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Risk factors of acute radiation pneumonitis in patients with non-small cell lung cancer after concur-rent three-dimensional conformal radiotherapy and chemotherapy

Tingting ZHUANG ; Qing LIU ; Li ZHANG ; Xiao HU ; Yan WANG ; Ming CHEN

Chinese Journal of Radiation Oncology.2009;18(6):443-447. doi:10.3760/cma.j.issn.1004-4221.2009.06.443

Objective To analyze the incidence and related factors of acute radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who underwent three-dimensional conformal ra-diotherapy with concurrent chemotherapy. Methods From January 2006 to October 2008, 90 NSCLC pa-tients treated with concurrent chemoradiotherapy were retrospectively reviewed. The clinical characteristics and treatment plan parameters from dose-volume histogram (DVH) were analyzed. Results Grade 1, 2,3, 4 and 5 RP was found in 32.2%, 30.0%, 5.6%, 0% and 1.1% of the patients. Primary tumor loca-tion was the only significant clinical factor in univariate analysis. And significant differences were found when the groups was divided by the mean lung dose (MLD) of 17 Gy, V_(5) of 47% ,V_(10) of 36% ,V_(20) of 24%,V_(30) of 23% and V_(40) of 22%, respectively. Multivariate analysis showed the MLD was the only independent predictive factor of RP. Conclusions Some factors may contribute to the RP. MLD should be set below 17 Gy in three-dimensional conformal radiation, especially when the tumor locates in the lower lobe.

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The effect of scan position consistency on automatic registration of computer tomography-magnetic resonance images in patients with nasopharyngeal carcinoma

Zhanyu WANG ; Haixin HUANG ; Dongning HUANG ; Yusong LONG

Chinese Journal of Radiation Oncology.2009;18(6):435-437. doi:10.3760/cma.j.issn.1004-4221.2009.06.435

Objective To study the effect of scan position consistency on computer tomography-magnetic resonance (CT-MR) images automatic registration in patients with nasopharyngeal carcinoma.Methods Fifteen patients with nasopharyngeal carcinoma were enrolled in this study and scanned with the same position to acquire CT images and MR-1 images. Then they were reacanned with different position for MR-2 images. Image registration of CT-MR-1 and CT-MR-2 was finished using mutual information method.The registration errors were evaluated by measuring the distances between marks. Results The error of au-tomatic CT-MR registration with consistent scan position was 1.32 nun, comparing with the minimum of 2.00 ram and the maximum of 3.83 mm with different positions. Conclusion Keeping consistent scan position can improve the accuracy of image registration.

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A prospective study on quality of life in patients with head and neck cancer treated by intensity-modulated radiotherapy versus conventional radiotherapy

Chao YAN ; Zhonghe WANG ; Haisheng HU ; Yening FIN

Chinese Journal of Radiation Oncology.2009;18(6):431-434. doi:10.3760/cma.j.issn.1004-4221.2009.06.431

Objective To prospectively assess the influence of intensity-modulated radiotherapy (IMRT) and conventional radiotherapy on quality of life (QOL) in patients with head and neck cancer (HNC) for clinical guidance. Methods From May 2007 to May 2008, 102 HNC patients were enrolled in this study. Fifty-two patients were treated with IMRT and 50 with conventional radiotherapy. In patients with IMRT, at least one parotid gland was spared, and the contralateral submandibular gland was spared in 24 patients. The parotid and submandibular gland were not spared in patient with conventional radiotherapy.QOL was assessed using EORTC QLQ C30 and HN35 questionnaires at 4 time points (before radiotherapy,end of radiotherapy, 2 months and 6 months after radiotherapy). A change of 10% in scores of the instru-ment range had been previously demonstrated to be clinically significant. Results In the study, 94% (31/33) of the QOL domains were worse after IMRT or conventional radiotherapy, including 49% (16/33) with significant difference (U=2.72-5.98, all values of P<0.01) and 33% (11/33) with clinical signifi-cance. At 2 months after radiotherapy, 12% (4/33) of the domains showed clinically significant improve-ment, however, 15% (5/33) of the domains did not show any improvement (U=3.10-5.93,all value of P < 0.01). Continuous improvement in most domains of QOL was shown at 6 months after radiotherapy. Clini-cally and statistically significant improvement were shown in 21% (7/33) of the domains, and some were even better than pretreatment except in dry mouth and sticky saliva scales (U=4.49 , P<0.01 and U=4.87 ,P <0.01). Compared with conventional radiotherapy, the dry mouth and sticky saliva caused by IM-RT were milder (U=4.57,P <0.01 and U=5.57, P < 0.01) and continuous improvement were shown over time after radiotherapy (U=7.23, P <0.01 and U = 7.57, P < 0.01). Similar improvement weren't shown in patients with conventional radiotherapy. Conclusions QOL in HNC patients is significant worse after ra-diotherapy. QOL can be improved continuously over time after treatment except dry mouth and sticky saliva which are the main factors affecting QOL. IMBT, causing less dry mouth and sticky saliva when compared with conventional radiotherapy, has benefits for the preservation of QOL.

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Effect of E1A gene on radiosensitivity of nasopharyngeal carcinoma cells

Huaping XIAO ; Jianwu CHEN ; Yuping LIAO ; Rongrong ZHOU

Chinese Journal of Radiation Oncology.2009;18(6):489-491. doi:10.3760/cma.j.issn.1004-4221.2009.06.489

Objective To study the effect of E1A gene on the radiosensitivity of nasopharyngeal carcinoma (NPC) cells and its mechanism. Methods Ad-E1A gene was transfected into human NPC cells (CNE2), then the positive clones (CNE2-Ad-E1A) were identified by RT-PCR. CNE2 cells, CNE2 cells transfected with Ad-β-gal (CNE2-Ad-β-gal) and CNE2-Ad-E1A cells were irradiated with 0 Gy,2 Gy,4 Gy,6 Gy and 8 Gy respectively using 6 MV X-ray. Clone forming assays were carried out, cell survival curves were drawn and the sensitivity enhancing ratio (SER) was calculated. The redistributions of cell cy-cle were analyzed by flow cytometry. RT-PCR was used to detect the expression of wtp53. Results RT-PCR confirmed that E1A gene had been integTated into positively transfected cells and stably expressed. Cell survival curves showed that the SER of D0,Dq and SF_2 value was 1.37, 1.95 and 1.46 in CNE2-Ad-E1A cells. The D_0,D_q and SF_2 value was 1.57 Gy,1.82 Gy, 0.89 in CNE-2 cells and 1.53 Gy,1.78 Gy,0.82 in CNE2-Ad-β-gal cells, respectively. The G_2/M arrest was shown in CNE2-Ad-E1A cells. Moreover, the expression of wtp53 gene was markedly enhanced in Ad-E1A-CNE2 cells. Conclusions E1A gene can ef-fectively enhance the radiosensitivity of human NPC cells, which may be associated the enhancement of wt-p53 expression and G_2/M arrest.

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Application of correlation statistical analysis model in IMRT planning optimization

Xiaoyun DI ; Xiadong LI ; Jian WANG ; Binbing WANG ; Weijun CHEN

Chinese Journal of Radiation Oncology.2009;18(6):483-487. doi:10.3760/cma.j.issn.1004-4221.2009.06.483

Objective To study the application of correlation statistical analysis model in IMRT planning optimization. Methods A correlation statistical analysis model was established. IMRT plans of 5 prostate cancer patients were randomly chosen from the ADAC Pinacal 7.6 version planning system. The beam parameters, objective functions of the target area and optimization parameters of the primary plan were kept unchanged. The main optimization parameters including EUD parameter a,weight (w) and EUD_(max) of OAR were adjusted in optimization procedure successively. The correlation analysis (CF) and optimization efficiency analysis (OF) were carried out on the results of the optimization. The optimal value of parameters (MORt{}) with the best dose distribution was obtained and substituted in the corresponding primary plan.After optimization, the dose distributions of the two IMRT plans were compared. Results There were signif-icant differences with different optimization methods. The EUD parameter a and weight factor (w) almost had no effect on volume dose of OAR (OF < 0.01), though had obvious effect on the maximum dose and mean dose (OF≈1). The CF analysis showed that the correlation between the PTV ( V_(95)) volume and OAR dose was different when the EUD parameter a and w were applied for optimization. Meanwhile, the difference was proportional to the distance between the target area and OAR. The mean dose of OAR was decreased and the mean dose of PTV was more close to the prescription dose when the optimization parameters of the prima-ry plan were substituted with MOR{a} ,MOR{w} and MORt{EUD_(max)}. Besides, the DVH and isedose dis-tribution of the secondary plan were better. Conclusions The correlation statistical analysis model can be used to accurately determine the scope of optimization parameters in the IMRT planning procedure in prostate cancer, and an IMRT plan which fulfils the clinical requirement can be obtained efficiently.

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Study of effect of lung tumor location and volume on dosimetric parameters using Alderson Rando phantom

Fuli ZHANG ; Mingmin ZHENG ; Jianping CHEN ; Junmao GAO

Chinese Journal of Radiation Oncology.2009;18(6):452-454. doi:10.3760/cma.j.issn.1004-4221.2009.06.452

Objective To study the effect of the location and volume of tumors on the normal lung dose-volume parameters for lung cancer. Methods An sphere with a diameter of 2 cm made of tissue-equiv-alent material used for simulating tumor was inserted into the superior lobe, middle lobe, inferior lobe of the right lung, and superior lobe, inferior lobe of the left lung of the Rando phantom, respectively. 5-field sIM-RT plans were designed. The prescribed dose was 60 Gy/2 Gy/30 f, and 99% of the planning target volume received this dose. Dose-volume parameters of normal lung tissue including V_5, V_(10), V_(20), V_(30), V_50 and mean lung dose were analyzed and compared. Results For the dose-volume parameters, the diameter and the po-sition of the tumor have a significant effect (P < 0.05). With the diameter expanding from 2 cm to 3 cm,the parameters associated with tumor in various lobes increased by a range between 3.83%-125.38%,while the parameters linked with tumor in different lobes increased by a range between 10.46%-51.46% with the diameter expanding from 3 cm to 4 cm. Conclusions Location and diameter of sphere-like tumor have obvious effect on dose-volume parameters. Knowing about the degree of influence will help oncologists and physicists to evaluate treatment planning better and reduce radiation pneumonitis.

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Prospective study of lung V5 and V10 in predicting radiation-induced lung injury in advanced non-small-cell lung cancer treated with three-dimensional conformal radiation therapy

Heyi FU ; Bing LU ; Bingqing XU ; Yinxiang HU ; Jiaying GAN ; Weiwei OUYANG ; Shengfa SU ; Gang WANG ; Huiqin LI

Chinese Journal of Radiation Oncology.2009;18(6):439-442. doi:10.3760/cma.j.issn.1004-4221.2009.06.439

Objective To analyze the low dose-volume associated with radiation-induced lung injury (RILI) in patients with advanced non-small cell lung cancer (NSCLC) treated by three-dimensional confor-real radiation therapy (3DCRT). Methods Data of 100 patients with histologically proved NSCLC treated with 3DCRT or IMRT between November 2006 and January 2009 were collected. Nine patients treated with radiotherapy alone and 91 with radiotherapy combined with chemotherapy. A median dose of 70 Gy (range,60-80 Gy) was delivered with late-course accelerated hyperfractionated radiotherapy (LAHRT). Twenty-four patients received dose of 61-69 Gy and 76 received more than 70 Gy. The V_5 ,V_(10) ,V_(20) ,V_(30)and mean lung dose (MLD) were calculated from the dose volume histogram system. The RILI was evaluated according to Common Toxicity Criteria 3.0(CTC 3.0). Results The range of V_5 ,V_(10) ,V_(20) ,V_(30) was 37%-98%,27%-78%, 17%-54% and 9%-31%, respectively, with a median value of 65%, 47.5%, 31% and 24%, respectively. The acute RILI of grade 1, 2, 3, 4 and 5 was observed in 34, 27, 8, 1 and 1 patients,respectively. The chronic RILI of grade 1, 2 and 3 was observed in 46, 14 and 2 patients, respectively. V_5 ,V_(10) ,V_(20) and MLD were significantly correlated with acute RILI of ≥ grade 1. V_5 ,V_(20) ,V_(30) and MLD were significantly correlated with acute RILI of ≥ grade 2. The acute RILI of ≥ grade 2 was significantly in-creased when V_5, V_(20) and V_(30) were more than 65%, 31% and 24%, respectively. The acute RILI of ≥ grade 3 was significantly increased when V_5 was more than 65%. The acute RILI of ≥ grade 1 was signifi-candy increased when V_(20)was more than 31%. The gross tumor volume and planning target volume were sig-nificantly correlated with the acute RILI of ≥ grade 1 and chronic RILI of ≥ grade 2. Conclusions The dose-volume V_5 and V_(10) are effective in predicting RILI.

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Role of radiotherapy and prognostic factors in breast cancer patients at high-risk of recurrence trea-ted with modified radical mastectomy and chemotherapy

Shulian WANG ; Zihao YU ; Yexiong LI ; Yuan TANG ; Shunan QI ; Jianzhong CAO ; Wenqing WANG ; Tao LI ; Jing JIN ; Weihu WANG ; Yongwen SONG ; Xinfan LIU

Chinese Journal of Radiation Oncology.2009;18(6):466-469. doi:10.3760/cma.j.isan.1004-4221.2009.06.466

Objective To analyze the outcome and prognostic factors in breast cancer at high-risk of recurrence and evaluate the role of radiotherapy. Methods 381 breast cancer patients treated with mastec-tomy and axillary dissection were retrospectively analyzed. The including criterias were pathologic diagnosis of invasive breast cancer, T_3-T_4 and/or four or more positive axillary nodes. The survival rates was calculat-ed by Kaplan-Meier method, and compared by Logrank test. Cox regression model was used to select poten-tial prognostic variables. Results The median follow up was 48 months. The 5-year overall survival (OS) and locoregional recurrence-free survival (LRFS) rates were 76.8% and 89.7%, respectively. Radiothera-py significantly improved the OS (80.9% vs. 62.3%, χ~2=15.47, P=0.001) and LRFS (93.4% vs. 77.1% χ~2=19.95,P=0.000). The use of ipsilateral chest wall and supraclavicular nodal radiation was associated with increased 5-year chest wall recurrence free survival (96.8% : 86.2%, χ~2= 12.66, P=0.001) and 5-year supraclavicular node recurrence free survival (97.7% : 90.7 %, χ~2= 9.98, P=0.002).However, axillary irradiation had no impact on 5-year axillary recurrence free survival (98.4% : 96.1% ,χ~2=0.74, P=0.389). In multivariate analysis, absence of radiotherapy (χ~2=14.42, P=0.000), 10 or more positive axillary nodes (χ~2=21.60, P=0.000), and T_4 stage (χ~2=10.79, P=0.001) were inde-pendent unfavorable prognostic factors for overall survival. Conclusions Radiotherapy improves the overall survival of breast cancer patients with T_3, T_4 and/or four or more positive axillary nodes. The chest wall and supraclavicular nodal radiation should be given to this group of patients.

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Quality of life in patients with nasopharyngeal carcinoma after intensity modulated radiotherapy

Liqin MA ; Yu ZHANG ; Jianji PAN ; Ling YANG ; Xiangquan KONG ; Xiaolei NI

Chinese Journal of Radiation Oncology.2009;18(6):425-429. doi:10.3760/cma.j.issn.1004-4221.2009.06.425

Objective To analyze the status of quality of life (QOL) and the related factors in pa-tients with uasopharyngeal carcinoma (NPC) after radiotherapy, and to explore the significance of intensity modulated radiotherapy (IMRT) in decreasing side effects and improving QOL. Methods A questionnaire including 35 items was designed according to EORTC QLQ-30 and the related symptoms and side effects of NPC. 142 NPC patients surviving with disease-free after radiotherapy were surveyed for the evaluation of QOL. The median follow-up was 25 months. The information of social demography and clinical details were collected. The patients were divided into IMRT group (75 patients) and conventional radiotherapy (CRT) group (67 patients). A statistical software package SAS 8.1 was used to compare the marks of QOL between the groups and analyze the influencing factors. Results In IMRT group and CRT group, the marks of affec-tire cognitive domain were 82.8±14.7 and 77.5±16.0(t=2.07, P=0.040);and the marks of disease and treatment-related symptoms, and reactive domain were 78.9±10.3 and 69.8±13.3 (t=4.59, P=0.000). The marks were significantly different in xerostomia, trismus, deglutitory choke, hoarseness, re-striction of neck movement and dysphagia (P < 0.05). Of the influencing factors of QOL, the domain of body function was sex (regression coefficient was -4.692), the self-evaluation of total QOL were follow-up time and educational background (regression coefficients were -0.618 and 12.316, respectively), the fi-nancial status was family monthly income per capita (regression coefficient was -11.133), and the disease and treatment-related symptoms and reactive domain were group (techniques of radiation) and age (regression coefficients were -9.384 and -5.853, respectively). Conclusions IMRT could improve the QOL through decreasing the side effects of patients with NPC including xerostomia, trismus, restriction of neck movement and dysphagia. Sex, age, family monthly income per capita, educational background, fol-low-up time and the irradiation techniques may affect QOL.

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Definition of internal target volume and domestric study for hepatocellular carcinoma using four-dimensional CT

Mian XI ; Mengzhong LIU ; Xiaowu DENG ; Li ZHANG ; Xiaoyan HUANG ; Ling CAI

Chinese Journal of Radiation Oncology.2009;18(6):477-481. doi:10.3760/cma.j.issn.1004-4221.2009.06.477

Objective To define individualized internal target volume (ITV) for hepatocellular car-cinoma using four-dimensional (4D) CT, and to compare the differences in target volume definition and dose distribution among 3D, 4D and respiratory-gated plans. Methods 4DCT scanning was obtained for 12 pa-tients with hepatoceUular. Gross tumor volume (GTV), clnical target volume (CTV) and normal tissues were contoured on all 10 respiratory phases of 4DCT images. The 3D, 4D and gated treatment plans were prepared for each patient using three different planning target volumes (PTVs): 1) PTV3D was derived from a single CTV plus conventional margins;2) PTV4D was derived from ITV4D, which encompassed all 10 CTVs plus setup margins (SMs);3) PTV_(Gating) was derived from ITV_(Gating), which encompassed 3 CTVs within ga-ting-window at end-expiration plus SMs. The PTV volume and dose distribution were compared among differ-ent plans. Results The PTV3D was the largest in all 12 patients, but still missed partial target volume in 5 patients when comparing with PTV4D. Both the 4D plans and the gated plans spared more normal tissues than the 3D plans, especially the hver. Without increasing normal tissue dose, the 4D plans allowed for increas-ing the calculated dose from (50.8±2.0) Gy (3D plans) to (54.7±3.3) Gy, and the gated plans could further increase the dose to (58.0±3.9) Gy. Conclusions The 4DCT-based plans can ensure optimal tar-get coverage with less irradiation of normal tissues and allow dose escalation when compared with 3D plans.Respiratory gated radiotherapy can further reduce the target volumes to spare more surrounding tissues, espe-cially for patients with large extent of respiratory mobility.

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