Primary pulmonary choriocarcinoma (PPC) is a rare and highly malignant germ cell tumor. This tumor is prone to brain metastasis, severely affecting the quality of life of patients. The optimal treatment regimen for PPC brain metastasis remains undetermined, and there is a lack of support for the efficacy of radiotherapy in improving symptoms and the appropriate radiation exposure dose for such patients. We report a case of a 73-year-old Asian male with PPC and brain metastasis, who was admitted due to numbness and discomfort in his right limbs. Since the patient and his family initially refused chemotherapy due to his poor physical condition, he was first subjected to cranial radiotherapy. The patient received a total dose of 37.5 Gy in 15 fractions using intensity-modulated radiation therapy (IMRT), followed by an additional 8 Gy with CyberKnife. He demonstrated marked sensitivity to radiotherapy, with strong tolerance and compliance. Compared to admission, his neurological symptoms improved significantly, and tumor progression was effectively controlled. Our findings suggest that localized brain radiotherapy can significantly enhance the quality of life in patients with PPC and brain metastasis, with minimal adverse effects.

BACKGROUND:Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a newly defined type of epithelial tumor in the 2021 World Health Organization (WHO) fifth edition classification of thoracic tumors, with a low incidence. Currently, its treatment and prognosis remain unclear. Pathologically, it can be distinguished from SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC) based on histological morphology and immunohistochemistry, yet whether there are differences in their clinical features, sensitivity to radiotherapy, and prognosis remains unknown. This study aimed to analyze the clinical characteristics of patients with SMARCA4-UT and SMARCA4-dNSCLC and to identify prognostic factors. METHODS:A retrospective analysis was performed on pathologically confirmed SMARCA4-UT and SMARCA4-dNSCLC patients with complete follow-up data who were admitted to Shandong First Medical University Affiliated Tumor Hospital from June 2022 to February 2025. The differences in clinicopathological characteristics and imaging findings between the two groups were statistically analyzed, and the impacts of surgery, radiotherapy, immunotherapy, and clinicopathological factors on the prognosis of patients in both groups were assessed. RESULTS:A total of 27 SMARCA4-UT patients and 40 SMARCA4-dNSCLC patients were enrolled. Both groups showed similar biological characteristics in terms of gender, age, smoking history, tumor size, symptoms, stage, presence of pleural metastasis, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII). However, there were differences in the predilection sites: SMARCA4-UT occurred more frequently in the mediastinal pleura (22.22%) and right lower lobe (25.93%), while SMARCA4-dNSCLC occurred more frequently in the right upper lobe (25.00%) and left upper lobe (22.50%) (P<0.05). Furthermore, SMARCA4-UT more often presented with local invasion into adjacent structures and more extensive lymph node metastasis (proportion with metastasis in ≥5 lymph node stations: 55.56% vs 27.50%). Both types showed high sensitivity to radiotherapy, with a 6-month local control rate (LCR) of 84.62% vs 83.33% after radiotherapy; the objective response rate (ORR) of immunotherapy was 91.67% vs 68.18% (P>0.05). Regarding survival, the two groups did not show significant differences in progression-free survival (PFS) or overall survival (OS). Cox multivariate regression analysis indicated that surgery could improve the prognosis of both types, while a high NLR (≥3.57) was a predictor of poor prognosis. CONCLUSIONS:SMARCA4-UT and SMARCA4-dNSCLC share similar clinical characteristics and survival outcomes, with minor differences in local invasion, mediastinal lymph node metastasis, and primary tumor location. Surgery improved survival in both groups. Although both tumor types exhibited high sensitivity to radiotherapy, this did not translate into a significant survival benefit for the patients. Pretreatment NLR is a potential prognostic indicator.

Radiotherapy (RT), which is a therapeutic treatment modality that is commonly used for cancer, employs high‐energy irradiation to induce the generation of reactive oxygen species (ROS) and to cause DNA damages. Nevertheless, the therapeutic efficacy of RT is predominantly constrained due to inadequate DNA damage in malignancies and deleterious impacts on healthy tissues. In the current study, bovine serum albumin (BSA)–coated AgBiS2 nanodots, also known as AgBiS2@ BSA nanodots, were developed for enhanced breast cancer treatment. This was accomplished by the use of an extremely simple and eco‐friendly method. Both scanning transmission electron microscopy (STEM) and scanning electron microscopy (SEM) images revealed that prepared nanoradiosensitizers, AgBiS2@ BSA, were spherical in shape and uniformly distributed. AgBiS2@ BSA nanodots possessed excellent biocompatibility and exhibit excellent monodispersity as well. Furthermore, in vitro assays such as MTT, colony formation assay, and intracellular ROS generation assay revealed the significant cell inhibitory impact of the produced AgBiS2@ BSA nanodots under X‐ray irradiation under X‐ray irradiation. Remarkably, the combined administration of AgBiS2@ BSA nanodots along with X‐ray irradiation increased ROS level within cells by increasing the localized radiation dosage and improving the anti‐tumor effectiveness of RT.

This study aimed to investigate the prognostic potential of the pre-radiotherapy systemic immune-inflammation index (SII) for the survival of advanced lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations, which might provide a basis for optimizing the comprehensive treatment scheme. A total of 111 lung adenocarcinoma patients with EGFR mutations, who received thoracic radiotherapy, were included in this retrospective study. The primary endpoint of the study was based on the overall survival (OS) of patients. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off value of each immune inflammation index. Kaplan–Meier analysis was performed for the comparison of OS. The Cox proportional-hazard model was used for the multivariate and univariate regression analyses to determine the correlations of prognostic factors with the disease. SII was divided into the high SII group (≥ 620.2; 45.95

Alternative polyadenylation (APA) plays a major role in controlling transcriptome diversity and therapeutic resistance of cancers. However, long non-coding RNAs (lncRNAs) involved in pathological APA remain poorly defined. Here, we functionally characterize LINC00921, a MED13L/P300-induced oncogenic lncRNA, and show that it is required for global regulation of APA in non-small cell lung cancer (NSCLC). LINC00921 shows significant potential for reducing NSCLC radiosensitivity, and high LINC00921 levels are associated with a poor prognosis for patients with NSCLC treated with radiotherapy. LINC00921 controls NUDT21 stability by facilitating binding of NUDT21 with the E3 ligase TRIP12. LINC00921-induced destabilization of NUDT21 promotes 3 ' UTR shortening of MED23 mRNA via APA, which, in turn, leads to elevated MED23 protein levels in cancer cells and nuclear translocation of beta-catenin and thereby activates expression of multiple beta-catenin/T cell factor (TCF)/lymphoid enhancer-binding factor (LEF)-regulated core oncogenes (c-Myc, CCND1, and BMP4). These findings highlight the importance of functionally annotating lncRNAs controlling APA and suggest the clinical potential of therapeutics for advanced NSCLC.

Background and Purpose:This study aimed to investigate inter-/intra-observer delineation variability in GTVs of primary esophageal carcinomas (ECs) based on planning CT with reference to different combinations of diagnostic multimodal images from endoscopy/EUS, esophagography and FDG-PET/CT.Materials and Methods:Fifty patients with pathologically proven thoracic EC who underwent diagnostic multimodal images before concurrent chemoradiotherapy were enrolled. Five radiation oncologist independently delineated the GTVs based on planning CT only (GTVC), CT combined with endoscopy/EUS (GTVCE), CT combined with endoscopy/EUS and esophagography (X-ray) (GTVCEX), and CT combined with endoscopy/EUS, esophagography, and FDG-PET/CT (GTVCEXP). The intra-/inter-observer variability in the volume, longitudinal length, generalized CI (CIgen), and position of the GTVs were assessed.Results:The intra-/inter-observer variability in the volume and longitudinal length of the GTVs showed no significant differences (p>0.05). The mean intra-observer CIgen values for all observers was 0.73 ± 0.15. The mean inter-observer CIgen values for the four multimodal image combinations was 0.67 ± 0.11. The inter-observer CIgen for the four combined images was the largest, showing significant differences with those for the other three combinations. The intra-observer CIgen among different observers and inter-observer CIgen among different combinations of multimodal images showed significant differences (p<0.001). The intra-observer CIgen for the senior radiotherapists was larger than that for the junior radiotherapists (p<0.001).Conclusion:For radiation oncologists with advanced medical imaging training and clinical experience, using diagnostic multimodal images from endoscopy/EUS, esophagography, and FDG-PET/CT could reduce the intra-/inter-observer variability and increase the accuracy of target delineation in primary esophageal carcinomas.

目的 评估乳腺癌术后放疗患者内乳淋巴引流区(IMC)非计划性照射剂量,明确乳腺癌手术方式对IMC非计划性受照剂量的影响.方法 回顾性分析2012-01-12-2017-01-26山东省肿瘤防治研究院210例保留乳房术(BCS)后及138例改良根治术(MRM)后接受乳腺(胸壁)±锁骨上淋巴引流区(SCF)放疗的患者,其中131例行患侧乳腺(胸壁)+SCF照射,217例仅行患侧乳腺(胸壁)照射,所有患者原治疗计划中均未接受IMC照射.依据肿瘤放射治疗协作组(RTOG)标准勾画患侧IMC,依据手术方式不同分为BCS及MRM组,比较2组患者间IMC非计划性受照剂量、第1～3肋间IMC受照剂量的差异性.结果 IMC非计划性受照剂量中位数为29.69 Gy,MRM组患者IMC及第1、2肋间IMC非计划性受照剂量高于BCS组(32.85 vs 27.10 Gy,Z=-3.327,P=0.001;26.60 vs 12.50 Gy,Z=-6.922,P<0.001;34.63 vs 30.42 Gy,Z=-2.777,P=0.005),而第3肋间2组差异无统计学意义(37.41 vs 36.24 Gy,Z=-1.103,P=0.270).131例接受侧乳腺(胸壁)+SCF放疗患者IMC(32.87 vs 27.19 Gy)、第1(26.8 vs 13.09 Gy)和2(34.65 vs 30.46 Gy)肋间内乳区非计划性受照剂量高于单纯患侧乳腺(胸壁)放疗组.二分类logistic回归分析结果显示,手术方式及是否行SCF照射均与IMC非计划性受照剂量有关联(OR=1.034,95％CI:1.015～1.054,P=0.001;OR=1.034,95％CI:1.014～1.054,P=0.001).结论 手术方式和SCF照射野的加入均会影响IMC非计划性受照剂量.相较于MRM患者,BCS患者IMC非计划性受照剂量更低,尤其是第1肋间.

Objective:To investigate the effectiveness of abdominal compression in tumor motion and the target volume, and analyze the suitable margins of planning target volume (PTV) for patients treated with lung-SBRT based on 4DCT.Methods:Patients diagnosed with peripheral pulmonary tumor were enrolled. The patients were divided into the whole group, upper-middle-lobe group (group A) and the lower-lobe group (group B). Each patient underwent 3DCT, 4DCT with abdominal compression (4DCT com) and 4DCT with free breath (4DCT free) scans. The GTVs were delineated and IGTVs on these images. PTV MIP 5 mm, PTV MIP 4 mm, PTV MIP 3 mm were constructed with a 5, 4, 3 mm margin in left-right (LR), anterior-posterior (AP) directions and cranial-caudal (CC) directions. Results:The median motion vector with compression reduced by 30.92% in whole group, increased by 3.42% in group A and reduced by 18.80% in group B, respectively. And there were no significant differences of TMA LR, TMA AP, TMA CC and motion vector by the Wilcoxon test ( P>0.05). The median sizes of IGTV MIP com , IGTV MIP free and IGTV10 com, IGTV10 free were 4.01, 5.36 cm 3and 6.59, 7.65 cm 3, with statistically significant difference ( Z=-3.45, -3.14, P<0.01). The median ratio of DI of IGTV CBCT com in PTV MIP 5 mm, PTV MIP 4 mm and PTV MIP 3 mm≥95% was 100%, 100% and 83.33%, respectively. Conclusions:The patients′ respiratory pattern changed with abdominal compression and abdominal compression is useful in reducing the size of IGTV MIP and IGTV10, which could reduce the target volume and protect the normal tissue. Adding a 4 mm margin to IGTV MIP com based on 4DCT account for respiration in SBRT is a tendency for precise radiotherapy.

目的 探讨同步加量调强放疗(SIB-IMRT)联合多西他赛顺铂(DP)治疗颈段和胸中上段食管癌疗效,并评估其可行性.方法 选择2009-05-01-2012-07-31山东省肿瘤医院行放化疗治疗的食管癌患者23例,其中肿瘤位于颈段3例,胸上段13例,胸中段7例;肿瘤长度2.5～10 cm,中位长度5.5 cm.放疗采用SIB-IMRT(PTV-G 60.2 Gy/28次;PTV-C 50.4 Gy/28次),放疗同时联合DP方案化疗,共完成2个周期.生存分期采用Kaplan-meier曲线描述,并行Log-rank检验.影响生存单因素分析采用Cox回归.结果 23例患者均坚持至同步放化疗结束.Ⅲ/Ⅳ度骨髓抑制发生率34.8％(8/23),Ⅲ/Ⅳ度急性放射性食管炎发生率30.4％(7/23).1年内3例出现食管瘘.近期疗效评估:完全缓解(CR)7例(30.4％),部分缓解(PR)9例(39.1％),疾病稳定(SD)5例(21.7％),疾病进展(PD)2例(8.7％),近期疾病控制率91.3％(21/23).中位生存时间30个月,1、2、3和5年总生存率(OS)分别为78％、57％、35％和25％.根据近期疗效的不同进一步对比OS,CR患者具有更好的生存情况(χ2=11.641,P=0.009).多因素分析显示,病变位置(HR=0.367,95％CI为0.157～0.859,P=0.021)及近期疗效(HR=3.401,95％CI为1.797～6.436,P<0.001)与生存相关,胸段食管癌预后好于颈段食管癌,近期疗效好的患者OS更高.结论 SIB-IMRT联合DP方案化疗治疗颈段和胸中上段食管鳞癌,近期疗效CR患者具有更好的生存情况.急性毒副作用主要表现为血液学毒性和放射性食管炎,但食管瘘发生率较高,因此具体的分割模式和病例的选择需进一步探讨.

Objective:To observe the feasibility of magnetic resonance (MR)-guided stereotactic body radiotherapy (SBRT) for non-small cell lung cancer, and analyze the dosimetric differences in the presence or absence of magnetic field.Methods:Three patients with non-small cell lung cancer were prospectively treated with MR-guided linac (MR linac) for SBRT, and the dose was calculated with or without magnetic field models. The differences of dose distribution with or without magnetic field models were compared. At the same time, the target coverage, plan pass rate and treatment time were described, and the complexity of the conventional accelerator backup plan and the magnetic field model were compared.Results:The treatment time of 3 patients was (36.67±6.11) min, and the average time of online adaptive planning was (14.4±1.7) min, which was basically tolerated by patients. The treatment plan pass rate (3%/3 mm) was 98.9%, the Gamma pass rate (3%/3 mm) of the online plan during treatment was 98.5% and the target coverage was 99.1%, which met the clinical needs. The dose in the low dose area of the lung was slightly lower than that in the case without magnetic field, whereas the dose in ribs and skin was slightly higher than that in the plan without magnetic field. The number of machine unit (MU) for online adaptive plan was slightly higher than that of the reference plan, and the number of MU for the conventional accelerator standby treatment plan was significantly lower than that of the MR linac plan under the same target coverage. The follow-up results showed that there was no adverse reaction, and the short-term efficacy was partially relieved.Conclusions:In the case of considering the influence of magnetic field, the treatment plan meeting the clinical needs can be obtained. It is proven that SBRT radiotherapy for lung cancer guided by magnetic resonance accelerator is feasible, whereas the treatment time and process are complex.

Abstract Background This study aimed to investigate the effect of abdominal compression on tumour motion and target volume and to determine suitable planning target volume (PTV) margins for patients treated with lung stereotactic body radiotherapy (SBRT) based on four-dimensional computed tomography (4DCT). Methods Twenty-three patients diagnosed to have a peripheral pulmonary tumour were selected and divided into an all lesions group (group A), an upper middle lobe lesions group (group B), and a lower lobe lesions group (group C). Two 4DCT scans were performed in each patient, one with and one without abdominal compression. Cone beam computed tomography (CBCT) was performed before starting treatment. The gross target volumes (GTVs) were delineated and internal gross target volumes (IGTVs) were defined. IGTVs were generated using two methods: (1) the maximum intensity projections (MIPs) based on the 4DCT were reconstructed to form a single volume and defined as the IGTVMIP and (2) GTVs from all 10 phases were combined to form a single volume and defined as the IGTV10. A 5-mm, 4-mm, and 3-mm margin was added in all directions on the IGTVMIP and the volume was constructed as PTVMIP5mm, PTVMIP4mm, and PTVMIP3mm. Results There was no significant difference in the amplitude of tumour motion in the left–right, anterior–posterior, or superior-inferior direction according to whether or not abdominal compression was applied (group A, p = 0.43, 0.27, and 0.29, respectively; group B, p = 0.46, 0.15, and 0.45; group C, p = 0.79, 0.86, and 0.37; Wilcoxon test). However, the median IGTVMIP without abdominal compression was 33.67% higher than that with compression (p = 0.00), and the median IGTV10 without compression was 16.08% higher than that with compression (p = 0.00). The median proportion of the degree of inclusion of the IGTVCBCT in PTVMIP5mm, PTVMIP4mm, and PTVMIP3mm ≥ 95% was 100%, 100%, and 83.33%, respectively. Conclusions Abdominal compression was useful for reducing the size of the IGTVMIP and IGTV10 and for decreasing the PTV margins based on 4DCT. In IGTVMIP with abdominal compression, adding a 4-mm margin to account for respiration is feasible in SBRT based on 4DCT.

Background The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed. Methods Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LC CT . The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LC T2 , LC 2T1 , LC 5T1 and LC 10T1 , respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality. Results LC CT –LC 10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LC CT –LC T2 , 11.36% and 2.94% for LC CT –LC 2T1 , and 8.89% and 7.69% for LC 5T1 –LC CT , respectively. The center of mass (COM) of LC CT –LC 10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LC CT –LC T2 , LC CT –LC 2T1 and LC CT –LC 5T1 , respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%). Conclusion For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter (intra) variability was minimal for the delineation of the LC based on 10th min DE-TIWI.

Objective: To investigate the effect of anatomic and technical parameters on the incidental internal mammary lymph node (IMN) irradiation (IIMNI) dose among postmastectomy patients. Methods: We retrospectively delineated the IMN on planning CT images from 138 patients who had undergone postmastectomy radiotherapy (PMRT). We analyzed the IIMNI dose coverage and its relationship with anatomic and technical parameters. Results: The IIMNI mean dose was 32.85 ± 9.49 Gy, and 10 of 138 patients (7.25%) treated with PMRT received ≥45 Gy. In univariate analysis, the body weight, body mass index, body surface area, thoracic transverse diameter (DT), ratio of DT to the thoracic anteroposterior diameter (DAP)(RT/AP), planning target volume of IMN (PTVIMN) included in PTV (IMNin) and the ratio of IMNin to PTVIMN (RIMNin) and PTV posterior border were the parameters affecting IIMNI dose. In multivariate analysis, body weight, RT/AP, and RIMNin were correlative factors that affected IIMNI dose. Conclusions: For patients who underwent PMRT without IMN irradiation (IMNI), there was a wide variety in IIMNI doses. A minority of patients had adequate IIMNI dose coverage, and the higher IIMNI doses were associated with the less body weights and more RIMNin.

Objective:To assess the feasibility of delayed-enhancement MRI in contouring the lumpectomy cavity (LC) for patients with invisible seroma or a low cavity visualization score (CVS≤2) in the excision cavity after breast-conserving surgery (BCS).Methods:Twenty-six patients with stage T 1-2N 0M 0 who underwent prone radiotherapy after BCS were recruited. The LC delineated on CT simulation images was denoted as LC CT. The LCs delineated on T 2WI, as well as on different delayed phases (2-, 5-and 10-minute) of delayed-enhancement T 1WI were defined as LC T2, LC 2T1, LC 5T1 and LC 10T1, respectively. Subsequently, the volumes and locations of the LCs were compared between CT simulation images and different sequences of MR simulation images using deformable image registration. Results:The volumes of LC T2, LC 2T1, LC 5T1 and LC 10T1 were all larger than that of LC CT. A statistical significance was found between the volume of LC CT and those of LC 2T1 or LC 5T1, respectively (both P<0.05). The conformal index (CI), degree of inclusion (DI), dice similarity coefficient (DSC) and the distance between the center of mass of the targets (COM) of LC CT-LC 10T1 were better than those of LC CT-LC T2, LC CT-LC 2T1 and LC CT-LC 5T1, however, there was no statistical difference among them (all P>0.05). Conclusions:It is feasible to delineate the LC based on prone delayed-enhancement MR simulation images in patients with low CVS after BCS. Meanwhile, the LCs derived from prone delayed-enhancement T 1WI of 10-minute are the most similar with those derived from prone CT simulation scans using titanium clips, regardless of the volumes and locations of LCs.

AbstractPurposeThe application value of 18F‐FDG PET‐CT combined with MRI in the radiotherapy of esophageal carcinoma was discussed by comparing the differences in position, volume, and the length of GTVs delineated on the end‐expiration (EE) phase of 4DCT, 18F‐FDG PET‐CT, and T2W‐MRI.MethodsA total of 26 patients with thoracic esophageal cancer sequentially performed 3DCT, 4DCT, 18F‐FDG PET‐CT, and MRI simulation for thoracic localization. All images were fused with the 3DCT images by deformable registration. GTVCT and GTV50% were delineated on 3DCT and the EE phase of 4DCT images, respectively. The GTV based on PET‐CT images was determined by thresholds of SUV ≥ 2.5 and designated as GTVPET2.5. The images of T2‐weighted sequence and diffusion‐weighted sequence were referred as GTVMRI and GTVDWI, respectively. The length of the abnormality seen on the 4DCT, PET‐CT, and DWI was compared.ResultsGTVPET2.5 was significantly larger than GTV50% and GTVMRI (P = .000 and 0.008, respectively), and the volume of GTVMRI was similar to that of GTV50% (P = .439). Significant differences were observed between the CI of GTVMRI to GTV50% and GTVPET2.5 to GTV50% (P = .004). The CI of GTVMRI to GTVCT and GTVPET2.5 to GTVCT were statistically significant (P = .039). The CI of GTVMRI to GTVPET2.5 was significantly lower than that of GTVMRI to GTV50%, GTVMRI to GTVCT, GTVPET2.5 to GTV50%, and GTVPET2.5 to GTVCT (P = .000‐0.021). Tumor length measurements by endoscopy were similar to the tumor length as measured by PET and DWI scan (P > .05), and there was no significant difference between the longitudinal length of GTVPET2.5 and GTVDWI (P = .072).ConclusionThe volumes of GTVMRI and GTV50% were similar. However, GTVMRI has different volumes and poor spatial matching compared with GTVPET2.5.The MRI imaging could not include entire respiration. It may be a good choice to guide target delineation and construction of esophageal carcinoma by combining 4DCT with MRI imaging. Utilization of DWI in treatment planning for esophageal cancer may provide further information to assist with target delineation. Further studies are needed to determine if this technology will translate into meaningful differences in clinical outcome.

Objective: To evaluate the incidental coverage dose to the internal mammary nodes (IMN) in patients treated with postmastectomy radiotherapy (PMRT) and its relationship with the treatment plan. Patients and methods: We retrospectively analyzed 138 patients undergoing PMRT and divided them into three groups: three-dimensional conformal radiotherapy (3D-CRT), fieldin-field forward intensity-modulated radiotherapy (F-IMRT), and inverse intensity-modulated radiotherapy (I-IMRT). The IMN were contoured according to the Radiation Therapy Oncology Group consensus and not included in the planning target volume. We analyzed incidental IMN dose coverage and its relationship with the lung and heart. Results: The mean dose (Dmean) to the IMN was 32.85 Gy for all patients, and the dose delivered to the IMN showed no differences in 3D-CRT, F-IMRT, and I-IMRT (33.80, 29.65, and 32.95 Gy, respectively). In addition, 10.42%, 2.04%, and 9.76% of patients achieved >= 45 Gy with 3D-CRT, F-IMRT, and I-IMRT, respectively. No differences were evident among the three treatment plans regarding IMN dose in the first three intercostal spaces (ICS1-3). The Dmean, V20, V30, V40, and V50 of ICS2 and ICS3 were superior to those of ICS1 for all three plans. For 3D-CRT, a moderate positive correlation was evident between the Dmean to the IMN and the Dmean to the heart. For IF-IMRT and I-IMRT, positive correlations were evident between the Dmean of the IMN and the Dmean and V20 of the lung. Conclusion: The mean incidental dose to the IMN for IMRT (F-IMRT and I-IMRT) and 3D-CRT after modified radical mastectomy was insufficient to treat subclinical disease. A substantial dose was delivered to the IMN in some patients. Higher incidental doses to the IMN were associated with a higher heart mean dose for 3D-CRT and a higher dose to the lung for IMRT. Future prospective studies should further explore subgroups that do not require IMN irradiation.

ZNF350, a BRCA1-interacting protein, could mediate BRCA1-induced sequence-specific transcriptional repression of several genes, including GADD45α. As a potential breast cancer susceptibility gene, single nucleotide polymorphisms (SNPs), especially missense SNPs, may influence the transcriptional repression of its target tumor suppressor genes and individuals' breast cancer risk. Using the gene-based haplotype-tagging SNPs strategy, we evaluated the association between six ZNF350 polymorphisms and breast cancer risk in a case-control set from a northern Chinese population. The impact of ZNF350 variations on transcriptional repression of GADD45α was also examined. It was found that ZNF350 rs2278420 (L66P) and rs2278415 (S501R) missense genetic variants are in complete linkage disequilibrium and have a significant impact on inter-individual susceptibility to breast cancer. Additionally, ZNF350 GGCGT or GGCGC haplotype is also associated with a significantly increased breast cancer risk compared with the GGCAC haplotype. ZNF350 L66P variant modifies the risk of breast cancer not only by itself but also in a gene-environment interaction manner with age, age at menarche, menopause status, or estrogen receptor status. Interestingly, we observed that ZNF350 L66P and S501R SNPs could weaken the capability of ZNF350-mediated GADD45α transcription repression and it may be an underlying mechanism of the observed epidemiological associations. Our results highlight ZNF350 as an important gene in human mammary oncogenesis and ZNF350 missense genetic polymorphisms confer susceptibility to breast cancer.

To investigate the differences in target volumes and dosimetric parameters between the supine and prone positions for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS) for Chinese breast cancer patients, thirty breast cancer patients who underwent three-dimensional conformal radiation therapy (3DCRT) EB-PBI after BCS were enrolled. Supine and prone scan sets were acquired during free breathing for all patients. Target volumes and organs at risk (OARs) including the heart, ipsilateral lung and bilateral breast were contoured by the same radiation oncologist. For each patient, supine and prone EB-PBI plans were generated based on the same planning criteria. The clinical target volume (CTV) and planning target volume (PTV) in the prone position were significantly greater than those in the supine position (P = 0.003, 0.004, respectively). A 0.95 Gy reduction in the mean dose (D-mean) to the heart (P= 0.000) was apparent in the supine position compared to the prone position. The D(mean )to the ipsilateral lung was significantly lower in the prone position than in the supine position (1.59 Gy vs. 1.72 Gy, P= 0.029). Therefore, for Chinese breast cancer patients, carrying out 3DCRT EB-PBI in the prone position during free breathing is feasible.

To explore the differences and correlations between the target volumes defined using preoperative prone diagnostic magnetic resonance imaging (MRI) and postoperative prone computed tomography (CT) simulation imaging based on deformable image registration (DIR) for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS). Eighteen breast cancer patients suitable for EB-PBI were enrolled. Preoperative prone diagnostic MRI and postoperative prone CT scan sets for all the patients were acquired during free breathing. Target volumes and ipsilateral breast were all contoured by the same radiation oncologist. The gross tumor volume (GTV) delineated on the preoperative MRI images was denoted as the GTVpreMR and the tumor bed (TB) delineated on the postoperative prone CT images was denoted as the GTVpostCT. The MIM software system was used to deformably register the MRI and CT images. When based on the coincidence of the compared target centers, there were statistically significant increases in the conformity index (CI) and degree of inclusion (DI) values for GTVpostCT-GTVpreMR, GTVpostCT-CTVpreMR + 10, CTVpostCT + 10-GTVpreMR, and CTVpostCT + 10-CTVpreMR + 10 when compared with those based on the DIR of the thorax (Z = − 3.724, − 3.724, − 2.591, − 3.593, all P < 0.05; Z = -3.724, − 3.724, − 3.201, − 3.724, all P < 0.05, respectively). Although based on DIR, there was relatively poor spatial overlap between the preoperative prone diagnostic MRI images and the postoperative prone CT simulation images for either the whole breast or the target volumes. Therefore, it is unreasonable to use preoperative prone diagnostic MRI images to guide postoperative target delineation for EB-PBI.

Objective To detect the changes of heart volume during concurrent chemoradiotherapy for esophageal cancer based on repeated enhanced 4DCT. Methods Patients with squamous cell esophageal cancer underwent repeated enhanced 4DCT and 3DCT scans before and after 10, 20 and 30 fractions of radiotherapy, respectively. The heart was contoured on 3DCT, end expiratory (EE) and maximum intensity projection (MIP) of 4DCTimages. The changes in theheart volume, blood pressure and heart rate were statistically compared at different time points. Results A total of forty-six patients completed 4 fractions of 3DCT and enhanced 4DCT scans. Compared with the initial values, the heart volume was significantly decreased by 3.27%, 4.45% and 4.52% after 10 fractions of radiotherapy, and reduced by 6.05%, 5.64% and 4.51% following 20 fractions of radiotherapy on 3DCT, EE and MIP, respectively (P=0.000-0.027). The heart volume after 30 fractions of radiotherapy did not significantly differ from the initial volume (P>0.05). After radiotherapy, there was a significant decrease inboth systolic and diastolic blood pressure (P=0.000 and P=0.009) and a significant increase in the heart rate (P=0.001) compared with those measured before radiotherapy. Conclusions Enhanced 4DCT scan can clearly reflect the changes of heart volume throughout concurrent chemoradiotherapy. The heart volume starts to shrink during the early stage of radiotherapy and continue to decrease until the middle-and late-stage, whereas it restores to the initial volume after radiotherapy. Simultaneously, blood pressure declines and heart rate is accelerated during radiotherapy. Key words: Esophageal neoplasm/concurrent chemoradiotherapy; Tomography, X-ray computed, four-dimensional; Heart volume