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.5 Published 2023-05-15

	Abdominal Tumors Review Articles Consensus Physics·Technique·Biology Thoracic Tumor

Consensus

	389	Branch Association of Radiation Oncology of Shanghai Medical Association Consensus on stereotactic body radiation therapy for pancreatic cancer
		Branch Association of Radiation Oncology of Shanghai Medical Association, Group of Stereotactic Body Radiation Therapy, Branch Association of Radiation Oncology of Shanghai Medical Association
		Pancreatic cancer is a life-threatening and lethal malignancy with a 5-year survival rate of only approximately 9%. Despite that immunotherapy or targeted therapy has been confirmed effective in other cancers, limited survival benefits have been achieved in pancreatic cancer. Therefore, surgery, chemotherapy and radiotherapy are still the main regimens of pancreatic cancer. Owing to that most of the patients have locally advanced or advanced pancreatic cancer at the initial diagnosis, radiotherapy is a pivotal local therapy for prolonging patients' survival and improving the quality of life. Given that stereotactic body radiation therapy has been gradually used in the treatment of pancreatic cancer, a consensus on stereotactic body radiation therapy for pancreatic cancer is required. Under the promotion of Radiation Oncology Society of Shanghai Medical Association, the consensus on stereotactic body radiation therapy for pancreatic cancer has been formulated based on the latest research and practice in stereotactic body radiation therapy for pancreatic cancer combined with national conditions in China, aiming to promote the standardization of stereotactic body radiation therapy for pancreatic cancer, and eventually provide favorable outcomes for pancreatic cancer patients.
		2023 Vol. 32 (5): 389-399 [Abstract] ( 58 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumor

	400	Phase II trial of hippocampal avoidance whole-brain irradiation with simultaneous integrated boost for treatment of brain metastases of lung cancer
		Li Zhuoran, Wang Wenqing, Deng Lei, Zhai Yirui, Zhang Tao, Bi Nan, Wang Jingbo, Wang Jianyang, Wang Xin, Liu Wenyang, Xiao Zefen, Chen Dongfu, Lyu Jima, Feng Qinfu, Zhou Zongmei
		Objective To evaluate the efficacy and safety of hippocampal avoidance whole-brain irradiation with simultaneous integrated boost in the treatment of brain metastases of lung cancer. Methods Forty lung cancer patients with brain metastases who received whole-brain radiotherapy with simultaneous integrated boost and hippocampal avoidance in Cancer Hospital, Chinese Academy of Medical Sciences from 2014 to 2020 were enrolled in this study. Brain MRI, survival follow-up and evaluation of side effects were performed before radiotherapy and at 1, 3, 6 and 12 months after radiotherapy, respectively. Overall survival (OS), progression-free survival (PFS) and changes in cognitive function were analyzed. Continuous data were described as Mean ± SD. Categorical data were described by frequency and composition ratio or percentage. Survival analysis was conducted by Kaplan-Meier method. Influencing factors of survival were identified by univariate and multivariate Cox's regression analyses. Results A total of 40 patients were enrolled in the study. The median follow-up time was 14.2 months and the median OS, PFS and intracranial PFS of all patients were 14.8 months, 6.7 months and 14.8 months, respectively. Multivariate analysis showed that male gender and newly diagnosed stage Ⅳ disease were associated with worse OS and PFS, respectively. The Hopkins verbal learning test-revised (HVLT-R) scores at baseline and 1, 3 and 6 months after radiotherapy were 21.94±2.99, 20.88±3.12, 20.03±3.14, and 19.78±2.98, respectively. The HVLT-R score at 6 months after radiotherapy was decreased by approximately 9.8% compared with the baseline. No grade 3 or above toxic and side effect occurred in the entire cohort. Conclusion Hippocampal avoidance whole-brain irradiation with simultaneous integrated boost is a safe and effective treatment for brain metastases of lung cancer, which is expected to reduce the impact of radiotherapy on cognitive function.
		2023 Vol. 32 (5): 400-406 [Abstract] ( 51 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumors

	407	Long-term outcomes of definitive radiotherapy-based comprehensive treatment for inoperable stage I-III non-metastatic pancreatic cancer
		Cao Biyang, Liu Xiaoliang, Zhang Letian, Wu Chenchen, Yang Wei, Wang Qianqian, Tong Fang, Wang Jing
		Objective To analyze long-term outcomes of inoperable non-metastatic pancreatic cancer patients treated with definitive radiotherapy-based comprehensive treatment. Methods Clinical data of 168 patients with medically unfit, refusal to surgery or inoperable non-metastatic pancreatic cancer treated with radiotherapy-based comprehensive treatment in PLA General Hospital between January 2016 and December 2020 were retrospectively analyzed. Survival outcomes,prognostic factors and patterns of treatment failure were analyzed in the radiotherapy (n=95) and combined chemoradiotherapy (n=73) groups. The survival analysis was conducted by Kaplan-Meier method. The survival curve was compared by log-rank test. Independent prognostic factors were identified by Cox proportional harzard model. Results With a median follow-up of 20.2 months in the entire group, the median overall survival (OS) and median progression-free survival (PFS) were 18.0 and 12.3 months. The corresponding median OS and median PFS after receiving radiotherapy were 14.3 and 7.7 months. The 1-, 2-and 3-year OS rates were 72.1%, 36.6% and 21.5%, and the 1- and 2-year local control rates were 82.6% and 64.3%, respectively. The median OS for stage Ⅰ, stage Ⅱ and stage III were 27.1, 18.0 and 17.0 months, respectively. There was no significant difference in the median OS of patients with localized disease (stage Ⅰ-Ⅱ) between the radiotherapy and combined chemoradiotherapy groups (21.1 vs. 20.4 months, P=0.470). In patients with locally advanced disease (stage Ⅲ), combined chemoradiotherapy group showed better median OS compared with radiotherapy group (19.2 vs. 13.8 months, P=0.004). Clinical stage, CA19-9 before radiotherapy, comprehensive treatment and biological effective dose (BED₁₀) were identified as the independent prognostic factors for OS (P=0.032, 0.011, 0.003 and 0.014). The cumulative 1- and 2-year actuarial rates of treatment failure, local-regional recurrence and distant metastasis were 48% and 74.4%, 15.0% and 27.4%, 23.6% and 33.1%, respectively. Liver metastasis (16.1%, 27/168) and local recurrence (11.9%, 20/168) were the primary patterns of treatment failure. Conclusions Definitive radiotherapy-based comprehensive treatment effectively prolongs long-term survival in patients with inoperable non-metastatic pancreatic cancer. Definitive radiotherapy can be an alternative treatment option with curative intent for patients with localized pancreatic cancer who are medically unfit or refuse to undergo surgery. The combination of radiotherapy and chemotherapy remains an effective treatment choice for locally advanced unresectable pancreatic cancer.
		2023 Vol. 32 (5): 407-414 [Abstract] ( 67 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	415	The efficacy of intensity-modulated radiotherapy in radical radiotherapy for cervical cancer: a propensity score matching analysis
		Rao Huiting, Feng Tao, Wu Chufan, Lou Hanmei, Lyu Xiaojuan
		Objective To compare the clinical efficacy and toxicity of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in radical radiotherapy for cervical cancer. Methods Clinical data of 1002 patients with cervical cancer treated with radical radiotherapy at Zhejiang Cancer Hospital from September 2013 to December 2016 were retrospectively analyzed. All patients were divided into the IMRT group and 3D-CRT group according to the technology of external beam radiation therapy (EBRT). After 1∶1 propensity score matching (PSM), clinical prognosis of patients receiving IMRT or 3D-CRT was compared. Continuous data were expressed as Mean ± SD or median. Categorical data were described by case number (percentage). Quantitative data were compared by t-test. Qualitative data were compared by chi-square test or Fisher's exact test. Survival rates in two groups were calculated by Kaplan-Meier method and log-rank test. Results The percentage of patients who received pelvic and para-aortic radiotherapy in the IMRT group was significantly higher than that in the 3D-CRT group (14.9% vs. 1.2%, P<0.001). The percentage of patients whose positive lymph nodes dose reached 55 Gy or more in the IMRT group was significantly higher than that in the 3D-CRT group (26.6% vs. 15.5%, P=0.002). In the IMRT group, the 5-year disease-free survival (DFS) rate (74.6% vs. 68.9%, P=0.084) and overall survival (OS) rate (79.4% vs. 74.9%, P=0.270) were slightly higher than those in the 3D-CRT group, but there were no significant differences between two groups. In the IMRT group, the local recurrence (3.0% vs. 6.9%, P=0.020) and distant lymph node metastasis rates (4.2% vs. 9.0%, P=0.013) were significantly lower compared with those in the 3D-CRT group. In terms of acute radiotherapy toxicities, grade 3-4 leukopenia (46.3% vs. 37.9%, P=0.028) and anemia (18.8% vs. 14.0%, P<0.001) occurred significantly more frequently in the IMRT group than in the 3D-CRT group. Conclusions Both IMRT and 3D-CRT could achieve good therapeutic outcomes in radical radiotherapy of cervical cancer. IMRT can boost the radiation dose of metastatic lymph nodes and has significant advantages in reducing local recurrence and distant lymph node metastasis.
		2023 Vol. 32 (5): 415-421 [Abstract] ( 69 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	422	Study of three-dimensional dose distribution based-deep learning in predicting distant metastasis in head and neck cancer
		Cai Jiajun, Li Yongbao, Xiao Fan, Qi Mengke, Lu Xingyu, Zhou Linghong, Song Ting
		Objective To investigate the role of three-dimensional dose distribution-based deep learning model in predicting distant metastasis of head and neck cancer. Methods Radiotherapy and clinical follow-up data of 237 patients with head and neck cancer undergoing intensity-modulated radiotherapy (IMRT) from 4 different institutions were collected. Among them, 131 patients from HGJ and CHUS institutions were used as the training set, 65 patients from CHUM institution as the validation set, and 41 patients from HMR institution as the test set. Three-dimensional dose distribution and GTV contours of 131 patients in the training set were input into the DM-DOSE model for training and then validated with validation set data. Finally, the independent test set data were used for evaluation. The evaluation content included the area under receiver operating characteristic curve (AUC), balanced accuracy, sensitivity, specificity, concordance index and Kaplan-Meier survival curve analysis. Results In terms of prognostic prediction of distant metastasis of head and neck cancer, the DM-DOSE model based on three-dimensional dose distribution and GTV contours achieved the optimal prognostic prediction performance, with an AUC of 0.924, and could significantly distinguish patients with high and low risk of distant metastasis (log-rank test, P<0.001). Conclusion Three-dimensional dose distribution has good predictive value for distant metastasis in head and neck cancer patients treated with IMRT, and the constructed prediction model can effectively predict distant metastasis.
		2023 Vol. 32 (5): 422-429 [Abstract] ( 60 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	430	Dose volume histogram prediction method for organ at risk in VMAT planning of nasopharyngeal carcinoma based on equivalent uniform dose
		Li Huijuan, Li Yang, Zhuang Yongdong, Chen Zhongben
		Objective To evaluate the practicability of dose volume histogram (DVH) prediction model for organ at risk (OAR) of radiotherapy plan by minimizing the cost function based on equivalent uniform dose (EUD). Methods A total of 66 nasopharyngeal carcinoma (NPC) patients received volume rotational intensity modulated arc therapy (VMAT) at Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences from 2020 to 2021 were retrospectively selected for this study. Among them, 50 patients were used to train the recurrent neutral network (RNN) model and the remaining 16 cases were used to test the model. DVH prediction model was constructed based on RNN. A three-dimensional equal-weighted 9-field conformal plan was designed for each patient. For each OAR, the DVHs of individual fields were acquired as the model input, and the DVH of VMAT plan was regarded as the expected output. The prediction error obtained by minimizing EUD-based cost function was employed to train the model. The prediction accuracy was characterized by the mean and standard deviation between predicted and true values. The plan was re-optimized for the test cases based on the DVH prediction results, and the consistency and variability of the EUD and DVH parameters of interest (e.g., maximum dose for serial organs such as the spinal cord) were compared between the re-optimized plan and the original plan of OAR by the Wilcoxon paired test and box line plots. Results The neural network obtained by training the cost function based on EUD was able to obtain better DVH prediction results. The new plan guided by the predicted DVH was in good agreement with the original plan: in most cases, the D_98% in the planning target volume (PTV) was greater than 95% of the prescribed dose for both plans, and there was no significant difference in the maximum dose and EUD in the brainstem, spinal cord and lens (all P>0.05). Compared with the original plan, the average reduction of optic chiasm, optic nerves and eyes in the new plans reached more than 1.56 Gy for the maximum doses and more than 1.22 Gy for EUD, and the average increment of temporal lobes reached 0.60 Gy for the maximum dose and 0.30 Gy for EUD. Conclusion The EUD-based loss function improves the accuracy of DVH prediction, ensuring appropriate dose targets for treatment plan optimization and better consistency in the plan quality.
		2023 Vol. 32 (5): 430-437 [Abstract] ( 51 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	438	Evaluation of technical performance of stereotactic radiosurgery algorithm in optical surface imaging system in non-coplanar radiotherapy
		Liu Shoupeng, Chen Hongjia, Lai Jialu, Mao Erbu, Zhou Ji, Huang Yang, Liu Denghong, Zhong Renming
		Objective To evaluate the accuracy and stability of stereotactic radiosurgery (SRS) algorithm in optical surface imaging (OSI) system in non-coplanar radiotherapy. Methods Three OSI imaging systems were used to measure the phantom repeatedly at different couch rotation angles to analyze the accuracy and stability of OSI system. Seven patients with multiple brain metastases who underwent single-center non-coplanar radiotherapy were randomly selected, and the accuracy and stability of OSI for patient imaging were analyzed. Stability is defined as the difference between the two OSI measurements when the couch is turned from 0° to a non 0° angle, and then back to 0°, using the 0° cone beam CT (CBCT) as the "gold standard". Accuracy is defined as the difference between OSI and CBCT (at 0° couch angle) measurement data. The measurement data with normal distribution were described as Mean ± SD. The data with non-normal distribution were expressed as M (Q). The difference of the former data was compared by one-way ANOVA, and the difference of the latter data was assessed by Kruskal-Wallis H nonparametric test. Results For non-coplanarity, the translation accuracy of the phantom and the patient was ≤ 1.30 mm and ≤ 1.00 mm, and the rotation accuracy was ≤ 0.50° and ≤ 0.60°, respectively. The translation errors mainly occurred in the left-right and head-foot directions. In terms of stability, the maximum standard deviation of phantom coplanar translation and rotation was 0.06 mm and 0.06°. The maximum standard deviation of patient translation and rotation was 0.17 mm and 0.19°. Conclusions Although the new SRS algorithm improves the non-coplanar accuracy, it still cannot meet the precise requirements of non-coplanar single isocenter radiotherapy for multiple brain metastases, especially in the left-right and head-foot directions. When the couch rotation angle is large, OSI is not recommended for image-guided radiotherapy. However, its high stability can be used to monitor the intrafractional motion of patients.
		2023 Vol. 32 (5): 438-444 [Abstract] ( 50 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	445	Expression profiling of cell-derived exosomal lncRNAs resistant to concurrent chemoradiotherapy in nasopharyngeal carcinoma
		Li Cheng, Xiong Wei, Cao Ruixue, Wang Qiaoli, Xu Guoqiang
		Objective To screen the key exosomal long non-coding RNAs (lncRNAs) molecules that cause nasopharyngeal carcinoma cells to develop chemoradiotherapy resistance. Methods In vitro, a model of concurrent chemoradiotherapy for human nasopharyngeal carcinoma cells was constructed, and the continuous shock method of high-dose concurrent chemoradiotherapy was used to induce the establishment of chemoradiotherapy-resistant nasopharyngeal carcinoma cell lines, and its resistance formation was verified. Exosomes produced by chemoradiotherapy-resistant cell lines and respective mother cell lines for nasopharyngeal carcinoma were extracted and identified. Finally, biochip technology was used to detect the differential expression levels of exosomal lncRNAs. Results After 10 repeated treatments of concurrent chemoradiotherapy, CNE-1 CRR and CNE-2 CRR were successfully obtained. Compared with the mother cell lines, CNE-1 CRR and CNE-2 CRR had a tendency to transform from epithelial to interstitial morphology, and the number of cell clones was higher, and the values of average lethal dose (D₀), quasi-threshould dose (D_q), survival fraction after 2 Gy irradiation (SF₂) and cell survival rate were higher. Nasopharyngeal carcinoma cells were detected by PCR chip of exosomal lncRNAs. Compared with their respective mother cell lines, 18 lncRNAs in CNE-1 CRR exosomes were significantly up-regulated and 31 lncRNAs were significantly down-regulated, and 15 lncRNAs were significantly up-regulated and 38 lncRNAs were significantly down-regulated in CNE-2 CRR exosomes. CNE-1 CRR also had similar expression profiles to CNE-2 CRR. Conclusion There are significantly up-regulated and down-regulated lncRNAs in the exosomes of CNE-1 CRR and CNE-2 CRR.
		2023 Vol. 32 (5): 445-450 [Abstract] ( 60 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	451	*LncRNA TTN-AS1* affects the radiosensitivity of breast cancer cells by regulating miR-107/HMGA1 signaling axis**
		Mao Xinhui, Wang Zhen, Zhang Jianqing, Zhu Chengbin
		Objective To investigate the effect and mechanism of long non-coding RNA (lncRNA) TTN-AS1 on the radiosensitivity of breast cancer cells. Methods The expression of TTN-AS1 in breast cancer cells was detected by real-time reverse transcription PCR (qRT-PCR). MDA-MB-231 cells were divided into the 0 Gy group, 4 Gy group, negative control (NC) +4 Gy group, si-TTN-AS1+4 Gy group, si-TTN-AS1+miR-107 inhibitor+4 Gy group, and si-TTN-AS1+miR-107 inhibitor+si-HMGA1+4 Gy group. CCK-8 assay and flow cytometry were used to detect the proliferation and apoptosis rates in each group. Results Compared with breast epithelial cells, TTN-AS1 was significantly highly expressed in breast cancer cell lines (P<0.001). Compared with the NC+4 Gy group, the cell proliferation ability was significantly decreased (P<0.05) and cell apoptosis was significantly increased (P<0.001) in the si-TTN-AS1+4 Gy group. Compared with the 0 Gy group, the expression levels of TTN-AS1 and HMGA1 from 8 h to 24 h after radiotherapy were significantly up-regulated (both P<0.01), whereas the expression of miR-107 was significantly down-regulated from 8 h to 24 h after radiotherapy in the 4 Gy group (P<0.001). The cell proliferation ability in the si-TTN-AS1+miR-107 inhibitor+4 Gy group was significantly higher than that in the si-TTN-AS1+4 Gy group (P<0.001), and cell apoptosis was significantly lower than that in the si-TTN-AS1+4 Gy group (P<0.001). Compared with the si-TTN-AS1+miR-107 inhibitor+4 Gy group, cell proliferation ability was significantly decreased (P<0.001), whereas cell apoptosis was significantly increased in the si-TTN-AS1+miR-107 inhibitor+si-HMGA1+4 Gy group (P<0.001). Conclusion TTN-AS1 can promote the radiosensitivity of breast cancer cells by regulating the miR-107/HMGA1 signaling axis.
		2023 Vol. 32 (5): 451-456 [Abstract] ( 67 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	457	Resveratrol up regulates the expression of SIRT1 and mediates protective effect on radiation-induced myocardial injury
		Xu Yilin, Chen Yanxin, Cai Yini, Xu Peng, Zeng Zhimin, Huang Long, Liu Anwen
		Objective To evaluate the effect of resveratrol on radiation-induced myocardial injury in mice. Methods A total of 80 C57BL/6 mice were randomly divided into the control group, resveratrol (Res) group, radiation (RT) group and radiation+resveratrol (RT+Res) group. In the RT group, mice were given with heart radiation and mice in the Res group were given with resveratrol by gavage for 3 months. Cardiac ultrasound was used to evaluate cardiac function at 3 months after cardiac radiation. The hearts of mice were collected for HE staining, immunofluorescence, TUNEL staining, Masson staining and Western blot to evaluate the expression of silent information regulator 1 (SIRT1), the level of oxidative stress, inflammatory response, apoptosis and the degree of fibrosis in myocardial tissues. Experimental data were expressed as Mean ± SD. Continous data were statistically analyzed by t-test. Results After 3 months of irradiation, compared with the control group, the ejection fraction (EF) and fractional shortening (FS) of cardiac function were decreased, and myocardial degeneration and disorder, reactive oxygen species (ROS) and inflammatory levels (interleukin-1β, interleukin-6, tumor necrosis factor-α), myocardial apoptosis (TUNEL positive cell rate) and fibrosis were increased in the RT group. In the RT+Res group, the cardiac function was improved, the expression of SIRT1 was increased, and the levels of oxidative stress, inflammation, myocardial apoptosis and fibrosis were decreased. Conclusions Resveratrol can reduce oxidative stress, inflammatory infiltration, apoptosis and fibrosis of myocardium in mice with radiation-induced myocardial injury, thereby improving cardiac structural abnormalities and cardiac dysfunction. This protective effect can be mediated by upregulation of SIRT1 expression.
		2023 Vol. 32 (5): 457-463 [Abstract] ( 52 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	464	Use of magnetic resonance scanner with a linear accelerator during precision radiotherapy for breast cancer
		Wang Wei, Li Zhenjiang, Li Jianbin
		Magnetic resonance-guided radiotherapy (MRgRT) not only offers real time magnetic resonance (MR) imags with high-resolution and good soft tissue contrast to guide the delineation of the target volume during simulation and daily radiotherapy, but also reveals the position and shape changes of the target volumes and organs at risk (OAR) during treatment dynamically, which provides the evidence for the individual-adptive planning revision. Thus, MRgRT has the potential to dramatically impact cancer research and treatment. And this treatment mode is theoretically more suitable for the disease with obvious tissue deformation, such as breast. In this review, application of MR scanner with a linear accelerator (MR-linac) in radiotherapy workflows for breast cancer patients was summarized, and its implications and opportunities on breast cancer irradiation were highlighted.
		2023 Vol. 32 (5): 464-469 [Abstract] ( 52 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	470	The roles and clinical controversies of radiotherapy and immunotherapy in abscopal effect
		Zhang Lu, Liu Hongbo, Ding Xiao, Lu Haijun
		As early as the 20^th century, it has been observed that radiotherapy (RT), as a local therapy, can activate the adaptive immune system, resulting in spontaneous regression of tumors out of the radiation field, which is known as "abscopal effect". Although the occurrence of abscopal effect is still rare, with the gradual increase in the application of immunotherapy, more and more clinical cases of abscopal effect have been reported. Increasing attention has been paid to the therapeutic potential of RT in inducing systemic anti-tumor response. Especially, the combination of RT and immunotherapy enhances the research value of abscopal effect. However, its mechanism has not been fully elucidated, and the optimal timing, dose and fractionation of RT are also under study. How to classify the beneficiary groups is also a key issue. In this article, the history of abscopal effect, and the role of RT and immunotherapy in this phenomenon were briefly introduced, and the existing controversies in clinical application were illustrated, aiming to clarify the direction of current research and development and open a new chapter for tumor treatment in a short period of time.
		2023 Vol. 32 (5): 470-475 [Abstract] ( 43 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	476	Research progress on GLIM criteria for malnutrition in patients with malignant tumors
		Wang Yunxiao, Pan Wenyan, Zhang Ye
		Malnutrition is a common complication in patients with malignant tumors, which affects the clinical outcome of cancer patients. Accurate identification of malnutrition is the premise of nutritional intervention and treatment, but uniform diagnostic criteria for malnutrition are currently lacking. With the official release of the Global Leadership Initiative on Malnutrition (GLIM) initiated by global nutrition experts in 2018, a large cohort of studies have been carried out. In this article, the specific content and controversies of the GLIM criteria, its accuracy validation and clinical predictive value in patients with malignant tumors were mainly reviewed, aiming to provide reference for subsequent research and clinical application of malignant tumor-related malnutrition.
		2023 Vol. 32 (5): 476-480 [Abstract] ( 52 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	481	Application of 4DCT-based lung functional imaging in radiotherapy for lung cancer
		Zhong Wenjing, Li Ying, Cui Haixia
		Radiation pneumonia is a side effect that cannot be ignored in the current radiation therapy for lung cancer. At present, there are studies and reports of the introduction of functional imaging technology into lung cancer radiotherapy plans, in which 4DCT has better application prospects in radiotherapy for lung cancer because of its advantages of simple operation, high spatial resolution and no additional cost, etc. Compared with single-photon emission computed tomography (SPECT)-CT, positron emission tomography (PET)-CT, MRI has a better application prospect in radiotherapy of lung cancer. The use of 4DCT to obtain the patient's lung function status can predict radiation pulmonary toxicity and assist clinicians to deliver prompt interventions. Moreover, it can help carry out radiotherapy for functional lung avoidance, mitigate the damage of normal lung tissues, and alleviate chest toxicity, which may have wider application value in the future. In this article, research progress on functional lung imaging algorithms based on 4DCT and the application of radiation therapy for lung cancer was reviewed.
		2023 Vol. 32 (5): 481-487 [Abstract] ( 54 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	488	Recent progress on cGAS-STING pathway in tumor radiotherapy
		Qiu Jieping, Cheng Jingjing, Bao Yawei, Xu Jun, Tian Jieyong, Qian Dong
		Radiotherapy is widely used in the treatment of primary and metastatic malignant tumors. It is traditionally believed that the killing effect of radiotherapy on tumor is based on the direct or indirect damage of ionizing radiation to DNA. In recent years, the anti-tumor role and mechanism of anti-tumor immune response induced by ionizing radiation have captivated widespread attention and achieved significant progress. Among them, Cyclic GMP-AMP synthase (cGAS)-stimulator of interference genes (STING) pathway is considered to be one of the key regulatory hubs. cGAS is a cytoplasmic DNA receptor that can bind to tumor-derived double-stranded DNA and activate the downstream STING, thereby activating anti-tumor immune response of the host. In view of the latest progress in this field, the important role and potential mechanism of cGAS-STING pathway in radiotherapy immune effect were mainly summarized, and the application prospect of targeting cGAS-STING pathway in radiotherapy sensitization was explored.
		2023 Vol. 32 (5): 488-492 [Abstract] ( 73 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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