非小细胞肺癌术后放射治疗纵隔移位研究

目的:分析非小细胞肺癌(NSCLC)术后放疗(PORT)流程中含靶区纵隔移位规律和实施中期评估的价值。方法:100例NSCLC术后N 2期和R 1-2切除并任何N期患者，以骨性解剖建立坐标轴，测量纵隔三维方向在PORT流程中的移位规律。采用 WilCoxon、 Krusk...

Study on quality control of mediastinal shift radiotherapy with target volume after operation for non-small cell lung cancer

Objective To analyze the mediastinal displacement of target volume in the postoperative radiotherapy (PORT) process for non-small cell lung cancer (NSCLC) and the value of mid-term evaluation. Methods For 100 patients with postoperativeN2stage NSCLC, R1-2 and any N staging, bone anatomy was utilized to measure the change of the first and second CT localization on the same level. Statistical analysis were performed using the WilCoxon, Kruskal-Wallis and χ² tests. The cut-off values were calculated with the receiver operating characteristic (ROC) curve. Results Among the included patients, in the PORT process, the mediastinal displacement in the x (front and rear), Y (left and right) and Z (upper and lower) directions were 0.04-0.53cm, 0.00-0.84cm and 0.00-1.27cm, respectively, and the order of mediastinal displacement distance wasz >Y>X, respectively. According to the ROC curve calculation, the cut-off values were 0.263, 0.352 and 0.405, respectively, which were greater than the cut-off values in 25 cases (25%), 30 cases (30%) and 30 cases (30%), respectively. There was significant difference in the three-dimensionalmediastinal displacement (P=0.007,<0.001 and<0.001). The mediastinal displacement in thex, Y and Z directions had no statistical significance regarding resection site (P=0.355, 0.239 and 0.256) and operation mode (P=0.241, 0.110 and 0.064). Comparative analysis of modified whole group mediastinal shift> and cut-off values, medium-simulation (m-S) and the originally planned radiotherapy shown that there was no significant difference in the incidence of radiation esophagitis (RE) and radiation pneumonitis in PORT patients (all P>0.05);however, the incidence of ≥grade 3 RE in the modified plan after m-S was significantly lower than that in the originally planned PORT patients, which were 0 and 7%, respectively (P<0.001). Conclusions Mediastinal displacement exists in the PORT process of N2 or/and R1-2 cases after radical operation of NSCLC, and obvious movement occurs in 20%-30% of patients. Relocating and modifying the target volume and radiotherapy plan in the middle of the PORT process is beneficial to quality assurance and quality control.