Dual regulatory role of TGF-β in radiaotherapy

doi:10.3877/cma.j.issn.1674-0785.2024.03.012

Abstract

Abstract:

Radiotherapy exerts therapeutic effects on tumors by killing cancer cells through the ionizing radiation effect of high-energy rays. Transforming growth factor-beta (TGF-β), whose expression is increased in irradiated tissues, plays a dual regulatory role by decreasing radiosensitivity and reversing radiation resistance. TGF-β also has a role in the tumor microenvironment to promote epithelial-mesenchymal transition, and induce immune escape of tumor cells and radiofibrosis in normal tissues. This paper discusses the dual role of TGF-β in radiotherapy, aiming to provide a theoretical basis for radiotherapy.

Key words: Transforming growth factor-beta, Tumor, Radiotherapy

Xinying Zheng, Huiyong Zhang, Xing Huang, Lei Qiu, Qingliang Fang, Zhenhui Lu, Lei Wang. Dual regulatory role of TGF-β in radiaotherapy[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(03): 309-314.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2024.03.012

https://zhlcyszz.cma-cmc.com.cn/EN/Y2024/V18/I03/309

Figures/Tables 1

References 71

1	Delaney G, Jacob S, Featherstone C, et al. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines [J]. Cancer, 2005,104(6): 1129-1137.
2	Hanna TP, Shafiq J, Delaney GP, et al. The population benefit of evidence-based radiotherapy: 5-Year local control and overall survival benefits [J]. Radiother Oncol, 2018,126(2): 191-197.
3	Grimes DR. Radiofrequency radiation and cancer: a review [J]. JAMA Oncol, 2022,8(3): 456-461.
4	Shi X, Yang J, Deng S, et al. TGF-beta signaling in the tumor metabolic microenvironment and targeted therapies [J]. J Hematol Oncol, 2022,15(1): 135.
5	Reisländer T, Groelly FJ, Tarsounas M. DNA Damage and Cancer Immunotherapy: A sting in the tale [J]. Mol Cell, 2020,80(1): 21-28.
6	Barcellos-Hoff MH, Cucinotta FA. New tricks for an old fox: impact of TGFβ on the DNA damage response and genomic stability [J]. Sci Signal, 2014,7(341): re5.
7	Shiloh Y. ATM and related protein kinases: safeguarding genome integrity [J]. Nat Rev Cancer, 2003,3(3): 155-168.
8	Li Y, Liu Y, Chiang YJ, et al. DNA damage activates TGF-β signaling via ATM-c-Cbl-mediated stabilization of the type II receptor TβRII [J]. Cell Rep, 2019,28(3): 735-745.
9	Kirshner J, Jobling MF, Pajares MJ, et al. Inhibition of transforming growth factor-beta1 signaling attenuates ataxia telangiectasia mutated activity in response to genotoxic stress [J]. Cancer Res, 2006,66(22): 10861-10869.
10	Kciuk M, Bukowski K, Marciniak B, et al. Advances in DNA repair-emerging players in the arena of eukaryotic DNA repair [J]. Int J Mol Sci, 2020,21(11):3934.
11	Centurione L, Aiello FB. DNA repair and cytokines: TGF-β, IL-6, and thrombopoietin as different biomarkers of radioresistance [J]. Front Oncol, 2016,6: 175.
12	Liang S, Thomas SE, Chaplin AK, et al. Structural insights into inhibitor regulation of the DNA repair protein DNA-PKcs [J]. Nature, 2022,601(7894): 643-648.
13	Ramu AK, Ali D, Alarifi S, et al. Reserpine inhibits DNA repair, cell proliferation, invasion and induces apoptosis in oral carcinogenesis via modulation of TGF-β signaling [J]. Life Sci, 2021,264: 118730.
14	Dai L, Dai Y, Han J, et al. Structural insight into BRCA1-BARD1 complex recruitment to damaged chromatin [J]. Mol Cell, 2021,81(13): 2765-2777.
15	Huang RX, Zhou PK. DNA damage response signaling pathways and targets for radiotherapy sensitization in cancer [J]. Signal Transduct Target Ther, 2020,5(1): 60.
16	Kang SH, Bak DH, Chung BY, et al. Centipedegrass extract enhances radiosensitivity in melanoma cells by inducing G2/M cell cycle phase arrest [J]. Mol Biol Rep, 2021,48(2): 1081-1091.
17	Reynisdóttir I, Polyak K, Iavarone A, et al. Kip/Cip and Ink4 Cdk inhibitors cooperate to induce cell cycle arrest in response to TGF-beta [J]. Genes Dev, 1995,9(15): 1831-1845.
18	Derynck R, Budi EH. Specificity, versatility, and control of TGF-β family signaling [J]. Sci Signal, 2019,12(570): eaav5183.
19	Subbarayan K, Massa C, Lazaridou M F, et al. Identification of a novel miR-21-3p/TGF-beta signaling-driven immune escape via the MHC class I/biglycan axis in tumor cells [J]. Clin Transl Med, 2021,11(3): e306.
20	Lee YJ, Han Y, Lu HT, et al. TGF-beta suppresses IFN-gamma induction of class II MHC gene expression by inhibiting class II transactivator messenger RNA expression [J]. J Immunol, 1997,158(5): 2065-2075.
21	Du F, Qi X, Zhang A, et al. MRTF-A-NF-κB/p65 axis-mediated PDL1 transcription and expression contributes to immune evasion of non-small-cell lung cancer via TGF-β [J]. Exp Mol Med, 2021,53(9): 1366-1378.
22	Gorelik L, Flavell RA. Immune-mediated eradication of tumors through the blockade of transforming growth factor-beta signaling in T cells [J]. Nat Med, 2001,7(10): 1118-1122.
23	Sun X, Cui Y, Feng H, et al. TGF-beta signaling controls Foxp3 methylation and T reg cell differentiation by modulating Uhrf1 activity [J]. J Exp Med, 2019,216(12): 2819-2837.
24	Lainé A, Labiad O, Hernandez-Vargas H, et al. Regulatory T cells promote cancer immune-escape through integrin αvβ8-mediated TGF-β activation [J]. Nat Commun, 2021,12(1): 6228.
25	Zhang F, Wang H, Wang X, et al. TGF-beta induces M2-like macrophage polarization via SNAIL-mediated suppression of a pro-inflammatory phenotype [J]. Oncotarget, 2016,7(32): 52294-52306.
26	李旭, 黄尚科, 王玉珍, 等. 乳腺癌组织肿瘤相关巨噬细胞与肿瘤浸润转移的临床及病理关系[J/OL]. 中华临床医师杂志(电子版), 2017,11(18): 2217-2222. URL
27	张琪悦, 王晓东. IL-8与肿瘤免疫的研究进展 [J/OL]. 中华临床医师杂志(电子版), 2023,17(5): 605-613.
28	李晓梅, 叶红, 秦书明, 等. TMPRSS4通过上皮间质转化促进乳腺癌细胞的增殖、侵袭和转移[J/OL]. 中华临床医师杂志(电子版), 2018,12(5): 279-287.
29	Feng F, Zhao Z, Cai X, et al. Cyclin-dependent kinase subunit2 (CKS2) promotes malignant phenotypes and epithelial-mesenchymal transition-like process in glioma by activating TGFβ/SMAD signaling [J]. Cancer Med, 2023,12(5): 5889-5907.
30	Ebert MS, Neilson JR, Sharp PA. MicroRNA sponges: competitive inhibitors of small RNAs in mammalian cells [J]. Nat Methods, 2007,4(9): 721-726.
31	Su Y, Feng W, Shi J, et al. circRIP2 accelerates bladder cancer progression via miR-1305/Tgf-β2/smad3 pathway [J]. Mol Cancer, 2020,19(1): 23.
32	Esposito M, Fang C, Cook KC, et al. TGF-β-induced DACT1 biomolecular condensates repress Wnt signalling to promote bone metastasis [J]. Nat Cell Biol, 2021,23(3): 257-267.
33	Chen X, Yan N. Stachydrine inhibits TGF-β1-induced epithelial-mesenchymal transition in hepatocellular carcinoma cells through the TGF-β/Smad and PI3K/Akt/mTOR signaling pathways [J]. Anticancer Drugs, 2021,32(8): 786-792.
34	Lamouille S, Xu J, Derynck R. Molecular mechanisms of epithelial-mesenchymal transition [J]. Nat Rev Mol Cell Biol, 2014,15(3): 178-196.
35	Liu Y, He K, Hu Y, et al. YAP modulates TGF-β1-induced simultaneous apoptosis and EMT through upregulation of the EGF receptor [J]. Sci Rep, 2017,7: 45523.
36	Hao Y, Baker D, Ten D P. TGF-β-Mediated Epithelial-Mesenchymal Transition and Cancer Metastasis [J]. Int J Mol Sci, 2019,20(11): 2767.
37	Xue G, Restuccia DF, Lan Q, et al. Akt/PKB-mediated phosphorylation of Twist1 promotes tumor metastasis via mediating cross-talk between PI3K/Akt and TGF-β signaling axes [J]. Cancer Discov, 2012,2(3): 248-259.
38	刘蔚, 祝训浩, 王修竹. TGF-β促进胰腺癌发展的相关研究进展 [J]. 临床医学进展, 2022,12(12): 11405-11411.
39	庄乾伟, 刘广龙, 王丽珍, 等. 转TGF-β1基因小鼠体内放疗敏感性初步评价 [J]. 中国口腔颌面外科杂志, 2013,11(3): 183-191.
40	Aubrey BJ, Kelly GL, Janic A, et al. How does p53 induce apoptosis and how does this relate to p53-mediated tumour suppression? [J]. Cell Death Differ, 2018,25(1): 104-113.
41	Wei H, Wang H, Wang G, et al. Structures of p53/BCL-2 complex suggest a mechanism for p53 to antagonize BCL-2 activity [J]. Nat Commun, 2023,14(1): 4300.
42	Brentnall M, Rodriguez-Menocal L, De Guevara RL, et al. Caspase-9, caspase-3 and caspase-7 have distinct roles during intrinsic apoptosis [J]. BMC Cell Biol, 2013,14: 32.
43	Sheikh MS, Fornace AJ. Death and decoy receptors and p53-mediated apoptosis [J]. Leukemia, 2000,14(8): 1509-1513.
44	Ahmed MM, Alcock RA, Chendil D, et al. Restoration of transforming growth factor-beta signaling enhances radiosensitivity by altering the Bcl-2/Bax ratio in the p53 mutant pancreatic cancer cell line MIA PaCa-2 [J]. J Biol Chem, 2002,277(3): 2234-2246.
45	Shi X, Yang J, Deng S, et al. TGF-β signaling in the tumor metabolic microenvironment and targeted therapies [J]. J Hematol Oncol, 2022,15(1): 135.
46	Zhang Q, Yu N, Lee C. Mysteries of TGF-beta paradox in benign and malignant cells [J]. Front Oncol, 2014,4: 94.
47	Madhav A, Andres A, Duong F, et al. Antagonizing CD105 enhances radiation sensitivity in prostate cancer [J]. Oncogene, 2018,37(32): 4385-4397.
48	Konge J, Leteurtre F, Goislard M, et al. Breast cancer stem cell-like cells generated during TGFβ-induced EMT are radioresistant [J]. Oncotarget, 2018,9(34): 23519-23531.
49	Ehrhart EJ, Segarini P, Tsang ML, et al. Latent transforming growth factor beta1 activation in situ: quantitative and functional evidence after low-dose gamma-irradiation [J]. FASEB J, 1997,11(12): 991-1002.
50	Park SH, Kim JY, Kim JM, et al. PM014 attenuates radiation-induced pulmonary fibrosis via regulating NF-kB and TGF-b1/NOX4 pathways [J]. Sci Rep, 2020,10(1): 16112.
51	Ying H, Fang M, Hang QQ, et al. Pirfenidone modulates macrophage polarization and ameliorates radiation-induced lung fibrosis by inhibiting the TGF-β1/Smad3 pathway [J]. J Cell Mol Med, 2021,25(18): 8662-8675.
52	Tang Y, Yuan Q, Zhao C, et al. Targeting USP11 may alleviate radiation-induced pulmonary fibrosis by regulating endothelium tight junction [J]. Int J Radiat Biol, 2022,98(1): 30-40.
53	Zhen S, Qiang R, Lu J, et al. TGF-β1-based CRISPR/Cas9 Gene Therapy Attenuates Radiation-induced Lung Injury [J]. Curr Gene Ther, 2022,22(1): 59-65.
54	胡蝶. TGF-β3通过上皮间质转化抑制放射性肺纤维化及其机制研究 [D]. 广东药科大学, 2018.
55	Santibanez JF, Obradovic H, Kukolj T, et al. Transforming growth factor-beta, matrix metalloproteinases, and urokinase-type plasminogen activator interaction in the cancer epithelial to mesenchymal transition [J]. Dev Dyn, 2018,247(3): 382-395.
56	Broxmeyer H E. Associated guilt: radiation/bystanders[J]. Blood,2021,137(24):3314-3316.
57	Zhang J, Yao D, Zhang J, et al. TGF-β mediates thoracic radiation-induced abscopal effects of testis injury in rat [J]. Biochem Biophys Res Commun, 2019,514(3): 678-683.
58	Zhang YM, Zhang LY, Li YY, et al. Radiation-induced bystander effect on the genome of bone marrow mesenchymal stem cells in lung cancer [J]. Antioxid Redox Signal, 2023,38(10-12): 747-767.
59	Gu J, Sun Y, Song J, et al. Irradiation induces DJ-1 secretion from esophageal squamous cell carcinoma cells to accelerate metastasis of bystander cells via a TGF-β1 positive feedback loop [J]. J Exp Clin Cancer Res, 2022,41(1): 259.
60	Rodrigues-Junior DM, Tan SS, Lim SK, et al. Circulating extracellular vesicle-associated TGFbeta3 modulates response to cytotoxic therapy in head and neck squamous cell carcinoma [J]. Carcinogenesis, 2019,40(12): 1452-1461.
61	Schirmer MA, Mergler CP, Rave-Frank M, et al. Acute toxicity of radiochemotherapy in rectal cancer patients: a risk particularly for carriers of the TGFB1 Pro25 variant [J]. Int J Radiat Oncol Biol Phys, 2012,83(1): 149-157.
62	Mortensen R, Holmstrom MO, Lisle TL, et al. Pre-existing TGF-beta-specific T-cell immunity in patients with pancreatic cancer predicts survival after checkpoint inhibitors combined with radiotherapy [J]. J Immunother Cancer, 2023,11(3): e006432.
63	Reuther S, Szymczak S, Raabe A, et al. Association between SNPs in defined functional pathways and risk of early or late toxicity as well as individual radiosensitivity [J]. Strahlenther Onkol, 2015,191(1): 59-66.
64	Anscher MS, Marks LB, Shafman TD, et al. Using plasma transforming growth factor beta-1 during radiotherapy to select patients for dose escalation [J]. J Clin Oncol, 2001,19(17): 3758-3765.
65	Angele S, Romestaing P, Moullan N, et al. ATM haplotypes and cellular response to DNA damage: association with breast cancer risk and clinical radiosensitivity [J]. Cancer Res, 2003,63(24): 8717-8725.
66	Grossberg AJ, Lei X, Xu T, et al. Association of transforming growth factor beta polymorphism C-509T with radiation-induced fibrosis among patients with early-stage breast cancer: A secondary analysis of a randomized clinical trial [J]. JAMA Oncol, 2018,4(12): 1751-1757.
67	Bentzen SM, Skoczylas JZ, Overgaard M, et al. Radiotherapy-related lung fibrosis enhanced by tamoxifen [J]. J Natl Cancer Inst, 1996,88(13): 918-922.
68	Yamazaki T, Gunderson AJ, Gilchrist M, et al. Galunisertib plus neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: a single-arm, phase 2 trial [J]. Lancet Oncol, 2022,23(9): 1189-1200.
69	Wick A, Desjardins A, Suarez C, et al. Phase 1b/2a study of galunisertib, a small molecule inhibitor of transforming growth factor-beta receptor I, in combination with standard temozolomide-based radiochemotherapy in patients with newly diagnosed malignant glioma [J]. Invest New Drugs, 2020,38(5): 1570-1579.
70	Formenti SC, Lee P, Adams S, et al. Focal irradiation and systemic TGFbeta blockade in metastatic breast cancer [J]. Clin Cancer Res, 2018,24(11): 2493-2504.
71	Murphy JE, Wo JY, Ryan DP, et al. Total neoadjuvant therapy with Folfirinox in combination with losartan followed by chemoradiotherapy for locally advanced pancreatic cancer: A phase 2 clinical trial [J]. JAMA Oncol, 2019,5(7): 1020-1027.

联合使用放疗的药物	可能涉及的潜在机制	年份	研究内容或结果	试验ID
Galunisertib	抑制TβRI/ALK5	2022	局晚期直肠癌的新辅助放化疗加入Galunisertib后CR率提高至32%，且耐受性良好^[68]。	NCT02688712
Galunisertib	抑制TβRI/ALK5	2020	Galunisertib联合基于替莫唑胺的标准放化疗改善胶质母细胞瘤患者的PFS，且安全性良好^[69]。	NCT01220271
Fresolimumab	中断IDO-Treg-MDSC轴	2018	转移性乳腺癌放疗期间使用高剂量（10 mg/kg）Fresolimumab可延长OS，并导致良好的全身免疫反应^[70]。	NCT01401062
Losartan	通过RAS从而抑制TGF-β通路的激活	2019	FOLFIRINOX、Losartan和放化疗的新辅助治疗可降低局部晚期胰腺导管腺癌的分期，且切缘阴性率为61%^[71]。	NCT01821729
PD-L1/TGF-ßRII双抗	同时抑制TGF-β和PD-L1	2020	评估PD-L1/TGF-βRII联合放疗用于食管鳞癌新辅助治疗的有效性和安全性。	NCT04481256
PD-L1/TGF-ßRII双抗	同时抑制TGF-β和PD-L1	2020	评估Bintrafusp alfa联合根治性放化疗（卡铂、紫杉醇和放疗）治疗食管或胃食管交界处鳞状细胞癌患者的可行性。	NCT04481256
Captopril	阻断TGF-β分泌	2018	评估TGF-ß在腹部放射损伤中的作用及Captopril阻断TGF-ß对正常组织的保护作用。	NCT03613506
Fresolimumab	中和TGFβ1、TGFβ2和TGFβ3亚型	2015	评估Fresolimumab联合立体定向消融放疗对早期NSCLC的有效性和安全性。	NCT02581787

联合使用放疗的药物	可能涉及的潜在机制	年份	研究内容或结果	试验ID
Galunisertib	抑制TβRI/ALK5	2022	局晚期直肠癌的新辅助放化疗加入Galunisertib后CR率提高至32%，且耐受性良好^[68]。	NCT02688712
Galunisertib	抑制TβRI/ALK5	2020	Galunisertib联合基于替莫唑胺的标准放化疗改善胶质母细胞瘤患者的PFS，且安全性良好^[69]。	NCT01220271
Fresolimumab	中断IDO-Treg-MDSC轴	2018	转移性乳腺癌放疗期间使用高剂量（10 mg/kg）Fresolimumab可延长OS，并导致良好的全身免疫反应^[70]。	NCT01401062
Losartan	通过RAS从而抑制TGF-β通路的激活	2019	FOLFIRINOX、Losartan和放化疗的新辅助治疗可降低局部晚期胰腺导管腺癌的分期，且切缘阴性率为61%^[71]。	NCT01821729
PD-L1/TGF-ßRII双抗	同时抑制TGF-β和PD-L1	2020	评估PD-L1/TGF-βRII联合放疗用于食管鳞癌新辅助治疗的有效性和安全性。	NCT04481256
PD-L1/TGF-ßRII双抗	同时抑制TGF-β和PD-L1	2020	评估Bintrafusp alfa联合根治性放化疗（卡铂、紫杉醇和放疗）治疗食管或胃食管交界处鳞状细胞癌患者的可行性。	NCT04481256
Captopril	阻断TGF-β分泌	2018	评估TGF-ß在腹部放射损伤中的作用及Captopril阻断TGF-ß对正常组织的保护作用。	NCT03613506
Fresolimumab	中和TGFβ1、TGFβ2和TGFβ3亚型	2015	评估Fresolimumab联合立体定向消融放疗对早期NSCLC的有效性和安全性。	NCT02581787

[1]	Yan Zhang, Chunmei Liu, Jin Yao, Miaomiao Chen, Wen Xu, Pintong Huang. Value of ultrasound O-RADS classification and clinical characteristics in diagnosis of ovarian serous tumors of different pathological types [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(03): 268-274.
[2]	Minhua Luo, Wenping Wang, Wentao Kong. Contrast-enhanced ultrasound findings of hepatic inflammatory pseudotumors and their diagnostic value [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(03): 297-303.
[3]	Xiangjun Chen, Li Yu, Xing Wang, Junqing Liang, Di Wu, Zhijun Li. Clinical efficacy study of different methods combined with radiotherapy in the repair of thin keloid [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(03): 215-222.
[4]	DaRebai· ReDati, Lin Liu, Weimin Zhao, Tao Meng, Cheng Lei, Bo Jin, Jianjun Bi, Xinyu Li, Haijiang Wang. Clinical observation of lateral lymph node dissection after neoadjuvant chemoradiotherapy for middle and low rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(04): 415-418.
[5]	Yexin Shi, Xiang Ma, Ming Lu, Qingcheng Xia, Pengchao Wang, Qingyu Song, Qinghong Zhao. Research progress of colorectal tumor localization under laparoscopy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(04): 463-466.
[6]	Guodong Zhao, Jinjun Lu, Yongqiang Xu. Clinical effect and experience summary of laparoscopic low anterior rectal resection with different submesenteric artery types [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 334-337.
[7]	Zuodu Xie, Xiaxing Deng. Research and application of Da Vinci robot in pancreatic surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 346-348.
[8]	Hui Zhang, Yi Li, Meiling Dai. Progress in the application of implants in breast reconstruction [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 349-352.
[9]	Nan Deng, Ping Liu. Multidisciplinary consultation on difficult cases in Urology of the Guangdong Medical Association (Phase 14): Malignant tumor of the left renal pelvis and massive hydronephrosis of the left kidney [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 296-299.
[10]	Chao Zhang, Fei Guo, Fubo Wang, Chen Ye, Yue Yang, Bo Yang. Laparoscopic partial nephrectomy: a new choice for the treatment of renal cancer with renal vein tumor thrombus [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 219-224.
[11]	Huiyu Zhou, Dingyang Lyu, Weibing Shuang. Combined systemic immune-inflammatory index and prognostic nutritional index predicts prognosis in patients with renal cell carcinoma undergoing laparoscopic nephrectomy [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 225-231.
[12]	Huanhuan Ma, Chenhui Ma, Xiaobo Deng, Bofang Wang, Puyi He, Yunpeng Wang, Bo Xu, Rong Yu, Na Wang, Hao Chen. Research progress in evaluation systems of solid tumor response for malignant solid liver tumors [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(03): 377-383.
[13]	Wenyuan Zhao, Yuting Tian, Jihai Zhang, Jun Zhang. Value of CT tumor volume measurement parameters combined with laboratory indexes in guiding preoperative staging prediction in patients with colon cancer [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(04): 306-309.
[14]	Wei Duan, Fei Liu, Guangyuan Xu, Yuhao Cheng, Xing Chen. Effect of different dosimetric parameters of intensity modulated radiotherapy plans for esophageal cancer on the occurrence and severity of radiation pneumonia [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(04): 320-324.
[15]	Haiqiang Chu, Yuanyou Yang, Gang Ren. Progress in research of radiotherapy-based combined therapy for pancreatic cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(04): 392-396.

Please choose a citation manager

Content to export