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.2 Published 2022-02-15

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

Head and Neck Tumors

	115	Study of level Ⅴmetastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of the neck node levels
		Li Zhihui, Guo Wenyan, Jiang Chaoyang, Gao Hui, Li Dong,Zhang Ling
		Objective According to 2013 updated consensus guidelines of neck node levels, the distribution characteristics of cervical lymph nodes of nasopharyngeal carcinoma (NPC) were analyzed, aiming to provide preliminary reference for the clinical target volume (CTV) delineation of level Ⅴ in NPC. Methods A total of 1 110 patients pathologically diagnosed with NPC from 2012 to 2020 were retrospectively recruited for further analysis. All patients’ MRI and contrast-enhanced CT simulation scan imageswere retrospectively reviewed, metastatic lymph nodes were mapped using the 2013 International Consensus Guidelines. Then, the correlation between Ⅴa, Ⅴb and Ⅴc metastatic lymph nodes and other lymph nodes was analyzed. An NPC case diagnosed with T1N0M0 was selected as the baseline standard for the normal anatomical structure and proportion of Ⅴc area. The metastatic lymph nodes in Vc were delineated on the CT simulation scan image of sample case, and the distribution characteristics of the metastatic lymph nodes inⅤc were analyzed.Results Among the 1 110 patients, 1 004(90.5%) patients had lymph node metastases. The most common area of metastatic lymph node levels were level Ⅶa (74.7%) and level Ⅱb(70.7%), and the skip metastasis of lymph nodes was rare (1.0%). The multivariate analysis showed lymph node metastasis in level Va was correlated with levels Ⅱb, Ⅲ, Ⅳa, Ⅴb, and Ⅷ region (P=0.010,0.001,0.001,0.001, 0.037). Lymph node metastasis in level Ⅴb was correlated with levels Ⅲ, Ⅳa, Ⅴa and Ⅴc region (P=0.006,0.001,0.001, 0.001). Lymph node metastasis in level Ⅴc was correlated with levels Ⅳb and Ⅴb region (P=0.008, 0.001). There were 28 cases of lymph node metastasis in levelⅤc. A total of 38 metastatic lymph nodes were counted in level Vc. Among them, 33(86.8%) lymph nodes were located in the medial of the omohyoid muscle (Ⅴc-1 region), and 5(13.2%) were located in the lateral of the omohyoid muscle (Ⅴc-2 region). Conclusions This study reflects the principle of individualized CTV delineation, which is based on the levels of nodal spread in NPC patients. When correlation is observed among different level V, V should be delineated as the moderate risk lymphatic drainage (CTVn2). It is recommended to individualized delineate level Vc when the CTVn2 covers Vc. The Ⅴc-2 region should be delineated as CTVn2 only when there is nodal spread in the ipsilateral Ⅴc-1 region.
		2022 Vol. 31 (2): 115-119 [Abstract] ( 109 ) [HTML 1KB] [ PDF 1642KB] ( 0 )

	120	Meta-analysis of chrono-chemotherapy combined with radiotherapy for locally advanced nasopharyngeal carcinoma
		Yang Jianquan, Guo Wen, Lang Jinyi, Lu Man
		Objective To systematically compare the efficacy and safety of chrono-chemotherapy combined with radiotherapy in patients with locally advanced nasopharyngeal carcinoma. Methods Seven databases were searched, including the Cochrane Library (Issue 5, 2021), PubMed, Embase, CBM, CNKI, VIP and Wanfang Database. The method ological quality of the eligible studies was evaluated. The Meta-analysis was performed by the Revman 5.3software. Results Sixteen studies consisting of 1275 patients were finally included. Among them, 642 patients were treated with chrono-chemotherapy combined with radiotherapy and 633 patients received conventional chemotherapy combined with radiotherapy. Results showed that compared with conventional chemotherapy group, the effective rate was significantly elevated (OR=1.66,95%CI:1.17-2.34,P=0.004), the incidence of leucopenia, thrombocytopenia, gastrointestinal reaction, grade 3-4 oral mucosal reaction and grade 3-4 radiothermitis was significantly reduced (all P<0.001), and the quantity of CD3, CD4 and CD4/CD8 was significantly increased in the chrono-chemotherapy group. Conclusion Current evidence shows that compared with conventional chemotherapy, chrono-chemotherapy combined with radiotherapy could improve the effective rate, reduce adverse reactions and mitigate the destruction of immune function simultaneously.
		2022 Vol. 31 (2): 120-124 [Abstract] ( 185 ) [HTML 1KB] [ PDF 876KB] ( 0 )

	125	Prospective study of apatinib combined with chemoradiotherapy for head and neck squamous cell carcinoma
		Li Mengmeng, Li Tingting, Cai Feng, Zhang Yajun, Zhang Xianwen, Liu Jingjing, Zhou Yufu, Sun Qian, Wang Gengming, Chen Rujun, Chen Xin, Zha Genlan, Jiang Hao
		Objective To evaluate the efficacy and safety of apatinib in combination with chemoradiotherapy for head and neck squamous cell carcinoma (HNSCC). Methods 37 patients orally received apatinib at 250mg/d during concurrent chemoradiotherapy until completion of radiotherapy, complete remission assessed by imaging examination, the onset of unacceptable toxicity or death. Baseline characteristics,Objective response rates (ORR) and adverse events were assessed in all enrolled patients with complete baseline and safety data. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method. Prognostic factors were statistically identified using Cox regression models. Results The ORR was 85%(95%CI:72%-98%). The median PFS was 17.9 months and the 2-year OS rate was 62%(95%CI:48%-80%). Ineffective short-term efficacy (HR=0.035, 995%CI:0.02-0.652, P=0.025) was an independent risk factor for poor OS. In addition, ineffective short-term efficacy (HR=0.104, 95%CI:0.017-0.633, P=0.014) and lymphocytopenia (HR=17.539, 95%CI:2.040-150.779, P=0.009) were independent risk factors for poor PFS. Common adverse events (>60%) included lymphocytopenia (76%),leukopenia (68%) and irradiation-induced mucosal injury (65%). The most common treatment-associated grade 3 adverse event was lymphopenia (49%). Conclusions Apatinib combined with chemoradiotherapy yield significant anti-tumor activity for HNSCC with controllable toxicity. For patients with advanced HNSCC, short-term efficacy and lymphocytopenia may be potential predictors for clinical efficacy of apatinib combined with chemoradiotherapy.
		2022 Vol. 31 (2): 125-130 [Abstract] ( 108 ) [HTML 1KB] [ PDF 2022KB] ( 0 )

Thoracic Tumors

	131	Prognostic analysis of patients with brain metastases from non-small cell lung cancer treated with supplemental radiotherapy under different prognostic scores
		Shen Dongxing, Liu Zhikun, Li Zhensheng, Han Huina, Shang Yuguang, Zhu Longyu, Kong Deyou, Zhang Andu, Kong Jie, Zhang Jian, Yang Fang, Qu Fuyin, Zhang Jun
		Objective To analyze the prognosis and influencing factors of different radiotherapy modes in patients with brain metastases from non-small cell lung cancer (NSCLC), and to explore the best benefit population with radiotherapy boost under different prognostic scores. Methods 634 patients with brain metastasis from NSCLC admitted to the Fourth Hospital of Hebei Medical University from 2013 to 2015 were analyzed retrospectively. According to different radiotherapy modes, they were divided into three groups:no radiotherapy group (n=330), whole-brain radiotherapy group (WBRT)(n=127) and whole-brain radiotherapy combined with boost group (WBRT+boost)(n=177). The intracranial progression-free survival (iPFS) and overall survival (OS) were calculated by Kaplan-Meier method. The multivariate prognostic factors were analyzed by the Cox models. Results The median iPFS and OS of all patients were 6.9 months and 9.0 months, respectively. In the no radiotherapy, WBRT and WBRT+boost groups, the 1-year iPFS was 15.1%, 16.3% and 40.2%(P=0.002), and the 1-year OS was 33.7%, 38.2% and 48.1%(P<0.001), respectively. Multivariate survival analysis demonstrated that different radiotherapy modes were the independent factors affecting iPFS and OS. Subgroup analysis revealed that for patients with 1-3 brain metastases, the 1-year OS and iPFS in the WBRT+boost group were better than those of WBRT alone (P=0.026, P=0.044) when GPA score was 2.5-4.0;the 1-year OS and iPFSin the WBRT+boost group were better than those of WBRT alone (P=0.036, P=0.049) when there was no targeted therapy;for patients with ≥4 brain metastases, the 1-year iPFS in the WBRT+boost group was better than that of WBRT alone (P=0.019, P=0.012) when GPA score was 2.5-4.0 and there was no targeted therapy. When the GPA score was 0-2 or there was targeted therapy, the 1-year OS and iPFS in the WBRT+boost group were better than those of WBRT alone, but the difference was not statistically significant (all P>0.05). Conclusions Radiotherapy can significantly improve the iPFS and OS of NSCLC patients with brain metastases. When the number of brain metastases is 1-3, GPA score is 2.5-4.0 or no targeted therapy, boost may improve the iPFS and OS;when the number of brain metastases is more than 4, GPA score is 2.5-4.0 or no targeted therapy, boost may only bring iPFS benefit;when GPA score is 0-2 or targeted therapy, boost may not benefit significantly.
		2022 Vol. 31 (2): 131-137 [Abstract] ( 112 ) [HTML 1KB] [ PDF 960KB] ( 0 )

	138	Risk assessment of brain metastasis after prophylactic cranial irradiation for 550 limited stage small cell lung cancer patients with remission after radiochemotherapy
		Chen Mengyuan, Jin Jianan, Ji Yongling, Hu Xiao, Chen Ming
		Objective To evaluate the risk and prognostic factors of brain metastasis (BM) after prophylactic cranial irradiation (PCI) in limited stage small cell lung cancer (LS-SCLC) patients with complete and partial remission (CR/PR) after radiochemotherapy. Methods Baseline data of 550 patients with LS-SCLC who obtained CR/PR after chemoradiotherapy and received PCI in Zhejiang Cancer Hospital between 2002 and 2017 were collected. The risk of BM and clinical prognosis were retrospectively analyzed. The survival analysis was performed by Kaplan-Meier method. Multivariate prognostic analysis was conducted byCox models. Results The overall BM rate after PCI was 15.6%(86/550), with 9%(4/43), 13%(7/52), and 16.5%(75/455) for stage Ⅰ, Ⅱ and Ⅲ patients, respectively. The median overall survival (OS) for the entire cohort was 27.9 months, and the 5-year OS rate was 31.0%. The OS was 24.9 and 30.2 months for patients with or without BM, and the 5-year OS rates were 8.9% and 36.1%(P<0.001). BM was an independent factor of OS (P<0.001). Clinical staging remained the influencing factor of OS and BM-free survival (P<0.001, P=0.027). Having tumors of ≥5cm in diameter significantly increased the risk of BM (P=0.034) rather than the OS (P=0.182). The median OS of patients aged<60 years was significantly longer than those aged ≥60 years (34.9 months vs. 24.6 months,P=0.001). The median OS of patients irradiated with 2 times/d was 29.8 months, significantly longer than 24.5 months of those irradiated with 1 time/d (P=0.013). Age, sex, radiotherapy fraction and efficacy of radiochemotherapy (CR/PR) were not associated with the incidence rate of BM (all P>0.05). Conclusions SCLC patients with tumors of ≥5cm in diameter may have a higher risk of developing BM after PCI. Patients aged<60 years achieve better OS compared with their counterparts aged ≥60 years.
		2022 Vol. 31 (2): 138-142 [Abstract] ( 92 ) [HTML 1KB] [ PDF 999KB] ( 0 )

	143	Preliminary analysis of recurrence-free survival after radical intensity-modulated radiotherapy combined with/without chemotherapy for upper cervical and thoracic esophageal cancer
		Shen Wenbin, Gao Hongmei, Xu Jinrui, Li Shuguang, Li Youmei, Zhu Shuchai
		Objective To investigate the recurrence-free survival (RFS) and influencing factors of intensity-modulated radiotherapy±chemotherapy (IMRT±C) for the upper thoracic esophageal cancer. Methods The medical records of 168 patients with cervical and upper thoracic esophageal cancer who met the inclusion criteria from January 2011 to December 2015 were retrospectively analyzed. The RFS was calculated by the Kaplan-Meier method. Multivariate prognostic analysis was performed by Cox models. The recurrence factors were identified by the Logistics model. Results The 1-,3-,and 5-year RFS rates were 67.8%,38.0%,and 20.4%,respectively, and the median RFS was 21.9 months. The locoregional recurrence rate was 47.6%(80/168). The recurrence sites were local esophagus (n=63), regional lymph nodes (n=7), and local esophagus+regional lymph node recurrence (n=10). Multivariate analysis showed that hoarseness, cTstaging,combined with chemotherapy,95%PTV1 exposure dose and GTV average exposure dose were the influencing factors of RFS (P=0.029,<0.001,0.031,0.038,0.020). Logistics model showed that cTstaging,cNstaging,short-term efficacy,irradiationmethod,GTV maximum transverse diameter and PTV average exposure dose were the influencing factors of recurrence (P=0.046,0.022,0.001,<0.001,0.012,0.001). Conclusions Patients with cervical and upper thoracic esophageal cancer treated with radical IMRT combined with/without chemotherapy have a higher locoregional recurrence rate,and the recurrence rate is mainly the esophagus. The independent factors that affect RFS are different from the risk factors of recurrence.
		2022 Vol. 31 (2): 143-148 [Abstract] ( 111 ) [HTML 1KB] [ PDF 813KB] ( 0 )

	149	Analysis of prognostic factors in 135 patients with pulmonary metastasis from esophageal squamous cell carcinoma
		Cui Xiaoying, Miao Xianyuan, Sheng Liming, Cheng Lei, Chen Ying, Du Xianghui
		Objective To investigate the prognostic factors of patients with esophageal squamous cell carcinoma with pulmonary metastasis. Methods Clinical characteristics of 135 esophageal squamous cell carcinoma patients presenting with pulmonary metastasis after treatment in Zhejiang Cancer Hospital from 2008 to 2018 were retrospectively analyzed. Thesurvival rate was calculated by Kaplan-Meier method. Univariate analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox models. Results The median follow-up time of 135 patients with esophageal squamous cell carcinoma was 94.2 months (19.5-258.9 months), and 109 patients died (80.7%). The 1-and 2-year overall survival rates were 47.4% and 25.1%, with the median survival time was 11.1 months (7.3-14.9 months).Univariate prognostic analysis showed that age, number of lung metastases, treatment of lung metastases, lymph node metastasis, distant organ metastasis, and the interval between the first treatment and lung metastasis were the prognostic factors of esophageal squamous cell carcinoma with lung metastasis (all P<0.05). Multivariate analysis demonstrated that age and number of lung metastases were the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases (all P<0.05). Conclusions Age and number of lung metastases are the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases. Surgery or radiotherapy-based regional therapy can enhance clinical prognosis.
		2022 Vol. 31 (2): 149-152 [Abstract] ( 98 ) [HTML 1KB] [ PDF 743KB] ( 0 )

Abdominal Tumors

	153	Evaluation of pancreatic subclinical dysfunction and sparing of pancreas after intensity-modulated radiation therapy for gastric cancer
		Sun Guanyu, Ma Yifu, Ma Jiayan, Guo Qiuchen, Zhou Chengliang, Chen Li, Yang Yongqiang, Qian Jianjun, Zhang Liyuan, Tian Ye
		Objective To evaluate the pancreatic subclinical dysfunction after intensity-modulated radiation therapy (IMRT) for gastric cancer by analyzing biochemical indexes and pancreatic volume changes, and to reduce the dose of pancreas by dosimetric prediction and dose limitation. Methods 30 patients with gastric cancer who received 45Gy postoperative adjuvant radiotherapy were retrospectively selected. The pancreas was delineated and its dose and anatomical relationship with planning target volume (PTV) were evaluated. Fasting blood glucose, serum lipase and amylase, and pancreatic volume changes before and after radiotherapy were analyzed. The correlation between the changes of biochemical indexes and volume and pancreatic dose was evaluated by Pearson analysis. The threshold of the dosimetric prediction was obtained by receiver operating characteristic (ROC) curve. Finally, the feasibility of dosimetric limitation in IMRT was assessed. Results The pancreatic volume of 30 patients was 37.6cm³, and 89.0% of them were involved in PTV. Dmean of the pancreas was 45.92Gy, and 46.45Gy, 46.46Gy and 45.80Gy for the pancreatic head, body and tail, respectively. The fasting blood glucose level did not significantly change. The serum lipase levels were significantly decreased by 66% and 77%(both P<0.001), and the serum amylase levels were significantly declined by 24% and 38%(both P<0.001) at 6 and 12 months after radiotherapy. Pancreatic volumes of 22 patients was decreased by 47% within 18 months after radiotherapy. ROC curve analysis showed that pancreatic V45Gy had the optimal predictive value for the decrease by 1/3 of serum lipase and amylase levels at 6 months and serum amylase level at 12 months after radiotherapy, and the cut-off value was V45Gy<85%. Pancreatic Dmean yielded the optimal predictive value for the decrease by 2/3 of serum lipase level at 12 months after radiotherapy, and the cut-off value was Dmean<45.01Gy. After"whole pancreas" and"outside PTV pancreas" dose limit, V45Gy of the pancreas was decreased by 11% and 7%, Dmean of the pancreas was declined by 2% and 2%, and Dmean of the pancreatic tail was decreased by 3%, respectively. Conclusions Serum lipase and amylase levels significantly decline at 6 and 12 months after adjuvant radiotherapy for gastric cancer, and pancreatic volume is decreased significantly within 18 months after radiotherapy. Pancreatic V45Gy<85% and Dmean<45.01Gy are the dose prediction values for the decrease of serum lipase and amylase levels. The dose can be reduced to certain extent by dosimetric restriction.
		2022 Vol. 31 (2): 153-159 [Abstract] ( 109 ) [HTML 1KB] [ PDF 5570KB] ( 0 )

	160	Analysis of risk factors of thrombocytopenia toxicityduring concurrent chemoradiation of gastric cancer
		Zhang Li, Zhang Yujing, Wang Jijin, Zhang Li, Cai Xiaojun, Song Ying
		Objective To investigate the related risk factors of thrombocytopenia grade 2+[TPG2(+)] in patients with gastric cancer during chemoradiotherapy. Methods The pre-treatmentclinical data, hematologic parameters, and the correlation between dose distribution of vertebrae andTPG2(+) in non-metastaticgastric adenocarcinoma patients receiving concurrent chemoradiation in Sun Yat-sen University Cancer Center were retrospectively analyzed. Results A total of 58 patients were included, including 23 cases (40%) in theTPG2(+) group and 35(60%) in the TPG2(-) group. There was no statistical difference in baseline clinical data between two groups (all P>0.05). Univariate Logistic regression analysis showed that several baseline parameters including platelet count (PLT),basophil count (BA),lactate dehydrogenase (LDH) and length of CTV (LCTV),the number of vertebrae (VBN), vertebral body volume (VBV), Dmax, Dmean,V5Gy,V10Gy,V20Gy,V30Gy and V40Gywere correlated with TPG2(+)(all P<0.05). However, the multivariate Logistic regressionanalysisshowed that low PLT (P=0.048),high LDH (P=0.028),increased LCTV (P=0.013),high V20Gy/VBN (P=0.030) were associated with the risk of TPG2(+). Conclusion In gastric adenocarcinoma patients treated with chemoradiotherapy,correction of PLT reduction before treatment,avoidinglonger CTV and controlled V20Gy correction for vertebral number may reduce significant thrombocytopenia induced by chemoradiotherapy.
		2022 Vol. 31 (2): 160-164 [Abstract] ( 87 ) [HTML 1KB] [ PDF 1036KB] ( 0 )

Physics·Technique·Biology

	165	Application value of low-dose 4DCT scanning in simulation and target delineation for solitary pulmonary tumors
		Shang Dongping, Luan Lijuan, Wang Lizhen, Sun Qingning, Yu Jinming, Yin Yong
		Objective To explore the feasibility of low-dose 4DCT scanning in simulation and target delineation for solitary pulmonary tumors (SPTs). Methods 23 patients with SPTs received 4DCT scanning simulation with the conventional scanning (CON), low voltage (LV), low current (LA) and low voltage combined with low current (LVA) in sequence. Based on the 4DCT images derived from the four sets of scanning parameters, the internal gross tumor volume (IGTVCON, IGTVV, IGTVA, IGTVVA) of SPTs were delineated and matched. Taking IGTVCON as reference, the tumor displacement and the centroid position of IGTVV, IGTVA and IGTVVA were compared with IGTVCON. The radiation doses under different scanning parameters were compared. Results The volumes of IGTVCON, IGTVV and IGTVA were (12.26±12.30) cm³,(12.21±12.16) cm³ and (11.87±11.70) cm³, respectively (P=0.337). IGTVVA was (11.34±11.07) cm³, significantly smaller than IGTVCON (P=0.005). There was no significant difference in the centroid positions of IGTVCON, IGTVV, IGTVA and IGTVVA in three directions (P=0.491, 0.360, 0.136). The Dice′s similarity coefficient (DSCVA) was significantly lower than DSCV and DSCA (P=0.004, 0.030). The tumor displacement measured by the four sets of 4DCT images was similar in the LR direction (P=0.470), and also in the AP direction (P=0.108). For the displacement in the SI direction, LVA scanning was smaller than CON (P=0.015). The radiation doses under four different scanning conditions were (397.0±140.3) mGy·cm,(175.0±61.8) mGy·cm,(264.8±95.3) mGy·cm and (116.8±41.2) mGy·cm, respectively (P<0.001). Conclusions LV or LA scanning exert no significant effect on the volume, centroid position of IGTV and the tumor displacement in 4DCT simulation for SPTs. The radiation dose that patients receive under LV and LV scanning is lower than that of CON. Consequently, LV or LA scanning is feasible in 4DCT simulation and target delineation for SPTs.
		2022 Vol. 31 (2): 165-169 [Abstract] ( 103 ) [HTML 1KB] [ PDF 1104KB] ( 0 )

	170	Preliminary application of volumetric-modulated arc therapy dosimetry verification system based on three-dimensional dose reconstruction of patient anatomical structures
		Ma Yangguang, Mai Rizhen, Pei Yuntong, Guo Yuexin
		Objective To perform testing and clinical application of a volumetric-modulated arc therapy (VMAT) dosimetry verification system based on three-dimensional dose reconstruction of patient anatomical structures. Methods ArcCheck array calibration was performed. Then, 200MU was delivered with a 10cm×10cm field when the source to center of ArcCheck was 100cm to calibrate the absolute dose and the dose was simultaneously measured by a FC65-G detector in the center of the ArcCheck. The absolute dose calibration value or the CT value of ArcCheck was adjusted to minimize the differences between the planning and measurement values of FC65-G, reconstructed value by 3DVH and reconstructed percent depth dose by 3DVH. 10 lung and 10 cervical cancer VMAT cases were selected and measured by ArcCheck and FC65-G under the delivery of a TrueBeam LINAC. The three-dimensional doses of all cases were reconstructed by 3DVH and compared with the planning and measurement values. Results Different array calibration files of ArcCheck exerted different effect upon the two-dimensional dose measured by ArcCheck and three-dimensional dose reconstructed by 3DVH. The optimal reconstructed dose was obtained when self-calibration file was adopted and 249.96cGy was regarded as the absolute dose calibration value. The deviations of the mean dose (Dmean) and D95% of the target were within ±4.2% and parameters of some organs at risk significantly differed compared with the reconstructed and planning dose for all cases. A negative mean point dose difference was obtained and the reconstructed dose was closer to the measured value. The γ-passing rate of the target for some cases was low, the proportion of regions irradiated by 50% prescription dose was slightly higher and the proportion of other organs was relatively high. Conclusion The 3DVH model can be accurately established and tested with the acceptance test method in the present study, which can provide detailed information for dose verification.
		2022 Vol. 31 (2): 170-175 [Abstract] ( 115 ) [HTML 1KB] [ PDF 1612KB] ( 0 )

	176	Study of dose distortion and Bragg peak location correction in MRI-guided proton therapy
		Deng Xiuzhen, Li Xiufang, Guo Mengya, Gu Shuaizhe, Liu Qi, Chen Zhiling
		Objective To analyze the influence of magnetic field on the proton beam delivery and dose distribution, and develop a correction method for the Bragg peak (BP) shift under the vertical magnetic field, providing reference for the dose calculation and beam delivery of MRI-guided proton therapy. Methods Monte Carlo (MC) simulation was used to study the dose distribution of the proton beam in the water phantom under the magnetic field. The BP location was corrected by the method of"angle correction+ energy correction", and the correction parameters were calculated by the analytical formula based on the simulation data. Results The magnetic field caused the dose distortion and shift of BP location. The shift degree was increased with the increase of field strength and initial energy. Compared with MC simulation, the result of calculating proton deflection in the air by the analytical method yielded a deviation within 0.2%. Based on the simulation data and calculation formulas, the correction parameters under different conditions could be calculated within 1s by using the MATLAB programming. The calculation results showed that the air layer with magnetic field, isocenter depth, irradiation direction exerted different influence on the correction parameters. After correction, the BP location was basically consistent with the expected (offset ≤0.2mm). Conclusions The BP shift under the vertical magnetic field can be effectively corrected by "the angle correction+ energy correction" method. The correction parameters under different conditions can be quickly and accurately calculated by the calculation formulas based on simulation data.
		2022 Vol. 31 (2): 176-181 [Abstract] ( 105 ) [HTML 1KB] [ PDF 2075KB] ( 0 )

	182	Study of establishment of evaluation index system for stability of linac equipment
		Yuan Jinhui, Li Qingsong, Shen Yan
		Objective To build an evaluation index system for linac stability and establish a scientific, systematic and Objective evaluation standard for the stability of linac equipment. Methods Based on the Delphi and AHP methods, a three-level index system for the stability of linac equipment was established, and the correlation coefficients and weights were calculated using Microsoft Excel 2007 and SPSS 16.0. Results The enthusiasm of experts in two rounds was 85%(17/20) and 92%(23/25), the authority coefficients were 0.79 and 0.87, and the expert Kendall coordination coefficients were 0.957(first-level index, P<0.05), 0.637(second-level index, P<0.05) and 0.527(third-level index, P<0.05), respectively. Finally, a three-level index system covering 2 first-level indicators of mechanical treatment system and accessory system, 9second-level indicators and 32 third-level indicators was established. The CVs of all levels of indicators were less than 0.25 and passed the consistency test. Conclusion The evaluation index system for linac equipment stability has good scientificity, operability and versatility, which can provide theoretical and quantitative reference for linac stability evaluation and equipment purchase.
		2022 Vol. 31 (2): 182-186 [Abstract] ( 95 ) [HTML 1KB] [ PDF 759KB] ( 0 )

	187	Uncertainty of active breathing coordinator technology for liver and lung cancer therapy using proton and heavy ion
		Xie Wenbo, Li Yongqiang
		Objective To study and analyze the uncertainty of active breathing coordinator (ABC) technology for liver and lung cancer therapy using proton and heavy ion. Methods Before each treatment, each patient received a verification radiograph through the supporting imaging frame in treatment room. 200 verification radiographs were taken for 20 lung cancer patients and 200 for 20 liver cancer patients. Ipiodol markers, which were fixed relative to the location of the tumor, were injected into the liver cancer patients. The position changes of ipiodol markers could reflect the position changes of liver tumors. Verification radiographs were registered with the vertebral body as the main target, and the change value of tumor location was recorded. Results For liver cancer cases, the values of position change in the left and right, head and foot, and dorsal abdomendirection were (-0.05± 0.28) cm,(0.15±0.33) cm,(-0.12±0.27) cm,and (-0.03±0.13) cm,(-0.05±0.14) cm and (0.02±0.16) cmfor lung cancer cases, respectively (P=0.280,<0.001,<0.001). For liver cancer cases,the dispersionin the left and right, head and foot, and dorsal abdomendirectionwas (0.20±0.09) cm,(0.25±0.06) cm,(0.19±0.09) cm, and (0.09±0.03) cm,(0.10±0.03) cm and (0.13±0.03) cm for lung cancer cases,respectively (P<0.001,<0.001, 0.008). The proportion of tumor location changes of≤5mm in three directions in liver and lung cancer patientswas (92%, 83%, 93%) vs. (99%, 99%, 100%)(P=0.030, 0.002, 0.007). Conclusion The application of ABC technology in the proton heavy ion therapy of lung and liver cancer has good reproducibility, and the stability of ABC technology in the treatment of lung cancer is better than that of liver cancer.
		2022 Vol. 31 (2): 187-191 [Abstract] ( 124 ) [HTML 1KB] [ PDF 1758KB] ( 0 )

	192	Effect of hyperthermia combined with paclitaxel on proliferation, apoptosis and cycle of human tongue squamous cell carcinoma cell line CAL-27
		Zhou Xuexiao, Shen Pei, Shi Fan, Shao Yun, Cong Yuan,Xu Ting, Wang Shengzhi
		Objective To observe the effect of hyperthermia combined with paclitaxel on the proliferation, apoptosis and cycle of human tongue squamous cell carcinoma cell line CAL-27, and to explore the underlying mechanism. Methods The working concentration of paclitaxel was determined by CCK-8 assay, and the cultured CAL-27 cells were divided into the control, paclitaxel, 42℃ hyperthermia and combined treatment groups. The ability of cell proliferation was detected by colony formation assay, and the cell cycle and apoptosis were determined by flow cytometry. The expression levels of AKT, p-AKT, Bcl-2 and Bax proteins in each group were measured by Western blot. Results Compared with the control group, the proliferation was significantly inhibited and the apoptosis of CAL-27 cells was significantly promoted in the combined treatment, hyperthermia and paclitaxel groups (all P<0.05), and the anti-proliferation and apoptosis-promoting effect in the combined treatment group was significantly better than those in the hyperthermia and paclitaxel groups (all P<0.05). Western blot showed that hyperthermia combined with paclitaxel could significantly up-regulate the expression level of Bax protein and significantly down-regulate the expression levels of P-AKT and Bcl-2 in CAL-27 cells (all P<0.05). Conclusions Hyperthermia combined with paclitaxel can play a synergistic role in inhibiting proliferation and promoting apoptosis of tongue squamous cell carcinoma CAL-27 cells. The mechanism may be related to the inhibition of AKT activation and the activation of Bax/Bcl-2 apoptosis signaling pathway.
		2022 Vol. 31 (2): 192-195 [Abstract] ( 95 ) [HTML 1KB] [ PDF 1004KB] ( 0 )

	196	Effect of compound UC2288 on radiosensitivity of CNE-2R cell line and nude mouse transplanted tumor
		Liang Renba, Zhu Xiaodong
		Objective To evaluate the effect of compound UC2288 on the radiosensitivity of CNE-2R cell line and nude mouse transplanted tumor. Methods The UC2288 concentration was referenced to previous experimental results (IC50=12.20μmol/L). The effect of UC2288 combined with 2,4,6,8Gy X-ray irradiation on the radiosensitivity of CNE-2R cell line was detected by clone formation experiment. The effect of UC2288 combined with 2,4,6,8Gy X-ray irradiation on the proliferation of CNE-2R cell line was determined by CCK8 assay. The nude mouse model of transplanted tumor was constructed with CNE-2R cell line. The radiosensitivity of transplanted tumor of UC2288 combined with 2Gy/fraction X-ray irradiation for three consecutive days was evaluated. Results The experimental concentration of UC2288 was 8μmol/L. The clonality of CNE-2R cell line was reduced under UC2288 combined with X-ray 2,4,6, and 8Gy irradiation, andthe radiosensitizationratio was 1.60. The proliferation of CNE-2R cell line was significantly decreased under UC2288 combined with X-ray 2,4,6, and 8Gy irradiation. UC2288 inhibited the growth of transplanted tumor in nude mice, and the inhibitory effect was strengthened with the extension of observation time, and the most obvious effect was observed at 16d.(P<0.01). Theradiosensitizationratio was 4.33. The proliferation of CNE-2R cell line was decreased under UC2288 combined with X-ray irradiation. Conclusion UC2288 can increase the radiosensitivity of nasopharyngeal carcinoma radioresistant cell line CNE-2R.
		2022 Vol. 31 (2): 196-200 [Abstract] ( 142 ) [HTML 1KB] [ PDF 1766KB] ( 0 )

Review Articles

	201	Current status and progress of proton and heavy ion radiotherapy for glioma in adults
		Sun Pian, Kong Lin
		Glioma is the most common primary malignant brain tumor. Surgery combined with postoperative radiotherapy is the standard treatment, but the outcome is unsatisfactory. Currently, proton and carbon ion, the most advanced radiotherapy technology, offer substantial clinical advantages over the conventional photon therapy in multiple tumors. However, the effect of proton and carbon ion radiotherapy in glioma has not been clarified clearly. This article will elaborate on the basic research and clinical outcomes of proton and carbon ion radiotherapy for glioma.
		2022 Vol. 31 (2): 201-207 [Abstract] ( 90 ) [HTML 1KB] [ PDF 832KB] ( 0 )

	208	Advances in organ preservation for locally advanced rectal cancer after neoadjuvant chemoradiotherapy
		Zhao Ying, Tang Yuan, Jin Jing
		Neoadjuvant chemoradiotherapy combined with total mesorectal excision is the standard treatment for stage T3-T4/N+ locally advanced rectal cancer (LARC). However, proctectomy is burdened with consistent postoperative morbidity, severely affecting the quality of life. “Organ preserving” methods could achieve similar oncological outcomes in highly selected patients whose tumors demonstrate (almost) clinical complete response to neoadjuvant treatment, while maintaining the quality of life and anorectal function by keeping the anus. This article aims to summarize the strategies of organ preservation after neoadjuvant treatment of LARC, salvage treatment for regrowth or recurrence, and anorectal function after organ preservation strategies.
		2022 Vol. 31 (2): 208-213 [Abstract] ( 150 ) [HTML 1KB] [ PDF 834KB] ( 0 )

	214	Optimizing the target volume to boost the efficacy of radiation-induced immunomodulatory effects
		Geng Xiaotao, Wang Xin, Li Minghuan
		Radiotherapy is a pivotal method in cancer treatment harbouring immunomodulatory effects. Radiotherapy combined with immunotherapy has been proven to yield promising preliminary results in certain types of tumors. Most studies have concentrated on the dose fractionation of radiotherapy and timing of radiotherapy and immunotherapy. With the development of related studies, attention has been gradually paid to the influence of target volume upon circulating lymphocytes and tumor microenvironment. The interaction between target volume and immunotherapy has been valued. For tumors not suitable for hypofractionated radiotherapy, such as advanced esophageal cancer, conventional fractionated radiotherapy has been adopted. The volume and planning of target volume play a pivotal role in radiotherapy combined with immunotherapy. This article illustrates the feasibility of radiotherapy combined with immunotherapy, theory and conception of optimizing target volume.
		2022 Vol. 31 (2): 214-218 [Abstract] ( 83 ) [HTML 1KB] [ PDF 1644KB] ( 0 )

	219	Research progress on the role of IDO signaling pathway in radiotherapy for non-small cell lung cancer
		Wu Linfang, Wang Chunyu, Yang Yufan, Bi Nan, Wang Lyuhua
		Indoleamine 2,3-dioxygenase (IDO) is one of the rate-limiting enzymes that degrade tryptophan (Trp) into kynurenine (Kyn). Inflammatory factor IFN-γ mediates tumor′s immune escape by activating the IDO signaling pathway, upregulating theKyn/Trp (K/T ratio) and suppressing the activity of both CD⁺₈T and regulatory T cells. Radiotherapy plays a major role in treating non-small cell lung cancer. It not only bi-directionally regulates immune response of the host, but also collaborates with immunosuppressive agents to kill tumors. Meanwhile, immune status of the host can affect the therapeutic effect of radiotherapy. In recent years, studies have shown that IDO activity levels change before and after radiotherapy and is related to clinical prognosis. Nevertheless, relevant mechanism remains unclear. This article aims to elucidate the application of IDO signaling pathway in radiotherapy for non-small cell lung cancer.
		2022 Vol. 31 (2): 219-222 [Abstract] ( 97 ) [HTML 1KB] [ PDF 790KB] ( 0 )

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Cancer Hospital of Chinese
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