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.4 Published 2022-04-15

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

Guidelines

	303	Clinical guidelines for small static field dosimetry
		National Cancer Center/National Cancer Quality Control Center
		The dosimetry of small photon fields is the theoretical basis for the calculation accuracy of real physical dose in precise radiotherapy such as stereotactic radiotherapy, stereotactic radiosurgery and intensity modulated radiotherapy. Compared with conventional beam, small fields incline to introduce larger error in clinical application with increasing dose uncertainty. In order to ensure the small fields measuring accuracy and the specialized detector usage standardization, a clinical practice guideline of small fields dosimetry was established under the organization and leadership of National Cancer Center/National Cancer Quality Control Center with the cooperation of many large medical institutions in China. This guideline mainly covers the clinical procedures of reference dose and relative dose measurements in small static photon fields, thus domestic radiotherapy units can apply small field related radiotherapy technology safely, reliably, efficiently, and accurately.
		2022 Vol. 31 (4): 303-333 [Abstract] ( 178 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	334	Implications of different metastatic sites for thoracic radiation in extensive-stage small cell lung cancer
		Jia Huijun, Ma Jintao, Meng Chunliu, Yu Hao, Luo Jing, Xu Liming, Liu Ningbo, Wang Ping, Zhao Lujun
		Objective To evaluate the efficacy and safety of thoracic radiotherapy in the treatment of patients with extensive-stage small cell lung cancer (ES-SCLC) with different metastatic sites. Methods A retrospective analysis was performed among 830 ES-SCLC patients who were admitted to our hospital from 2010 to 2019. They all received the first-line chemotherapy and had no progression after chemotherapy. 341 patients of them received thoracic radiotherapy after chemotherapy. The main endpoint was overall survival. The Chi-square test was used to compare the categorical data including gender and age, etc. Univariate survival analysis was estimated by Kaplan-Meier method and the log-rank test was used to compare the survival curves between two groups. A multivariate prognostic analysis was made by the Cox proportional hazard model. Results In all the patients, the overall survival (OS) was 12.4 months. The patients with thoracic radiotherapy had significantly higher OS than the patients without thoracic radiotherapy (15.2 months vs.10.8 months,P<0.001). Thoracic radiotherapy significantly improved the OS in patients without liver metastasis (16.0 months vs.11.4 months, P<0.001) in the oligometastatic patients. But for the oligometastatic patients with liver metastasis, the OS benefit was not significant (14.2 months vs. 10.6 months, P=0.072). For polymetastatic patients without liver metastasis, thoracic radiotherapy offered significant OS benefits (14.5 months vs.10.9 months,P<0.001), but for the polymetastatic patients with liver metastasis, the OS was not improved with thoracic radiotherapy (10.2 months vs.9.2 months,P=0.715). Conclusions In ES-SCLC patients, thoracic radiotherapy provides significant OS benefits in patients with oligometastases ES-SCLC without liver metastasis and for the liver metastatic patients may also benefit from thoracic radiotherapy based on the effectiveness of chemotherapy. In patients with multiple metastases, thoracic radiotherapy only improves the OS in patients without liver metastasis, but does not improve the prognosis in patients with liver metastasis.
		2022 Vol. 31 (4): 334-339 [Abstract] ( 209 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	340	Prognostic analysis of patients with brain metastases from non-small cell lung cancer treated with different doses of whole brain radiotherapy
		Shen Dongxing, Liu Zhikun, Li Zhensheng, Han Huina, Shang Yuguang, Zhu Longyu, Kong Deyou, Zhang Jian, Qu Fuyin, Zhang Jun
		Objective To analyze the prognosis and influencing factors of patients with brain metastases from non-small cell lung cancer (NSCLC) treated with different doses of whole brain radiotherapy (WBRT). Methods A total of 244 NSCLC patients with brain metastases who underwent WBRT in the Fourth Hospital of Hebei Medical University from 2013 to 2015 were analyzed retrospectively. According to different doses of WBRT (EQD2Gy), they were divided into the 30-39Gy group (n= 104) and ≥40Gy group (n= 140). The intracranial progression-free survival (iPFS) and overall survival (OS) were compared betweentwo groups. According to the number of brain metastases, GPA score, KPS score, chemotherapy and targeted therapy, the prognosis of different doses of WBRT was further analyzed. Results The median iPFS and OS of all patients were 6.9 months and 11.8 months, respectively. Univariate survival analysis:the 1-year iPFS and 1-year OS between two groups were 22.5% and 25.4%(P=0.430) and 41.1% and 46.4%(P=0.068), respectively. Multivariate survival analysis:different doses of WBRT were not associated with the improvement of iPFS and OS;independent factors influencing iPFS included local boost, gender, number of brain metastases, chemotherapy and targeted therapy;independent factors influencing OS included gender, number of brain metastases, chemotherapy and targeted therapy. Subgroup analysis:in patients with KPS≥90, the 1-year iPFS and OS of patients with WBRT ≥ 40Gy were seemingly better than those of their counterparts with 30-39Gy, but the difference was statistically significant only in OS (P=0.047), the difference was not statistically significant in iPFS (P=0.068);in patients with chemotherapy, the 1-year iPFS and OS of patients with WBRT≥40Gy were better than those of their counterparts with 30-39Gy (P=0.017, P=0.012);in patients with targeted therapy, the 1-year iPFS and OS in the WBRT≥40Gy group were better than those in the 30-39Gy group (P=0.012, P=0.045). Conclusions The 30-39Gy may be the appropriate dose of WBRT for NSCLC patients with brain metastases. WBRT≥40Gy does not bring more benefits. WBRT≥40Gy may benefit NSCLC patients with brain metastases with high KPS score or active systemic therapy.
		2022 Vol. 31 (4): 340-346 [Abstract] ( 189 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	347	Single-fraction SRS and multi-fraction SRT for brain metastases from colorectal cancer
		Pan Mianshun, WangMeng, Li Yong, Wu Junlan, Wang Peng, Shao Xianjun, Liang Xiaohua, Zhang Feifei, Shen Meihua
		Objective To compare the efficacy and side effects of multi-fraction stereotactic radiotherapy (SRT) and single-fraction stereotactic radiosurgery (SRS) in the treatment of brain metastases from colorectal cancer.Methods A total of 98 patients with brain metastases from colorectal cancer searched from the database of Professional Committee of Brain Metastasis of Shanghai Anticancer Association were recruited in this study. Among them, 46 patients weretreated with SRT and 52 patients with SRS. Clinical characteristics of all patients were analyzed between two groups and the local tumor control rate, median survival time and the incidence of radiation-induced brain injury were compared between two groups. Results The objective remission rates (ORR) in the SRT and SRS groups were 76.1% and 67.3%, respectively. The 12-month local tumor control rates were 88.3% and 83.9% between two groups, with no statistical difference (P=0.689). The median overall survival time of all patients was 11.6 months, 10.8 months in the SRT group and 12.7 months in the SRS group. There was no statistical difference between two groups (P=0.129). Multivariate analysis showed that the main factors leading to poor prognosis included the number of tumors of >3(P=0.026), low GPA score (P=0.035), and lack of systematic treatment mode and bevacizumab (P=0.001). There was no statistical difference in the incidence of acute and late radiation-induced brain injury between two groups. Conclusions Both SRT and SRS are effective therapies for brain metastases from colorectal cancer. The synergistic application of systematic treatment mode may be one of the main reasons affecting the survival time of the patients.
		2022 Vol. 31 (4): 347-351 [Abstract] ( 196 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	352	Research and realization of automatic evaluation of stereotactic radiotherapy plan for early non-small cell lung cancer
		Huang Shixiong, Yang Songhua, Zeng Degao, Zeng Biao
		Objective To realize the automatic evaluation of the target conformity, dose overflow, dose drop and other indicators in stereotactic body radiation therapy (SBRT) plan for the early non-small cell lung cancer (NSCLC) in the Eclipse planning system. Methods Eclipse Scripting API application development interface and C# programming language were used to develop it with script plug-ins combined with independent programs. According to the requirements of the NSCLC SBRT plan in Radiation Therapy Oncology Group (RTOG) 0915 report, the automatic evaluation of related indicators was realized. A rule of equal interval sampling and double thresholds was designed during the period,which could more accurately and conveniently evaluate the dose drop outside the target area. Results 13 clinical cases of NSCLC SBRT plans were randomly selected, the method in this study and the module equipped with the Eclipse system to were utilized to evaluate and compare the results. It was concluded that the results of the two methods were in line with the clinical requirements, and the former was more efficient (P<0.05). Conclusions The NSCLC SBRT plan evaluation software in this article has a friendly interface. It can not only realize the automatic evaluation of target conformity, dose overflow and dose drop, but also effectively improve work efficiency and better serve the clinical and scientific research work of radiotherapy.
		2022 Vol. 31 (4): 352-358 [Abstract] ( 199 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	359	Study of three-dimensional dose distribution prediction in cervical cancer brachytherapy based on U-Net fully convolutional network
		Xiang Yida, Zhou Jianliang, Bai Xue, Wang Binbing, Shan Guoping
		Objective Topredict the three-dimensional dose distribution of regions of interest (ROI) with brachytherapy for cervical cancer based on U-Net fully convolutional network, and evaluate the accuracy of prediction model. Methods First, 100 cases of cervical cancer intracavity combined with interstitial implantation were selected as the entire research data set, and divided into the training set (n=72), validation set (n=8), and test set (n=20). Then the U-Net was used to construct two models based on whether the uterine tandem and the implantation needles were included as the distinguishing factors. Finally, dose distribution of 20 cases in the test set were predicted using the trained model, and comparative analysis was performed. The performance of the model was jointly evaluated byΔD90%,ΔD2cm³and the mean absolute deviation (MAD). Results Compared with the model without the uterine tandem and the implantation needles,theΔD2cm³of the rectum was increased by (16.83±1.82)cGy (P<0.05), andtheΔD90% or ΔD2cm³of the other ROI were not different significantly (all P>0.05). The MAD of the high-risk clinical target volume, rectum, sigmoid, small bowel, and bladder was increased by (11.96±3.78)cGy,(11.43±0.54)cGy,(24.08±1.65)cGy,(17.04±7.17)cGy and (9.52±4.35)cGy, respectively (all P<0.05). The MAD of the intermediate-risk clinical target volume was decreased by (120.85±29.78)cGy (P<0.05). The mean value of MAD for all ROI was decreased by (7.8±53)cGy (P<0.05), which was closer to the actual plan. Conclusions U-Net fully convolutional network can be used to predict three-dimensional dose distribution of patients with cervical cancer undergoing brachytherapy. Combining the uterine tube with the implantation needles as the input parameters yields more accurate predictions than a single use of the ROI structure as the input.
		2022 Vol. 31 (4): 359-364 [Abstract] ( 206 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	365	Exploration of combined application of three Varian OBI image-guided systems in image-guided radiotherapy for nasopharyngeal cancer
		Zhang Bingxin, Shi Xiangli, Liang Guangli, Wang Wei
		Objective To compare the comprehensive performance of three Varian on-board image (OBI) image systems (KV-CBCT, KV-planar and MV-EPID) and to explore the value of the combinedapplication of these three systems in daily image-guided radiotherapy for nasopharyngeal cancer. Methods KV-CBCT, KV-planar and MV-EPID scanning and registration were carried out in the left and right/abdominal and back/head and foot direction on human head and neck phantom. The set-up error, registration time, additional radiation dose and image quality of the three systems were compared by F-test. Results KV-CBCT,kV-planar and MV-EPID were scanned for 55 times, respectively, and the set-up errors in the left and right/abdominal and back/head and foot direction of the three image-guided systems were (0.00±5.43)/(-0.02±5.49)/(0.02±5.58)mm,(0.04±5.49)/(0.02±5.56)/(0.02±5.54)mm,(0.02±5.22)/(0.11±5.34)/(-0.04±5.33)mm,respectively (P=0.999,1.000, 0.989). The average time consuming was (200±45) s,(120±36) s and (115±42) s;the additional radiation dose from low to high was kV-planar, KV-CBCT and MV-EPID;the image quality from low to high was MV-EPID, kV-planar and KV-CBCT. Conclusions Three image-guided systems can meet the requirements of image-guided radiotherapy for nasopharyngeal cancer. Based on the overall performance of the three systems, 1 CBCT+4kV planar per week is recommended and EPID should be used as a backup system in daily image-guided radiotherapy for nasopharyngeal cancer. This scheme makes full use of the high image quality of CBCT and the low radiation of kV planar to realize the regular detection of nasopharyngeal cancer volume change and the implementation of high-precision radiotherapy.
		2022 Vol. 31 (4): 365-369 [Abstract] ( 203 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	370	The role of miR-21 in Endostar combined with X-ray irradiation of cardiac fibroblasts
		Cao Dongdong, Ouyang Weiwei, Zhao Xing, Su Shengfa, Zhang Jun, Fu Shimei, Feng Zhangxin, Li Qingsong, Ma Zhu, Yang Wengang, Chen Xiaxia, Lu Bing
		Objective To investigate the implication of micro RNA-21(miR-21) in Endostar combined with X-ray irradiation of cardiac fibroblasts (CF). Methods Rat CFs were used in this experiment and been divided into the blank control group, 10Gy X-ray irradiation group, Endostar group, 10Gy X-ray+Endostar group, 10Gy X-ray+Endostar+NC mimic group (negative control 1), 10Gy X-ray+Endostar+miR-21 mimic group, 10Gy X-ray+Endostar+NC inhibitor group (negative control 2) and 10Gy X-ray+Endostar+miR-21 inhibitor group. The proliferation of CF was determined by Methyl thiazolyl tetrazolium (MTT) assay. The expression level of Collagen Ⅰ protein was analyzed by Western blot. The expression levels of Collagen Ⅰ and miR-21 mRNA were assayed by real-time quantitative polymerase chain reaction (q-PCR). Results In the 10Gy X-ray+Endostar+miR-21 mimic group, the CF proliferation, Collagen Ⅰ and miR-21 mRNA were increased significantly compared with those in the blank control group, 10Gy X-ray+Endostar group, and negative control group 1 (all P<0.05). In the 10Gy X-ray+Endostar+miR-21 inhibitor group, the CF proliferation and expression levels of Collagen Ⅰ mRNA were decreased significantly compared with those in the blank control group, 10Gy X-ray+Endostar group and negative control group 2(all P<0.05). Conclusions The CF proliferation and Collagen Ⅰ expression are increased when the expression level of miR-21 gene is simulated. When inhibiting the expression of miR-21 gene, the CF proliferation and Collagen Ⅰ expression are reduced.
		2022 Vol. 31 (4): 370-375 [Abstract] ( 190 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	376	Effects of LEF1 and CTNNB1 on cycle arrest, apoptosis and radiation resistance of esophageal carcinoma cells
		Ge Dahe, Liu Yaqing, Nan Jun, Li Jian, Ding Hui, QiaoShulin, An Yuan, Xu Chunjin
		Objective To investigate the relationship between the expression level of lymphocyte enhancer-binding factor 1(LEF1) and CTNNB1 and the cycle arrest, apoptosis and radiation resistance of esophageal cancer cells and unravel the related mechanisms. Methods Recombinantplasmids and empty plasmids expressing LEF1 and CTNNB1were constructed and transfected into esophageal cancer cells. RT-PCR assay was used to detect the transfection efficiency of the plasmids. Clone formation assay, CCK8 assay, cell cycle test by flow cytometry, apoptosis test by flow cytometry and Western blot were performed to detect the differences in theradioresistance, proliferation, cell cycle and apoptosis of esophageal cancer cells before and after transfection. Results The survival rate of clonal colony cells in the pGEX-LEF1+pCMV6-CTNNB1 group was significantly better than those in other groups (P<0.05). The proliferation of clonal colony cellsat 72h, 96h and 120h in the pGEX-LEF1+pCMV6-CTNNB1 group was significantly better than those in the pGEX+pCMV6,pGEX-LEF1+pCMV6 and pCMV6-CTNNB1+pGEX groups (all P<0.05). The percentage of G2 phase arrest cells in the pGEX-LEF1+pCMV6-CTNNB1 group was significantly higher than those in the other groups (all P<0.05). The apoptosis rate of esophageal cancer cells in the pGEX-LEF1+pCMV6-CTNNB1 group was significantly lower compared with those in the pGEX+pCMV6, pGEX-LEF1+pCMV6 and pCMV6-CTNNB1+pGEX groups (all P<0.05). The expression levels of Bax and Caspase 3 proteins in the pGEX-LEF1+pCMV6-CTNNB1 group were significantly lower than those in the pGEX+pCMV6, pGEX-LEF1+pCMV6 and pCMV6-CTNNB1+pGEX groups (all P<0.05). The expression level of Bcl-2 protein in the pGEX-LEF1+pCMV6-CTNNB1 group was significantly higher compared with those in the other groups (all P<0.05). Conclusion LEF1 and CTNNB1 can regulate the proliferation and G2 phase arrest of esophageal cancer cells after radiation intervention by mediating the Wnt signaling pathway, and improve the radiation resistance of esophageal cancer cells by inhibiting cell apoptosis.
		2022 Vol. 31 (4): 376-382 [Abstract] ( 175 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	383	Progress on delineation of clinical target volume of primary tumour of nasopharyngeal carcinoma
		Lin Lin, Bai Yongrui
		Accurate delineation of clinical target volume (CTV) of nasopharyngeal carcinoma is of significance to prevent local recurrence and improve the survival rate of patients. When intensity-modulated radiotherapy (IMRT) was first introduced, CTV was delineated based on two-dimensional radiotherapy experience. The local recurrence-free survival is high, but the adverse reactions induced by radiotherapy are severe and the patients’ quality of life is poor. How to reduce CTV to alleviate acute and late radiotherapy-induced adverse reactions without deteriorating therapeutic effect has currently become a research hotspot. Despite the 2010 Chinese Nasopharyngeal Carcinoma IMRT Target and Dose Design Guideline Expert Consensus and the International Guideline for the Delineation of the CTV for Nasopharyngeal Carcinoma as references, the optimal individualized and standardized delineation of CTV remains controversial. This review summarizes the progress on the delineation of CTV of primary tumour of nasopharyngeal carcinoma, aiming to provide practical reference for clinicians.
		2022 Vol. 31 (4): 383-388 [Abstract] ( 211 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	389	Research status and progress on neoadjuvant therapy for esophageal cancer
		Zhu Junge, Li Jianbin, Zhang Yingjie
		China is a country with high incidence of esophageal cancer. In recent years, with the deepening research, the value of neoadjuvant therapy in locally advanced resectable esophageal cancer has been widely approved by clinicians, compared with surgery alone or adjuvant therapy. However, the survival results of different neoadjuvant therapy options may be quite different, and many problems remain unresolved. In this article, a systemic literature review was carried out to summarize the radiotherapy target, radiotherapy dose, chemotherapy regimen of neoadjuvant chemoradiotherapy and time to surgery, as well as review the research status and progress on targeted therapy and immunotherapy as neoadjuvant therapy for esophageal cancer.
		2022 Vol. 31 (4): 389-394 [Abstract] ( 184 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	395	Analysis of risk factors associated with brain metastasis of limited small cell lung cancer after prophylactic cranial irradiation
		Li Mingxu, Hu Songliu
		Small cell lung cancer (SCLC) has the biological characteristics of high recurrence and metastasis. The brain is the common site of SCLC extrapulmonary metastasis. Prophylactic cranial irradiation (PCI) can effectively reduce the incidence of brain metastasis and prolong the overall survival of patients with limited SCLC. Nevertheless, nearly one third of patients develop brain metastases after PCI. This article reviews the risk factors of brain metastasis after PCI, aiming to determine which subgroup of patients with limited SCLC can benefit from PCI and provide reference for the clinical application of PCI.
		2022 Vol. 31 (4): 395-399 [Abstract] ( 171 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	400	Advances in the application of preventive extended-field radiotherapy to advanced cervical cancer
		Jiang Meijing, Li Yong, Wang Mingxing, Ge Xin, Jin Hong, Li Qi
		Cervical cancer is a common malignant tumor in gynecology, and its morbidity and mortality rates rank the fourth among female malignant tumors. Lymph node metastasis is the most important pattern of metastasis and a critical independent prognostic factor for cervical cancer. Considering the high missed diagnosis rate of para-aortic lymph node metastasis, and the high treatment failure rate caused by para-aortic lymph node metastasis after cervical cancer treatment,a small number of clinicians have applied preventive extended-field radiotherapy in the treatment of patients with ⅢB and Ⅲ c1 cervical cancer in recent years. This article reviews the prognosis and side effects of preventive extended-field radiotherapy in patients with stage ⅢB and Ⅲ c1 cervical cancer.
		2022 Vol. 31 (4): 400-403 [Abstract] ( 191 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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