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.10 Published 2022-10-15

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

Guideline

	863	Guideline of target delineation and treatment planning of adjuvant radiotherapy for breast cancer
		National Cancer Center / National Cancer Quality Control Center
		Postoperative radiotherapy is an important part of the comprehensive treatment for breast cancer. The quality of radiotherapy is crucial for both the long‐term prognosis and the quality of life of patients with breast cancer. The guideline is established to provide uniformed criteria, aiming to improve the capacity of breast cancer adjuvant radiotherapy in China. The guideline covers the whole process of radiotherapy, including patient selection, simulation, target and organ at risk (OAR) delineation, dose schemes, OAR dose limitation as well as treatment planning. Based on this guideline, each institution could develop personalized standard operating procedures according to its equipment and patient‐specific requirements.
		2022 Vol. 31 (10): 863-878 [Abstract] ( 113 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumor

	879	Analysis of therapeutic effect of pediatric patients with intracranial primary non‐germinomatous germ cell tumors
		Shi Xuejiao, Zhou Renhua, Lu Dongqing, Zhou Qing, Zhu Chuanying, Chen Shuxian, Li Yiyuan, Jiang Mawei
		Objective To investigate the clinical features of pediatric patients with intracranial primary non‐germinomatous germ cell tumors (NGGCT) and evaluate the treatment outcomes and prognostic factors of NGGCT. Methods Clinical data of 40 children with NGGCT who were treated with radiotherapy (RT) at our department between November 2008 and June 2019 were retrospectively analyzed. Ninety percent of them received craniospinal irradiation (CSI). All children received platinum‐based chemotherapy. Survival analysis was conducted using the Kaplan‐Meier estimate. The prognostic factors were analyzed by log‐rank test. Results The primary sites were pineal gland, sellar / suprasellar region and basal ganglia. The median age of onset was 108 months (20‐204 months). The median follow‐up time was 33 months (8‐131 months), and the 3‐year and 5‐year overall survival (OS) rates were 82.0%. The 3‐year and 5‐year progression‐free survival (PFS) rates were 78.6% and 73.0%. Univariate analysis showed that increased alpha‐fetoprotein (AFP) (P=0.02), age at first diagnosis>10 years (P=0.006), metastasis at first diagnosis (P<0.001), and the pathological type (choriocarcinoma, yolk sac tumor and / or embryonal carcinoma) (P=0.036) were independent adverse prognostic factors. Conclusions Increased AFP, age>10 years at first diagnosis, tumor metastasis and pathological type were independent adverse prognostic factors of NGGCT. The overall prognosis of NGGCT children is worse than that of their counterparts with germinoma, and multidisciplinary intensive therapy is needed to improve survival.
		2022 Vol. 31 (10): 879-883 [Abstract] ( 85 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	884	The effect of combined chemoradiotherapy versus chemotherapy alone on the survival of ⅣB stage esophageal squamous cell carcinoma
		Li Shenglei, Wang Kunlun, Yang Hui, Li Bingxu, Li Yan, Yuan Ling
		Objective To investigate the survival benefit of radiotherapy on the basis of systemic treatment for stage ⅣB esophageal squamous cell carcinoma (ESCC). Methods Based on inclusion and exclusion criteria, we collected the treatment information of 298 patients with newly diagnosed stage ⅣB ESCC admitted to Affiliated Cancer Hospital of Zhengzhou University from January 2016 to February 2021. All patients were divided into two groups based on treatment: early radiotherapy intervention group (CRT group,n=197) and salvage radiotherapy intervention or no intervention group (CT group,n=101). Propensity score matching (PSM) was used to balance baseline characteristics between two groups. Kaplan‐Meier method was used to calculate the survival rate and log‐rank was used to test the difference. Cox model was used to analyze the multivariate prognosis. Results In the CRT and CT groups, the Objective response rate (ORR) and disease control rate (DCR) were 52.8% vs. 31.5%(P=0.006) and 98.9% vs. 85.4%(P=0.001) respectively, and the 1‐, 2‐ and 3‐year survival rates were 74.2% vs. 52.8%、31.5% vs. 10.1% and 15.7% vs. 2.2%, respectively. Median progression‐free survival (PFS) was 8.5 months (95%CI: 6.7‐10.3 months) vs. 4.4 months (95%CI: 3.5‐5.3 months)(P<0.001). Median overall survival (OS) were 17.1 months (95%CI: 14.9‐19.3 months) vs. 12.7 months (95%CI: 8.0‐17.4 months)(P<0.001). The difference of adverse reactions was mainly in hematology. Conclusions For newly diagnosed stage ⅣB patients with ESCC, radiotherapy should be combined with systemic therapy as early as possible. It yields longer PFS and OS, and effectively improves dysphagia. Adverse reactions are tolerated. Further validation is recommended in larger prospective studies.
		2022 Vol. 31 (10): 884-890 [Abstract] ( 101 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	891	The impact of whole brain radiation therapy on overall survival in patients with extensive stage small cell lung cancer with brain metastases
		Ma Jintao, Jia Huijun, Meng Chunliu, Ren Kai, Yu Hao, Xu Liming, Liu Ningbo, Wang Ping, Zhao Lujun
		Objective To evaluate whether whole brain radiation therapy(WBRT) could benefit small cell lung cancer (SCLC) patients with brain metastases. Methods Clinical data of 245 patients who were diagnosed with extensive stage SCLC with brain metastases admitted to our hospital from 2010 to 2020 were retrospectively analyzed. Among them, 168 patients received WRBT (WBRT group, radiation dose: 30Gy in 10 fractions), and 77 patients did not receive WBRT (non‐WBRT group). All patients received 4‐6 cycles of chemotherapy, and the chemotherapy regimen included cisplatin (or carboplatin) plus etoposide. One hundred and fifteen patients received thoracic radiotherapy. The endpoint was overall survival after brain metastases(BM‐OS). Chi-square test was used to compare categorical data, and stabilized inverse probability of treatment weighting(sIPTW) was used to match the factors between WBRT and no‐WBRT groups. Survival analysis was estimated by Kaplan‐Meier method, and the log‐rank test was used to compare survival curves between two groups. Results The median BM‐OS for the whole group of patients was 9.1 months, and 10.6 months and 6.7 months in the WBRT and non‐WBRT groups, respectively(P=0.003). After balanced influencing factors with stabilized sIPTW, significant difference still existed in BM‐OS between two groups(P=0.02). In 118 patients with synchronous brain metastases, the median BM‐OS in two groups were 13.0 months and 9.6 months(P=0.007); and in 127 patients with metachronous brain metastases, the median BM‐OS were 8.0 months and 4.1 months(P=0.003). In 50 patients without extracranial metastases, the median BM‐OS were 13.3 months and 10.9 months(P=0.259)in two groups; while in 195 patients with extracranial metastases, the median BM‐OS were 9.5 months and 5.9 months(P=0.009)in two groups. Conclusions WBRT could prolong the OS in extensive stage SCLC patients with brain metastases.
		2022 Vol. 31 (10): 891-896 [Abstract] ( 89 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	897	Nomogram based on IVIM‐DWI and radiomics in predicting recurrence after concurrent chemoradiotherapy for patients with cervical cancer
		Zhang Yu, Zhang Kaiyue, Jia Haodong, Su Rixin, Fang Xin, Qian Liting, Dong Jiangning
		Objective To investigate the value of nomogram based on intravoxel incoherent motion diffusion weighted imaging (IVIM‐DWI) and MRI‐derived radiomics for predicting recurrence after concurrent chemoradiotherapy (CCRT) in patients with locally advanced cervical cancer (LACC). Methods Clinical data of 111 patients with ⅠB‐ⅣA cervical cancer who underwent CCRT at Anhui Provincial Hospital from December 2014 to December 2019 and were continuously followed up were retrospectively analyzed. Pre‐treatment IVIM‐DWI parameters (ADC, D, D^* and f) and pre‐ and post‐treatment 3D texture parameters (from axial T₂WI) of the primary lesions were measured. Least absolute shrinkage and selection operator (LASSO) algorithm and multivariate logistic regression analysis were used to filter texture features and calculate radiomics score (Rad‐score). A Cox regression model was used to analyze independent risk factors for recurrence after CCRT in patients with LACC and construct a nomogram. Results External beam radiotherapy dose, f value , pre‐treatment Rad‐score and post‐treatment Rad‐score (HR=0.204, 3.253, 2.544, 7.576) were the independent prognostic factors for recurrence after CCRT in cervical cancer patients and jointly formed the nomogram. The area under curve (AUC) of the nomogram for predicting 1‐, 3‐ and 5‐year disease‐free survival (DFS) was 0.895, 0.888 and 0.916, with internal validation C‐indexes of 0.859, 0.903 and 0.867, respectively. The decision curves analysis showed that the nomogram has a higher net clinical benefit compared to other models, and the clinical impact curves further visualized its predictive accuracy. Conclusions The nomogam based on IVIM‐DWI and radiomics has high clinical value in predicting recurrence after CCRT in patients with LACC, providing reference for prognostic assessment and individualized treatment of cervical cancer patients.
		2022 Vol. 31 (10): 897-903 [Abstract] ( 88 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	904	Prognostic value of combined detection of three indexes in patients with advanced cervical squamous cell carcinoma
		Shao Jia, He Aiqin, Zhang Can, Yao Juan
		Objective To evaluate the prognostic value of combined detection of platelet‐to‐lymphocyte ratio (PLR), neutrophil‐to‐lymphocyte ratio (NLR) and squamous cell carcinoma antigen (SCC) for patients with advanced cervical squamous cell carcinoma undergoing radical radiotherapy. Methods Clinical data of 127 patients with advanced cervical squamous cell carcinoma who received radical radiotherapy in the Affiliated Tumor Hospital of Nantong University from January 2016 to February 2019 were analyzed retrospectively. The enrolled cases were divided into the survival group and death group according to the survival at the end of 3 years after treatment. The laboratory indexes of peripheral blood were collected before treatment, PLR and NLR were calculated, and the differences of clinical parameters were compared between two groups. The prediction model was established, and the prediction efficiency of PLR, NLR and SCC alone and combined prediction models for 3‐year overall survival (OS) in patients with advanced cervical squamous cell carcinoma was compared through the ROC curve. Univariate and multivariate analyses of prognosis were carried out by binary logistic regression model. Results A total of 127 patients with advanced cervical squamous cell carcinoma were included in the study. There were 96 cases in the survival group and 31 cases in the death group. There were significant differences between two groups in FIGO stage, longest diameter of tumor, lymph node metastasis, PLR, NLR and SCC (all P<0.05). The area under ROC curve (AUC) of PLR, NLR and SCC was 0.660, 0.712 and 0.700, respectively. The AUC of PLR+NLR+SCC combined prediction model was increased to 0.784. Logistic multivariate analysis showed that FIGO Ⅲ, FIGO Ⅳ, lymph node metastasis, PLR≥205.555, NLR≥3.060 and SCC≥6.950 ng/ml were the independent risk factors for 3‐year OS in patients with advanced cervical squamous cell carcinoma (all P<0.05). Conclusions PLR, NLR and SCC have good value in predicting the 3‐year OS of patients with advanced cervical squamous cell carcinoma, and the combined prediction model of PLR+NLR+SCC has higher prediction value.
		2022 Vol. 31 (10): 904-909 [Abstract] ( 93 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	910	The development and verification of an independent dose calculation toolkit for proton Therapy
		Guo Mengya, Li Xiufang, Liu Qi, Wang Jie, Deng Xiuzhen, Gu Shuaizhe, Pu Yuehu, Chen Zhiling
		Objective To develop and validate the accuracy of an independent dose calculation toolkit for the horizontal beamline of Shanghai Advanced Proton Therapy (SAPT) facility based on an open‐source dose calculation engine. Methods Machine data, such as absolute integral depth doses (IDDs) and lateral profiles in air were measured and lateral profiles in water were derived by Monte‐Carlo simulations. The dose computation models for SAPT horizontal beamline pencil beams in water were achieved by combining machine data and dose calculation engine. The verification of the dose reconstruction toolkit included absolute dose verification and relative dose verification. The absolute dose verification is performed to mainly compare the reconstructed value and the measured value at different depths along the center axis of the beam direction of a cube plan. The relative dose verification is conducted to mainly compare the lateral profile or two‐dimensional dose distribution between the measured value and the reconstructed value. Meanwhile, the precision of double‐gaussian and single‐gaussian lateral beam models was compared. Results The deviations of the absolute dose between the calculated and measured values were basically within 2%. The deviations of 20%‐80% penumbra between the measured and the calculated values were within 1 mm, and deviations of the full width at half height were within 2 mm. For 3 cube plans and 2 clinical cases, the two‐dimensional gamma pass rates (3 mm/3%) between the measured and calculated dose distributions at the corresponding depths were greater than 95%. The double‐gaussian lateral beam model was more accurate in the high dose gradient region and deeper depth. Conclusion The precision of independent dose calculation toolkit is acceptable for clinical requirements, which can be employed to investigate other dose‐related issues.
		2022 Vol. 31 (10): 910-915 [Abstract] ( 83 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	916	Breast bracket combined with polyurethane foam improves the accuracy of immobilization in breast cancer radiotherapy
		Yao Wenyan, Liu Biaoshui, Fang Jianlan, Fang Yongwen, Xiao Liangjie, Wang Yuliu, Lin Chengguang, Wu Jianhua, Lin Huanxin, Lin Chuyan, Xu Senkui
		Objective To compare the difference between breast bracket combined with polyurethane foam and single polyurethane foam in the accuracy of immobilization, providing a better immobilization for breast cancer radiotherapy. Methods Fifty breast cancer patients who received radiotherapy in Sun Yat‐sen University Cancer Center from March 2021 to July 2021 were selected. Among them, 25 patients were immobilized with polyurethane foam (foam group), and the other 25 patients were immobilized with polyurethane foam combined with breast bracket (combination group). All patients were scanned by CBCT once a week to obtain setup errors in the SI, LR and AP directions for t‐test. The formula M_PTV=2.5Σ+0.7σ was used to calculate the margin of the planning target volume(M_PTV). Results The setup errors in the foam group were SI (2.0±3.26) mm, LR (0.88±2.76) mm, AP (1.22±3.55) mm, Rtn ‐0.24°±0.85°, Pitch 0.16°±1.11°, Roll ‐0.32°±1.05°, and the M_PTV were 6.75 mm, 8.46 mm and 8.73 mm, respectively. The setup errors in the combination group were SI (1.0±3.01) mm, LR (0.62±2.74) mm, AP (1.82±3.21) mm, Rtn 0.64°±0.59°, Pitch 0.71°±1.22°, Roll 0.29°±0.73°, and the M_PTV were 6.35 mm, 7.47 mm, and 7.61 mm, respectively. After comparing the setup errors in the three‐dimensional directions between two groups, the t value of LR, SI, AP and Rtn, Pitch, Roll was -4.304, -2.681, 1.384, and -9.457, -3.683, -5.323, respectively. And the differences in the LR, SI, Rtn, Pitch and Roll directions were statistically significant (all P<0.05). Conclusions The immobilization effect of polyurethane foam combined with breast bracket is better and the M_PTV is also smaller than those of polyurethane foam alone. Therefore, it is recommended to use polyurethane foam combined with breast bracket for immobilization in breast cancer radiotherapy.
		2022 Vol. 31 (10): 916-921 [Abstract] ( 99 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	922	*The expression level of SKP2* gene affects the radiosensitivity in hepatocellular carcinoma cells**
		Yang Weifang, Wang Xuequan, Xia Xinhang, Ran Gang, Wang Wei, Zhou Jiahui, Yang Haihua, Pi Wenhu
		Objective To investigate the effect of S‐phase kinase‐associated protein 2 (SKP2) expression level on radiosensitivity of human hepatocellular carcinoma (HCC) cells and the correlation of SKP2 expression with clinical prognosis of patients with HCC. Methods The expression levels of SKP2 gene in liver cancer tissues and normal tissues were validated and its correlation with clinical prognosis of HCC patients was analyzed based on the TCGA database. Western blot was used to determine the SKP2 protein levels in HCC cell lines before and after radiation. CRISPR/Cas9 technology was employed to delete the promoter and first exon of SKP2 gene in PLC/PRF/5 (PLC) and Hep3B HCC cells for generating the SKP2 knockout cell lines. The difference of radiosensitivity and cell survival rate between normal (SKP2 ^{+/ +}) and SKP2 knockout (SKP2 ^{‐/ ‐}) HCC cells was determined by using cell clonogenic assay and CCK8 kit. Results Compared with normal tissues, the expression levels of SKP2 gene in HCC were increased based on the results of TCGA database analysis. K‐M analysis showed that the HCC patients with high SKP2 expression had relatively poor prognosis. The 5‐year overall survival (OS) was 34.6% in high SKP2 expression HCC patients and 50.6% in low SKP2 expression HCC patients, respectively (HR=2.18, 95%CI=1.46‐3.27, P<0.001). In vitro experiment showed that the expression levels of SKP2 were significantly increased after radiation in HCC cells. Simultaneously, deletion of SKP2 significantly increased the radiosensitivity of HCC cells. Conclusion The expression level of SKP2 gene is increased in HCC patients, and patients with high SKP2 expression have worse prognosis than those with low expression. Radiation can upregulate the SKP2 expression levels in HCC cells, while the radiosensitivity of the cells is significantly increased after SKP2 deletion.
		2022 Vol. 31 (10): 922-927 [Abstract] ( 88 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	928	Establishment and identification of C57BL/6 mouse model with radiation‐induced pulmonary fibrosis
		Yuan Meng, Men Yu, Sun Xin, Zhao Maoyuan, Bao Dan, Yang Xu, Sun Shuang, Bao Yongxing, Ma Zeliang, Liu Yunsong, Hui Zhouguang
		Objective To establish the mouse model with radiation‐induced pulmonary fibrosis, and to identify and analyze it from the aspects of function, imaging and pathology. Methods Thirty C57BL/6 mice were randomly divided into the control group, 16 Gy irradiation group and 20Gy irradiation group. The mice in the irradiation groups received a single 16 Gy or 20 Gy chest X‐ray irradiation, and underwent functional examination, imaging examination and pathological examination at 3 and 6 months after irradiation. Results At 6 months after irradiation, hair on the chest and back of the mice turned white and fell off, and the airway resistance was increased significantly. CT images showed extensive patch shadows and consolidation in the lung. Three dimensional reconstruction suggested that the lung of mice was distorted and deformed, and the volume was decreased significantly. Pathological examination confirmed that there was extensive pulmonary fibrosis. Conclusions Significant pulmonary fibrosis occurs after 6 months of chest irradiation in mice. The animal model of radiation‐induced pulmonary fibrosis in C57BL/6 mice was successfully established.
		2022 Vol. 31 (10): 928-932 [Abstract] ( 100 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	933	Potential mechanism of NVP‐LDE225 combined with radiotherapy for melanoma
		Liu Xin, Xiang Jiabao, Yin Yao, Wang Yizheng, Chen Yifei
		Objective To explore the potential mechanism and feasibility of sonic hedgehog (SHH) signal pathway inhibitor NVP‐LDE225 combined with radiotherapy in the treatment of melanoma. Methods The Gli1 mRNA expression of the melanoma cells (Melan‐A and SK‐MEL‐2) was detected by qPCR. After treatment with NVP‐LDE225, GDC‐0449 or combined with radiation for 24 hours, the number and activity of Melan‐A and SK‐MEL‐2 were detected by cell counting and CCK‐8 kit. The survival and proliferation ratio of Melan‐A and SK‐MEL‐2 were detected by cell cloning. The changes of cell cycle of melanoma Melan‐A cells were determined by flow cytometry. The levels of the Bax and Caspase3 of Melan‐A apoptosis protein in melanoma cells were detected by Western blot. Results NVP‐LDE225, an inhibitor of Smo, decreased the mRNA expression of Gli1 in the melanoma cells in a dose‐dependent manner, inhibited the proliferation ratio of the melanoma cells, induced apoptosis, and arrested melanoma cells in G₀ / G₁ phase. Gamma ray irradiation after NVP‐LDE225 treatment further inhibited the SHH signal pathway, arrested the melanoma cells in G₂ / M phase, and further increased the inhibitory effect on melanoma cell proliferation. Conclusions NVP‐LDE225, an inhibitor of Smo, can inhibit SHH signal pathway in melanocytes, suppress cell proliferation, and further increases the effect of inhibiting cell proliferation after combining with irradiation. It can be used as a potential drug in combination with radiotherapy in the treatment of melanoma, which is worthy of further study.
		2022 Vol. 31 (10): 933-938 [Abstract] ( 96 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	939	Research progress on preventive measures of radiation‐related caries caused by radiotherapy for nasopharyngeal carcinoma
		Li Yanyao, Jiang Li, Zou Ling
		Nasopharyngeal carcinoma (NPC) is one of the most common head and neck malignant tumors. A series of oral complications caused by radiotherapy, such as xerostomia, oral mucositis, limitation of mouth opening and radiation‐related caries, have greatly affected the quality of life of patients with nasopharyngeal carcinoma after radiotherapy. In this study, related studies on the preventive measures of radiation‐related caries caused by radiotherapy for nasopharyngeal carcinoma in recent years were reviewed, aiming to provide some guidance and theoretical basis for reducing the incidence of radiation‐related caries and improving the quality of life of patients with nasopharyngeal carcinoma after radiotherapy.
		2022 Vol. 31 (10): 939-943 [Abstract] ( 82 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	944	Research progress on efficacy and influencing factors of postoperative radiotherapy for stage ⅢA(N₂) non‐small cell lung cancer
		Ling Lixian, Fu Jianfei
		Non‐small cell lung cancer(NSCLC) is highly malignant and has poor prognosis, in which stage ⅢA(N₂) NSCLC approximately accounts for 20%. Patients with stage ⅢA(N₂) NSCLC have high heterogeneity and distinct survival difference. Loco‐regional recurrence and distant metastasis are the main causes of treatment failure. At present, whether stage ⅢA(N₂) NSCLC patients should receive postoperative radiotherapy(PORT) remains controversial. Such patients still lack high level proof to receive PORT.
		2022 Vol. 31 (10): 944-948 [Abstract] ( 78 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	949	Research progress on biomarkers related to the efficacy of neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma
		Zheng Xiaoli, Jiao Ruidi, Yang Yang, Ge Hong
		Esophageal squamous cell carcinoma is one of the most common malignant tumors in China. Neoadjuvant chemoradiotherapy combined with surgery significantly improved the survival rate of locally advanced operable esophageal squamous cell carcinoma, but approximately half of the patients had poor or no efficacy. To accurately predict the efficacy of neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma and select the dominant population of neoadjuvant chemoradiotherapy, many studies on biomarkers have emerged, which have promoted the progress of neoadjuvant therapy for esophageal squamous cell carcinoma to some extent. In this article, the studies on biomarkers predicting the efficacy of neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma were reviewed.
		2022 Vol. 31 (10): 949-954 [Abstract] ( 77 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	955	Advances in radiotherapy based comprehensive treatment of primary hepatocellular carcinoma with portal vein tumor thrombus
		Chen Lining, Tang Yuan, Jin Jing
		Primary hepatocellular carcinoma is the fourth most common malignant tumor in China, with the 2nd highest mortality rate. Clinical prognosis of hepatocellular carcinoma complicated with portal vein tumor thrombus is extremely poor. At present, multiple interventions have been adopted to treat primary hepatocellular carcinoma complicated with portal vein tumor thrombus, such as surgery, radiotherapy and targeted therapy, etc. In this article, the treatment of primary hepatocellular carcinoma with portal vein tumor thrombus was summarized, and the effect and prospect of radiotherapy based comprehensive treatment were illustrated.
		2022 Vol. 31 (10): 955-960 [Abstract] ( 76 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	961	Research progress on the definition of intermediate risk factors and postoperative adjuvant therapy for early cervical cancer
		Sun Yang, Chen Ya'nan
		Cervical cancer is still a common gynecolgical tumor in China. Radical surgery is often the first choice for the treatment of early stage cervical cancer (FIGO stage ⅠB‐ⅡA), and postoperative pathological examination often has adverse prognostic factors affecting the survival. According to the NCCN guidelines, patients with cervical cancer who meet Sedlis criteria and have intermediate‐risk factors (lymphatic vascular space involvement, tumor size or deep interstitial infiltration) are recommended to receive concurrent chemotherapy with postoperative pelvic external irradiation ± cisplatin. However, the diagnostic criteria, indications and methods of adjuvant therapy for patients with intermediate risk factors after early cervical cancer surgery are still controversial. In this article, research progress on the definition of intermediate risk factors for early cervical cancer after radical hysterectomy and adjuvant treatment was mainly reviewed.
		2022 Vol. 31 (10): 961-965 [Abstract] ( 72 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	966	Radiosensitization mechanism of metformin and analysis of clinical application prospect
		Xiong Xin, Fan Xingwen
		Metformin is the basic drug for type 2 diabetes mellitus. More and more studies have shown that metformin has anti‐tumor effect, and its radiosensitization effect has been gradually found. Metformin can increase the radiosensitivity of tumor cells by improving hypoxia, increasing reactive oxygen species, inhibiting DNA damage repair, inducing cell cycle arrest and regulating immune microenvironment. However, several recently published randomized controlled trials have not confirmed that metformin can increase the efficacy of chemoradiotherapy. In this review, the mechanism and clinical results of metformin radiosensitization were summarized. The dose of metformin will be an important factor for basic and clinical research in the future.
		2022 Vol. 31 (10): 966-970 [Abstract] ( 62 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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