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.8 Published 2022-08-15

	Thoracic Tumors Review Articles Guideline Physics·Technique·Biology Head and Neck Tumor

Guideline

	677	Quality Control Guidelines for Computed Tomography Simulator
		National Cancer Center / National Cancer Quality Control Center
		CT simulator can provide patients' anatomical information for the design of radiotherapy plan. It is the basis for 3D plan design, dose calculation and plan evaluation of radiation therapy. The purpose of the quality control of CT simulator is to ensure the safety of CT simulated positioning process and accurate delineation of the radiotherapy target area and its surrounding vital organs, as well as to provide accurate data required for the dose calculation of radiotherapy plan. This guideline mainly covers four aspects of quality control: mechanical properties, image quality, positioning process and radiation protection.
		2022 Vol. 31 (8): 677-684 [Abstract] ( 93 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumor

	685	The effect of radiotherapy on survival in newly‐diagnosed metastatic head and neck squamous cell carcinoma(HNSCC)
		Huang Zhou, Liu Weixin, Zhao Dan, Xu Xiaolong, Xiao Shaowen, Zheng Baomin, Wang Weihu, Sun Yan
		Objective To evaluate the survival outcomes of radiotherapy in patients with newly‐diagnosed metastatic head and neck squamous cell carcinoma (HNSCC) based on data from the Surveillance, Epidemiology and End Results(SEER) database. Methods A total of 1226 patients newly‐diagnosed with metastatic HNSCC between 2010 and 2015 were selected from the SEER database. There were 762 patients (62.1%) in the radiotherapy group and 464 patients (37.9%) in the non‐radiotherapy group. Kaplan‐Meier method was used to calculate the cancer‐specific survival (CSS) and overall survival (OS). The effect of radiotherapy on survival was assessed by Cox multivariate regression and Propensity score‐matched analyses (PSM). According to the results of multivariate analysis, the patients were further divided into low‐, intermediate‐ and high‐risk groups, and the effect of radiotherapy on survival was analyzed in different risk groups. Results The median CSS and OS time of the whole group was 11.0 months and 10.0 months, respectively. For patients in the radiotherapy group and non‐radiotherapy group, the median CSS time was 13.0 months and 6.0 months, and the median OS time was 12.0 months and 6.0 months, respectively. Multivariate analysis showed that age (CSS, P=0.045;OS, P=0.002), primary tumor site (CSS, P=0.021;OS, P<0.001), T stage (CSS, P=0.001;OS, P=0.002), N stage (CSS, P=0.002;OS, P<0.001), number of metastatic organs (CSS, P<0.001;OS, P<0.001), surgery (CSS, P<0.001;OS, P<0.001), radiotherapy (CSS, P<0.001;OS, P<0.001), and chemotherapy (CSS, P<0.001;OS, P<0.001)were the independent prognostic factors. After PSM, patients with and without radiotherapy in the low‐,intermediate‐,and high‐risk groups, the 3‐year CSS rates were 62.5% vs 23.5%(P=0.008), 22.4% vs 15.7%(P=0.001)and 10.5% vs 9.6%(P=0.203), respectively; the 3‐year OS were 58.0% vs 20.8%(P=0.002), 19.8% vs 12.7%(P=0.001)and 7.0% vs 6.1%(P=0.166), respectively. Conclusion Radiotherapy significantly improves CSS and OS in the low‐ and intermediate‐risk groups, but patients in the high‐risk group do not benefit from radiotherapy.
		2022 Vol. 31 (8): 685-690 [Abstract] ( 86 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	691	The patterns of failure with three‐dimensional radiation therapy for primary tumors of stage Ⅳ NSCLC
		Wu Xinyu, Su Shengfa, Ouyang Weiwei, Li Qingsong, Ma Zhu, Yang Wengang, Chen Xiaxia, Geng Yichao, Lu Bing
		Objective To explore the characteristics of failure patterns of three‐dimensional radiotherapy combined with first‐line drug therapy for primary tumors of stage Ⅳ non‐small cell lung cancer(NSCLC)and investigate the influence of radiotherapy‐related factors. Methods 708 patients newly‐diagnosed with stage Ⅳ NSCLC from March 2003 to July 2020 were selected. Chi‐square test was used for univariate analysis of failure patterns. Kaplan‐Meier method, Log‐rank test and Cox regression model were employed for multivariate analysis. Results The incidence of first‐line treatment failure in 708 cases was 71.2%, and the incidence of treatment failure was 22.7%, 28.8%, 13.3%, and 6.4% for ≤6 months, >6-12 months, >12-24 months, and>24 months, respectively, and the median survival time was 7.2, 13.4, 22.2, and 37.6 months, which was significantly different(χ²=226.013,P<0.001). The incidence of recurrence failure(RF)was 21.3%.There was no significant difference in the incidence of RF between oligometastasis(OM)and non‐oligometastasis(NOM). The incidence of DF was 66.3% and the order of incidence was brain>bone>lung>pleural cavity>liver>distant lymph nodes>adrenal gland>other sites, occurring in approximately 1/2 of AM and 1/3 of PSM cases. Metastatic status, time to treatment failure, pathological type, gender, combined treatment intensity were the independent influencing factors for predicting prognosis. Conclusions The failure pattern of radiotherapy for primary tumors of stage Ⅳ NSCLC is different from that of first‐line drug therapy, with significantly lower local failure and predominantly metastatic failure. The incidence of brain metastasis is the highest. The later time to treatment failure, the longer the overall survival(OS). OM, female, non‐squamous cell carcinoma, late treatment failure, 4-6 cycles of chemotherapy over the same period ≥63 Gy are the independent prognostic factors for prolonging survival.
		2022 Vol. 31 (8): 691-697 [Abstract] ( 68 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	698	Dosiomics‐based prediction of incidence of radiation pneumonitis in lung cancer patients
		Yan Meng, Zhang Zhen, Yu Jiaqi, Wang Wei, Wang Qingxin, Zhao Lujun
		Objective To explore the potential of dosiomics in predicting the incidence of radiation pneumonitis by extracting dosiomic features of definitive radiotherapy for lung cancer, and building a machine learning model. Methods The clinical data, dose files of radiotherapy, planning CT and follow‐up CT of 314 patients with lung cancer undergoing definitive radiotherapy were collected retrospectively. According to the clinical data and follow‐up CT, the radiation pneumonia was graded, and the dosiomic features of the whole lung were extracted to establish a machine learning model. Dosiomic features associated with radiation pneumonia by LASSO‐LR with 1000 bootstrap and AIC backward method with 1000 bootstraps were selected. Training cohort and validation cohort were randomly divided on the basis of 7:3.Logistic regression was used to establish the prediction model, and ROC curve and calibration curve were adopted to evaluate the performance of the model. Results A total of 120 dosiomic features were extracted. After LASSO‐LR dimensionality reduction, 12 features were selected into the "feature pool".After AIC, 6 dosiomic features were finally selected for model construction. The AUC of training cohort was 0.77(95%CI: 0.65 to 0.87), and the AUC of validation cohort was 0.72 (95%CI: 0.64 to 0.81). Conclusion The dosiomics prediction model has the potential to predict the incidence of radiation pneumonia, but it still needs to include multicenter data and prospective data.
		2022 Vol. 31 (8): 698-703 [Abstract] ( 76 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	704	Association of plasma EBV‐DNA copy number and cytokines with B symptoms in patients with extranodal natural killer/T‐cell lymphoma, nasal type
		Zhang Yuetong, Zhang Yujing, Wang Jijin, Shao Han, Wang Hanyu, Dai Shuqin, Huang Huiqiang
		Objective To investigate the association of plasma EBV‐DNA copy number, serum cytokines and B symptoms in patients with extranodal natural killer/T‐cell lymphoma, nasal type (ENKTL), unravel the mechanism and assess the prognostic value of clinical indicators. Methods Clinical data of 173 newly‐diagnosed ENKTL patients (116 male, 57 female; median age: 43, 4 to 71 years)were retrospectively analyzed. According to Ann Arbor stage, 126 cases were classified as stage I‐II and 47 cases of stage Ⅲ‐IV. The primary sites of tumors included nasal cavity (n=100), extranasal upper aerodigestive tract (extranasal UADT, n=34), and extra‐upper aerodigestive tract (extra‐UADT, n=39). Prior to treatment, 91 patients had B symptoms and 82 cases of without B symptoms. According to plasma EBV‐DNA copy levels, all patients were divided into the negative group (n=36), low load group (<10⁴ copies/ml, n=73) and high load group (≥10⁴ copies/ml, n=64). Serum cytokines including IFN‐γ, IL‐2, IL‐4, IL‐6, IL‐10 and TNF‐α were detected. Correlation analysis was performed by Cochran‐Armitage trend test and Spearman correlation analysis. Survival analysis was conducted using univariate and multivariate Cox regression hazard analysis and survival curves were derived from Kaplan‐Meier survival analysis. Results The incidence of B symptoms and fever showed a significant upward trend with the increasing plasma EBV‐DNA copy levels. In addition, serum levels of IFN‐γ, IL‐6 and IL‐10 cytokines were higher in patients with B symptoms than those without B symptoms (all P<0.05). Serum IFN‐γ, IL‐6, and IL‐10 levels were also positively correlated with plasma EBV‐DNA copy number. The occurrence of B symptoms was associated with high‐risk clinical features including advanced stage, primary tumor invasion, regional lymph node involvement, and elevated pre‐treatment LDH. Survival analysis showed that stage, B symptoms, plasma EBV‐DNA, and the above serum cytokines affected the prognosis of overall survival (OS) and progression‐free survival (PFS) (all P<0.05). However, multivariate analysis showed that the occurrence of B symptoms was not an independent prognostic factor of ENKTL patients. Conclusion This exploratory study suggests that the incidence of B symptoms is associated with increasing levels of EBV‐DNA copies and cytokines, and these indicators are also important factors influencing the prognosis of ENKTL patients.
		2022 Vol. 31 (8): 704-709 [Abstract] ( 95 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	710	Partial stereotactic ablative boost radiotherapy in bulky non‐small cell lung cancer: a dosimetric comparison between proton and photon
		Bai Yun, Gao Xianshu, Ma Mingwei, Zhao Zhilei, Liu Peilin, Cao Xi, Qin Shangbin, Liu Siwei, Gao Yan, Ren Xueying, Li Hongzhen, Zhang Min, Li Xiaomei, Lyu Feng, Li Xiaoying, Qi Xin, Chen Jiayan, Xie Mu
		Objective Partial stereotactic ablative boost radiotherapy(P‐SABR)is a method to deliver SABR boost to the gross tumor boost volume(GTVb), followed by conventionally fractionated radiotherapy to the whole tumor area(GTV). GTVb is the max volume receiving SABR while ensuring the critical organ‐at‐risk(OAR)falloff to 3 GyE/f. We investigated the potential advantage of proton therapy in treating bulky non‐small cell lung cancer(the tumor length greater than 8 cm). Methods Nine patients with bulky NSCLC treated with photon P‐SABR in our institute were selected. For the treatment planning of proton therapy, the GTVb target area was gradually outwardly expanded based on the photon GTVb target area until the dose to critical OARs reached 3 GyE/f. The GTV and CTV areas remained the same as photon plan. A proton intensity‐modulated radiation treatment plan(proton‐IMPT), a photon intensity‐modulated radiation treatment plan(photon‐IMRT)and a photon volumetric modulated arc therapy(photon‐VMAT)were created for each patient, respectively. The dosimetric parameters of different treatment plans were compared. Results The volume ratio of GTVb‐photon and GTVb‐proton to GTV was(25.4±13.4)% and(69.7±30.0)%,respectively(P<0.001). In photon‐IMRT, photon‐VMAT, and proton‐IMPT plan groups, the mean dose of CTV was(76.1±4.9)Gy, (78.2±3.6)Gy, and(84.7±4.9)Gy, respectively; the ratio of tumor volume with Biologic Effective Dose(BED)≥ 90 Gy to GTV volume was(70.7±21.7)%, (76.8±22.1)%,and(97.9±4.0)%,respectively. The actual dose and BED to the tumor area of the proton‐IMPT plan group were significantly higher than those of the photon plan group(both P<0.05). Besides, the OARs dose was significantly decreased in the proton‐IMPT group, with(49.2±22.0)%, (56.8±19.0)% and(16.1±6.3)% of the whole lung V5 for photon‐IMRT, photon‐VMAT and proton‐IMPT, respectively(all P<0.001). Conclusions Larger GTV boost target volume, higher BED and reduced OARs dose can be achieved in proton plans compared with photon plans. Proton P‐SABR is expected to further improve the local control rate of bulky NSCLC with fewer adverse effects.
		2022 Vol. 31 (8): 710-715 [Abstract] ( 97 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	716	Analysis of different fixation devices in precision radiotherapy for prostate cancer under bowel and bladder preparation protocol
		Huang Sijuan, Zhong Ziyue, Tang Hao, Liu Yang, He Mengxue, Guo Xuan, He Liru, Lin Zhiyue, Yao Wenyan, Xu Senkui, Yang Xin
		Objective To provide evidence for the selection of fixation devices and CTV to PTV margins (M_ptv) in precision radiotherapy for pelvic tumors by analyzing three fixation devices in precision radiotherapy for prostate cancer. Methods From April 2015 to December 2020, 133 prostate cancer patients treated with pelvic drainage area irradiation in our center were retrospectively analyzed. The patients were fixed with 1.2m vacuum bag (n=39), 1.8m vacuum bag (n=44) and personalized prone plate by our center (n=50). Each patient was asked to complete our bowel and bladder preparation process before positioning and radiotherapy. The registration of CBCT to planned CT before each treatment adopted the same registration box and algorithm. Setup errors in the SI, LR and AP directions under qualified bowel and bladder conditions were recorded. Setup errors in three directions under three fixation devices and corresponding M_ptv values were analyzed. The correlation between setup errors with age and body mass index (BMI) was analyzed. Results Analysis of 3333 setup errors data showed: in the SI and LR directions, the mean setup errors of 1.2m vacuum bag (3.26mm, 2.34mm) were greater than those of 1.8m vacuum bag (2.51mm, P<0.001; 1.90mm, P<0.001), and personalized prone plate (3.07mm, P=0.066; 2.10 mm, P=0.009). In the AP direction, the mean setup errors of 1.2m vacuum bag (supine)(2.20mm) were smaller than those of 1.8m vacuum bag (3.33mm, P<0.001) and personalized prone plate (3.61mm, P<0.001). The setup errors of 1.8m vacuum bag in all directions were smaller than those of personalized prone plate (P≤0.028). According to Van Herk's expansion formula, the M_ptv of 1.2m vacuum bag in three directions was approximately 4 mm. The M_ptv of 1.8m vacuum bag and personalized prone plate in the SI and LR directions was approximately 3 mm, and more than 5 mm in the AP direction. The setup errors were not correlated with age or BMI. Conclusions From the setup errors results of three devices, 1.8m vacuum bag is the best, followed by personalized prone plate. And supine position is better than prone position in the AP direction.
		2022 Vol. 31 (8): 716-721 [Abstract] ( 65 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	722	Accuracy of optical surface‐guided hypo‐fractionated radiotherapy for intracranial metastasis with open face mask immobilization
		Li Tantan, Liu Qingfeng, Zhang Tao, Zhang Ye, Zhang Wei, Chen Huan, Li Zhaohui, Huan Fukui, Yi Junlin
		Objective To investigate the feasibility of surface‐guided hypo‐fractionated radiotherapy for intracranial metastasis with open face mask immobilization. Methods Nineteen patients treated with hypo‐ fractionated radiotherapy for intracranial metastasis in our hospital were included. Before the start of treatment, each patient underwent simulation with open face mask immobilization. During the treatment, cone‐beam CT(CBCT)images were collected for verification each time. Laser‐guided positioning was used for the first time in the treatment, and surface images were captured after six‐dimensional position correction as the reference images for subsequent treatment. Subsequent treatment was randomly divided into laser‐guided positioning group(LG, 85/F)and optical surface‐guided positioning group(SG, 101/F). The six‐dimensional error data of patients with two positioning methods were compared and expressed as mean ± standard deviation. Meanwhile, the correlation and consistency between the optical surface error data and the gold standard CBCT error data were compared in the laser‐guided fraction. GraphPad Prism 6.0 software was used for data processing and mapping, and SPSS 21.software was used for mean analysis and normality test. Pearson correlation analysis was used to analyze the correlation, and Bland‐Altman plot analysis was used to test the coincidence between two methods. Results Compared with the laser‐guided positioning, the 3D error of optical surface‐guided positioning was reduced from(0.35±0.16)cm to(0.14±0.07)cm. The Pearson coefficient of correlation along all three directions was less than 0.01,R² was 0.91,0.70 and 0.78 on Lat, Lng and Vrt, and R² was 0.75,0.85 and 0.77 on Pitch, Roll and Rtn(all P<0.01), respectively. The measurement results of two methods were positively correlated. The Bland‐Altman plot analysis showed that the 95% limits of agreement were within preset 3 mm tolerance([-0.29 cm, 0.19 cm], [-0.25 cm, 0.25 cm], [-0.27 cm, 0.19 cm]), and the 95% limits of agreement were within preset 3° tolerance(Pitch[-1.76°,1.76°], Roll[-1.54°,1.60°], ROT[-2.18°,1.69°]), indicating agreement between two methods. Conclusions The optical surface‐guided positioning can reduce the setup errors in the hypo‐fractionated radiotherapy for intracranial metastasis with open face mask immobilization. The optical surface error and CBCT error have good correlation and agreement.
		2022 Vol. 31 (8): 722-726 [Abstract] ( 69 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	727	Sulfasalazine increases the radiosensitivity of colorectal cancer cells by promoting ferroptosis
		Li Meng, Li Chan, Chen Yao, Pan Haixia, Jin Tao, Tian Shumei, Zhao Gang, Xie Ke
		Objective To investigate the radiosensitization effect of low‐dose sulfasalazine (SAS) on colorectal cancer (CRC) cells. Methods Proliferation inhibition effect of SAS on CRC cells was detected by CCK‐8 assay, and the concentration of SAS in vitro assays was based on its IC10 value. CRC cells were treated with SAS alone or combined with inhibitors of apoptosis, autophagy, ferroptosis and necroptosis, then cell viability was detected by CCK‐8 assay. Trypan blue staining, clone formation assay and cell growth curves were used to verify the radiosensitization effect of SAS on CRC cells in vitro. CRC cells were treated with SAS and radiotherapy, then the intracellular contents of lipid peroxidation and the protein levels of GPX4, PTGS2, cleaved PARP and active caspase 3 were evaluated, respectively. Subcutaneous xenograft tumor mouse model was established to further verify the radiosensitization effect of SAS in vivo. Results High dose (lethal dose) of SAS could induce apoptosis and ferroptosis in CRC cells. Low dose (non‐lethal dose) of SAS enhanced the radiosensitivity of CRC cells in vitro, and the radiosensitivity effect of SAS could only be abolished by ferroptosis inhibitor (Fer‐1). Low dose of SAS combined with radiotherapy significantly down‐regulated the expression of GPX4, whereas increased the intracellular lipid peroxidation levels and the expression of PTGS2. SAS also showed significant radiosensitization effect in subcutaneous xenograft tumor model. Conclusion Our findings suggest that low‐dose SAS could increase the radiosensitivity of CRC cells by promoting ferroptosis.
		2022 Vol. 31 (8): 727-731 [Abstract] ( 60 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	732	Research progress on chemotherapy for clinical stage Ⅱ nasopharyngeal carcinoma in the era of intensity‐modulated radiotherapy
		Liu Yang, Zhang Ye, Yi Junlin
		The prognosis of patients with clinical stage Ⅱ nasopharyngeal carcinoma has been significantly improved by the application of intensity‐modulated radiotherapy (IMRT). Although the NCCN guidelines recommend concurrent chemoradiotherapy strategies for clinical stage Ⅱ nasopharyngeal carcinoma, the evidence is mostly based on the research results under the condition of two‐dimensional conventional radiotherapy, and whether combined chemotherapy is required under the condition of IMRT faces challenges. In this article, current research progress on chemotherapy for clinical phase Ⅱ nasopharyngeal carcinoma was reviewed. Several studies have shown that concurrent, adjuvant and induction chemotherapy failed to improve the efficacy but significantly increased the incidence of toxic and side effects. Because of the heterogeneity in clinical stage Ⅱ nasopharyngeal carcinoma, some studies have found that high‐risk patients could benefit from chemotherapy. Currently, how to distinguish high‐risk patients in clinical stage Ⅱ nasopharyngeal carcinoma is a hot spot. The characteristics of metastatic lymph nodes, EB virus DNA, inflammatory markers, and other factors have certain reference value for screening high‐risk patients, which needs further verification. The prediction model integrating multiple tumor characteristics seems to better identify high‐risk groups and guide the treatment decision of high‐risk stage Ⅱ nasopharyngeal carcinoma.
		2022 Vol. 31 (8): 732-736 [Abstract] ( 70 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	737	Research progress on bevacizumab in the treatment of radiation‐induced brain necrosis
		Han Shuai, Wang Wenyan, Zhou Huandi, Xue Xiaoying
		Radiation‐induced brain necrosis (RIBN) is a serious late and irreversible complication after radiation therapy for primary or secondary brain tumors as well as head and neck tumors, and there is no effective treatment. In recent years, bevacizumab has been increasingly applied in the treatment of RIBN, which has been proven to yield certain efficacy and improve patient survival. However, the optimal treatment timing and regimen have been controversial and lack of basic consensus. In this article, research progress on these issues was briefly reviewed.
		2022 Vol. 31 (8): 737-740 [Abstract] ( 68 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	741	Research progress on the radiotherapy treatment of brain metastases from non‐small cell lung cancer
		Zhang Qiaolu, E Mingyan
		The incidence rate of lung cancer ranks second and the mortality rate ranks first in the world. Non‐small cell lung cancer (NSCLC) is the main pathological type and is prone to brain metastasis. At present, the main treatment methods of brain metastases from NSCLC include surgery, radiotherapy, chemotherapy, molecular targeting and immunotherapy. Radiotherapy is a common local treatment of brain metastases. With the development of technology and drugs, how to combine radiotherapy with other treatments is a hot topic in clinical research. In this article, advances in radiotherapy for brain metastases from NSCLC were reviewed, aiming to provide reference for the selection of treatment options in clinical practice.
		2022 Vol. 31 (8): 741-744 [Abstract] ( 81 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	745	Whether radiotherapy for pelvic tumor increases the risk of second primary cancer
		Huang Yan, Lu Chunhua, Zhang Ying, Lin Qing
		Second primary cancer (SPC) is one of the main late toxicities of tumor therapy. According to statistics, one out of every 12 cancer survivors will develop SPC, and more than half of the cancer survivors will die of SPC. At present, approximately 70% of cancer patients receive radiotherapy (RT) throughout the course of disease. Whether high‐dose radiation will increase the risk of SPC has captivated widespread attention. Among them, most pelvic tumor patients should receive RT because of the high incidence. In this article, relevant studies of potential pathogenesis of SPC, impact of different RT techniques, selection of RT timing, and RT for male, female and pediatric pelvic tumors were reviewed, aiming to investigate whether pelvic RT will increase the risk of SPC.
		2022 Vol. 31 (8): 745-749 [Abstract] ( 82 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	750	Research progress on tryptophan metabolism involved by gut microbiota in the diagnosis and treatment of acute radiation‐induced intestinal injury
		Zhao Tianshu, Cai Shang, Tian Ye
		Gut microbiota not only affects the activity of tryptophan metabolism rate limiting enzymes in intestinal cells, but also cooperatively produces a variety of catalytic enzymes, which directly affects the type and quantity of tryptophan metabolites in the intestine. Multiple tryptophan‐associated indole compounds originating from the gut microbiome are significantly decreased in the peripheral blood of mice, and negatively correlated with radiation dose ranging from 2 to 10.4 Gy, which might be biomarkers for acute radiation‐induced intestinal injury. Recent studies have reported that indole 3‐propionic acid (IPA), indole‐3‐carboxaldehyde (I3A) and kynurenic acid (KYNA), which are tryptophan catabolites derived from gut microbiota, aryl hydrocarbon receptor, which is one of the receptors for tryptophan catabolites, and inhibition of indoleamine 2,3 dioxygenase‐1, which is a main rate‐limiting enzyme in intestinal tryptophan catabolism, can protect against radiation‐induced intestinal toxicity. A more comprehensive understanding of the dynamics of tryptophan catabolites and their roles in acute radiation‐induced intestinal injury is needed to deepen the understanding of the pathogenesis in radiation‐induced intestinal injury and exploration of effective diagnostic and therapeutic approaches.
		2022 Vol. 31 (8): 750-753 [Abstract] ( 68 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	754	Research progress on tumor radiotherapy‐induced coronary artery diseases
		Li Hongfei, Zhong Qiuzi, Zhang Wenduo
		In recent years, radiotherapy has been widely applied in tumor patients. The short‐term and long‐term impact on the cardiovascular system has captivated increasing attention from radiologist and cardiologist. Along with higher radiation dose and longer follow‐up, the incidence rate of coronary artery disease tends to significantly elevate, especially in patients with breast cancer and lung cancer. With the advancement of radiotherapy technologies, different tumors, different radiation doses and different modes of radiation delivery exert different effects on coronary artery. There are still some disputes about how to prevent, diagnose, evaluate, and treat the high‐risk population of coronary artery diseases after radiotherapy. How to optimize the treatment strategy before and after radiotherapy to reduce the incidence of short‐term and long‐term coronary artery diseases in cancer patients needs further clinical research.
		2022 Vol. 31 (8): 754-758 [Abstract] ( 75 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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