Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2022 Vol.31 Issue.1 Published 2022-01-15

	Review Articles Investigation Research Physics·Technique·Biology MR Accelerator

MR Accelerator

	1	Preliminary study of clinical application of magnetic resonance linear accelerator in liver malignancies
		Zong Yuan, Men Kuo, Wang Shulian, Tang Yuan, Jing Hao, Tian Yuan, Qin Shirui, Liu Yueping, Song Yongwen, Fang Hui, Qi Shunan, Lu Ningning, Li Ning, Yang Zhuanbo, Wan Bao, Zhang Yanxin, Li Yexiong, Chen Bo
		Objective To investigate the workflow, efficacy and safety of MR-Linac in liver malignancies. Methods Clinical data of 15 patients with hepatocellular carcinomas (HCC) or liver metastases treated with MR-Linac between November 2019 and July 2021 were retrospectively analyzed. The workflow of MR-Linac was investigated and image identification rate was analyzed. Patients were followed up for response and toxicity assessment. Results Fifteen patients (6HCC, 8 liver metastases from colorectal cancer, 1 liver metastasis from breast cancer) were enrolled. A total of 21 lesions were treated, consisting of 10 patients with single lesion, 4 patients with double lesions and 1 patient with triple lesions. The median tumor size was 2.4cm (0.8-9.8cm). The identification rate for gross tumor volume (GTV) in MR-Linac was 13/15. Although GTV of two patients were unclearly displayed in MR-Linac images, the presence of adjacent blood vessel and bile duct assisted the precise registration. All the patients were treated with stereotactic body radiation therapy (SBRT). For HCC, the median fraction dose for GTV or planning gross tumor volume (PGTV) was 6Gy (5-10Gy) and the median number of fractions was 9(5-10). The median total dose was 52Gy (50-54Gy) and the median equivalent dose in 2Gy fraction (EQD2Gy) at α/β= 10 was 72Gy (62.5-83.3Gy). For liver metastases, the median fraction dose for GTV or PGTV was 5Gy (5-10Gy) and the median number of fractions was 10(5-10). The median total dose was 50Gy (40-50Gy) and the median EQD2Gy at α/β=5 was 71.4Gy (71.4-107.1Gy). At 1 month after SBRT, the in-field Objective response rate (ORR) was 8/13 and the disease control rate was 13/13. At 3-6 months after SBRT, the in-filed ORR was increased to 6/6. During the median follow-up of 4.0 months (0.3-11.6), 4-month local progression-free survival, progression-free survival and overall survival were 15/15, 11/15 and 15/15, respectively. Toxicities were mild and no grade 3 or higher toxicities were observed. Conclusions MR-Linac provides a platform with high identification rates of liver lesions. Besides, the presence of adjacent blood vessel and bile duct also assists the precise registration. It is especially suitable for liver malignancies with promising local control and well tolerance.
		2022 Vol. 31 (1): 1-7 [Abstract] ( 129 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	8	Preliminary application of MR-Linac in breast cancer radiotherapy in a single academic center
		Jing Hao, Tang Yu, Tian Yuan, Zhang Ke, Qin Shirui, Cao Ying, Fang Hui, Zhao Xuran, Chen Bo, Song Yongwen, Jin Jing, Liu Yueping, Qi Shunan, Tang Yuan, Lu Ningning, Li Ning, Wang Shulian, Li Yexiong
		Objective To describe a prospective study of pre-operative tumor-bed boost performed at the 1.5 T MR-Linac in combination with adjuvant whole breast irradiation, and a first case, with an accentuation on clinical feasibility and safety. Methods A phase II, single arm study recruiting early stage patients follows a paradigm that first boosts the tumor bed and then undergoes breast conservative surgery in 2 weeks, and last irradiates the whole breast in 6 weeks. The primary endpoint is ≥ grade 2 acute breast toxicity. A 43 years old patient affected by a breast carcinoma, not special type of the right-sided lateral quadrant, staged cT2N0M0, was planned and treated. The dose, 8Gy for one time, was calculated by Monaco on CT simulation images. Both the air electron stream effect (ESE) and the electron return effect (ERE) at the presence of 1.5 T magnetic field were evaluated. During the pre-treatment evaluation, we carried out adaptation-to-position adjustment. Results The normal organ dosimetry is within toleration. The Dmax to the skin, the chin and the right upper arm was 8.44Gy, 28.5cGy and 17.8cGy, respectively. There was no increased toxicity from ERE and ESE, and the treatment was well tolerated without > grade 1 acute toxicity. The patient received breast conservative surgery on day 7 without delayed wound healing. Conclusions This is the first case successfully treated within a clinical trial by pre-operative tumor-bed boost under 1.5 T MR-Linac in our institution. More participants are needed to validate and optimize the paradigm.
		2022 Vol. 31 (1): 8-14 [Abstract] ( 146 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	15	The standard adapt-to-shape workflow for prostate cancer on MR-linac—Experience from National Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences
		Lu Ningning, Tian Yuan, Qin Shirui, Chen Jiayun, Wang Shulian, Li Yexiong
		With aligned MR registration, the MR-Linac provides superior soft tissue resolution for prostate cancer. No fiducial markers or electromagnetic transponders insertion is needed to guarantee high-precision radiotherapy. The highly-recommended Adapt-To-Shape (ATS) workflow can resolve all the problems encountered during prostate cancer radiotherapy, including prostate volume changes and adjacent organs motion, both inter-fractionally and intra-fractionally. With all the above advantages, MR-Linac performs outstandingly than conventional linac in prostate cancer RT delivery, and probably helps us to reduce the CTV-PTV margin safely in the near future.Nevertheless, it is difficult to implement the ATS workflow in clinical practice. In this article, the standard ATS workflow for prostate cancer was summarized based on our own experience.
		2022 Vol. 31 (1): 15-19 [Abstract] ( 127 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	20	Clinical implementation of MR-Linac systems in adaptive radiation therapy for head and neck cancer
		Wu Runye, Yi Junlin
		Adaptive radiation therapy (ART) has been proposed as a method to account for changes in head and neck cancer and normal tissues to enhance the therapeutic ratios. Online magnetic resonance-guided radiotherapy (MRgRT) using hybrid MR-Linac systems is a novel innovative application in ART for head and neck cancer. The concept of MR-Linac systems is the ability to acquire MR images for ART and also online imaging during treatment delivery. Daily ART allows to improve the targeting accuracy while avoiding organs at risk for head and neck cancer. Although an increasing number of studies related to clinical application and technical aspect of MRgRT in head and neck cancer have been published, MRgRT for ART of head and neck cancer remains in its infancy. The purpose of this article is to summarize and discuss the rationale, clinical implementation, and prospect of this promising adaptive radiotherapy modality for treating head and neck cancer.
		2022 Vol. 31 (1): 20-23 [Abstract] ( 104 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	24	Application and basic application process of MR accelerator in lung cancer
		Wang Jianyang, Xiao Xi, Yan Lingling, Cao Ying, Men Kuo, Bi Nan
		Radiotherapy is one of the most important components of cancer treatment. Image-guided radiotherapy (IGRT) is the mainstream tool in the precision radiation oncology. Magnetic resonance (MR) accelerator can perform MRI for tumors during radiotherapy, deliver real-time tracing and monitoring of tumors and thus realize the MRI-guided adaptive radiotherapy. Here,the latest research status and clinical application of MR accelerator in lung cancer were reviewed.
		2022 Vol. 31 (1): 24-28 [Abstract] ( 125 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	29	Clinical dosimetry commissioning of 1.5 T MR-linac
		Li Minghui, Tian Yuan, Zhang Ke, Niu Chuanmeng, Wang Hongkai, Men Kuo, Dai Jianrong
		Objective To introduce the clinical dosimetry commissioning methods and results of the 1.5 T MR-linac. Methods In May, 2019, an Elekta Unity 1.5 T MR-linac was installed in Cancer Hospital, Chinese Academy of Medical Sciences and dosimetry commissioning was performed with magnetic field compatible measuring instruments. Commissioning items include absolute dose calibration, data acquisition and planning system model verification. Results Absolute dose calibration in magnetic field should be corrected by magnetic field correction factor. The standard output dose of Unity was 87 cGy. Gamma analysis (3%/2mm) was performed on the beam collection data and the planning system calculation data. The average pass rate of dose verification of standard field test cases was 96.41%, and the TG119 test case was 98.24%. The IROC end to end test case was 97.5%(7%/4mm). Conclusions The planning system model and the beam collection data have good consistency. The dose verification results of the standard field and TG119 test cases meet the general tolerance limit requirements of the AAPM TG218 report, and the verification results of the IROC end-to-end test cases meet the IROC center standards.
		2022 Vol. 31 (1): 29-34 [Abstract] ( 104 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Investigation Research

	35	Post-traumatic growth status and influencing factors of tumor patients undergoing radiotherapy
		Liang Qunying, Yi Hanxiao, Li Yun, Qiu Haimei, Shi Juntian
		Objective To investigate the post-traumatic growth status of tumor patients receiving radiotherapy and analyze its influencing factors, aiming to provide theoretical basis for clinical doctors and nurses to formulate targeted intervention strategies. Methods A cross-sectional survey of 170 tumor patients receiving radiotherapy admitted to Department of Radiotherapy of Sun Yat-sen Memorial Hospital was conducted by convenience sampling method, general information questionnaire and a post-traumatic growth inventory (PTGI). Results The average PTGI score of 170 patients was 83.11±16.74, and 141 cases of them had significant post-traumatic growth, accounting for 82.9%(score ≥71). Logistic regression analysis showed that personality type, work status, and the times of hospitalization were the influencing factors of post-traumatic growth (all P<0.05). Conclusions Tumor patients undergoing radiotherapy obtain a high level of post-traumatic growth. Medical staff should make full use of the patients’ potential for post-traumatic growth and implement interventions as soon as possible to promote the physical and mental health of tumor patients undergoing radiotherapy.
		2022 Vol. 31 (1): 35-38 [Abstract] ( 124 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	39	The teaching practice and exploration of the course of New Technology of Radiotherapy and Oncology
		Lian Xin, Zhen Hongnan, Hu Ke, Qiu Jie, Hou Xiaorong, Zhang Fuquan
		Objective To evaluate and summarize the teaching effect of"New Technology of Radiotherapy and Oncology" in the form of questionnaire, understand the degree of demand for the course of all kinds of medical students and improve the teaching contents and methods. Methods The course of"New Technology of Radiotherapy and Oncology" was a specialized elective course in Peking Union Medical College. After two rounds of teaching practices, we evaluated the students participating in the course or non-course participants by anonymous questionnaire. The questionnaire items include the course content, setting, teachers and improvement suggestions. Results A total of 73 questionnaires were sent out, and the recovery rate was 100%. Among them, 52(71%) were from students who chose the courses. 83% of the students"strongly agree" that the teaching content of this course is the latest development, the latest achievement or the problem to be solved, 94% were"satisfied" or"very satisfied" with their learning effect, and 92% and 83% were satisfied with the teachers and teaching plan, respectively. After taking the course, students rated"broadening of mind"(96%) as the biggest gain, followed by"facilitating interdisciplinary collaboration"(79%). 86% of the non-course participants felt the need to supplement the existing curriculum with new techniques in oncology radiotherapy, hoping that the curriculum would"broaden the mind"(76%), improve clinical application (81%) and facilitate interdisciplinary collaboration (71%). Conclusion The questionnaire results show that the teaching practice of this course covers the different needs of all kinds of students, which is worthy of implementation and further improvement.
		2022 Vol. 31 (1): 39-42 [Abstract] ( 131 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	43	Research on automatic segmentation of tumor target of lung cancer in CBCT images by multimodal style transfer technology based on deep learning
		Chen Jie, Wang Keqiang, Jian Jianbo, Wang Peng, Guo Zhichao, Zhang Wenxue
		Objective Due to the low contrast between tumors and surrounding tissues in CBCT images, this study was designed to propose an automatic segmentation method for central lung cancer in CBCT images. Methods There are 221 patients with central lung cancer were recruited. Among them, 176 patients underwent CT localization and 45 patients underwent enhanced CT localization. The enhanced CT images were set as the lung window and mediastinal window, and elastic registration was performed with the first CBCT validation images to obtain the paired data set. The CBCT images could be transformed into"enhanced CT" under the lung window and mediastinal window by loading the paired data sets into cycleGAN network for style transformation. Finally, the transformed images were loaded into the UNET-attention network for deep learning of GTV. The results of segmentation were evaluated by Dice similarity coefficient (DSC), Hausdorff distance (HD) and the area under the receiver operating characteristic curve (AUC). Results The contrast between tumors and surrounding tissues was significantly improved after style transformation. The DSC value of cycleGAN+UNET-attention network was 0.78±0.05, HD value was 9.22±3.42 and AUC value was 0.864, respectively. Conclusion The cycleGAN+UNET-attention network can effectively segment central lung cancer in CBCT images.
		2022 Vol. 31 (1): 43-48 [Abstract] ( 153 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	49	A new automatic planning approach:clinical practice of Eclipse scripting application programming interface combined with RapidPlan
		Lou Zhaoyang, Cheng Chen, Lei Hongchang, Zhu Weihua, Wang Xiaoshen, Wang Xingliu, Zhu Hao, Zhou Zongkai, Lan Maoying, Ge Hong
		Objective To propose an automatic planning approach for Eclipse15.6 planning system based on Eclipse scripting application programming interface (ESAPI) and evaluate its clinical application. Methods 20 patients with nasopharyngeal carcinoma and 20 cases of rectal cancer were selected in the clinical planning. The developed automatic planning script SmartPlan and RapidPlan were used for automatic planning and dosimetric parameters were compared with manual planning. The differences were compared between two groups by using Wilcoxon signed rank test. Results The dosimetric results of automatic and manual plans could meet clinical requirements. There was no significant difference in target coverage in nasopharyngeal carcinoma planning between two groups (P>0.05), and automatic plans were superior to manual plans in organs at risk sparing (P<0.05). Except for the homogeneity index of PTV and the maximum dose of bowel in rectal cancer plans, the other dosimetric parameters of the automatic plans were better than those of the manual plans (all P<0.05). Conclusions Compared with the manual plans, the automatic plans have the same or similar target coverage, similar or better protection of organs at risk, and more convenient implementation. The developed SmartPlan based on ESAPI has clinical feasibility and effectiveness.
		2022 Vol. 31 (1): 49-54 [Abstract] ( 143 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	55	Dosimetric study of ¹²⁵I seed implantation guided by 4D template for advanced malignant tumors
		Liu Zhigang, Lei Guangyan, Song Yongchun, Sun Ruifang, Lyu Weidong, Song Yangrong, Zhang Xi, Liu Jia, Cheng Hao, Han Le, Zhao Kun, Gao Wei, Li Xiaolong, Ning Xiaoju, Qiang Libin
		Objective To investigate the safety and dose of 4D template (real-time adjustable angle template) in the treatment of advanced malignant tumors with ¹²⁵I seeds. Methods 98 patients with advanced malignant tumors admitted to Department of Thoracic Surgery of Shaanxi Provincial Tumor Hospital were treated with 4D template-navigated radioactive ¹²⁵I seed implantation from June 2018 to December 2019. Preoperative TPS plan, intraoperative optimization, postoperative verification of immediate dose and postoperative evaluation of implantation dose were performed. The treatment results were observed. Results All 98 patients completed the seed implantation. The implantation dose of GTV of implantation site receiving external irradiation was (12489±414)cGy and the dose of no external irradiation was (15036±514)cGy. V100% was 84.7%-94.1%, and 88.2%-93.7%. The implantation dose of CTV was (7450±621)cGy,and (9080±761)cGy. The quality of dose implantation was evaluated as:excellent in 89 cases (91%, 89/98), good in 7 cases (7%, 7/98), fair in 2 cases (2%, 2/98), and poor in 0 case, respectively. The symptom relief rate of patients with pain was 92%(36/39). The 1-and 2-year local control rates were 61%, 36% and 82%, 54% in patients treated with and without external irradiation, respectively. The difference was statistically significant (P=0.02). The incidence rates of pneumothorax and hemoptysis were 19%(9/48) and 10%(5/48). No corresponding complications were observed in other parts of the patients. Conclusion 4D template-assisted ¹²⁵I seed therapy is safe and effective for malignant tumors, and intraoperative adjustment of needle angle and dose optimization can realize the precise control of implantation dose.
		2022 Vol. 31 (1): 55-58 [Abstract] ( 225 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	59	Application of deformable image registration in radiotherapy dose accumulation of helical tomotherapy combined with brachytherapy for cervical cancer
		Wang Wei, Zhou Qing, Jiang Mawei
		Objective To assess the feasibility of deformable image registration (DIR) in evaluating cumulative dose distribution of bladder and rectum of cervical cancer patients during helical tomotherapy (HT)-based intensity-modulated radiotherapy (IMRT) and high-dose-rate(HDR) brachytherapy. Methods Clinical data of 18 patients were retrospectively analyzed. Cumulative bladder/rectum D2cm³ and high-risk clinical target volume (HR-CTV) D90% parameters were calculated and compared to two direct parameter-adding methods with two registration-adding methods. Equivalent uniform dose (EUD group) and overlapping high dose (OHD group) methods were employed as parameter-adding methods. The registration-adding methods including rigid image registration (RIR group) and deformable image registration (DIR group) were adopted based on a commercial image registration software (MIM Maestro®). The dice similarity coefficient (DSC) and mean distance to agreement (MDA) were measured to assess the accuracy of RIR and DIR. Results In the EUD,OHD,RIR and DIR groups, the cumulative doses of bladder/rectum D2cm³ and HR-CTV D90% were (80.11±3.59)Gy (EQD2Gy),(82.23±3.46)Gy (EQD2Gy),(80.99±6.01)Gy (EQD2Gy) and (81.19±3.11)Gy (EQD2Gy)(P=0.516);(72.90±3.58)Gy (EQD2Gy),(73.83±4.28)Gy (EQD2Gy),(72.45±6.05)Gy (EQD2Gy) and (71.98±2.89)Gy (EQD2Gy)(P=0.625), and (85.51±2.91)Gy (EQD2Gy),(87.65±3.46)Gy (EQD2Gy),(81.53±3.63)Gy (EQD2Gy) and (85.81±3.30)Gy (EQD2Gy)(P<0.001), respectively. The mean DSC of the bladder, rectum and HR-CTV were 0.69, 0.65 and 0.63 with RIR;and 0.85, 0.81 and 0.78 with DIR (P<0.001), respectively. In DIR, the average MDA of bladder, rectum, and HR-CTV were 2.88, 2.48 and 2.66mm, respectively. Conclusions The cumulative DVH parameters among 4 groups show no significant difference in the bladder/rectum D2cm³/D0.2cm³. Since the DIR group achieves satisfactory volume matching of greater than 0.8 with DSC analysis, it can yield acceptable results for clinical application between HT IMRT and HDR BT for cervical cancer.
		2022 Vol. 31 (1): 59-64 [Abstract] ( 137 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	65	Exploration of the application of half-field intensity-modulated irradiation technique in the radiotherapy for esophageal cancer
		Liu Yang, Ding Danhong, Wei Shengtao, Wang Yingying, Li Dingjie
		Objective To explore a new technique for lung dose reduction in esophageal cancer radiotherapy based on the dose distribution characteristics of the half-field combined with intensity-modulated radiotherapy (IMRT) technique. Methods A three-dimensional water tank was used to measure the dose distribution at the edge of the symmetrical field and half-field, which was then compared and analyzed. Twenty patients with the middle and lower thoracic esophageal cancer receiving radiotherapy with prescription doses of 50.4-60.0Gy were selected. Based on the Varian Vital beam linear accelerator and Eclipse planning system, flattening filter (FF) technique symmetrical field and half-field beam design and the flattening filter-free (FFF) technique symmetrical field and half-field design were adopted to compare and analyze various dose data and treatment MU numbers for the target area and the endangered organs. The field settings were chosen in the front 1 and back 4 mode. Results Compared with the symmetrical field plan, the half-field plan significantly improved the irradiated dose to the lung with a statistically significant difference (P<0.05), and the half-field FFF was slightly better than the half-field FF mode. Compared with the total lung V5Gy, V20Gy, V30Gy, and Dmean dosimetric parameters (Gy), the FF symmetric field and FFF half-field were (49.64±5.39)% vs.(42.70±5.53)%,(15.99±3.93)% vs.(13.32±3.06)%,(9.24±2.77)% vs.(8.50±2.62)%, and (10.45±1.76)% vs.(9.50±1.53)%, respectively. There was a significant reduction in the volume dose values for all structures of the lung (all P<0.05). For other comparative data, the irradiated dose for the heart of the symmetrical field was better than that of the half-field mode (P<0.05), and the differences in conformity index (CI) and homogeneity index (HI), number of treated MU, and spinal cord associated with the target area were not statistically significant (all P>0.05). Conclusions During radiotherapy for esophageal cancer, target area coverage and dose volume data of the lung are the main parameters affecting the efficacy and side effects. IMRT treatment based on the half-field mode can give full play to the advantages of half-field and IMRT, and significantly improve the irradiated dose to the lung, which can offer an additional clinical option.
		2022 Vol. 31 (1): 65-70 [Abstract] ( 90 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	71	Effect of circLPAR3 on radiosensitivity of esophageal cancer cells by targeting miR-1238
		Yuan Xiaosun, Zhang Lei, Rao Shilei, Zhang Kai, Ma Huili, Li Changsheng, Zhang Jingwei, Ren Zhonghai
		Objective To evaluate the effect of circLPAR3 on the radiosensitivity of esophageal cancer cells and investigate its mechanism. Methods The cancer tissues and and adjacent tissues of 37 patients with esophageal cancer were collected, and esophageal cancer cell lines Eca-109, EC9706 and KYSE30 and esophageal epithelial cells HET-1A were cultured in vitro. The expression levels of circLPAR3 and miR-1238 in the tissues and cells were measured by RT-qPCR. Eca-109 cells were transfected with circLPAR3siRNA and miR-1238 mimics or co-transfected with circLPAR3siRNA and miR-1238 inhibitor. Cell cloning experiment was conducted to evaluate the effects of silencing circLPAR3, overexpressing miR-1238, or silencing both circLPAR3 and miR-1238 on the radiosensitivity of Eca-109 cells. After Eca-109 cells that silenced circLPAR3, overexpressed miR-1238 or silenced both circLPAR3 and miR-1238 were exposed to 4Gy irradiation, CCK-8 assay (A value), flow cytometry and Western blot were employed to assess the effects of silencing circLPAR3, overexpressing miR-1238, or silencing both circLPAR3 and miR-1238 combined with 4Gy irradiation on the proliferation and apoptosis of Eca-109 cells and the expression levels of CyclinD1, p21, Bcl-2 and Bax proteins. Dual luciferase reporter gene experiment and RNA pull down experiment were performed to verify the regulatory relationship between circLPAR3 and miR-1238. Results Compared with adjacent tissues, the expression level of circLPAR3 was up-regulated in the esophageal cancer tissues (P<0.05), while that of miR-1238 was down-regulated (P<0.05). Compared with HET-1A cells, the expression levels of circLPAR3 were up-regulated in the esophageal cancer cell lines Eca-109, EC9706 and KYSE30(all P<0.05), whereas those of miR-1238 were down-regulated (all P<0.05). Silencing circLPAR3 or overexpressing miR-1238 reduced the survival fraction of Eca-109 cells (all P<0.05), and the sensitization ratio was 1.21 and 1.75, respectively. Silencing circLPAR3 or overexpressing miR-1238decreased the A value of Eca-109 cells and the expression levels of CyclinD1 and Bcl-2 proteins (all P<0.05), while increased the apoptosis rate of Eca-109 cells and the expression levels of p21 and Bax proteins (all P<0.05). After silencing circLPAR3 or overexpressing miR-1238 combined with 4Gy irradiation, the A value of Eca-109 cells and the expression levels of CyclinD1 and Bcl-2 proteins were decreased (all P<0.05), while Eca-109 cell apoptosis rate and the expression levels of p21 and Bax proteins were increased (all P<0.05). circLPAR3 targeted and negatively regulated the expression level of miR-1238 in Eca-109 cells. After silencing miR-1238 and circLPAR3simultaneously, the survival fraction of Eca-109 cells was higher than that when only silencing circLPAR3, and the sensitization ratio was 0.59. Silencing miR-1238 reversed the effects of silencing circLPAR3 combined with 4Gy irradiation on the proliferation and apoptosis of Eca-109 cells. Conclusion circLPAR3 is highly expressed in esophageal cancer tissues and cell lines, and silencing the expression of circLPAR3 can inhibit the proliferation of esophageal cancer Eca-109 cells, promote their apoptosis, and enhance cell radiosensitivity by up-regulating miR-1238.
		2022 Vol. 31 (1): 71-78 [Abstract] ( 93 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	79	Experimentation of effect of PD-1 inhibitor on myocardial inflammation microenvironment and radiation-induced injury
		Zhou Kaiyan, Liu Lingfeng, Cao Li, Wang Gang, Zhao Chaofen, Kuang Huaxiang, Hu Yinxiang, Zhang Haojia, Su Shengfa, Lu Bing
		Objective To explore the potential mechanism of PD-1 inhibitor P on RIMI from the perspective of immune microenvironment. Methods To establish a mouse model of radiation-induced myocardial injury (RIMI), twenty C57BL/6 mice were randomly divided into 4 groups, 5 in each group. Group A was the healthy control group;Group B was the PD-1 inhibitor group;Group C was the simple irradiation group, with a heart irradiation of 15Gy;Group D was the irradiation+ PD-1 inhibitor group. One month after irradiation, the mice were anesthetized and sacrificed. The morphological changes of myocardial tissues were observed by HE staining. The myocardial fibrosis was assessed by Masson staining. CD⁺₃, CD⁺₃CD⁺₄, CD⁺₃CD₈ lymphocyte subsets and cytokines (IL-4, IL-6, IL-17A, TNF-α, TGF-β1 and INF-γ) levels were determined by flow cytometry. The apoptosis rate of myocardial cells was detected by TUNE. Results One month after irradiation, there was no obvious myocardial fibrosis in group B, and collagen fibers were distributed in the interstitium of myocardial cells in groups C and D. Semi-quantitative analysis results showed that the myocardial collagen volume fraction (CVF) of groups A, B, C and D were (1.97±0.36)%,(2.83±1.03)%,(5.39±0.77)% and (7.72±1.43)%, respectively. The CVF between group A and group B was similar (P=0.314), and the differences in CVF between the other groups were statistically significant (all P<0.05). Compared with group A, the absolute value and percentage of CD⁺₃ T lymphocytes were significantly increased in groups B, C and D (all P<0.01). The values in group D were significantly higher than those in group B and group C (all P<0.01);The absolute value and percentage of CD⁺₃CD4 T lymphocytes were similar among four groups (all P>0.05);The absolute value and percentage of CD⁺₃CD₈ T lymphocytes in group D were significantly higher than those in groups A,B and C (all P<0.001). The expression levels of IL-6, IL-17A, and TGF-β1 in group D were significantly higher compared with those in groups A, B and C (all P<0.001). The apoptotic index was gradually increased in four groups, and the differences in apoptotic index among four groups were statistically significant (all P<0.001). Conclusion PD-1 inhibitors can aggravate RIMI by promoting myocardial immune inflammatory response.
		2022 Vol. 31 (1): 79-84 [Abstract] ( 99 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	85	Research progress on non-surgical treatment of ameloblastoma
		Jin Yi, Yang Pei, Jin Hekun, Wu Xiangwei, Wang Hui
		Ameloblastoma is a relatively common benign tumor that occurs in the dental epithelial tissues, which is characterized with local infiltration and growth,high-risk recurrence and metastasis, etc. At present, radical osteotomy is the main treatment of ameloblastoma, whereas it yields high recurrence rate and causes multiple postoperative complications such as facial and functional deformities, etc. For inoperable patients, non-surgical interventions, such as radiotherapy, chemotherapy and molecule-targeted therapy, are urgently needed to improve prognosis and retain organs. This article summarizes the current status and research progresses on non-surgical treatment of ameloblastoma, aiming to provide evidence for individualized treatment of ameloblastoma.
		2022 Vol. 31 (1): 85-89 [Abstract] ( 106 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	90	Postoperative radiotherapy for non-small cell lung cancer treated with neoadjuvant chemotherapy followed by surgery
		Bao Yongxing, Hui Zhouguang
		Neoadjuvant chemotherapy followed by surgery (NCS) is a common therapy pattern of non-small cell lung cancer (NSCLC). However, patients treated with NCS still suffer from relatively high locoregional recurrence. Postoperative radiotherapy (PORT) plays an important role in improving locoregional control, whereas its effect on survival remains controversial. Some studies propose that PORT yields no survival benefits for stage Ⅱ-ⅢA(N2) patients treated with NCS, whereas other researches indicate that PORT can bring survival benefits for high-risk patients. The indications of PORT include R1/R2 resection and ypN2. PORT is recommended with three-dimensional conformal therapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) within the dose range of 50-54Gy (R0 resection). The target volume is inconclusive and the irradiation range of mediastinum involving with the metastatic lymph node regions is recommended in many studies.The adverse effects of PORT are acceptable in most studies.Nevertheless, the evidence level of relevant studies is relatively low. These results remain to be clarified by prospective randomized clinical trials.
		2022 Vol. 31 (1): 90-96 [Abstract] ( 114 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	97	Effect of local treatment on lateral pelvic lymph node metastasis in rectal cancer
		Tang Yuan, Jin Jing
		Lateral pelvic lymph node (LPLN) metastasis is a poor prognostic factor for rectal cancer, which is more common in low site, T3-T4 stage, and positive lymph nodes in mesorectum. However, there is no accurate predictor of metastasis. At present, high-resolution MRI is the optimal diagnosis of LPLN metastasis, but the threshold value is still unclear. The treatment mode of LPLN metastasis in locally advanced rectal cancer is controversial worldwide. European and American countries advocate chemoradiotherapy combined with total mesorectal resection, while Japan recommends total mesorectal resection combined with LPLN dissection. The combination of radiotherapy and surgery could achieve good local control. Further more, by using the information of lateral lymph nodes before and after radiotherapy, patients with high risk can be screened for intensive treatment, such as LPLN dissection or dose-escalation approaches. Currently, there is still a lack of high-quality evidence on the efficacy of various approaches in the treatment of LPLN metastasis, and more research is needed to improve the treatment strategies.
		2022 Vol. 31 (1): 97-101 [Abstract] ( 102 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	102	Research progress on radical hypofractionated radiotherapy for prostate cancer
		Wang Fang, Wang Xin
		Radiotherapy is one of the important treatment strategies for localized prostate cancer. Conventional fractionated external beam radiotherapy is the standard dose-fraction regimen of radical radiotherapy for localized prostate cancer. In recent years, hypofractionated radiotherapy technique has been developed rapidly. The moderately hypofractionated radiotherapy has been considered as an alternative to conventional fractionated radiotherapy in conditional institutions. Increasing evidence has been obtained in the application of ultra-hypofractionated radiotherapy (also known as stereotactic body radiotherapy, SBRT) in patients with low-and intermediate-risk prostate cancer. However, the efficacy and safety of SBRT for high-risk prostate cancer have not been fully demonstrated. In this review, research progressess on the efficacy and safety of radical hypofractionated radiotherapy and the techniques of SBRT for prostate cancer were summarized.
		2022 Vol. 31 (1): 102-107 [Abstract] ( 102 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	108	The realization modes of non-coplanar radiotherapy technology
		Ma Min, Dai Jianrong
		Non-coplanar radiotherapy is a kind of radiotherapy technology which employs multiple non-coplanar fixed fields or non-coplanar arcs. The non-coplanar field can be defined that the central axis of each field is not on the same plane, while the non-coplanar arc can be described that the trajectory formed by each arc is not on the same plane. Compared with coplanar radiotherapy, non-coplanar radiotherapy can achieve multi-angle or multi-radian irradiation, which effectively improves the focusing level of ray and is beneficial to enlarge the radiation dose of the target area between the surrounding normal tissues. Its dosimetric advantages have been proven in multiple types of tumors, such as intracranial tumors, liver cancer and lung cancer, etc. Multiple approaches can be employed to realize non-coplanar radiotherapy, which can be divided into the non-coplanar conic radiotherapy, non-coplanar conformal radiotherapy, non-coplanar intensity-modulated radiotherapy and non-coplanar volumetric modulated arc therapy according to the established sequence. In this review, the development process and principal characteristics of these implementations were summarized.
		2022 Vol. 31 (1): 108-111 [Abstract] ( 132 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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