Chinese Journal of Radiation Oncology

中华放射肿瘤学杂志

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Chinese Journal of Radiation Oncology

	2023 Vol.32 Issue.2 Published 2023-02-15

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

Investigation Research

	93	Radiation dose and fractionation regimen for limited stage small cell lung cancer: a survey of current practice patterns of Chinese radiation oncologists
		Xu Chang, Li Meng, Chen Ming, Zhu Shuchai, Bi Nan, Cai Xuwei, Yuan Shuanghu, Cao Jianzhong, Hu Xiao, Li Jiancheng, Zhou Wei, Wang Ping, Wang Jun, Zhao Lujun, Liu Ningbo
		Objective To investigate the radiation dose and fractionation regimens for limited stage small cell lung cancer (LS-SCLC) in Chinese radiation oncologists. Methods Over 500 radiation oncologists were surveyed through questionnaire for radiation dose and fractionation regimens for LS-SCLC and 216 valid samples were collected for further analysis. All data were collected by online questionnaire designed by WJX software. Data collection and statistical analysis were performed by SPSS 25.0 statistical software. The differences in categorical variables among different groups were analyzed by Chi-square test and Fisher's exact test. Results Among 216 participants, 94.9% preferred early concurrent chemoradiotherapy, 69.4% recommended conventional fractionation, 70.8% preferred a total dose of 60 Gy when delivering conventional radiotherapy and 78.7% recommended 45 Gy when administering hyperfractionated radiotherapy. Conclusions Despite differences in LS-SCLC treatment plans, most of Chinese radiation oncologists prefer to choose 60 Gy conventional fractionated radiotherapy as the main treatment strategy for LS-SCLC patients. Chinese Society of Clinical Oncology (CSCO), National Comprehensive Cancer Network (NCCN) and Chinese Medical Association guidelines or expert consensus play a critical role in guiding treatment decision-making.
		2023 Vol. 32 (2): 93-98 [Abstract] ( 67 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Head and Neck Tumors

	99	Analysis of LMP specific T cell immune response and clinical factors in stage III-IVa nasopharyngeal carcinoma
		Cui Haobo, Chen Ting, Fan Peiwen, Wang Ruozheng
		Objective To explore the Epstein-Barr virus (EBV) latent infection membrane protein (LMP) 1 or LMP2 specific T cell immune response and clinical significance in stage III-IVa nasopharyngeal carcinoma (NPC), aiming to provide ideas and evidence for immunotherapy in NPC. Methods Fifty-nine NPC patients admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from February 2018 to October 2020 for primary treatment were collected. Peripheral blood monocytes (PBMCs) were stimulated by LMP antigen. Intracellular cytokine staining and flow cytometry were applied to study the expression levels of IL-2, IL-13, interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) from CD4⁺T and CD8⁺ T cells, and then analyzed in conjunction with clinical factors. Results The positive rates of total PBMCs to LMP1 and LMP2 in NPC patients were different. The positive rate of LMP1 specific CD4⁺ T cells was statistically higher in stage T₃-T₄ NPC than that in stage T₁-T₂ (51.0% vs. 10.0%, P=0.042). There were also differences in the expression of cytokines between LMP1 and LMP2, CD4⁺T cells and CD8⁺T cells. Survival analysis showed the 2-year and 3-year overall survival (OS) rates were 91.5% and 88.2%, and the 2-year and 3-year progression-free survival (PFS) rates were 83.3% and 75.3%. Univariate analysis suggested that smoking history, male and LMP1 stimulated IL-13 positive expression in CD4⁺ T cells affected the disease progression (P=0.026, 0.045 and 0.006); multivariate analysis showed LMP1 stimulated IL-13 positive expression in CD4⁺ T cells and smoking history were the independent prognostic factors affecting PFS (P=0.017, 0.019). Conclusions LMP1 and LMP2 generate specific T-cell immune response in PBMCs of NPC patients, with differential expression in two T-cell subsets. LMP1 and LMP2 specific T cell immune response is associated with primary tumor size and metastatic lymph node volume. LMP1 stimulated IL-13 positive expression in CD4⁺ T cells and smoking history affects the disease progression.
		2023 Vol. 32 (2): 99-105 [Abstract] ( 58 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	106	Neck contour changes and relevant factors in nasopharyngeal carcinoma patients treated with helical tomotherapy
		He Huilang, Chen Shuxian, Chen Xuanguang, Zhang Zixian, Liu Jindi, Yao Wenyan, Liu hui
		Objective To study the change pattern of neck diameter and relevant factors in nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy, aiming to provide reference for clinical practice. Methods Fifteen NPC patients treated with helical tomotherapy at Sun Yat-Sen University Cancer Center from November 2020 to February 2021 were enrolled in this study. The transverse diameters of NPC patients' neck contours and body weight of all patients during radiotherapy were recorded weekly. We used descriptive statistics to explore the distribution of transverse diameters of NPC patients' neck contours during radiotherapy. And Spearman correlation analysis was used to assess the association between weight loss and changes in neck contour transverse diameter. Results During radiotherapy, the distribution of transverse diameters of NPC patients' neck contours was completely different from the initial values. Specifically, the transverse diameters were significantly reduced at the 4th week of the radiotherapy. Moreover, the reduction of transverse diameter of neck contour was highly correlated with the weight loss (r=0.803, P<0.05), and moderately correlated with gender (r=0.523, P<0.05). However, there was no statistical correlation between the alteration of neck diameter and age, TNM stage, and the mean dose of GTV_nd-L, GTV_nd-R, PTV_nd-L and PTV_nd-R (all P>0.05). Conclusions The neck contours of NPC patients are altered regularly during helical tomotherapy, which are narrowed the most obviously in the 4th week. Extensive attention should be paid to the changes of neck contour during radiotherapy in clinical practice.
		2023 Vol. 32 (2): 106-110 [Abstract] ( 72 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	111	Analysis of clinical efficacy of postoperative low-dose radiotherapy in patients with advanced hypopharyngeal cancer without high-risk factors
		Tao Hengmin, Shen Zhong, Wang Ru, Wei Yumei
		Objective To evaluate the efficacy of low-dose radiotherapy in patients with advanced hypopharyngeal cancer without high-risk factors. Methods Clinical data of 235 patients diagnosed with advanced hypopharyngeal cancer treated in Department of Head and Neck Surgery of Shandong Provincial ENT Hospital from December 2013 to August 2018 were retrospectively analyzed. All patients were divided into two groups: low-dose radiotherapy group (50 Gy, n=158) and high-dose radiotherapy group (>60 Gy, n=77). Clinical baseline characteristics, treatment, follow-up and survival of patients were collected. Survival curve was delineated using the Kaplan-Meier method, and the differences in survival between two groups were calculated using the log-rank test. Clinical baseline characteristics between two groups were compared by χ² test. Univariate and multivariate analyses of prognostic factors were conducted by logistic regression model. Results The median follow-up time was 45 months (5-94 months). The 3-year overall survival (OS) rate of the whole group was 68.5%, and 70.3% and 64.9% in the low-dose and high-dose groups, respectively (P=0.356). The 3-year progression-free survival (PFS) rate of the whole group was 64.3%, and 65.8% and 61.0% in the low-dose and high-dose groups, respectively (P=0.361). Univariate analysis showed that T stage, N stage, lesion location and degree of pathological differentiation significantly affected clinical prognosis (all P<0.05), whereas there was no significant relationship between age, sex, radiotherapy dose, interval between surgery and radiotherapy and survival. Multivariate analysis showed that T stage, N stage and the degree of pathological differentiation were the independent prognostic factors (all P<0.05) of the 3-year OS and PFS. Sex, radiotherapy dose and interval between surgery and radiotherapy were not correlated with OS and PFS. Conclusion This study showed that for hypopharyngeal cancer patients without positive surgical margins and extracapsular extension, postoperative radiotherapy at a dose of 50 Gy given to tumor bed and selective lymph node drainage area does not compromise local disease control and OS.
		2023 Vol. 32 (2): 111-117 [Abstract] ( 68 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumor

	118	Clinical efficacy and toxic effects of prophylactic cranial irradiation in non-small cell lung cancer: a meta-analysis
		Huang Shengkai, Zhang Huiliang, Feng Nan
		Objective To investigate the role of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (NSCLC) by meta-analysis. Methods Studies published from January 1, 1980 to August 30, 2021 were searched systematically in PubMed, Embase, Cochrane Systematic Review database and China National Knowledge Infrastructure Database. The searching keywords included "non-small cell lung cancer", "randomized controlled trial", "prophylactic cranial irradiation" and "clinical trial". The data extracted from the above studies were analyzed using Review Manager 5.3 and Stata 12.0 software. Outcomes included the development of brain metastases (BM), overall survival (OS), disease-free survival (DFS), toxicity, and quality of life (QoL). Results Ten trials, including 2005 NSCLC patients, met the inclusion criteria. Patients who underwent PCI had a significantly lower risk of BM than those who did not (OR=0.29, 95%CI: 0.22-0.40, P<0.001). Compared with non-PCI group, DFS in PCI group was significantly increased (HR=0.75, 95%CI: 0.63-0.89, P=0.001). However, there was no significant difference in OS (OR=0.90, 95%CI: 0.69-1.18, P=0.45). In addition, the incidence of fatigue was significantly increased in the PCI group (OR=2.64, 95%CI: 1.58-4.40, P<0.001). There was no significant difference in cognitive impairment between the PCI and non-PCI groups (OR=3.60, 95%CI: 0.97-13.32, P=0.06). Conclusions PCI is the standard treatment for NSCLC. Compared with non-PCI, PCI significantly reduces the incidence of BM and prolongs the DFS of NSCLC patients. The effect of PCI-related toxicity on the QoL and long-term OS needs further study.
		2023 Vol. 32 (2): 118-123 [Abstract] ( 65 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	124	Analysis of the rectum and bladder changes in prostate precise radiotherapy under the bowel and bladder preparation
		Li Ting, Guo Yujun, Yang Xin, Wu Manli, He Mengxue, Dai Xinyi, Tian Yue, Zhang Shujing, Mai Xiuying, He Liru, Huang Sijuan
		Objective To analyze the clinically acceptable and reproducible bladder and rectum volumes of prostate cancer patients during radiotherapy under bladder and bowel preparation, aiming to provide quantitative indicators for bowel and bladder preparation before and after radiotherapy. Methods Clinical data of 275 prostate cancer patients with strict bladder and bowel preparation and completion of whole course radical radiotherapy at Sun Yat-sen University Cancer Center from April 2015 to December 2020 were retrospectively analyzed. Patients were scanned with cone beam CT (CBCT) before each treatment and the setup error was recorded. Sixty-six patients were selected by simple random sampling and the bladder and rectum on daily CBCT was outlined using MIM software. The relationship between the ratio of daily bladder or rectum volume to the planned bladder or rectum volume (relative value of volume) and setup error was analyzed. Quantitative data were expressed as mean±SD. Normally distributed data were analyzed by paired t-test while non-normally distributed data were assessed by Kruskal-Wallis test. Results The bladder and rectum volume on planning CT were (370.87±110.04) ml and (59.94±25.07) ml of 275 patients. The bladder and rectum volumes on planning CT were (357.51±107.38) ml and (65.28±35.37) ml respectively of the 66 selected patients with 1611 sets of CBCT images. And the bladder and rectum volumes on daily CBCT were (258.96±120.23) ml and (59.95 ± 30.40) ml. The bladder volume of patients was decreased by 3.59 ml per day on average during the treatment and 0.37 ml for the rectum volume. According to the bladder volume on planning CT, all patients were divided into three groups: <250 ml, 250-450 ml and >450 ml groups. The relative value of volume in the 250-450 ml group during the course of radiotherapy was the smallest. And the setup error in the superior and inferior (SI) direction was (0.28±0.24) cm and (0.19±0.17) cm in the left and right (LR) direction, significantly lower than those in the other two groups (both P≤0.027). According to the rectum volume on planning CT, all patients were divided into four groups: <50 ml, 50-<80 ml, 80-120 ml and >120 ml groups. The <50 ml group had the smallest relative value of volume during radiotherapy, and the setup error in the SI direction was (0.26±0.22) cm and (0.24±0.22) cm in the anterior and posterior (AP) direction, significantly smaller than those in the other groups (both P≤0.003). The setup errors in the SI, LR, AP directions of the enrolled 66 patients were (0.30±0.25) cm, (0.20±0.18) cm and (0.28±0.27) cm, respectively. Among them, the relative value of bladder volume in the AP direction was (0.73±0.37) in the setup error <0.3 cm group, which was statistically different from those in the setup error 0.3-0.5 cm and >0.5 cm groups (both P<0.05). Conclusion Under the bladder and bowel preparation before planning CT, the appropriate bladder and rectum volumes are in the range of 250-450 ml and <50 ml, which yields higher reproducibility and smaller setup error.
		2023 Vol. 32 (2): 124-130 [Abstract] ( 54 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	131	Study of radiotherapy dose effect of neoadjuvant chemotherapy versus concurrent chemoradiotherapy in cervical cancer
		Li Fenghu, Mei Fan, Du Yanjun, Yin Shuishui, Tian Xue, Hu Lili, Hong Wei, Shan Lang, Ban Hong, Xu Congfeng, Liu Wen, Lu Bing, Li Jiehui
		Objective To compare the effect of neoadjuvant chemotherapy vs. concurrent chemoradiotherapy on the target volume and organs at risk for locally advanced bulky (>4 cm) cervical cancer. Methods From March 1, 2019 to June 30, 2021, 146 patients pathologically diagnosed with cervical cancer were selected and randomly divided into two groups using random number table method: the neoadjuvant chemotherapy (NACT) + concurrent chemoradiotherapy (CCRT) group (n=73) and CCRT group (n=73). Patients in the NACT+CCRT group received 2 cycles of paclitaxel combined with cisplatin NACT, followed by CCRT, the chemotherapy regimen was the same as NACT. In the CCRT group, CCRT was given. Statistical description of categorical data was expressed by rate. The measurement data between two groups were compared by Wilcoxon rank-sum test for comparison of two independent samples, and the rate or composition ratio of two groups was compared by χ2 test. Results Before radiotherapy, GTV in the NACT+CCRT group was (31.95±25.96) cm3, significantly lower than (71.54±33.59) cm3 in the CCRT group (P<0.01). Besides, CTV and PTV in the NACT+CCRT group were also significantly lower compared with those in the CCRT group (both P<0.05). In terms of target volume dosimetry, D100GTV, D95CTV, V100GTV, V100CTV and V95PTV in the NACT+CCRT group were significantly higher than those in the CCRT group (all P<0.05). The complete remision (CR) rates in the NACT+CCRT and CCRT groups were 86.3% and 67.6%, with statistical significance between two groups (P<0.01) . Regarding organs at risk, NACT+CCRT group significantly reduced the dose to the bladder, rectum, small intestine and urethra compared with CCRT group (all P<0.05). Conclusions NACT can reduce the volume of tumors in patients with large cervical masses, increase the radiation dose to tumors, reduce the dose to organs at risk, and make the three-dimensional brachytherapy easier. Therefore, NACT combined with CCRT may be a new choice for patients with locally advanced cervical cancer with large masses.
		2023 Vol. 32 (2): 131-137 [Abstract] ( 62 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	138	Feasibility study of predicting lung tumor target movement based on body surface motion monitoring
		Huang Taiming, Guan Qi, Zhong Jiajian, Qiu Minmin, Luo Ning, Deng Yongjin
		Objective To evaluate the feasibility of predicting lung cancer target position by online optical surface motion monitoring. Methods CT images obtained in different ways of stereotactic body radiotherapy (SBRT) plans from 16 lung cancer cases were selected for experimental simulation. The planned CT and the original target position were taken as the reference, and the 10 phases of CT in four dimension CT and each cone beam (CBCT) were taken as the floating objects, on which the floating target location was delineated. The binocular visual surface imaging method was used to obtain point cloud data of reference and floating image body surface, while the point cloud feature information was extracted for comparison. Based on the random forest algorithm, the feature information difference and the corresponding target area position difference were fitted, and an online prediction model of the target area position was constructed. Results The model had a high prediction success rate for the target position. The variance explainded and root mean squared error (RMSE) of left-right, superior-inferior, anterior-posterior directions were 99.76%, 99.25%, 99.58%, and 0.0447 mm, 0.0837 mm, 0.0616 mm, respectively. Conclusion The online monitoring of lung SBRT target position proposed in this study is feasible, which can provide reference for online monitoring and verification of target position and dose evaluation in clinical radiotherapy.
		2023 Vol. 32 (2): 138-144 [Abstract] ( 63 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	145	Development and application of three-dimensional point cloud radiotherapy real-time monitoring system based on depth camera
		Li Chunying, Lu Zhengda, Zhang Sai, Sun Jiawei, Gao Liugang, Xie Kai, Lin Tao, Sui Jianfeng, Ni Xinye
		Objective To develop the real-time radiotherapy monitoring system of three-dimensional (3D) point cloud by using depth camera and verify its feasibility. Methods Taking the depth camera coordinate system as the world coordinate system, the conversion relationship between the simulation CT coordinate system and the world coordinate system was obtained from the calibration module. The patient's simulation CT point cloud was transformed into the world coordinate system through the above relationship, and registered with the patient's surface point cloud obtained in real-time manner by the depth camera to calculate the six-dimensional (6D) error, and complete the positioning verification and fractional internal position error monitoring in radiotherapy. Mean and standard deviation of 6D calculation error, Hausdorff distance of point cloud after registration and the running time of each part of the program were calculated to verify the feasibility of the system. Fifteen real patients were selected to calculate the 6D error between the system and cone beam CT (CBCT). Results In the phantom experiment, the errors of the system in the x, y and z axes were (1.292±0.880)mm, (1.963±1.115)mm, (1.496±1.045)mm, respectively, and the errors in the rotation, pitch and roll directions were 0.201°±0.181°, 0.286°±0.326°, 0.181°±0.192°, respectively. For real patients, the translational error of the system was within 2.6 mm, the rotational error was approximately 1°, and the program run at 1-2 frames/s. The precision and speed met the radiotherapy requirement. Conclusion The 3D point cloud radiotherapy real-time monitoring system based on depth camera can automatically complete the positioning verification before radiotherapy, real-time monitoring of body position during radiotherapy, and provide error visual feedback, which has potential clinical application value.
		2023 Vol. 32 (2): 145-151 [Abstract] ( 57 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	152	A preliminary study of fecal microbiota transplantation alleviating inhibition of radiation-induced hippocampal neurogenesis in mice
		Li Junyan, Zhang Junjun, Tian Ye
		Objective To evaluate the effects of whole brain irradiation (WBI) and fecal microbiota transplantation (FMT) on hippocampal neurogenesis and the composition of gut microbiota in mice. Methods Forty specific pathogen free ICR male mice (8-week-old, weighed 30 g) were divided into four groups by simple random sample method: control group (group C), radiation group (group R), group C+FMT and group R+FMT, 10 in each group. Animal models were established by WBI at a dose of 10 Gy by 4 MeV electron beam. In group C+FMT and group R+FMT, mice were gavaged with normal fecal bacteria suspension on day 2 post-irradiation, while those in group C and group R were gavaged with phosphate buffered saline as alternative. Hippocampal tissues and feces in four groups were collected on day 15 post-irradiation. 16S rRNA sequencing was used to detect the species and abundance of fecal flora. BrdU⁺/NeuN⁺ immunofluorescence staining was performed to observe the neurogenesis in hippocampus of mice. Results WBI and FMT had no effect on survival rate and body weight of mice. WBI induced the inhibition of hippocampal neurogenesis and flora disorder. The quantity of Bacteroideae and Rumen bacteria was increased by 28.6% and 102.9%, whereas that of Lactobacillus was significantly decreased by 70.6% (P<0.05). FMT regulated the abundance of bacteria. The abundance of Enterobacteriaceae was significantly declined by 65.1% (P=0.028), while that of Lactobacillus was increased by 58.2% (P=0.015). FMT also promoted hippocampal neurogenesis to some extent after WBI. Conclusions This preliminary study demonstrates that FMT alleviates the inhibition of hippocampal neurogenesis and flora disorder induced by WBI in mice. Ionizing radiation directly acting on the whole brain of mice indirectly disturbs the composition of gut microbiota, which in turn affects the degree of hippocampal neurogenesis in the brain of mice. There is a bidirectional interaction between gut microbiota and brain.
		2023 Vol. 32 (2): 152-158 [Abstract] ( 67 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	159	Research advances in immune response of stereotactic body radiotherapy
		Liu Xiaojun, Ma Wen, Ma Chenru, Qiao Wanjia, Li Shuping
		The mechanisms of radiotherapy (RT) in cancer treatment are both by immunity and non-immunity pathways. According to different absorbed doses, the immune modulating effect of RT comprises of tumor microenvironment modulating effect, immune-modulatory effect as well as immune-ablative effect. RT could improve the therapeutic efficacy of immunotherapy, while immunotherapy could enlarge the immunity activating effect induced by RT in turn. Therefore, RT is emerging as a valuable partner of cancer immunotherapy. RT regimens have a vital impact on immunity within tumor microenvironment. Stereotactic body RT (SBRT) has obvious advantages regarding interferon production and abscopal effect. At present, potentially sub-ablative RT regimen of 8 Gy plus 3 fractionations is the most widely used SBRT. Several novel RT regimens, such as hybrid fractionation, singular site irradiation and multisite irradiation, have been designed to maximize the immune induction effect and improve the combination efficacy with immunotherapy in metastatic malignancies. In this review, the latest advances in the immune effect of RT were discussed and novel SBRT regimens were proposed, aiming to provide reference for enhancing the efficacy of radio-immunotherapy or immuno-radiotherapy in clinical practice.
		2023 Vol. 32 (2): 159-163 [Abstract] ( 74 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	164	Research progress of magnetic hyperthermia based on magnetic nanomaterials
		Xia Jindan, Wu Zhibing, Lan Kaiping
		Thermotherapy has become another important tumor treatment after surgery, radiotherapy, chemotherapy, and targeted treatment. Magnetic hyperthermia (MH) is a new type of hyperthermia, which has attracted widespread attention due to its advantages of non-invasiveness / minimal invasiveness, high efficiency and good tissue penetration. It provides a new option for the molecular level treatment of malignant tumors with high efficacy and low toxicity, which has become a new research direction of tumor treatment. Magnetic materials and suitable magnetic fields are needed to realize MH. Iron oxide nanoparticles (IONs) are widely studied as MH agents because of their high biocompatibility and heating ability. In this article, the research progress on magnetic iron oxide nanomaterials and MH combined with antitumor therapy based on magnetic nanoparticles were analyzed, and the potential application of MH in cancer treatment was reviewed.
		2023 Vol. 32 (2): 164-168 [Abstract] ( 60 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	169	Review on non-surgical treatment for elderly patients with locally advanced head and neck squamous cell carcinoma
		He Shanshan, Li Churong, Chen Sihao, Shao Shilong, Zhong Zuxian, Wang Dan, Liu Yi, Zhang Shichuan
		With the aging of population, the elderly (≥65 years old) cancer patients have become one of the main populations for cancer care. For inoperable locally advanced head and neck squamous carcinomas, cisplatin-based concurrent chemoradiotherapy is the first-line choice. Several large clinical studies have shown that patients under 70 years of age can still benefit from concurrent chemoradiotherapy, while it should be cautious to apply chemotherapy to patients aged 70-80 years. For elderly patients who are intolerant to cisplatin, carboplatin or other regimens with less gastrointestinal and renal toxicity should be considered. Although anti-epidermal growth factor receptor (EGFR) monoclonal antibodies combined with radiotherapy has been proved to be more effective than radiotherapy alone in total patient population, age-subgroup analysis showed limited benefit in elderly patients. The safety of immune checkpoint inhibitors in elderly patients has been validated and those with high programmed death ligand-1 (PD-L1) expression may benefit from concurrent or neoadjuvant immunotherapy, however, high-level evidence is still lacking. For patients older than 80 years, radiotherapy alone may be superior to concurrent chemoradiotherapy, and hypofractionated radiotherapy for palliative purposes can be safely used in this population.
		2023 Vol. 32 (2): 169-173 [Abstract] ( 52 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	174	Research progress on radiotherapy and radiation-associated adverse effects of high-risk neuroblastoma
		Zhang Shidi, Bai Yongrui, Chen Haiyan
		High-risk neuroblastoma (NB) is highly aggressive and has poor prognosis. Treatment of NB mainly includes comprehensive therapies, of which radiotherapy serves as a part of consolidation therapy. For patients who receive complete resection of the primary lesion, usually an irradiation dose of 21-23.4 Gy is given; for patients with incomplete resection, further study focused on radiation dose is necessary. Recurrence is most commonly observed in the bone lesions involved at presentation. Currently, the principle of irradiation to the metastatic sites is to treat lesions where metaio-dobenzylguanidine (MIBG) uptake remains positive after induction chemotherapy, or those become negative uptake but still at high risk of recurrence. On the premise of lacking of MIBG imaging, positron emission tomography CT (PET-CT) may assist in screening for metastatic sites requiring irradiation. The late side effects of radiotherapy are mainly mild musculoskeletal abnormalities. No significant increase is observed in the incidence of second primary tumor during short-term follow-up.
		2023 Vol. 32 (2): 174-178 [Abstract] ( 59 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	179	The indicators of selecting patients with breast cancer undergoing postoperative radiotherapy for deep inspiration breath hold technique
		Zhou Yingying, Chen Bo, Li Yang, Wang Binhao, Pan Lisheng, Wang Hongmei
		Cardiotoxicity caused by postoperative radiotherapy can increase the risk of cardiovascular adverse events in patients with breast cancer, especially those with left breast cancer, which is proportional to the dose of radiation to the heart. It has been proved that deep inspiration breath-hold (DIBH) technique can significantly reduce the cardiac dose in patients with left breast cancer, but the benefits of this technique vary greatly among different patients, and its implementation requires additional equipment, time, manpower and other resources. Hence, it is necessary to select patients who are suitable for this technique in advance. In addition to comprehensive analysis of general factors before simulation positioning that affect DIBH selection, this review also systematically summarized relevant indicators of CT simulation positioning images. These anatomical indicators included the measurement of the cardiac contact distances in parasagittal (CCD_ps) plane, the lateral heart-to-chest distance (HCD), the product of maximum heart width (HW_max) and the maximum heart depth (HD_max) during CT simulation positioning, and the maximum heart distance, heart volume in the irradiation field (HVIF), the difference of lung volume and heart volume between free breathing (FB) and DIBH measured after CT localization. All of them showed some instructive significance for evaluating whether DIBH should be applied in tangent field based radiotherapy planning. The automatic planning (rapid plan) function in the treatment planning system could quickly predict the benefit of DIBH for breast cancer patients. The purpose of this article is to help clinicians select patients who are suitable for DIBH technique, guaranteeing that DIBH technique resources can be used reasonably.
		2023 Vol. 32 (2): 179-183 [Abstract] ( 61 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	184	Research progress on use of tissue equivalent filler in postmastectomy radiation therapy of breast cancer
		Chen Li, Qian Jianjun, Tian Ye
		Although the use of postmastectomy radiation therapy (PMRT) has been proven to bring survival benefit to breast cancer patients, the use of chest wall tissue equivalent filler (bolus) remains controversial. In recent years, a large number of studies have shown that the use of bolus in PMRT does not significantly improve the local control rate, while it can significantly increase the acute skin toxicity, and even leads to more frequent and longer treatment interruption. Existing retrospective studies have indicated that for breast cancer patients undergoing mastectomy and systemic therapy, if there is no skin invasion, it is recommended not to routinely use bolus during radiotherapy. However, higher-level clinical studies are needed for further confirmation.
		2023 Vol. 32 (2): 184-188 [Abstract] ( 47 ) [HTML 1KB] [ PDF 0KB] ( 0 )

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