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.6 Published 2023-06-15

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

Head and Neck Tumors

	493	Effect and mechanism of hyperthermia on cell apoptosis of laryngeal squamous cell carcinoma patients
		Zhu Xiaofei, Wang Liang, Zheng Yingjuan, Yang Daoke, Zhang Peng, Fang Jie
		Objective To evaluate the effect of hyperthermia on the apoptosis and the expression levels of cysteine-containing aspartate-specific protease-3 (Caspase-3) and phosphorylated protein kinase B (p-AKT) in laryngeal squamous cell carcinoma cells. Methods A prospective study was conducted on 30 patients with laryngeal squamous cell carcinoma who were treated at the First Affiliated Hospital of Zhengzhou University from October, 2021 to October, 2022. Three times of hyperthermia were performed with a time interval of 24 h. The tumor tissue samples were collected from 30 patients before and after hyperthermia and divided into before hyperthermia group (group A ) and after hyperthermia group (group B). Self-control study mode was adopted for comrparative analysis. The cell apoptosis was detected by TUNEL assay. The expression levels of Caspase-3 and p-AKT in the tissues were detected by immunohistochemistry. Positive cell ratio and immunohistochemistry (IHC) score were recorded. Comparison between two groups was performed by paired t-test. The correlation between the degree of apoptosis and the changes of Caspase-3 and p-AKT molecules was assessed by Pearson correlation analysis. Results No evident adverse reactions were observed in 30 patients after hyperthermia. The apoptosis index of laryngeal squamous cell carcinoma cells in group A was 2.37%±1.33%, and 4.27%±3.93% in group B (P=0.006). In group A, the ratio of Caspase-3 positive cells in tumor tissues was 62.31%±19.49% and 80.79%±17.15% in group B (P=0.001). The ratio of p-AKT positive cells in group A was 31.26%±19.30%, and 26.26%±15.86% in group B (P=0.023). There was a positive correlation between the degree of apoptosis and the changes of Caspase-3 molecule (r=0.544, P=0.002), but a negative correlation was noted between the degree of apoptosis and the changes of p-AKT molecule (r=-0.434, P=0.017). Conclusion Hyperthermia can promote the apoptosis of tumor cells in laryngeal squamous cell carcinoma, which may be related to Caspase-3 dependent apoptosis, and the inhibition of AKT phosphorylation is also involved in this process.
		2023 Vol. 32 (6): 493-498 [Abstract] ( 51 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	499	Clinical efficacy and prognostic factors of postoperative adjuvant radiotherapy for pediatric ependymoma
		Sun Xiaoyang, Shi Xuejiao, Lu Dongqing, Zhou Renhua, Zhou Qing, Zhu Chuanying, Fan Wenqi, Jiang Mawei
		Objective To investigate the clinic opathological features, treatment and prognosis of children newly diagnosed with ependymoma. Methods Clinical data of 127 pediatric ependymoma (EPN) patients (0-16 years old) treated with tumor resection and postoperative radiotherapy at Xinhua Hospital Affiliated to Shanghai Jiao Tong University between 2001 and 2021 were retrospectively analyzed. Among them, 53 children were female and 74 were male. Local control (LR), event-free survival (EFS) and overall survival (OS) rates were analyzed by Kaplan-Meier method. The relationship between clinic opathological factors and clinical prognosis, and the effect of treatment on clinical prognosis of patients were analyzed by Cox proportional hazards model. Results At a median follow-up time of 29 months (3-251 months), the 3-year OS and EFS rates were 89.5% and 71.5%, respectively. For patients undergoing incomplete resection followed by postoperative adjuvant radiotherapy, the 3-year LR, OS and EFS rates were 78.3%, 65.8% and 85.7%, respectively. A total of 43 children were aged <3 years old when diagnosed and 84 aged ≥3 years old. The interval time between surgery and radiotherapy in children aged <3 years old was 91 d, and 35.5 d in those aged ≥3 years old (P<0.001). For patients <3 years old, the median EFS was 90 months when initiating radiotherapy within ≤70 d after surgery, compared to 43 months for those who initiated radiotherapy at >70 d after surgery (P=0.053). According to fifth edition of the WHO classification of tumors of the central nervous system (WHO CNS5), 39 children were classified as posterior fossa ependymoma group A (PFA group). The OS and EFS rates in the PFA group were significantly less than those in other groups (3-year OS rate were 69.2% vs. 94.6%, P<0.001; 3-year EFS rate were 46.9% vs. 79.1%, P<0.001). In the PFA group, 12 patients received postoperative adjuvant chemotherapy, 14 did not receive chemotherapy, and whether chemotherapy was given was unknown in 13 cases. No significant differences were observed in OS and EFS between patients treated with and without chemotherapy (P=0.260, P=0.730). Univariate Cox analysis showed that tumor location and WHO CNS5 molecular classification were significantly associated with EFS, and WHO CNS5 molecular classification was significantly correlated with OS. Multivariate Cox analysis showed that tumor location in the posterior fossa was an independent risk factor for EFS (HR=2.72, 95%CI=1.1~6.71, P=0.03). Conclusions Patients newly diagnosed with pediatric ependymoma can obtain favorable survival after surgery combined with postoperative adjuvant radiotherapy. Patients with residual tumors can achieve favorable LC and survival after postoperative adjuvant radiotherapy. Delaying of radiotherapy tends to lead to poor survival for patients aged <3 years old when diagnosed. Children in the PFA group obtain worse prognosis compared to their counterparts in other groups. The tumor location in the posterior fossa is an independent risk factor for pediatric ependymoma.
		2023 Vol. 32 (6): 499-505 [Abstract] ( 50 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Thoracic Tumors

	506	Efficacy of chemoradiotherapy versus surgery in cervical esophageal cancer: a population-based competing risk analysis
		Ji Guangqian, Zhang Xiaoxiao, Ma Zhenghui, Fan Xinling, Qi Shunan, Yi Junlin, Zhang Tao
		Objective To evaluate the value of chemoradiotherapy and surgery in cervical esophageal cancer (CEC). Methods Data of 459 patients with CEC from 2004 to 2017 were collected and retrospectively analyzed from the surveillance, epidemiology, and end results (SEER) database of National Cancer Institute (US). All patients were divided into the chemoradiotherapy group (n=379) and surgery group (n=80) according to the treatment methods. Survival analysis was performed by Kaplan-Meier method and survival curve was drawn. Multivariate survival analysis was conducted by Cox proportional hazards regression model. The death rate of different causes between two groups was calculated by cumulative incidence function (CIF). The differences of death rate between two groups were evaluated by Fine-Gray competing risk model. By analyzing the clinical characteristics and survival of CEC patients, the overall survival (OS) was compared between the surgery and chemoradiotherapy groups. Results The 2- and 5-year survival rates in the chemoradiotherapy group were 43.1% and 22.4%, while those of the surgical group were 46.8% and 26.0%, respectively. No significant difference was observed in the OS between the chemoradiotherapy and surgery groups (P=0.750). Cox multivariate analysis showed that treatment (surgery group vs. chemoradiotherapy group) was not an independent prognostic factor for OS. Based on the results of competing risk analysis, the risk of esophageal cancer-specific death in the chemoradiotherapy group was higher than that in the surgery group, and the difference was statistically significant between two groups (P<0.001). The risk of other cause-specific death in the chemoradiotherapy group was lower than that in the surgery group (P<0.001). The proportion of patients who died of oral, oropharyngeal, hypopharyngeal and laryngeal diseases in the surgery group was significantly higher than that in the chemoradiotherapy group(all P<0.001). Conclusions No significant difference is observed in the OS of CEC patients treated with chemoradiotherapy or surgery. In the surgery group, the risk of esophageal cancer-specific death is lower, whereas the risk of other cause-specific death is higher compared with those in the chemoradiotherapy group.
		2023 Vol. 32 (6): 506-511 [Abstract] ( 63 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	512	Involved-field irradiation and elective nodal irradiation for esophageal squamous cell carcinoma: a systematic review and meta-analysis
		Wang Hesong, Song Chunyang, Zhao Xiaohan, Deng Wenzhao, Shen Wenbin
		Objective To analyze whether involved-field irradiation (IFI) was associated with improved survival and reduced treatment-related adverse events compared with elective nodal irradiation (ENI) in Chinese patients with esophageal squamous cell carcinoma receiving radiotherapy. Methods 　Literature review was conducted from CNKI, Wanfang Data, PubMed, Embase, Web of Science and Cochrane Central databases (until July 31, 2022). Relevant data were collected according to the inclusion and exclusion criteria. Primary outcomes included overall survival (OS) rate and treatment-related adverse events. Secondary outcomes included progression-free survival (PFS) rate and local control rate (LCR). Risk of bias was assessed using the Cochrane Risk of Bias tool. The quality of the results was assessed by using the meta analysis of Evidence Evaluation and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methods. Results 　A total of 7 articles with 918 patients were included of which 465 received IFI and 453 received ENI. The 1-, 2-, 3-and 5-year OS rates in the IFI group were not significantly different from those in the ENI group (1-year OS rate: RR=1.00, 95%CI=0.94-1.07, P=0.97, high certainty; 2-year OS rate: RR=1.01, 95%CI=0.90-1.13, P=0.90, high certainty; 3-year OS rate: RR=0.86, 95%CI=0.71-1.05, P=0.14, high certainty; 5-year OS rate: RR=0.76, 95%CI=0.42-1.37, P=0.36, low certainty). In the IFI group, patients with ≥grade 2 acute radiation esophagitis (RR=0.71, 95%CI=0.58-0.87, P=0.001, high certainty), ≥grade 3 acute radiation esophagitis (RR=0.39, 95%CI=0.24-0.64, P<0.001, high certainty) and ≥grade 2 acute radiation pneumonitis (RR=0.72, 95%CI=0.52-0.99, P=0.04, high certainty) were significantly lower compared with those in the ENI group. However, no significant differences were observed in the incidence of ≥grade 3 late radiation esophagitis, ≥grade 3 acute radiation pneumonitis and ≥grade 3 late radiation pneumonitis between two groups. No significant differences were noted in the 1-, 2-, 3-PFS rates and LCR between two groups. Conclusions 　For Chinese patients with esophageal squamous cell carcinoma, IFI and ENI yield similar efficacy in terms of OS, PFS and LCR. However, IFI has a lower incidence of ≥grade 2 acute radiation esophagitis, ≥grade 3 acute radiation esophagitis and ≥grade 2 acute radiation pneumonitis than ENI.
		2023 Vol. 32 (6): 512-518 [Abstract] ( 68 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	519	Study on the inhibitory effect of UBE2T on radiosensitivity of lung adenocarcinoma
		Wu Mengjia, Wang Yunan, He Bo, Lu Yanyi, Xu Junzhu, Su Zixuan, Yin Fengmin, Liu Shujun, Bai Yuju, Hu Wei
		Objective To investigate the effect of ubiquitin binding enzyme 2T (UBE2T) on the radiosensitivity of lung adenocarcinoma and unravel its possible mechanism. Methods A total of 45 patients pathologically diagnosed with different stages of lung adenocarcinoma and treated with radiotherapy in the Second Affiliated Hospital of Zunyi Medical University from March, 2019 to December, 2021 were enrolled, and the efficacy was evaluated according to response evaluation criteria in solid tumors (RECIST1.1). All patients were divided into radiosensitive group (n=25) and radioresistant group (n=20). Radiosensitive group was complete remission (CR)+partial remission (PR), and radioresistant group was stable disease (SD) + progression disease (PD). Immunohistochemistry (IHC) was used to calculate the score based on the staining intensity and the number of positive cells. Chi-square test was combined to analyze the correlation between the expression level of UBE2T in paraffin specimens of lung adenocarcinoma patients and the radiosensitivity of patients. Lentivirus UBE2T-interfered (UBE2Tsh) A549 and UBE2T-overexpressed SPC-A-1 lung adenocarcinoma cells and their respective controls were constructed for irradiation and colony formation assay. The survivor fraction curve was fitted by single-hit multi-target model. The DNA double-strand break (DSB) marker γH2AX foci were detected by immunofluorescence (IF). The expression levels of UBE2T, γH₂AX and Rad51 proteins were detected by Western blot. Cell cycle and apoptosis rate of A549 were determined by flow cytometry. Binary variables were statistically analyzed by Fisher's exact probability method and measurement data were assessed by t-test. Results High-expression level of UBE2T was correlated with the radiosensitivity of lung adenocarcinoma patients (P<0.05). UBE2Tsh improved the radiosensitivity of A549 lung adenocarcinoma cells, and the sensitizing enhancement ratio (SER) was 1.795. UBE2T overexpression decreased the radiosensitivity of SPC-A-1 lung adenocarcinoma cells with an SER of 0.293. γH2AX foci number per cell were significantly increased in UBE2Tsh A549 cells after irradiation (P<0.01) . Compared with the control group, the expression level of γH2AX protein was up-regulated (P<0.01)and that of Rad51 protein was down-regulated in UBE2Tsh A549 cells after radiation (P<0.001). Compared with the control group, the expression level of γH2AX protein was down-regulated (P<0.05) and that of Rad51 protein was up-regulated in UBE2T overexpressed SPC-A-1 cells (P<0.001). The proportion of UBE2Tsh A549 cells in G₂ phase was decreased (P<0.01) and cell apoptosis was increased (P<0.001). Conclusions UBE2T might promote the radioresistance of lung adenocarcinoma cells by enhancing DNA DSB repair induced by radiotherapy, inducing cell cycle G₂ phase arrest, and reducing cell apoptosis.
		2023 Vol. 32 (6): 519-525 [Abstract] ( 65 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Abdominal Tumor

	526	Clinical implementation of iterative cone-beam computed tomography guided online adaptive radiotherapy for the pelvic malignancies
		Wang Guangyu, Yan Junfang, Wang Zhiqun, Zhang Yu, Sun Yuliang, Zeng Zheng, Sun Xiansong, Li Wenbo, Yang Bo, Zhang Fuquan
		Objective To evaluate the clinical application of online adaptive radiotherapy based on iterative cone-beam computed tomography (iCBCT) for the pelvic malignancies. Methods This was a prospective clinical trial of iCBCT guided online adaptive radiotherapy for pelvic malignancies in Department of Radiation Oncology, Peking Union Medical College Hospital. Clinical data of 13 patients with pelvic malignancies who received online adaptive radiotherapy from August to November, 2022 were preliminarily analyzed (2 cases of cervical cancer, 4 postoperative cervical cancer, 3 postoperative endometrial cancer, 3 bladder cancer and 1 prostate cancer). The feasibility of online adaptive radiotherapy, adaptive radiotherapy time, the frequency and magnitude of edits for organs at risk and target volume, target volume coverage and organs at risk doses were analyzed. Statistical analysis was performed by SPSS software. Data conforming to normal distribution were described by Mean±SD, and data with non-normal distribution were expressed by M (Q₁, Q₃). Data with homogeneous variances were analyzed by t-test, and data with non-normal distribution or heterogeneous variances were analyzed by nonparametric test. Results The average adaptive time was 15 min and 38 s (from acceptance of acquired CBCT scan to completion of the final plan selection). 85.4% (830/972 fractions) of influencer structures (system-defined organs adjacent to and with high impact on the generation of clinical target volume and planning target volume, primarily bladder, rectum and small intestine in pelvic neoplasms) automatically generated by artificial intelligence required no edits or minor editors, and 89.8% (491/547 fractions) of clinical target volume automatically generated by artificial intelligence required no edits or minor editors. The adapted plan was adopted in 98.5% (319/324 fractions) of radiotherapy fractions. Compared with the scheduled plan, the adapted plan showed better target volume coverage and reduced the dose of organs at risk. Conclusions iCBCT guided online adaptive radiotherapy for the pelvic malignancies can be achieved within clinically acceptable timeslots. In addtion, better dose coverage of target volume shows the advantages of online adaptive radiotherapy.
		2023 Vol. 32 (6): 526-532 [Abstract] ( 44 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Physics·Technique·Biology

	533	Research on multi-Atlas segmentation based on feature clustering
		Yan Kai, Bai Xue, Wang Binbing, Shan Guoping, Kang Xi
		Objective To study the improvement of normal tissue region of interest (ROI) segmentation based on clustering-based multi-Atlas segmentation method, thereby achieving better delineation of organs at risk. Methods CT images of 100 patients with cervical cancer who had completed treatment in Zhejiang Cancer Hospital during 2019-2020 were selected as the Atlas database. According to the volume characteristic parameters of the organs at risk (bladder, rectum and outer contour), the Atlas database was divided into several subsets by k-means clustering algorithm. The image to be segmented was matched to the corresponding Atlas library for multi-Atlas segmentation. The dice similarity coefficient (DSC) was used to evaluate the segmentation results. Results Using 30 patients as the test set, the sub-Atlas generated by different clustering methods were compared for the improvement of image segmentation results. Compared with general multi-Atlas segmentation methods, clustering-based multi-Atlas segmentation method significantly improve the segmentation accuracy for the bladder (DSC=0.83±0.09 vs. 0.69±0.15, P<0.001) and the rectum (0.7±0.07 vs. 0.56±0.16, P<0.001), but no statistical significance was observed for left and right femoral head (0.92±0.04, 0.91±0.02) and bone marrow (0.91±0.06). The average segmentation time of clustering-based multi-Atlas segmentation method was shorter than that of the general multi-Atlas segmentation method (2.7 min vs. 6.3 min). Conclusion The clustering-based multi-Atlas segmentation method can not only reduce the number of Atlas images registered with the image to be segmented, but also can be expected to improve the segmentation effect and obtain higher accuracy.
		2023 Vol. 32 (6): 533-538 [Abstract] ( 53 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	539	Actual measurement verification of dose calculation accuracy based on cone-beam CT images
		Chen Li, Zhou Gang, Sun Yanze, Peng Qiliang, Han Jieguan, Tian Ye
		Objective To evaluate the dose calculation accuracy of cone-beam CT (CBCT) image by actual measurement method. Methods CBCT images of 60 patients in the Second Affiliated Hospital of Soochow University from September, 2021 to May, 2022 were retrospectively analyzed. CBCT images of full-fan and half-fan scanning of the head, half-fan scanning of the chest and pelvis were obtained by the Varian OBI system. Hounsfield unit - electron density (HU-ED) curves corresponding to the scanning conditions were established with CIRS electron density phantom. The radiotherapy plans were designed on the CBCT images, and the dose calculation results of the detection point were compared with the ionization chamber measurement results to analyze the dose error. Then, three-dimensional dose verification system was adopted to detect the accuracy of the CBCT image radiotherapy plans implementation process in 60 patients, and the accuracy of dose calculation was verified according to the D_99%, D_mean, D_1%of target volume, D_mean and D_1% of organs at risk (OAR), and the γ pass rate. Results In point dose detection in phantom, the dose calculation errors of CBCT images in the above four scanning patterns were -1.06%±0.87%、-1.67%±0.86%, 0.91%±0.73%, -1.54%±0.90%, respectively. In dosimetric verification based on patients' CBCT image treatment plan, the mean difference of D_mean, D_99%, and D_1% of planning target volume (PTV) in all scanning modes were not higher than 2%, and the D_mean and D_1% differences of other OAR were not higher than 3%, except for the lens of patients in the head. The average γ values of target volume and OAR were less than 0.5 under the criteria of 3%/2 mm. Conclusions Under the condition of correctly establishing HU-ED curves, intensity-modulated radiation therapy (IMRT) / volumetric-modulated arc therapy (VMAT) planning based on CBCT images can be employed to estimate and monitor the actual dose to target volume and OAR in adaptive radiotherapy. Full-fan scanning patterns can further improve the accuracy of dose calculation for the head of patients.
		2023 Vol. 32 (6): 539-545 [Abstract] ( 49 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	546	Correlation between monitor units and pass rate of plan dose verification in VMAT plan for different cancers
		Tan Junwen, Long Yusong, He Xiantao, Li Gang, Feng Yongfu, Wang Zhanyu
		Objective To analyze the correlation between the monitor units and pass rate of plan dose verification in the volumetric intensity modulated arc therapy (VMAT) plan. Methods VMAT plans for 20 patients with nasopharyngeal carcinoma (NPC) and 30 patients with cervical cancer who underwent radiotherapy at Liuzhou Workers' Hospital from January to October 2020 were retrospectively chosen. The Detector 1500 array and Octavius 4D phantom from German PTW company were used for dose measurement. The pass rates of dose verification of relevant plans were analyzed under the conditions of 3%/2 mm and 2%/2 mm. The correlation between the monitor units and pass rate of plan dose verification in VMAT plans was assessed by Pearson's bivariate correlation analysis. Results Under the condition of 3%/2 mm, the correlation coefficients between the monitor units and gamma pass rate were -0.873 (P<0.001), -0.800 (P<0.001), -0.781 (P<0.001), -0.493 (P=0.006) for NPC_1Arc, NPC_2Arc, NPC_1Arc+NPC_2Arc and Cervix_2Arc, respectively. Under the condition of 2%/2 mm, the correlation coefficients between the monitor units and gamma pass rate were -0.842 (P<0.001), -0.770 (P<0.001), -0.748 (P<0.001) and -0.531 (P=0.003) for NPC_1Arc, NPC_2Arc, NPC_1Arc+NPC_2Arc and Cervix_2Arc, respectively. Conclusions ignificant negative correlation can be observed between the monitor units and plan dose verification pass rate in VMAT plan.
		2023 Vol. 32 (6): 546-550 [Abstract] ( 47 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	551	Study of the effect of PU-H71 on increasing radiosensitivity of cervical cancer cells
		Wang Jiankai, Miao Guoying, Wang Wenjuan, Hu Yongguo, Cai Hongyi
		Objective To investigate the effect of heat shock protein 90 (Hsp90) inhibitor PU-H71 combined with X-ray on radioresistant human cervical cancer cells. Methods The expression levels of Hsp90 gene between cervical cancer tissues and adjacent tissues were analyzed by bioinformatics. Radioresistant cervical cancer cell lines HeLa RR and SiHa RR were obtained by fractional irradiations (2 Gy per fraction, 30 fractions). The cell lines were divided into the control group (treated with dimethyl sulfoxide), irradiation alone group, PU-H71 group (treated with 0.5 μmol/L PU-H71), and PU-H71+irradiation group (irradiation at 24 h after treatment with 0.5 μmol/L PU-H71). Cell survival was detected by clonal formation assay. Immunofluorescence assay was used to detect γH2AX foci at 1, 6, and 24 h after cell treatment. The expression level of Rad51 protein at 1, 2, 6, 12, and 24 h after cell treatment was detected using Western blot. The expression level of phosphorylated DNA-dependent protein kinase catalytic subunit (p-DNA-PKcs) was measured at 2 h after cell treatment. Cell apoptosis at 48 h after cell treatment was assessed by flow cytometry. Results PU-H71 enhanced the sensitivity of radioresistant cervical cancer cells to X-ray. Compared with the irradiation alone group, the radiation sensitization ratios (SER) of HeLa RR and SiHa RR cells at 10% survival were 1.36 and 1.27, and the apoptosis rates were increased by approximately 72.1% and 63.1% in the PU-H71+irradiation group, respectively. PU-H71 delayed the duration of γH2AX foci induced by X-ray, inhibited the phosphorylation of DNA-dependent protein kinase catalytic subunit (DNA-PKcs), thus preventing non-homologous end joining (NHEJ) repair and delaying homologous recombination repair. Conclusion PU-H71 increases the radiosensitivity of radioresistant cervical cancer cells by inhibiting the repair pathway of DNA double-strand break, which is expected to be a radiosensitizer to enhance the efficacy of radiotherapy for cervical cancer.
		2023 Vol. 32 (6): 551-556 [Abstract] ( 60 ) [HTML 1KB] [ PDF 0KB] ( 0 )

Review Articles

	557	Research progress on clinical manifestations and mechanism of radiation-induced taste dysfunction in head and neck cancers
		Li Zixia, Peng Xingchen, Xu Xin
		Taste is a critical sensory function for human as it supports sustenance and alerts the body to toxins. Taste dysfunction is a common side effect of radiotherapy for the head and neck cancers, which is often accompanied by oral mucositis in the early stage. It is associated with anorexia, anxiety and depression, leading to declined quality of life and treatment tolerance. The incidence of radiation-induced taste dysfunction is high, and its clinical manifestations include increased taste threshold, tastelessness, and persistent bitter, sour or metallic taste, which exert significant effect upon the quality of life. At present, effective therapeutic measures for radiation-induced taste dysfunction are still lacking. In this article, research progresses on clinical characteristics and the potential mechanisms of radiation-induced taste dysfunction were reviewed, aiming to provide reference for the mechanism, prevention and treatment for taste dysfunction.
		2023 Vol. 32 (6): 557-561 [Abstract] ( 49 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	562	Advances and the status of radiotherapy in advanced esophageal cancer
		Chen Mingyue, Jie Wei, Zhou Zhiguo, Wang Jun, Bai Wenwen, Zhen Chanjun, Zhang Ping
		Radiotherapy plays an important role in the treatment of advanced esophageal cancer. Under the premise of effective systemic treatment, selecting patients who may benefit from local radiotherapy can effectively relieve symptoms and improve quality of life, and it is expected to prolong the survival time of patients. Moreover, immunotherapy plays an increasingly significant role in advanced esophageal cancer, and the efficacy of radiotherapy combined with immunotherapy is promising.
		2023 Vol. 32 (6): 562-566 [Abstract] ( 49 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	567	Research progress on the application of hydrogel spacer in brachytherapy for gynecological tumors
		Luo Huanli, Jin Fu, Peng Haiyan, Yang Xin, Li Chao, Wang Ying, Xie Yue
		Radiotherapy is an important treatment of gynecological tumors. Although novel techniques or measures in recemy years have improved the tumor control rate and reduced radiation toxicity, radiation toxicity remains a major problem due to the location of some key organs adjacent to the tumor. A new material-hydrogel, as an organ spacer, provides a new method to reduce the radiotherapy toxicity. In this article, the application of hydrogel as an organ spacer in brachytherapy for gynecological tumors was reviewed from the aspects of hydrogel characteristics, suitable population, mode of injection, interval distance and dose effect, clinical benefits and cost effectiveness, etc.
		2023 Vol. 32 (6): 567-571 [Abstract] ( 60 ) [HTML 1KB] [ PDF 0KB] ( 0 )

	572	Research progress on ferroptosis in radiosensitivity of malignant tumors
		Lin Wei, Wu Yadong
		As one of the most effective treatments for cancer, radiotherapy(RT)can eliminate the tumor cells and improve the survival rate of cancer patients. However, radiation resistance of tumor cells remarkably reduces the efficacy of RT. Therefore, it is significant to investigate the resistance mechanism and explore corresponding therapy for cancer. Ferroptosis is a novel mode of programmed cell death. Numerous studies have indicated an intimate connection between ferroptosis and tumor radiosensitivity. The mechanism involves lipid reactive oxygen species accumulation, glutathione metabolism and iron metabolism. It has been reported that ferroptosis inducers can act effectively and synergistically with RT, promote radiosensitivity and further improve tumor prognosis. In this article, relevant mechanisms and research progress were reviewed, and the future development direction of this field was discussed, aiming to provide reference for clinical trials and mechanism research of RT for malignant tumors.
		2023 Vol. 32 (6): 572-576 [Abstract] ( 50 ) [HTML 1KB] [ PDF 0KB] ( 0 )

中华放射肿瘤学杂志

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