomic prediction of neoadjuvant chemoradiotherapy resistance in rectal cancer
		Hao Yanhui, Feng Ruixing, Qi Yanjuan, Chen Fan, Yin Lin
		Objective To search for the key genes influencing the resistance of rectal cancer to chemoradiotherapy based on the weighted gene co-expression network analysis (WGCNA). Methods The data were collected from gene expression omnibus. The whole genome expression data GSE119409 of patients receiving radiotherapy and chemotherapy were obtained by gene expression ominibus. The weighted gene co-expression networks of pathological complete response group and non-pathological complete response group were constructed respectively. NetRep conservative evaluation method was used to comprehensively analyze the three key network attributes of gene connectivity, gene significance and module membership of each node in the network module, and to determine the key genes closely related to the sensitivity of rectal cancer to radiotherapy and chemotherapy. Results Network modules including black, blue, green, yellow and purple were obtained by WGCNA, and five key genes including SLC22A14, SIDT2, CABP4, EPHB6 and RAB11B were screened out. Conclusions Five gene co-expression network modules and five key genes related to chemoradiotherapy resistance of rectal cancer were screened by weighted gene co-expression network analysis, which provided clues for finding molecular markers and potential therapeutic targets for neoadjuvant chemoradiotherapy resistance evaluation.
		2021 Vol. 30 (12): 1268-1274 [Abstract] ( 116 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	1275	A study of automatic planning for esophageal cancer with intensity-modulated radiotherapy based on dose prediction and beam angle optimization
		Lou Zhaoyang, Lei Hongchang, Mao Ronghu, Guo Wei, Li Bing, Ge Hong
		Objective To propose an automatic planning method of intensity-modulated radiotherapy (IMRT) for esophageal cancer based on dose volume histogram prediction and beam angle optimization in Raystation treatment planning system. Methods 50 IMRT plans of esophageal cancer were selected as the training set to establish a dose prediction model for organs at risk. Another 20 testing plans were optimized in Raystation using RuiPlan and manual method, and the beam angle optimization and dose volume histogram prediction functions of RuiPlan were used for automatic planning. Dosimetric differences and planning efficiency between two methods were statistically compared with paired t-test. Results There were no significant dosimetric differences in the conformity index (CI),homogeneity index (HI) of PTV, V5Gy of both lungs and Dmax of the spinal cord between automatic and manual plans (all P>0.05).compared with those in the manual plans, the V20Gy and Dmean of the left and right lungs generated from automatic plans were reduced by 1.1%, 0.37Gy and 1.2%, 0.38Gy (all P<0.05), and the V30Gy, V40Gy and Dmean of the heart in automatic plans were significantly decreased by 5.1%, 3.0% and 1.41Gy, respectively (all P<0.05). The labor time, computer working time, and monitor unit (MU) number of automatic plans were significantly decreased by 65.8%, 14.1%, and 17.2%, respectively (all P<0.05). Conclusion RuiPlan automatic planning scripts can improve the efficiency of esophageal cancer planning by dose prediction and beam angle optimization, providing an alternative for esophageal cancer radiotherapy planning.
		2021 Vol. 30 (12): 1275-1279 [Abstract] ( 109 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1280	Comparative analysis of output factor of high-energy photon small field between measurements with or without correction of IAEA-483 report and Monte-Carlo simulation
		Xiao Zhenhua, Wang Zhenyu, Ouyang Bin, Wen Bixiu
		Objective To evaluate the accuracy of measurement of the output factor of high-energy photon small field (Scp) using commercial semi-diodes and ionization chambers in small fields in accordance with the IAEA-483 report, which has been proposed that all kinds of detectors should be revised for small field Scp measurement in clinical practice. Methods EGSnrc of Monte Carlo (MC) software was utilized to simulate the treatment head of Varian Novalis Tx linear accelerator, and the profile curve and relative dose value were generated by simulation in DOSXYZnrc based on derived phase space file. Measurement of PDD and Profiles was used to adjust and validate the simulation mode. Detectors including ionization chambers A16, A14sL,CC01,CC13, PFD and EFD and semi-diodes PFD, EFD and Razor under different radiation field settings (0.5cm to 10.0cm) were employed to measure the profile curves and Scp of FWHM equivalent rectangular fields, which were compared with data of Monte-Carlo simulation. The measurement of Scp was revised by data given in the IAEA-483 report. The data with or without correction were compared with the data of MC simulation. Results A curve deviation oF<2.0% between MC simulation and PFD measurement was accepted. MC simulated Profiles were consistent with PFD, EFD and Razor measurements, when the field was<3.0cm. Razor response in the out-field region was 2.3% higher than those of MC and PFD, and it increased with the increment of field and was 3.0% at 10.0cm. The maximum 20.0%-80.0% penumbra width was detected as 3.0 mm for CC13 at 10.0cm rectangular field. With the decrease of the radiation field, the deviation relative to MC simulation was increased as for Scp mean values of 7detectors before correction. The standard deviation (SD) of the measured value was increased rapidly when it was close to 1.0cm, ranging from 0.009-0.014 for the field of 5.0cm-1.5cm to 0.030-0.089 for the field of 1.0cm-0.5cm. The mean value of SD for the whole measurement before correction was 0.030. The mean SD of Scp measured by the six probes was 0.008, 0.013 at 0.8cm and 0.021 at 0.6cm after correction. When the equivalent field was ≥1.0cm, the corrected Scp and MC simulation deviation was ranged from -3.6% to -0.5%. The error was between -6.9% and -1.3% when the radiation field was<1.0cm. Conclusion The SD of Scp measured by different detectors after correction in accordance to the IAEA-483 report is small, which is in good agreement with the data of MC simulation, suggesting that it could be applied in clinical dosimetry.
		2021 Vol. 30 (12): 1280-1285 [Abstract] ( 115 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1286	Application of independent dose verification of volumetric modulated arc therapy based on Monte Carlo
		Cui Tiantian, Li Bing, Liu Ru, Ding Danhong, Li Dingjie, Lou Zhaoyang, Ge Hong
		Objective To develop a verification platform based on Monte Carlo (MC) for independent dose verification of volumetric modulated arc therapy (VMAT) plans. Methods The head model including collimator of Varian TrueBeam linear accelerator was constructed by using EGSnrc/BEAMnrc, and the independent dose verification platform for the patients’ VMAT plans was built based on the head model and an in-house code. The percent depth dose (PDD) curves and off-axis ratios for different field sizes, the dose distribution of two irregular fields and three VMAT plans of the head and neck, chest, and pelvis were simulated using the platform. The simulated results of the PDD curves and the off-axis ratios of different field sizes were compared with the blue water measurement results. The difference between the irregular fields and the actual ArcCHECK measurements was also investigated. Besides, the differences among the MC simulated dose, TPS calculated dose and the ArcCHECK measured dose were analyzed by several methods, such as γ analysis and dose-volume histogram to verify whether the platform could be independently employed for dose verification. Results The MC simulated results of PDD curves and off-axis ratios from 4cm×4cm to 40cm×40cm were in good agreement with the measured results. And the γ passing rates between the MC simulation and the ArcCHECK measurement for the irregular fields were above 98.1% and 99.1% for 3%/2 mm and 3%/3 mm, respectively. For VMAT plans of three patients, the γ results between the MC simulated dose and ArcCHECK measured dose were better than 93.8% and 95.9% under the criteria of 3%/2 mm and 3%/3 mm respectively. At the same time, the γ passing rates of nasopharyngeal, lung, and rectal cancers were 95.2%, 98.6% and 98.9% based on 3D γ analysis using TPS calculated dose and MC simulated dose under the criteria of 3%/3 mm;the passing rates of these three were 90.3%, 95.1% and 96.7% for 3%/2 mm, respectively. Conclusions The simulation results of the MC-based verification platform developed in this study show a good agreement with the actual measurement results, and the simulation results are closer to the real dose distribution using the patients’ data. The preliminary results demonstrate that the platform can be used for accurate independent dose verification of VMAT plans.
		2021 Vol. 30 (12): 1286-1291 [Abstract] ( 91 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1292	Study of volume resolution of prostate motion target by four-dimensional ultrasound
		Lu Zhengda, Bi Hui, Li Chunying, He Mu, Gao Liugang, Sun Jiawei, Xie Kai, Lin Tao, Sui Jianfeng, Ni Xinye
		Objective To explore the volume resolution of prostate motion target by four-dimensional (4D) ultrasound. Methods The prostate ultrasound model was selected, and the group comparison study was conducted using 4D ultrasound to outline the prostate target under different motion amplitudes (A) and motion period (T). The simulated A value was set as 0.5 mm, 1 mm, 2 mm, 3 mm, 4 mm, and 5 mm, respectively. The T value was set as 1s, 2s, 3s, and 4s, respectively. The volume of the target of the model prostate was calculated, and the static ultrasound image of the target was used as the control group to analyze the difference between two groups. Results When the model was still, the size of the target of ultrasound was consistent with that of CT scan (P>0.05). When the A values were 0.5 mm and 1 mm, there was no statistical difference between the volume in period 1-4s and the volume in the target at rest (all P>0.05). When the A values were 2 mm and 3 mm, and the T values were 1s, 2s and 3s there was statistical difference between the volume of target and that of of static ultrasonic target (all P<0.05). When the A value was 2 mm and the T value was 4s, there was no statistical difference between the target volume and the static target volume (P=0.710). The range within the group was 6.7cm³, and the standard deviation was 1.15cm³. When the A value was 3 mm and the T value was 4s, the volume repeatability of the target was poor, and the range within the group was 14.4cm³;when the A values were 4 mm and 5 mm, and the T values were 1-4s, the range within the group was 3.27-17.63cm³ and 6.51-21.02cm³, respectively. The volume repeatability of the target under each period was extremely poor, which could not meet the clinical requirements. Conclusion 4D ultrasound can provide reliable reference data for patients' target delineation within 1-4s of motion cycle and within 1 mm of motion amplitude, which exerts on effect upon the original position of probe.
		2021 Vol. 30 (12): 1292-1296 [Abstract] ( 102 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1297	Effect of skin color on the setup of surface optical system in radiotherapy
		Peng Haiyan, Luo Huanli, Liang Baozhong, Mao Kaijin, He Yang, Jin Fu
		Objective To investigate the sensitivity of the Catalyst HD in monitoring different skin colors, and assess the effect of skin color on the setup uncertainties using this system in radiotherapy. Methods The standard cards guiding skin color and the cylinder model guiding quality control in radiotherapy were utilized to simulate the patients’ positioning. During the first monitoring, Catalyst HD was employed to acquire the image of the phantom as the reference image after conventional positioning (indoor laser+phantom marking). When it was not the first monitoring, the couch was moved (-5 to 5 mm, step length of 2 mm) and Catalyst HD was adopted to obtain the surface image after conventional positioning. The bed deviation and corresponding setup errors monitored by Catalyst HD for different skin colors were recorded in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) direction, respectively. Results During Catalyst HD monitoring, the integration time and gain were increased with the darker color. The logarithm of integration time and gain was significantly linearly negatively correlated with the same color (R²>0.9). When the color difference with 1Y01SP was ΔE≤189, there was a significant correlation between the bed deviation and corresponding setup errors monitored by Catalyst HD in the SI and LR directions (RSI>0.5, RLR>0.5, RAP>0.9). The Catalyst HD monitoring was rapid and stable. When 218≤ΔE≤253, the correlation coefficients of them in the LR were RLR<0.3 and the Catalyst HD monitoring was stable. When 254≤ΔE≤285, the Catalyst HD failed to monitor stably. When ΔE>318, it failed to monitor this skin color. Conclusions Gain, integration time and color have a certain correlation. The Catalyst HD can accurately monitor the setup errors within a specific range of skin color.
		2021 Vol. 30 (12): 1297-1303 [Abstract] ( 122 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1304	Effect and possible mechanism of Salvianolic acid B on radiosensitivity of non-small cell lung cancer
		Wang Guohui, Yang Xiongtao, Yang Gaoshan
		Objective To evaluate the effect of Salvianolic acid B on the radiosensitivity of human non-small cell lung cancer cells and investigate its possible mechanism. Methods Non-small cell lung cancer cells A549 and H1299 were cultured in vitro. The toxicity of Salvianolic acid B on non-small cell lung cancer cells was detected by MTT assay. The effect of Salvianolic acid B on the radiosensitivity was assessed by clone formation assay. Transwell chamber assay was used to evaluate the effect of Salvianolic acid B on the migration of tumor cells. Western blot was employed to detect the expression levels of OTUD7B, MMP-2, MMP-9, E-cadherin, Akt and p-Akt regulated by Salvianolic acid B. Results Salvianolic acid B (5 μmol/L) could inhibit the proliferation of A549 and H1299 cells. Clone formation assay showed that Salvianolic acid B increased the radiosensitivity of A549 and H1299 cells, with a radiosensitization ratio of 1.45 and 1.38, respectively. Transwell chamber assay indicated that the ability of cell migration was significantly inhibited by Salvianolic acid B (P<0.05). Western blot revealed that the expression levels of OTUD7B in A549 and H1299 cells were induced by irradiation in a time-dependent manner. Salvianolic acid B could down-regulate the expression levels of MMP-2, MMP-9 and p-Akt, whereas up-regulate the expression level of E-cadherin by down-regulating the expression level of OTUD7B. Conclusions Salvianolic acid B can enhance the radiosensitivity of A549 and H1299 cells. The possible mechanism is that Salvianolic acid B down-regulates the expression level of OTUD7B induced by irradiation and inhibits the epithelial-mesenchymal transition process of tumor cells.
		2021 Vol. 30 (12): 1304-1308 [Abstract] ( 91 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1309	circ-PRKDC affects the proliferation, apoptosis and radiosensitivity of lung cancer cells by regulating miR-505-3p
		Yuan Xiaosun, Zhang Lei, Rao Shilei, Zhang Kai, Ma Huili, Li Changsheng, Zhang Jingwei, Ren Zhonghai
		Objective To investigate the effect of circ-PRKDC on lung cancer cell proliferation, apoptosis and radiosensitivity and its molecular mechanism. Methods Normal lung epithelial cells BEAS-2B and lung cancer cell lines NCI-H1299, NCI-H2170, NCI-H1975 were cultured. NCI-H1299 cells were divided into the si-NC, si-PRKDC, pcDNA-NC, pcDNA-PRKDC, miR-NC, miR-505-3p, anti-miR-NC, anti-miR-505-3p, si-PRKDC+anti-miR-NC and si-PRKDC+anti-miR-505-3p groups. RT-qPCR was used to detect the expression levels of circ-PRKDC and miR-505-3p. Western blot was employed to measure the protein expression. MTT was used to detect cell proliferation. Flow cytometry was utilized to detect cell apoptosis. Plate clone formation assay was conducted to detect the cell radiosensitivity. Dual luciferase reporter assay was performed to analyze the targeting relationship between circ-PRKDC and miR-505-3p. Results Compared with normal lung epithelial cells BEAS-2B, the expression levels of circ-PRKDC in the lung cancer cell lines NCI-H1299, NCI-H2170 and NCI-H1975 were significantly up-regulated (3.65, 3.10, 2.67 vs. 1.00, all P<0.05), whereas those of miR-505-3p were significantly down-regulated (0.42, 0.50, 0.54 vs. 1.02, all P<0.05). After low expression of circ-PRKDC, the expression level of CyclinD1 was significantly down-regulated (0.42 vs. 0.81, P<0.05), whereas those of Cleaved-caspase-3(0.71 vs. 0.33, P<0.05) and γ-H2AX (0.89 vs. 0.46, P<0.05) were significantly up-regulated, the cell A value was significantly decreased (0.413 vs. 0.839, P<0.05), cell apoptosis rate was significantly increased (20.35 vs. 6.21, P<0.05), cell survival fraction was significantly decreased (P<0.05), and β-catenin expression was significantly down-regulated (0.35 vs. 0.73, P<0.05). After high expression of miR-505-3p, the expression level of CyclinD1 was significantly down-regulated (0.34 vs. 0.83, P<0.05), those of Cleaved-caspase-3(0.65 vs. 0.32, P<0.05) and γ-H2AX (0.96 vs. 0.45, P<0.05) were significantly up-regulated, the cell A value was significantly decreased (0.386 vs. 0.851, P<0.05), the apoptosis rate was significantly increased (16.38 vs. 6.20, P<0.05), and the cell survival fraction was significantly decreased (P<0.05).compared with miR-NC, the luciferase activity of miR-505-3p group transfected with circ-PRKDC wild-type reporter plasmid was significantly decreased (0.44 vs. 1.00, P<0.05). Down-regulation of miR-505-3p could reverse the effect of low expression of circ-PRKDC on the proliferation, apoptosis, radiosensitivity and β-catenin expression of NCI-H1299 cells. Conclusion Low expression of circ-PRKDC may inhibit lung cancer cell proliferation, promote cell apoptosis and enhance cell radiosensitivity by up-regulating miR-505-3p, which is probably associated with the Wnt/β-catenin signaling pathway.
		2021 Vol. 30 (12): 1309-1315 [Abstract] ( 111 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	1316	Stereotactic body radiation therapy for liver and lung oligometastases from colorectal cancer:safety, local efficacy and prognostic factors
		Lei Junqin, Liu Wenyang, Jin Jing
		Oligometastasis is an intermediate status between the locally advanced andwide spread disease. Patients with oligometastasis may obtain long-term survival after local treatment. Stereotactic body radiation therapy (SBRT) can deliver radical ablative doses in a small number of fractions, which is a highly precise local ablation therapy. Approximately half of patients diagnosed with colorectal cancer (CRC) will develop metastases, with the liver and lung as the most common site of involvement. In this article, the safety, local efficacy and prognostic factors of SBRT for liver and lung oligometastases from CRC were illustrated. The highlights of SBRT implementation were also discussed. SBRT is safe and effective for oligometastases from CRC under respiratory motion management and robust quality assurance.
		Guide:
		2021 Vol. 30 (12): 1316-1320 [Abstract] ( 87 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1321	Research progress on accelerated partial breast irradiation for early breast cancer after breast-conserving surgery
		Luo Xiaodie, Gan Lu
		Currently,whole breast radiotherapy (WBRT) is the standard treatment for early breast cancer after breast-conserving surgery, which effectively reduces the recurrence rate. Accelerated partial breast irradiation (APBI), a special radiotherapy that only targets the limited volume of tissues surrounding the primary lesion, has attracted more and more attention because of the high proportion of tumor recurrence adjacent to the tumor resection cavity. In recent years, a number of prospective randomized controlled trails have demonstrated its safety and effectiveness, which is a feasible choice for specific low-risk patients after breast-conserving surgery.compared with WBRT, APBI shortens the treatment time, reduces the treatment cost and improves the cosmetic effect. At the same time, more and more APBI technologies have been developed, which enhance the accessibility and possess unique advantages for partial patients undergoing breast-conserving surgery. Nevertheless, the efficacy and side effects of APBI technologies still differ, which need to be treated differently. In this paper, multiple APBI technologies, research progresses at home and abroad and applicable population were reviewed. The unresolved problems were proposed and development prospect was predicted, aiming to provide reference for clinical application.
		2021 Vol. 30 (12): 1321-1325 [Abstract] ( 99 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1326	Research progress on clinical trials of radiaotherapy and chemotherapy in localized pancreatic cancer
		Chen Lining, Tang Yuan, Jin Jing
		Pancreatic cancer is technically divided into surgically resectable, borderline resectable or unresectable disease according to the relationship between tumor mass and adjacent blood vessels. Upon diagnosis, most of the lesions have been locally advanced or had distant metastases,and only 20% of the patients have the opportunity for tumor resection. Radiotherapy and chemotherapy are essential for pancreatic cancer. In this article, the literatures published in recent years were reviewed to focus on the research progress on the clinical trials of neoadjuvant radiochemotherapy, stereotactic body radiation therapy (SBRT), radiochemotherapy combined with immunotherapy for localized pancreatic cancer.
		2021 Vol. 30 (12): 1326-1329 [Abstract] ( 100 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1330	Research progress on risk factors of radiation pneumonitis caused by stereotactic body radiotherapy for non-small-cell lung cancer
		Fu Shoupeng, Zhang Yingjie, Li Jianbin
		Stereotactic body radiotherapy (SBRT/SABR) has become an important option in the treatment of early non-small-cell lung cancer (NSCLC). Radiation pneumonitis (RP) is the main side effect of early NSCLC patients after SBRT/SABR. Patient factors, tumor factors and treatment factors are all associated with the occurrence of RP in early NSCLC patients after SBRT/SABR. In recent years, relevant studies have further clarified the relationship between these factors and RP. In addition, the prediction factors related to RP occurrence are further discussed. In this paper, relevant research progresses in recent years were reviewed.
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		2021 Vol. 30 (12): 1330-1334 [Abstract] ( 105 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1335	Research progress on epigenetics in the repair of radiation-induced DNA damage in tumors
		Jie Xiaohua, Xu Shuangbing, Wu Gang
		Radiotherapy kills tumor cells by radiation-induced DNA double-strand breaks (DSB), however, abnormal DSB repair in tumor cells often leads to radioresistance, in which epigenetics plays an important role. Targeting aberrant epigenetic markers may be a potential means of cancer radiosensitization, but the clinical application of the combination of epigenetic drugs and radiotherapy requires further investigation. This article reviews the latest research progress the role of epigenetics in the repair of radiation-induced DNA damage in tumors.
		2021 Vol. 30 (12): 1335-1339 [Abstract] ( 90 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	1340	Research progress on biological mechanism of tumor hyperthermia
		Shen Pei, Zhou Xuexiao, Shi Fan, Wang Shengzhi
		In recent years, tumor hyperthermia has become a hot research topic as an adjuvant therapy to traditional tumor therapy. Hyperthermia can directly induce tumor cell necrosis or apoptosis, or inhibit tumor progression by destroying tumor blood vessels. Meantime, it can also activate the response of immune cells and cytokines in the immune system of the host, thereby regulating the immune state of tumor microenvironment. Multiple combined effects influence the tumor progression. A thorough understanding of the biological mechanism of hyperthermia is beneficial to the development of novel therapeutic methods. In this paper, the biological mechanism of hyperthermia in killing tumors was mainly reviewed.
		2021 Vol. 30 (12): 1340-1344 [Abstract] ( 86 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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