Myocardial fibrosis is a predominant pathological change of radiation-induced heart disease (RIHD) in late stage.It often occurs several or more than ten years after radiotherapy and can lead to myocardial remodeling, impaired cardiac function, and heart failure.At present there is no effective method to prevent or reverse the development of radiation-induced myocardial fibrosis.Many cells, cytokines, and other factors are involved in the development and progression of myocardial fibrosis in RIHD and some of them have been validated.But most investigators focused on the pathological changes and related mechanisms in early stage, and myocardial fibrosis was just regarded as an endpoint event.The definitive mechanisms of myocardial fibrosis in late stage remain unclear.This paper reveiws the studies about general mechanisms of myocardial fibrosis in RIHD and summarizes the roles of microcirculation dysfunction, mast cells, several cytokines, hypoxia, oxidative stress, and renin-angiotensin system, and points out the future research direction of the pathogenesis of myocardial fibrosis in RIHD.It provides new ideas for discovering the potential targets for clinical intervention of myocardial fibrosis in RIHD.

Radiotherapy is a major local treatment for cervical cancer.However, local uncontrollability due to radioresistance is still common.Therefore, the prediction of radiosensitivity is quite beneficial to develop an optimal treatment strategy for individual patients.Multiple factors could influence the radiosensitivity of cells, and p53 status is one of them.The upstream or downstream molecules of p53 could also be regulated to affect the radiosensitivity of cervical cancer.The aim of the review is to analyze the difference in p53 status between different types of cervical cancer and to discuss how p53 regulates the response to radiotherapy.

Peripheral T-cell lymphoma (PTCL) is a highly specific and invasive non-Hodgkin's lymphoma derived from mature T-cells that leave the thymus.At present, the clinical progress in PTCLs is behind that in B-cell lymphomas, and the current treatments for PTCLs have low efficacy and poor overall prognosis.Therefore, there is currently still no standard treatment for PTCL.The efficacy of the conventional CHOP chemotherapy regimen is poor, and the value of radiotherapy in early-stage PTLC patients remains to be determined.Autologous hematopoietic stem cell transplantation is the top choice for consolidation treatment for high-risk patients, but the efficacy of novel drugs for PTCLs needs to be further confirmed.In addition, PET/CT plays a more important role in predicting the prognosis of PTCLs.

In this article, recent clinical data of brachytherapy around the world are analyzed and combined with the clinical experience from the author and her research team.The author summarizes the indications, contraindications, target range, dosage, efficacy, and side effects to form a mature brachytherapy regimen.The systematic work may provide a reliable reference for domestic counterparts and be helpful for improving brachytherapy.This article mainly discusses head and neck and thoracic tumors.

Much progress has been made in the diagnosis and treatment of Hodgkin's lymphoma, which has become a highly curable malignancy.However, prolonged survival makes clinicians pay more attention to long-term toxicities of treatment.Consequently, individualized treatment based on disease stage and risk factors is a research hotspot at present.This article reviews recent advances in the individualized treatment of early-stage classical Hodgkin's lymphoma.

Objective To investigate the effects of numerous re-planning strategies on the anatomic and dosimetric outcomes of target volume and organs at risk (OARs) in patients with head and neck cancer receiving fractionated radiotherapy.Methods From 2015 to 2016,28 patients with head and neck cancer were enrolled in this study with Shandong Cancer Hospital,consisting of 19 patients with nasopharyngeal carcinoma, 4 patients with laryngocarcinoma, and 5 patients with carcinoma of the maxillary sinus.All of them received conventionally fractionated radiotherapy.Each patient had six weekly cone-beam CT (CBCT) scans, which were performed on the first day of every week, to obtain reference images.A virtual CT image was generated by registration of planning CT and each weekly CBCT image.The four re-planning strategies were used for the reconstruction of re-planned dose, while the initial planning was used as a reference.The weekly doses calculated using virtual CT were summed together to obtain the actual dose.The actual and initial planned doses were evaluated.The nonparametric Friedman test was used to evaluate the differences between multiple groups, and the differences between any two groups were analyzed by paired t test.Results The sizes of planning target volume, clinical target volume, and left/right parotid glands (PGs) changed significantly within the six weeks (P=0.041, 0.046, 0.024, and 0.017, respectively).For these four re-planning strategies, there were significant differences between the actual dose and the initial planned dose to the PGs (all P<0.05), with average values decreased by 5.02%, 11.17%, 12.08%, and 13.19%, respectively, compared with that in the reference strategy.Conclusions Re-planning during treatment course could ensure the sparing of OARs and allow for sufficient dose to the target volume.The higher the number of re-planning strategies, the more the actual dose is close to the initial planed dose;the efficiency of two re-planning strategies is the highest.

Objective To investigate the feasibility of defining the radiotherapy target of primary liver cancer using four-dimensional computed tomography (4DCT) and T2-weighted magnetic resonance (MR-T2) deformable image registration.Methods Ten patients with hepatocellular carcinoma (HCC) who first received radiotherapy were included in this study.The 4DCT in free breathing and MR-T2 in deep breathing were acquired sequentially.4DCT were sorted into ten series of CT images according to the respiratory phase.MIM software was used for deformable image registration.The accuracy of deformable image registration was assessed by the maximal displacements in three-dimensional directions of the portal vein and the celiac trunk and the degree of liver overlapping (P-LIVER).Gross tumor volume (GTV) was delineated on different series of CT images and the internal GTV (IGTV) was merged by ten GTVs on 4DCT images in each phase.The MR-T2 image was deformably registered to 4DCT images in each phase to acquire ten GTVDR.The IGTVDRwas obtained by merging the ten GTVDR.The differences between different target volumes were compared by paired t-test.Results The maximal displacements in three-dimensional directions of the portal vein were 0.3±0.8 mm along the x-axis, 0.8±1.8 mm along the y-axis, and 0.5±1.5 mm along the z-axis.The maximal displacements in three-dimensional directions of the celiac trunk were 0.1±1.0 mm along the x-axis, 0.7±1.2 mm along the y-axis, and 0.6±2.0 mm along the z-axis.Overlapping degree was 115.4±13.8%.The volumes of GTVs obtained from 4DCT images in each phase after DR increased by an average of 8.18%(P<0.05), and were consistent with those delineated on MR-T2 images.The IGTV after DR increased by an average of 9.67%(P<0.05).Conclusions MRI image can show more information and have a higher contrast than CT image.MRI images should be combined with 4DCT images for delineating the GTV.It can better determine the scope and trajectory of the target and improve the delineation accuracy of HCC target.

Objective To investigate the efficacy and toxicities of neoadjuvant chemoradiotherapy (neoCRT) in the management of unresectable locally advanced adherent colon cancer (LAACC).Methods A retrospective analysis was performed on the clinical records of 40 patients with initially diagnosed unresectable LAACC who received preoperative neoCRT in our center from October 2010 to December 2015.Results Thirty-nine patients completed the preoperative neoCRT.Thirty-four patients underwent radical resection after neoCRT, and the R0 resection rate, pathological complete response rate (pCR), tumor downstaging rate, nodal downstaging rate, and clinical downstaging rate were 91%, 24%(8/34patients), 76%(26/34patients),100%(32/32patients), and 94%(32/34patients), respectively.Among the 21 patients with bladder invasion, the full bladder was preserved in 7 patients (33%) and partial cystectomy was performed in 11 patients (52%).During the course of neoCRT, the grade 3-4 hematologic toxicity rate, grade 3 hand-foot syndrome rate, grade 3 radiodermatitis, and incomplete intestinal obstruction rate were 23%, 3%, 3%, and 5%, respectively.The 3-year sample size was 25 patients.For all the patients, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 75% and 80%, respectively.Of the 34 patients who received surgical radical resection, the 3-year OS and disease-free survival (DFS) rates were 87% and 81%, respectively.In addition, local tumor recurrence was identified in 3 patients, and distant metastasis was identified in 6 patients.Conclusions NeoCRT is an effective treatment for unresectable LAACC that results in significant tumor downstaging and enhanced R0 resection rate without an increase in surgical complications.The patients treated with radical surgical resection after neoCRT show a satisfactory short-term outcome.Further studies will be required to determine the clinical value of neoCRT in treating LAACC.

Objective To compare the efficacy between three-dimensional radiotherapy (3DRT) combined with chemotherapy and radiotherapy alone for patients with esophageal squamous cell carcinoma.Methods A retrospective analysis was performed for 1257 patients with esophageal squamous cell carcinoma who were admitted to our hospital from July 2003 to June 2012 and met the inclusion criteria;362 patients were treated with 3DRT combined with chemotherapy (chemoradiotherapy group) and 895 patients were treated with radiotherapy alone (radiotherapy group).The short-term outcome, overall survival (OS) rate, and causes of death were analyzed.The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis.Results The response rate was 99.1%(346/349) in the chemoradiotherapy group and 99.0%(813/821) in the radiotherapy group (P=0.397).The 1-, 3-, and 5-year OS rates were 74.0%,42.0%,and 32.9% in the chemoradiotherapy group and 65.9%,33.0%,and 23.3% in the radiotherapy group (P=0.000), and were 75.6%,43.5%,and 33.2% in the concurrent chemoradiotherapy group and 65.9%,33.0%,and 23.3% in the radiotherapy group (P=0.000).There were no significant differences in 1-, 3-, and 5-year OS rates between the concurrent chemoradiotherapy group and the sequential chemoradiotherapy group (P=0.583).The sequential chemoradiotherapy group had an insignificant increase in 1-, 3-, and 5-year OS rates compared with the radiotherapy group (P=0.065).Tumor recurrence and local control failure were the main causes of death, followed by distant metastasis.The chemoradiotherapy group had a significantly lower proportion of patients who died of local control failure than the radiotherapy group (7.4% vs.14.7%, P=0.003).Conclusions For patients with esophageal squamous cell carcinoma, chemoradiotherapy leads to significantly improved overall survival compared with radiotherapy alone;compared with radiotherapy alone, sequential chemoradiotherapy results in an increasing trend in OS rates, while concurrent chemoradiotherapy results in significantly increased OS rates.Chemoradiotherapy can reduce the deaths due to local control failure compared with radiotherapy alone.

Objective To evaluate the risk of locoregional recurrence (LRR) and the influencing factors for long-term survival in patients with epithelial-myoepithelial carcinoma (EMCa).Methods A retrospective analysis was performed for 18 EMCa patients, who received initial therapy or initial adjuvant therapy in our hospital from 1999 to 2015, to investigate their survival.Among these patients, 8(44%) underwent surgery alone, 9(50%) received adjuvant radiotherapy, and 1(6%) received radical concurrent chemoradiotherapy.Locoregional recurrence-free survival (LRFS) and overall survival (OS) rates were compared between these groups.The Kaplan-Meier mtthod was used to calculated survival rates and log-rank test was used to compare the LRFS.Results With a median follow-up time of 46 months, 5 patients developed LRR, and the 5-year LRFS and OS rates were 69% and 93%, respectively.The patients treated with radiotherapy had a significantly higher 5-year LRRFS rate than those not treated with radiotherapy (71% vs.57%, P=0.569).Conclusions LRR is the main failure mode of EMCa treatment, and further improving local control is the key to improved survival.