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.9 Published 2022-09-15

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

Guideline

	759	Guideline of target delineation and treatment planning for lymphoma radiotherapy
		National Cancer Center / National Cancer Quality Control Center
		Radiotherapy is an important component of combined treatment modality for lymphoma. Radical, consolidation and palliative radiotherapy are recommended in patients with different pathological subtypes and chemotherapy responses. With the development of novel systemic treatment and better understanding of long-term adverse effect with radiotherapy over the past 10 years, tremendous changes have taken place in the target delineation and dose prescription of radiotherapy. This guideline aims at establishing a standardized process in radiotherapy administration, including simulation, target delineation, dose prescription and plan evaluation for common lymphoma subtypes in China based on research evidence and expert opinions, with the purpose of promoting clinical application, improving treatment quality and efficacy as well as reducing adverse effects.
		2022 Vol. 31 (9): 759-771 [Abstract] ( 83 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Investigation Research

	772	Investigation of Chinese residency training program of radiation oncology
		Yang Yuexin, Zhou Jiaomei, Zhang Ye, Liang Jun, Chen Zhijian, Jin Jing
		Objective To evaluate the compliance with Chinese Residency Training Program of radiation oncology and provide reference for the improvement of system reform and base construction. Methods An survey was conducted among residents who had completed residency training program of radiation oncology by online questionnaires in four dimensions, including the fulfillment of training center in hardware, personnel and procedures, the compliance with syllabuses, mechanism of trainee evaluation, and the passing rate and satisfaction degree of trainees. Results The results showed that most training centers fulfilled the requirement of equipment, mentoring personnel and procedures. The training syllabuses had been followed and integrated with organization multi‐modalities. The trainees with high degree of satisfaction accounted for 65.6%, and the final qualification passing rate reached 75.5%. However, there were less reference textbooks, insufficient training in general medicine, limited clinical practice, and low output in academic publication. Conclusions The residency training program of radiation oncology has been established in China and achieved notable progress. For the further improvement, quantitative optimization of procedures, increasing opportunity of practice and strengthening scientific research involvement would be beneficial.
		2022 Vol. 31 (9): 772-777 [Abstract] ( 84 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumor

	778	The strategy and feasibility of dose optimization in clinical target volume Ⅱb in patients with N₀‐N₁ nasopharyngeal carcinoma
		Huang Wenxuan, Zong Dan, Zhang Bin, Wang Lijun, Zhang Lanfan, Ma Chengxian, Yin Li, Huang Shengfu, He Xia
		Objective To determine the safety of prophylactic irradiation dose CTV_60Gyoptimized to CTV_50Gy for II_b region in patients with stage N₀‐N₁ nasopharyngeal carcinoma (NPC) and the dose advantage and clinical value for parotid gland protection, and to understand the diagnostic value of PET‐CT and diffusion‐weighted imaging (DWI) for suspicious positive lymph nodes in the neck (5 mm≤maximum short diameter<10 mm). Methods Clinical data of 157 patients with primary non‐metastatic NPC (N₀‐N₁) admitted to our hospital from June 2015 to March 2017 were retrospectively analyzed. 104 patients underwent II_b clinical target volume optimization guided by multimodal imaging system. Survival analysis was performed by Kaplan ‐ Meier method. Univariate/multivariate regression analysis was performed to analyze the pattern of cervical lymph node recurrence. Paired t‐test was used to compare the differences in target volume and parotid gland dose parameters before and after dose optimization. Results Sixty patients underwent single‐neck optimization in stage N₁, 25 patients received double‐neck optimization (only those with retropharyngeal lymph node metastasis), and 19 patients underwent double‐neck optimization in stage N₀. Three patients had cervical regional recurrence, all in‐field. The 5‐year overall survival rate was 93.3%. The lymph node recurrence‐free survival rate, local recurrence‐free survival rate, distant metastasis‐free survival rate and disease‐free survival rate were 97.1%, 91.3%, 88.5% and 80.8%, respectively. Cervical lymph node recurrence was associated with local recurrence in the nasopharynx, regardless of retropharyngeal lymph node status. Fourteen patients had suspicious positive cervical lymph nodes in II_b region, with a mean maximum short diameter of 7.1 (5~9) mm on the largest cross‐sectional plane, and 11 of them were positive on PET‐CT, with a mean SUV_max of 2.96 (2.5~3.3). There was no significant difference in GTV after optimization (P>0.05). D_mean, D_max, D_50% and V_26Gy of parotid gland were significantly lower than those of conventional plan (all P<0.01). Conclusions It is safe to optimize CTV_60Gy to CTV_50Gy in II_b region in patients with N₀‐N₁ NPC, and the exposure dose to normal tissues around the parotid gland and neck is significantly reduced. For small lymph nodes that do not meet the diagnostic criteria, it needs to be individualized in combination with multimodality imaging systems, such as PET‐CT and DWI.
		2022 Vol. 31 (9): 778-784 [Abstract] ( 81 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	785	Effect of sarcopenia on survival and toxicity in postoperative recurrent esophageal squamous cell carcinoma patients receiving chemoradiotherapy
		Zhou Xilei, Yu Changhua, Zhu Weiguo, Wang Wanwei, Hu Shuiqing, Ji Fuzhi, Xiong Yaozu, Tong Yusuo
		Objective To evaluate the impact of sarcopenia on survival and treatment‐related toxicity in postoperative recurrent esophageal squamous cell carcinoma (ESCC) patients treated with chemoradiotherapy. Methods Clinical data of 147 patients with postoperative locoregional recurrent ESCC receiving chemoradiotherapy in Huai'an First People's Hospital from 2016 to 2017 were retrospectively analyzed. Pectoralis muscle area (PMA) was determined using routine pre‐radiotherapy CT simulation scan above the aortic arch level. Sarcopenia was defined as a cut‐off value of pectoralis muscle index (PMI) (PMA/height²) <11.55 cm²/m² for males and <8.69 cm²/m² for females. The incidence of toxicity, 1‐ and 3‐year overall survival (OS) rates were statistically compared between patients with and without sarcopenia. Results Sarcopenia was detected in 49 of 147 (33.3%) patients. The incidence of grade 3‐4 toxicities in sarcopenic patients was significantly higher compared to that in their counterparts without sarcopenia (40.8% vs. 18.4%,P=0.005). In addition, patients with sarcopenia had significantly worse 1‐year (61.2% vs. 82.7%) and 3‐year OS rates (10.2% vs. 28.6%) than those without sarcopenia (both , P<0.001). Multivariate analysis showed that sarcopenia was an independent prognostic factor for poor OS (P<0.001). Conclusion PMI based on CT simulation scan has prognostic value in postoperative locoregional recurrent ESCC patients treated with chemoradiotherapy, which probably serves as a novel diagnostic tool for sarcopenia.
		2022 Vol. 31 (9): 785-790 [Abstract] ( 81 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	791	*Efficacy of concurrent chemoradiotherapy with S‐1 vs.* radiotherapy alone for elderly patients with esophageal cancer: a meta‐analysis**
		Yang Jianquan, Guo Wen, Lang Jinyi, Lu Man
		Objective To evaluate the efficacy of concurrent radiotherapy combined with S‐1 (CCRT) versus radiotherapy (RT) alone in elderly patients with esophageal cancer by Meta‐analysis. Methods The Cochrane Library, PubMed, Web of science, EMbase, CBM, CNKI, VIP and Wanfang database were searched. The eligible studies were subject to evaluation of methodological quality. The Meta‐analysis was performed by the Revman 5.3 software. Results A total of 1693 patients were enrolled in 23 studies. The results showed that CCRT increased the incidence of CR [OR=2.08,95%CI (1.66‐2.61), P<0.001] and PR [OR=1.31,95%CI (1.08‐1.60), P=0.007] and total response rate [OR=2.99,95%CI (2.37‐3.77), P<0.001]. Furthermore, CCRT improved the 1‐year survival rate [OR=2.56, 95%CI (1.94‐3.38), P<0.001] and 2‐year survival rate [OR=2.33, 95%CI (1.77‐3.08), P<0.001]. Meanwhile, CCRT reduced the incidence of leucopenia, thrombocytopenia, radioactive esophagitis, nausea and vomiting (all P<0.05), but there was no significant difference in the incidence of anemia and radiation pneumonia between two groups (both P>0.05). Conclusions Available evidence suggests that CCRT combined with S‐1 can improve therapeutic efficacy and prolong survival time in elderly patients with esophageal cancer, but CCRT may increase the incidence of treatment‐related side effects. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high‐quality studies.
		2022 Vol. 31 (9): 791-797 [Abstract] ( 81 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	798	Quality of life in patients with early‐stage extra‐nodal NK/T cell lymphoma of nasal type after definitive radiation therapy
		Li Yimin, Zhang Yujing, Li Yiyang, Ye Yuming, Zhang Yuetong, Wang Jijin, Wang Hanyu
		Objective To investigate the quality of life in patients with early‐stage extra‐nodal NK/T cell lymphoma of nasal type (ENKTL) arising from the upper aerodigestive tract, who had remained progression‐free survival (PFS) for over 3 months after definitive intensity‐modulated radiation therapy (IMRT), and to analyze the factors related to main adverse symptoms. Methods 276 patients who received IMRT from March, 2012 to June, 2021 were included. There were 201 males and 75 females with a median age of 41.5 years (range: 13‐81 years) upon diagnosis. Consistent target delineation schemes and similar dose gradients were adopted for IMRT, with a median prescribed dose of 54.6 Gy/26F. Cross‐sectional investigation was performed with a modified EORTC QLQ‐H&N35 questionnaire, the incidence and severity of adverse symptoms, severity of disease and their influencing factors at each time‐point during their survival were statistically analyzed. Results The median age of patients at the investigation was 46.2 years, and the median PFS after IMRT was 47.2 months (range: 3.1‐115.7 months). The most common adverse symptoms included nasal symptoms (incidence rate 63.8%), dry mouth (50%), tooth diseases (47.1%), smell and taste alteration, and sexual apathy, etc. Most symptoms were mild (the average standardized score was 5.50, the full score of 100 indicating the most severe), and could be relieved remarkably over survival time, but some symptoms, such as tooth diseases and sexual apathy, were more obvious and recurred for several years. Age and anti‐PD‐1 immune therapy influenced the symptom scores, and tooth diseases were closely correlated with dry mouth. Conclusion The quality of life in patients with early‐stage ENKTL after definitive IMRT is high, and the most significant symptoms include nasal symptoms, tooth diseases, and sexual apathy, etc. , which need to be mitigated with more studies.
		2022 Vol. 31 (9): 798-804 [Abstract] ( 73 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	805	Effect of body mass index on normal tissue radiation doses and adverse reactions in brachytherapy for cervical cancer
		Zhang Zhaoming, Han Dongmei, Mao Zhuang, Zhang Ning, Cheng Guanghui
		Objective To explore the influence of body mass index (BMI) changes on the doses to normal tissues and adverse reactions of the lower digestive system and urinary system in the brachytherapy for cervical cancer. Methods Clinical data of 80 cervical cancer patients who received radical radiotherapy in our hospital from January 2020 to February 2021 were retrospectively analyzed. All patients received external beam radiation ± chemotherapy + brachytherapy. The delineation method of target areas and organs at risk (OAR) was determined based on the recommended scheme of GEC‐ESTRO. The target areas included high risk (HR)‐CTV and intermediate risk (IR)‐CTV, and OAR consisted of rectum, sigmoid colon, bladder, and small intestine. The target area dose was evaluated by D_90% of the HR‐CTV. The OAR volume dose was evaluated by using D_2cm³ Correlation analysis was used to compare the dosimetric relationship between BMI and D_2cm³,D_1cm³ and D_0.1cm³ in bladder, rectum, colon and small intestine. Logistic regression analysis was adopted to analyze the risk factors of acute and late adverse reactions in the lower gastrointestinal system and urinary system. Whether BMI was a risk factor was validated. Results BMI was negatively correlated with the D_2cm³、D_1cm³、D_0.1cm³ of the small intestine (P=0.034, 0.024, 0.034), and the correlation coefficients were -0.240, -0.255, and -0.241, respectively. Logistic regression analysis showed that BMI was not a risk factor for the occurrence of acute and late adverse reactions in the lower gastrointestinal system and urinary system. For every 1 Gy increase of D_2cm³、D_1cm³、D_0.1cm³ in the small intestine, the relative risk of acute adverse reactions in the lower gastrointestinal system was increased by 16.6%, 15.1%,and 12.7%, respectively. Conclusions In brachytherapy for cervical cancer, there is a negative correlation between BMI and D_2cm³、D_1cm³、D_0.1cm³ of the small intestine. As the BMI of patients declines, the radiation dose to the small intestine shows an increasing trend, which may increase the risk of acute adverse reactions in the lower gastrointestinal system.
		2022 Vol. 31 (9): 805-810 [Abstract] ( 91 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	811	Research on KBP model refining method using multi‐criterion optimization technology
		Cai Mafan, Zuo Guoping, Yang Zhen, Cao Ying, Zhang Zijian, Hu Yongmei, Yang Xiaoyu
		Objective Utilizing multi‐criterion optimization (MCO) technology to improve plan design quality based on knowledge‐based planning (KBP) model. Methods Fifty‐five patients with nasopharyngeal carcinoma (NPC) who had completed radiotherapy were selected, and fixed‐field intensity‐modulated radiotherapy (IMRT) technology was used in each case. Among them, 40 cases were randomly selected as training set 1. Then, IMRT plans in training set 1 were preprocessed by MCO technology to construct a new training set 2. With the initial training set 1 and the processed training set 2 as training samples, the traditional KBP model and the MCO‐KBP model refined by MCO technology were trained, respectively. Among the remaining 15 cases, 5 cases were randomly selected as the validation set, and the remaining 10 cases were used as the test set. After verification, the test set was used to statistically analyze the plan quality of the initial manual plan and the automatic plan generated by the traditional KBP model and the MCO‐KBP model. Results The target dose (D_95%) of plans generated by the traditional KBP model and the MCO‐KBP model met the clinical requirements. Conformity index (CI) and homogeneity index (HI) were almost the same (P>0.05), and the doses of organ at risk (OAR) of the automatic plans generated by the MCO‐KBP model were lower than those of the traditional KBP model. For example, compared with the traditional KBP model, the average D_max of the brainstem in the automatic plans generated by the MCO‐KBP model was lower by 2.13 Gy, the average D_mean of the left parotid gland was lower by 1.39 Gy, the average D_mean of the right parotid gland was lower by 1.59 Gy, and the average D_max of the left optic nerve was lower by 1.42 Gy, the average D_max of the right optic nerve was lower by 1.16 Gy, and the average D_max of the pituitary gland was lower by 1.88 Gy. All of the above‐mentioned dosimetry indexes were statistically significant. Conclusion Compared with the traditional KBP model, the IMRT plans designed by the refined MCO‐KBP model have obvious advantages in the protection of OAR, which proves the feasibility of utilizing MCO technology to improve the plan design quality of the KBP model.
		2022 Vol. 31 (9): 811-816 [Abstract] ( 74 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	817	Complexity score‐based plan quality control of VMAT
		Hu Jinyan, Zhang Liyuan, Ma Yangguang, Han Bin, Guo Yuexin
		Objective To explore the difference in the complexity of different treatment planning systems, multi‐leaf collimator (MLC) types and treatment sites of volume‐modulated arc therapy (VMAT), and propose a complexity score for plan quality control. Methods Statistical analysis of 12 complexity metrics including Monaco and Eclipse, Agility, Millennium and High‐definition MLC, nasopharyngeal, lung and cervical cancer was performed. Spearman correlation coefficient between complexity metrics was calculated. Principal component analysis was conducted to reduce the dimensionality of the original data set to the first two principal components and explain its physical meaning. Complexity score based on the principal components was calculated to establish warning and action thresholds for plan quality control. The correlation between complexity metrics and γ pass rate was analyzed. Results Except cervical cancer aperture sub‐regions metric, other metrics had significant differences between Monaco and Eclipse. Monaco MLC had a more regular field but higher MU, smaller leaf gap, and longer leaf travel distance. High‐definition MLC with smaller leaf width significantly added MLC aperture‐related metrics. The first two principal components explained over 80% of the total variance of the original dataset, complexity score was weighted average of first two principal components. The distribution of complexity score for different equipment and sites was different. The warning threshold was expressed as the average plus standard deviation, and the action threshold was expressed as the average plus 2 standard deviations. Complexity metrics and complexity scores had small correlation with γ pass rate, showing weak or irrelevant but statistically significant. Conclusions Different planning systems, MLC types, and treatment site complexity metrics are significantly different. The complexity score is a useful tool for plan quality control.
		2022 Vol. 31 (9): 817-822 [Abstract] ( 99 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	823	Carbon ion (¹²C⁶⁺) inhibits JAK2/STAT3 pathway and promotes CD8⁺ T cell infiltration in lung cancer
		Wang Jiangtao, Dai Ziying, Miao Yandong, Zhao Ting, Zhao Da, Guan Quanlin, Li Qiang, Ran Juntao
		Objective To explore the alteration of JAK2/STAT3 pathway after carbon ion (¹²C⁶⁺) irradiation and the difference in the infiltration of CD8⁺ T cells in lung cancer regulated by downstream protein FOXP3. Methods Significantly altered JAK2/STAT3 pathway and related differentially‐expressed genes and proteins such as FOXP3 in lung cancer after carbon ion irradiation were screened based on RNA sequencing analysis in the Lewis tumor model of C57BL/6 mice. The correlation between FOXP3 and major immune cell infiltration in the immune microenvironment of lung cancer was analyzed using the ssGSEA immune infiltration algorithm in the R software "GSVA" and CD8⁺ T cell infiltration in the immune microenvironment of lung cancer was evaluated based on the carbon ion combined with STAT3 inhibition pathway (niclosamide). Results The JAK2/STAT3 pathway was inhibited and the expression of related genes and proteins was downregulated in lung cancer after carbon ion irradiation. Immune scoring based on the ssGSEA algorithm showed that FOXP3 expression was significantly negatively correlated with CD8⁺ T cell infiltration in the immune microenvironment of lung cancer. The role of targeting the JAK2/STAT3 pathway in increasing CD8⁺ T cell infiltration in lung cancer was further clarified by carbon ion irradiation combined with STAT3 inhibition (niclosamide). Conclusion Carbon ion irradiation (¹²C⁶⁺) can play a synergistic role with immunotherapy by targeting the JAK2/STAT3 pathway.
		2022 Vol. 31 (9): 823-827 [Abstract] ( 73 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	828	Effect of lncRNA SNHG6 targeting miR‐485‐3p on proliferation and radiotherapy sensitivity of cervical cancer SiHa cells
		Zhang Dongli, Sun Guixia, Tian Jun, Liu Juncai
		Objective To investigate the effect of lncRNA SNHG6 on the proliferation and radiotherapy sensitivity of cervical cancer SiHa cells and its potential mechanism. Methods The expression levels of lncRNA SNHG6 and miR‐485‐3p in cervical cancer tissues, paracancer tissues, SiHa cells and SiHa cells exposed to X‐ray were detected. The relationship between lncRNA SNHG6 and miR‐485‐3p was analyzed. After overexpression or knockdown of SNHG6 and miR‐485‐3p, cell proliferation ability, number of invasion and apoptosis rate were determined by MTT, Transwell chamber assay and flow cytometry, respectively. The effect of miR‐485‐3p on the Wnt/β‐catenin pathway and the effect of XAV939 on SiHa cell proliferation and radiation sensitivity were analyzed. Results lncRNA SNHG6 was highly expressed in cervical cancer tissues and SiHa cells, whereas was lowly expressed in X‐ray irradiated SiHa cells. miR‐485‐3p was lowly expressed in cervical cancer tissues and SiHa cells, whereas was highly expressed in X‐ray irradiated SiHa cells. lncRNA SNHG6 targeted miR‐485‐3p. Down‐regulation of lncRNA SNHG6 expression inhibited cell proliferation and invasion, and enhanced its sensitivity to X‐ray radiotherapy, while miR‐485‐3p inhibitor transfected cells exerted the opposite effect. The up‐regulation of lncRNA SNHG6 promoted the proliferation and invasion of SiHa cells through miR‐485‐3p, and reduced the sensitivity of radiotherapy. Down‐regulation of miR‐485‐3p activated the Wnt/β‐catenin pathway, promoted cell proliferation and invasion of SiHa, and reduced its radiation sensitivity to X‐ray. Conclusion Overexpression of lncRNA SNHG6 targeting miR‐485‐3p activates the Wnt/β‐catenin pathway to regulate the proliferation and radiotherapy sensitivity of SiHa cells.
		2022 Vol. 31 (9): 828-833 [Abstract] ( 86 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	834	Research progress on the effect of radiotherapy of nasopharyngeal carcinoma and head and neck cancer on dental hard tissues and oral microbiota
		Zhu Hualing, Jiang Li, Zou Ling
		Nasopharyngeal carcinoma and head and neck cancer are the most common malignant tumors in clinical practice. As the most common treatment for nasopharyngeal carcinoma and head and neck cancer, radiotherapy will inevitably cause damage to normal structures such as dental hard tissues and affect the composition of oral microbiota, although it exerts high inhibitory effect against tumor cells. To provide theoretical basis for preventing or reducing the side effects of nasopharyngeal carcinoma and head and neck cancer after radiotherapy and improving the quality of life in patients, related research progress on the effect of radiotherapy of nasopharyngeal carcinoma and head and neck cancer on dental hard tissues and oral microbiota was reviewed.
		2022 Vol. 31 (9): 834-837 [Abstract] ( 62 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	838	Advances in application of ctDNA in radiotherapy for non‐small cell lung cancer
		Yang Yin, Zhang Tao, Bi Nan
		Circulating tumor DNA (ctDNA) has been the most common biomarker in liquid biopsy because of non‐invasive detection and overcoming intratumor heterogeneity. Lung cancer remains the leading cause of cancer‐related morbidity and mortality all over the world, with non‐small cell lung cancer (NSCLC) constituting 85% of the total cases. Radiotherapy plays an important role in phase Ⅰ‐Ⅳ NSCLC. It can not only kill tumor cells to eradicate cancer directly, but also increase the release of ctDNA indirectly, which improves the accuracy of liquid biopsy. As a result, ctDNA has the potential to be widely used in radiotherapy for NSCLC. In this review, research progress on ctDNA in the diagnosis, prognosis assessment, recurrence detection and response prediction in NSCLC patients treated with radiotherapy were summarized.
		2022 Vol. 31 (9): 838-842 [Abstract] ( 68 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	843	Progress on multisite SBRT combined with immune checkpoint inhibitor in oligometastasis of advanced NSCLC
		Yang Yang, Zheng Xiaoli, Ge Hong
		In recent years, the application of immune checkpoint inhibitors (PD‐1/PD‐L1/CTLA‐4, etc.) in the treatment of non‐small cell lung cancer (NSCLC) has developed rapidly. However, the response rate of immune checkpoint inhibitors alone is as low as 15%‐30%. There are still many problems in clinical practice, such as limited benefit population, lack of effective biomarkers and treatment resistance, etc. Compared with conventional fractionated radiotherapy, stereotactic body radiation therapy (SBRT) has the characteristics of higher single dose, less irradiation times and stronger immune activation ability. It has shown good anti‐tumor effect in patients with advanced NSCLC oligometastasis. The combination of immune checkpoint inhibitors and SBRT is the development trend of tumor therapy. Preclinical and clinical studies show that SBRT can enhance the efficacy of immunotherapy in patients with NSCLC. In the initial study, single‐lesion SBRT was first recommended to reduce potential toxicity. However, more and more studies have confirmed the feasibility and necessity of multi‐lesion SBRT. In this review, we not only elucidated the mechanism and the latest progress upon combined use of SBRT and immune checkpoint inhibitors in advanced NSCLC oligometastasis, but also explored the basic and clinical research of multi‐lesion SBRT combined with immunotherapy, aiming to guide clinical practice.
		2022 Vol. 31 (9): 843-847 [Abstract] ( 74 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	848	Active surveillance and response evaluation strategy after neoadjuvant therapy for esophageal cancer
		Liu Yunsong, Men Yu, Hui Zhouguang
		A considerable proportion of esophageal carcinoma patients could achieve pathological complete response (pCR) after neoadjuvant therapy, for whom accurate response evaluation and active surveillance rather than surgery‐aiming to avoid the complications, mortality and reduced quality of life after surgery‐has become a research hotspot. To detect residual disease and predict pCR accurately by appropriate method(s) is the key of active surveillance strategy. In this article, we elaborated the active surveillance strategy of esophageal cancer and characteristics of different evaluation methods in terms of radiology, pathology and combined detection.
		2022 Vol. 31 (9): 848-853 [Abstract] ( 73 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	854	Research progress on Clarity system in external beam radiation therapy of prostate cancer
		Li Yang, Liu Mengyu, Li Huixin, Xu Hanzi
		External beam radiation therapy (EBRT) is one of the main treatments for prostate cancer, and image‐guided implementation of EBRT is more suitable for accurate radiotherapy. As a new type of image‐guided technology, the Clarity system has been applied in the real‐time tracking during EBRT for prostate cancer in clinical practice. While improving the accuracy of EBRT targeting, it also significantly reduces the side effects of traditional EBRT. In this article, the application of Clarity system in EBRT of prostate cancer and its existing problems were systematically elucidated.
		2022 Vol. 31 (9): 854-857 [Abstract] ( 79 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	858	Research progress on pelvic insufficiency fracture (PIF) caused by radiotherapy and chemotherapy of cervical cancer
		Hu Tingting, Yang Hongjuan, Sun Yunchuan
		Pelvic insufficiency fracture (PIF) is a late complication which is not fully understood after radiotherapy and chemotherapy for cervical cancer and is easily misdiagnosed as bone metastasis. Previous clinical trials focused on the incidence, time and location of PIF, while the analysis of potential risk factors mainly emphasized the clinical characteristics of patients. There were few studies analyzing the correlation between treatment factors and the incidence. The damage of pelvis bone, especially the sacrum, after radiotherapy is mainly related to irradiation mode and dose. In this article, the radiotherapy technology, the formulation of bone‐conserving radiotherapy plan, the dose‐volume parameters of external irradiation and intracavitary brachytherapy, and the correlation between chemotherapy and this disease were reviewed. In the future, according to the advantages of precision radiotherapy technology, it is necessary to optimize the bone preservation plan, reduce the irradiation range and dose of sacrum and pelvis, and then reduce the incidence of PIF, which needs further clinical trials and practice to verify.
		2022 Vol. 31 (9): 858-862 [Abstract] ( 68 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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