The effects of intensity modulated radiation and the risk factors of radiation pneumonia in elderly patients with esophageal cancer / 中国医师进修杂志

Objective:To investigate the effects of intensity modulated radiation therapy (imRT) and risk factors of radiation pneumonia caused by imRT in elderly patients with esophageal cancer.Methods:The clinical data of 80 elderly patients diagnosed with esophageal cancer and performed imRT in Traditional Chinese Medicine Hospital of Kunshan from February 2018 to February 2020 were analyzed, and the therapeutic effect and the incidence of adverse reactions were counted.Results:In the 80 patients, 13 patients occurred radiation pneumonia.The results of univariate analysis showed that the gender, smoking history, pathological stage and age had no correlation with radiation pneumonia ( P> 0.05), while tumor location, diabetes, concurrent chemotherapy, reradiotherapy and chronic obstructive pulmonary disease had correlation with the occurrence of radioactive pneumonia ( P<0.05). The levels of V30, V35, V40 between radioactive pneumonia patients and non-radioactive pneumonia patients had no significant differences ( P>0.05), but the levels of V5, V10, V15, V20 and mean lung dose(MLD) between radioactive pneumonia patients and non-radioactive pneumonia patients had significant differences ( P<0.05). The effect of imRT was no remission in 9 cases (11.25%), partial remission in 59 cases (73.75%) and complete remission in 12 cases (15.00%), and the clinical effective rate was 88.75%(71/80). By comparing the adverse reactions caused by imRT, it was found that the incidence of radiation esophagitis, leukopenia, and acute radiation pneumonia were 93.75%(75/80), 12.50%(10/80) and 22.50%(18/80), respectively, with grade 1 and grade 2 adverse reactions. Conclusions:Risk factors for radiation pneumonia in elderly patients with esophageal cancer after imRT include tumor location, diabetes, V5, V10, V15, V20, MLD, concurrent chemotherapy, reradiotherapy and chronic obstructive pulmonary disease.

Application of CT-based radiomics analysis in predicting and identifying of treatment-associated pneumonitis / 国际肿瘤学杂志

As a non-invasive image analysis method, radiomics can deeply explore the clinical information hidden behind medical images, and has been widely used in medicine in recent years. Consolidation immunotherapy after concurrent chemoradiotherapy has become the standard treatment for locally advanced non-small cell lung cancer. The prediction and identification of treatment-associated adverse events radiation pneumonitis (RP) and immune checkpoint inhibitor-related pneumonitis (CIP) are of vital importance for the formulation of treatment plan and the selection of subsequent treatment. CT-based radiomics analysis shows great potential in predicting and identifying RP and CIP.

Research Progress of Macrophages in Development of Radiation Pneumonitis and Pulmonary Fibrosis / 肿瘤防治研究

Radiation pneumonitis and pulmonary fibrosis are important dose-limiting side effects of radiotherapy that influence the prognosis and quality of life of patients with thoracic cancer. The disorder of the immune system plays a key role, especially macrophages. With the discovery of underlying molecular mechanisms, including the chemotaxis and polarization of macrophages, the infiltration of inflammatory cells, the release of inflammatory and pro-fibrotic factors, extracellular matrix deposition and the remodeling of lung structure, increasing strategies are under investigation to facilitate the prevention or treatment of lung injury via targeting macrophages. In this paper, the role of macrophages in the development of radiation pneumonitis, pulmonary fibrosis, and potential drug use strategies were reviewed.

Application of 4DCT-based lung functional imaging in radiotherapy for lung cancer / 中华放射肿瘤学杂志

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

Dosiomics-based prediction of incidence of radiation pneumonitis in lung cancer patients / 中华放射肿瘤学杂志

Objective:To explore the potential of dosiomics in predicting the incidence of radiation pneumonitis by extracting dosiomic features of definitive radiotherapy for lung cancer, and building a machine learning model.Methods:The clinical data, dose files of radiotherapy, planning CT and follow-up CT of 314 patients with lung cancer undergoing definitive radiotherapy were collected retrospectively. According to the clinical data and follow-up CT, the radiation pneumonia was graded, and the dosiomic features of the whole lung were extracted to establish a machine learning model. Dosiomic features associated with radiation pneumonia by LASSO-LR with 1000 bootstrap and AIC backward method with 1000 bootstraps were selected. Training cohort and validation cohort were randomly divided on the basis of 7:3.Logistic regression was used to establish the prediction model, and ROC curve and calibration curve were adopted to evaluate the performance of the model.Results:A total of 120 dosiomic features were extracted. After LASSO-LR dimensionality reduction, 12 features were selected into the "feature pool".After AIC, 6 dosiomic features were finally selected for model construction. The AUC of training cohort was 0.77(95% CI: 0.65 to 0.87), and the AUC of validation cohort was 0.72 (95% CI: 0.64 to 0.81). Conclusion:The dosiomics prediction model has the potential to predict the incidence of radiation pneumonia, but it still needs to include multicenter data and prospective data.

Research progress of radiation recall pneumonitis caused by immune checkpoint inhibitors / 国际肿瘤学杂志

At present, tumor therapy has entered the era of immunotherapy. However, in recent years, it has been found that the application of immune checkpoint inhibitors after chest radiotherapy can not only play a synergistic anti-tumor effect, but also cause radiation recall pneumonitis (RRP). RRP is a rare immune-related adverse reaction, which even leads to death in severe cases. It is of great significance to study the mechanisms and influencing factors of RRP caused by immune checkpoint inhibitors for strengthening the cognitive management of RRP and reducing the risk of RRP.

Analysis on the incidence and risk factors of pneumonia in patients with lung cancer receiving thoracic radiotherapy and immunotherapy / 国际肿瘤学杂志

Objective:To analyze the incidence, risk factors and occurrence time of radiation pneumonia (RP) and immune checkpoint inhibitor-related pneumonia (CIP) in patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy.Methods:The clinicopathological data of 137 patients with lung cancer and lung metastatic cancer receiving thoracic radiotherapy and at least one cycle of immunotherapy from January 2019 to January 2022 in Renmin Hospital of Wuhan University were retrospectively analyzed. The occurrence of RP and CIP was determined according to the clinical symptoms and thin-slice chest CT. The risk factors of symptomatic RP were evaluated by univariate and multivariate analyses of clinical data and treatment plan. The relationship between the occurrence time of symptomatic RP and the sequence of thoracic radiotherapy and immunotherapy was compared.Results:In the 137 patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy, symptomatic RP was observed in 42 patients (30.7%) , including grade 2 RP in 33 patients (24.1%) , grade 3 RP in 6 patients (4.4%) , grade 4 RP in 1 patient (0.7%) , and grade 5 RP in 2 patients (1.5%) . The incidence of symptomatic RP was 40.0% (28/70) in patients who received thoracic radiation concurrent with immunotherapy and 20.9% (14/67) in non-synchronous patients, and the incidence of severe RP was 10.0% (7/70) and 3.0% (2/67) respectively. CIP was observed in 11 (8.0%) of 137 patients, including grade 2 CIP in 4 patients (2.9%) , grade 3 CIP in 6 patients (4.4%) , grade 5 CIP in 1 patient (0.7%) . There were 54.5% (6/11) of CIP patients with prior or concurrent symptomatic RP. Univariate analysis showed that smoking history ( χ2=9.85, P=0.002) , chronic obstructive pulmonary disease (COPD) history ( χ2=31.34, P<0.001) , thoracic radiotherapy concurrent with immunotherapy ( χ2=5.88, P=0.015) , total radiotherapy dose ( χ2=8.57, P=0.003) were associated with symptomatic RP. Multivariate logistic regression analysis showed that COPD history ( OR=9.96, 95% CI: 3.40-29.14, P<0.001) , thoracic radiotherapy concurrent with immunotherapy ( OR=2.84, 95% CI: 1.15-7.00, P=0.024) , and total radiotherapy dose ≥60 Gy ( OR=4.76, 95% CI: 1.68-13.50, P=0.003) were independent risk factors for symptomatic RP. RP occurred earlier in patients who received immunotherapy before thoracic radiotherapy [68.5 d (47.0 d, 101.8 d) ] than in patients who received immunotherapy after thoracic radiotherapy [117.5 d (79.0 d, 166.3 d) ], with a statistically significant difference ( Z=2.54, P=0.010) . Conclusion:The incidence of symptomatic RP is high in patients who receive both thoracic radiotherapy and immunotherapy. The history of COPD, thoracic radiotherapy concurrent with immunotherapy, and the total radiotherapy dose ≥60 Gy are independent influencing factors of symptomatic RP in patients with thoracic radiotherapy combined with immunotherapy. Symptomatic RP occurs earlier in patients who receive immunotherapy before thoracic radiotherapy than in patients who receive immunotherapy after thoracic radiotherapy.

Correlation between early adverse reactions of intensity-modulated radiotherapy and diabetes after radical mastectomy for breast cancer / 肿瘤研究与临床

Objective:To investigate the effect of diabetes on the occurrence of early adverse reactions of intensity-modulated radiotherapy in patients after radical mastectomy for breast cancer.Methods:The clinical data of 102 breast cancer patients who underwent intensity-modulated radiotherapy after radical mastectomy for breast cancer in Nanjing Drum Tower Hospital Group Suqian Hospital from October 2014 to December 2020 were retrospectively analyzed, including 32 cases in the diabetes group and 70 cases in the non-diabetes group. The incidence of early adverse reactions of intensity-modulated radiotherapy in the two groups was compared, the effects of blood glucose before radiotherapy on the early adverse reactions of intensity-modulated radiotherapy and the lymphocyte count before and after intensity-modulated radiotherapy were analyzed.Results:There were 9 cases (28.1%) and 1 case (3.1%) of grade 1 and 2 acute radiation pneumonitis in the diabetes group, and 6 cases (8.6%) and 1 case (1.4%) in the non-diabetes group, respectively, and there was a statistical difference between the two groups ( χ2 = 7.22, P = 0.027). Grade 1-3 acute radiation dermatitis occurred in 16 cases (50.0%), 13 cases (43.8%) and 3 cases (6.2%) in the diabetes group, and 53 cases (75.7%), 15 cases (21.4%) and 2 cases (2.9%) in the non-diabetes group, respectively, and the difference between the two groups was statistically significant ( χ2 = 6.99, P = 0.030). According to the level of fructosamine before radiotherapy, the patients with diabetes were divided into normal blood glucose control group (fructosamine ≤2.5 mmol/L) and poor blood glucose control group (fructosamine >2.5 mmol/L), and there was statistical difference in the morbidity of acute radiation dermatitis between the two groups ( P = 0.039). Before radiotherapy, there was no significant difference in lymphocyte count between the normal and poor blood glucose control groups ( P > 0.05). After radiotherapy, the lymphocyte count in both groups was significantly lower than that before radiotherapy, and the decrease was more obvious in the poor blood glucose control group, the difference was statistically significant ( P = 0.021). Conclusions:The postoperative patients with breast cancer complicated with diabetes have a high incidence of acute radiation pneumonia and acute radiation dermatitis. Patients with poor blood glucose control are more likely to have acute radiation dermatitis.

Application of CT radiomics analysis to predict symptomatic radiation pneumonitis for lung cancer / 中华放射医学与防护杂志

Objective:To build a predictive model for symptomatic radiation pneumonitis(RP) using the pretreatment CT radiomics features, clinical and dosimetric data of lung cancer patients by using machine learning method.Methods:A retrospective analysis of 103 lung cancer patients who underwent radiotherapy in the Affiliated Hospital of Jiangnan University from November 2018 to April 2020 was performed. Total normal lung tissues were segmented as an interested volume in pretreatment CT images, and then 250 radiomics features were extracted. The correlations of RP and clinical or dosimetric features were firstly investigated with univariate analysis. Then all clinical data, dosimetric data and CT radiomics features were collected and considered as predictors for modeling of RP grade ≥ 2. Features were selected through LASSO machine learning method, and the predictive model was built. Finally, nomogram for risk of RP were obtained according to the selected features.Results:The result of univariate analysis showed that symptomatic RP was significantly correlated with lung dosimetric parameters including mean lung dose (MLD), V20 Gy and V30 Gy( t=2.20, 2.34 and 2.93, P<0.05). Four features, including lung dose volume percentage V30 Gyand three radiomics features, entropy feature of GLCM, mean and median feature of wavelet histogram were selected among all clinical, dosimetric features and radiomics features. AUC of the predicted model obtained from selected features reached 0.757. For convenient clinical use, the nomogram were obtained, and then personalized RP risk prediction and early intervention could be performed according to this nomogram. Conclusions:Pretreatment CT radiomics and dosimetric features can be used in predicting symptomatic RP, which will be useful for advanced intervention treatment.

Symptomatic Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKIs and Concurrent Once-daily Thoracic Radiotherapy: Predicting the Value of Clinical and Dose-volume Histogram Parameters / 中国肺癌杂志

BACKGROUND@#The incidence of symptomatic radiation pneumonitis (RP) and its relationship with dose-volume histogram (DVH) parameters in non-small cell lung cancer (NSCLC) patients receiving epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and concurrent once-daily thoracic radiotherapy (TRT) remain unclear. We aim to analyze the values of clinical factors and dose-volume histogram (DVH) parameters to predict the risk for symptomatic RP in these patients.@*METHODS@#Between 2011 and 2019, we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and once-daily TRT simultaneously (EGFR-TKIs group) and 129 patients who had received concurrent chemoradiotherapy (CCRT group). The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event (CTCAE) criteria (grade 2 or above). Statistical analyses were performed using SPSS 26.0.@*RESULTS@#In total, the incidences of symptomatic (grade≥2) and severe RP (grade≥3) were 43.5% (37/85) and 16.5% (14/85) in EGFR-TKIs group vs 27.1% (35/129) and 10.1% (13/129) in CCRT group respectively. After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching, chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group (χ2=4.469, P=0.035). In EGFR-TKIs group, univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving ≥30 Gy (ilV30) [odds ratio (OR): 1.163, 95%CI: 1.036-1.306, P=0.011] and the percentage of total lung volume receiving ≥20 Gy (tlV20) (OR: 1.171, 95%CI: 1.031-1.330, P=0.015), with chronic obstructive pulmonary disease (COPD) or not (OR: 0.158, 95%CI: 0.041-0.600, P=0.007), were independent predictors of symptomatic RP. Compared to patients with lower ilV30/tlV20 values (ilV30 and tlV20<cut-off point values) and without COPD, patients with higher ilV30/tlV20 values (ilV30 and tlV20>cut-off point values) and COPD had a significantly higher risk for developing symptomatic RP, with a hazard ratio (HR) of 1.350 (95%CI: 1.190-1.531, P<0.001).@*CONCLUSIONS@#Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy. The ilV30, tlV20, and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.

Inhaled curcumin mesoporous polydopamine nanoparticles against radiation pneumonitis

Radiation therapy is an effective method to kill cancer cells and shrink tumors using high-energy X-ray or γ-ray. Radiation pneumonitis (RP) is one of the most serious complications of radiation therapy for thoracic cancers, commonly leading to serious respiratory distress and poor prognosis. Here, we prepared curcumin-loaded mesoporous polydopamine nanoparticles (CMPN) for prevention and treatment of RP by pulmonary delivery. Mesoporous polydopamine nanoparticles (MPDA) were successfully synthesized with an emulsion-induced interface polymerization method and curcumin was loaded in MPDA via π‒π stacking and hydrogen bonding interaction. MPDA owned the uniform spherical morphology with numerous mesopores that disappeared after loading curcumin. More than 80% curcumin released from CMPN in 6 h and mesopores recovered. CMPN remarkably protected BEAS-2B cells from γ-ray radiation injury by inhibiting apoptosis. RP rat models were established after a single dose of 15 Gy 60Co γ-ray radiation was performed on the chest area. Effective therapy of RP was achieved by intratracheal administration of CMPN due to free radical scavenging and anti-oxidation ability, and reduced proinflammatory cytokines, high superoxide dismutase, decreased malondialdehyde, and alleviated lung tissue damages were observed. Inhaled CMPN paves a new avenue for the treatment of RP.

Correlation Between Dose Volume Parameters and Radiation Pneumonitis in Elderly Patients with Esophageal Cancer After Three-dimensional Conformal Radiotherapy / 肿瘤防治研究

Objective To analyze the correlation between ≥grade 2 radiation pneumonitis (RP) and dose volume parameters of elderly patients with esophageal cancer after three-dimensional conformal radiotherapy. Methods We collected the data of 250 elderly patients with esophageal cancer who received three-dimensional conformal radiotherapy from different medical centers. The clinical features of patients were analyzed by Chi-square test while dose volume parameters were analyzed by Logistic univariate and multivariate analyses. ROC curve was used to determine the best cut-off value. Results After three-dimensional conformal radiotherapy, 20% of patients developed ≥grade 2 RP. Univariate analysis showed that bilateral pulmonary V5, V10, V20, V30 and mean lung dose were associated with ≥grade 2 RP but multivariate analysis revealed that only V5 and V20 were independent relevant factors of RP. ROC curve indicated that the best cut-off value was V5 < 52.9% and V20 < 23.2%. Conclusion Bilateral pulmonary V5 and V20 are independently related to ≥grade 2 RP in elderly patients with esophageal cancer after 3-D conformal radiotherapy.

High serum superoxide dismutase activity improves radiation-related quality of life in patients with esophageal squamous cell carcinoma

OBJECTIVES: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors in China. Intensity-modulated radiation therapy and volume-modulated arc therapy have become the main treatments for esophageal carcinoma; however, side effects caused by radiotherapy greatly impact the quality of life in these patients. This study aimed to explore the impact of serum superoxide dismutase (SOD) levels on the prognosis of patients with ESCC undergoing radiotherapy. METHODS: Patients aged between 18 and 80 years with lower-middle ESCC who underwent radiotherapy were eligible for this assessment. Adverse events, responses, treatment outcomes, and overall survival (OS) were assessed. Between 2012 and 2014, 195 patients were enrolled, of which 65 were assigned to the low- and high-SOD groups based on their serum SOD values. RESULTS: The baseline characteristics were similar between the two groups, except for the T staging. Adverse events in the low-SOD group were significantly higher than those in the high-SOD group (radiation esophagitis, p=0.007; radiation pneumonitis, p=0.032; leukopenia, p=0.023; thrombocytopenia, p=0.037; anemia, p=0.041). There were no significant differences in response, treatment outcomes, or OS. CONCLUSION: In conclusion, high serum SOD activity improved post-radiotherapy quality of life but did not impact the prognosis of patients with ESCC. To the best of our knowledge, this study is the first to report that serum SOD activity is associated with radiation-induced toxicity and moderately increased radiotherapeutic response in patients with ESCC undergoing radiotherapy.

Research progress on risk factors of radiation pneumonitis caused by stereotactic body radiotherapy for non-small-cell lung cancer / 中华放射肿瘤学杂志

Stereotactic body radiotherapy (SBRT/SABR) has become an important option in the treatment of early non-small-cell lung cancer (NSCLC). Radiation pneumonitis (RP) is the main side effect of early NSCLC patients after SBRT/SABR. Patient factors, tumor factors and treatment factors are all associated with the occurrence of RP in early NSCLC patients after SBRT/SABR. In recent years, relevant studies have further clarified the relationship between these factors and RP. In addition, the prediction factors related to RP occurrence are further discussed. In this paper, relevant research progresses in recent years were reviewed.

Study of application of radiomics model in predicting radiation pneumontis in patients with lung cancer and esophageal cancer / 中华放射肿瘤学杂志

Objective:To analyze and explore the common radiomics features of radiation pneumonitis (RP) in patients with lung cancer and esophageal cancer, and then establish a prediction model that can predict the occurrence of RP in two types of cancer after radiotherapy.Methods:Clinical data of 100 patients with stage Ⅲ lung cancer and 100 patients with stage Ⅲ esophageal cancer who received radical radiotherapy were retrospectively analyzed. The RP was graded by imaging data and clinical information during follow-up, and the planning CT images were collected. The whole lung was used as the volume of interest to extract radiomics features. The radiomics features, clinical and dosimetric parameters related to RP were analyzed, and the model was constructed by machine learning.Results:A total of 1691 radiomics features were extracted from CT images. After ANOVA and LASSO dimensionality reduction in lung cancer and esophageal cancer patients, 8 and 6 radiomics features associated with RP were identified, and 5 of them were the same. Using the random forest to construct the prediction model, lung cancer and esophageal cancer were alternately used as the training and validation sets. The AUC values of esophageal cancer and lung cancer as the independent validation set were 0.662 and 0.645.Conclusions:It is feasible to construct a common prediction model of RP in patients with lung cancer and esophageal cancer. Nevertheless, it is necessary to further expand the sample size and include clinical and dosimetric parameters to increase its accuracy, stability and generalization ability.

Meta-analysis of the incidence of radiation pneumonitis between European, American and Asian populations / 中华放射肿瘤学杂志

Objective:To compare the incidence of radiation pneumonitis (RP) between lung cancer patients from the European, American and Asian regions.Methods:The studies related to lung cancer and RP were searched from PubMed, Embase, and Cochrane library. According to the different places where the studies were conducted, the searched studies were divided into two types: Asian studies and European, American and Australian studies. The incidence of RP between two regions was summarized. Studies related to dosimetry parameters were searched from PubMed database.Results:A total of 3, 190 patients from 14studies were included. Meta-analysis results showed that the incidence of ≥ grade 3 RP was similar in patients from Asia and Europe, America and Australia (4.9% vs. 4.6%, P=0.895), whereas the incidence of grade 5 RP in Asia was significantly higher than that in Europe, America and Australia (1.5% vs. 0.2%, P=0.002). Moreover, the lung irradiation dose received by the patients in the Asian group was relatively low. Lung V 20Gy dose limitation standard was reported in 21studies. Further analysis found no statistical significance in lung V 20Gy dose limitation standard between two regions ( P=0.440), and the standard in Asian studies is likely to be even stricter. Conclusions:The incidence of RP after chemoradiotherapy in lung cancer patients in Asia is relatively higher compared with those in Europe, America and Australia. The differences in dose limitation standard should be noted when the thoracic radiation regimen based solely on the data from foreign studies is applied to the patients in Asia.

A nomogram model based on cone beam CT radiomics combined with clinical features and dosimetric parameters predicting radiation pneumonitis in patients with esophageal cancer receiving radiotherapy / 中华放射肿瘤学杂志

Objective:To develop and validate a nomogram model for predicting radiation-induced pneumonitis in esophageal cancer based on CBCT radiomics characteristics combined with clinical characteristics and lung dosimetric parameters.Methods:Clinical data, dosimetric parameters and CBCT images of 96 patients with thoracic middle esophageal squamous cell carcinoma treated by intensity-modulated radiation therapy (IMRT) from 2017 to 2019 were analyzed retrospectively. The CBCT images of each patient in three different time periods were obtained. All patients were assigned randomly into the primary cohort ( n=67) and validation cohort ( n=29). Double lungs were selected as the region of interest (ROI), and 3D-slicer software was used for image segmentation and feature extraction. The LASSO regression were applied to identify candidate radiomic features and construct the Rad-score. The optimal time period, clinical and dosimetric parameters were selected to construct the nomogram model, and then the area under the receiver operating characteristic curve (AUC) was used to evaluate the prediction effect of the model. Results:The predictive capacity of the model in the first time period was the highest. In the primary cohort, the AUC was 0.700(95% CI: 0.568-0.832), the sensitivity was 61.5%, and the specificity was 75.0%. In the validation cohort, the AUC was 0.765(95% CI: 0.588-0.941), the sensitivity was 84.6% and the specificity was 64.7%, respectively. In the combined nomogram model, the AUC in the primary cohort was 0.836(95% CI: 0.700-0.918), the sensitivity was 96.0% and the specificity was 54.8%. In the validation cohort, the AUC was 0.905(95% CI: 0.799-1.000), the sensitivity was 92.9% and the specificity was 73.3%, respectively. The diagnostic efficiency of combined nomogram model was the best. Conclusions:The nomogram model based on early lung CBCT radiomics has certain predictive efficiency for RP. The model of lung CBCT radiomics in early stage of radiotherapy can predict RP of esophageal cancer. The nomogram model based on Rad-score combined with V 5Gy, MLD and tumor stage yields better predictive accuracy, which can be used as a quantitative prediction model for RP.

Value of CD4/CD8 ratio and total B lymphocytes before radiotherapy in predicting radiation pneumonitis in patients with esophageal cancer and lung cancer / 国际肿瘤学杂志

Objective:To investigate the value of CD4/CD8 ratio and total B lymphocytes before radiotherapy in predicting the occurrence of radiation pneumonitis (RP) in patients with esophageal cancer and lung cancer.Methods:The clinicopathological data of 28 patients with esophageal and 16 patients with lung cancer undergoing radiotherapy from April 2018 to March 2020 in Hefei Cancer Hospital, Chinese Academy of Sciences were retrospectively analyzed, and the patients were divided into RP group ( n=16) and non-RP group ( n=28) according to whether RP occurred during and after treatment. The CD4/CD8 ratio and total B lymphocytes before radiotherapy between the two groups, and the CD4/CD8 ratio and total B lymphocytes before and after radiotherapy in the RP group were compared. Receiver operating characteristic curve was used to analyze the value of CD4/CD8 ratio and total B lymphocytes before radiotherapy in predicting RP. Results:The CD4/CD8 ratio before radiotherapy in the RP group was significantly lower than that in the non-RP group (0.993±0.179 vs. 1.708±0.170), with a statistically significant difference ( t=2.706, P=0.009); the total B lymphocytes in the RP group was significantly lower than that in non-RP group [(4.409±0.823)% vs. (8.153±1.017)%], with a statistically significant difference ( t=0.986, P=0.015). The CD4/CD8 ratio in the RP group was lower than that before radiotherapy when RP occurred (0.785±0.167 vs. 0.993±0.179), with no statistically significant difference ( t=1.376, P=0.189). The total B lymphocytes in the RP group was lower than that before radiotherapy when RP occurred [(3.487±1.018)% vs. (4.409±0.823)%], with no statistically significant difference ( t=0.804, P=0.433). The critical values of CD4/CD8 ratio and total B lymphocytes predicted RP were 0.580 and 0.357, respectively. The areas under the curve (AUC) of CD4/CD8 for predicting RP was 0.802 (95% CI: 0.653-0.932), the sensitivity was 89.29%, and the specificity was 68.75%. The AUC of total B lymphocytes for predicting RP was 0.694 (95% CI: 0.483-0.814), the sensitivity was 85.71%, and the specificity was 50.00%. The AUC of the two combined diagnostic method for RP was 0.834 (95% CI: 0.697-0.932), the sensitivity and specificity were 81.25% and 89.29%. AUC of the two combined tests was significantly higher than that of the single test, with statistically significant differences ( Z=1.115, P=0.046; Z=1.992, P=0.026). Conclusion:The CD4/CD8 ratio and total B lymphocytes in the RP group are lower than those in the non-RP group. The CD4/CD8 ratio and total B lymphocytes in the serum are of great significance in predicting the occurrence of RP in patients with malignant tumors receiving chest radiotherapy.

Impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer / Impacto da radioterapia torácica na função respiratória e capacidade de exercício em pacientes com câncer de mama

ABSTRACT Objective: To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer. Methods: Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose. Results: The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis. Conclusions: In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.

RESUMO Objetivo: Avaliar o impacto da radioterapia torácica na função respiratória e capacidade de exercício em pacientes com câncer de mama. Métodos: Pacientes com câncer de mama com indicação de radioterapia torácica após tratamento cirúrgico e quimioterápico foram submetidas a TCAR, avaliação respiratória e avaliação da capacidade de exercício antes da radioterapia torácica e três meses após o término do tratamento. Foram realizados teste de força muscular respiratória, medição da mobilidade torácica e prova de função pulmonar completa para a avaliação respiratória; realizou-se teste de exercício cardiopulmonar para avaliar a capacidade de exercício. A dose total de radioterapia foi de 50,4 Gy (1,8 Gy/fração) na mama ou na parede torácica, incluindo ou não a fossa supraclavicular (FSC). Histogramas dose-volume foram calculados para cada paciente com especial atenção para o volume pulmonar ipsilateral que recebeu 25 Gy (V25), em números absolutos e relativos, e a dose pulmonar média. Resultados: O estudo incluiu 37 pacientes. Após a radioterapia, observou-se diminuição significativa da força muscular respiratória, mobilidade torácica, capacidade de exercício e resultados da prova de função pulmonar (p < 0,05). A DLCO permaneceu inalterada. A TCAR mostrou alterações relacionadas à radioterapia em 87% das pacientes, o que foi mais evidente nas pacientes submetidas à irradiação da FSC. O V25% correlacionou-se significativamente com a pneumonite por radiação. Conclusões: Em nossa amostra de pacientes com câncer de mama, a radioterapia torácica parece ter causado perdas significativas na capacidade respiratória e de exercício, provavelmente por causa da restrição torácica; a irradiação da FSC representou um fator de risco adicional para o desenvolvimento de pneumonite por radiação.

Short-term clinical efficacy and adverse events of volumetric modulated arc therapy in patients with locally advanced non-small cell lung cancer / 中华放射肿瘤学杂志

Objective@#To evaluate the short-term clinical efficacy and adverse events of volumetric modulated arc therapy (VMAT) in the treatment of locally advanced non-small cell lung cancer (NSCLC).@*Methods@#From January to December 2016, 58 patients (47 male and 11 female) with unresectable locally advanced NSCLC received concurrent or sequential chemoradiotherapy. The radiation dose was ranged from 38 Gy to 66 Gy. The radiation dose was equal or higher than 56 Gy in 53 patients (92%). The median radiotherapy fraction was 30, 1.8 Gy to 3.0 Gy for each fraction. Twenty-eight patients (48%) received concurrent chemoradiotherapy.@*Results@#The median follow-up time was 9 months. The 1-year overall survival (OS) rate was 84% and the 1-year progression-free survival (PFS) rate was 48%.Eleven patients (19%) suffered from symptomatic radiation pneumonitis and one of them died of radiation pneumonitis. Within 6 months after radiotherapy, 31 patients (53%) developed asymptomatic local pulmonary fibrosis on CT images. Seventeen patients (29%) suffered from grade Ⅱ esophagitis. Ten cases (17%) had ≥ grade Ⅲ adverse events and 9 of them presented with leucopenia.@*Conclusions@#VMAT yields high short-term clinical efficacy and tolerable adverse events in the treatment of locally advanced NSCLC, which does not increase the risk of pneumonitis.