非小细胞肺癌术后放射治疗纵隔移位研究

doi:10.3760/cma.j.cn113030-20211026-00432

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摘要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N2期和R1-2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、Kruskal-Wallis、χ²检验统计分析,受试者工作特征(ROC)曲线计算临界值。结果纳入患者PORT流程中X(前后)、Y (左右)、Z(上下)方向纵隔移位分别为 0.04~0.53、0.00~0.84、0.00~1.27cm,纵隔移位距离的大小顺序分别为Z>Y>X;ROC曲线计算临界值分别为0.263、0.352、0.405,>临界值者分别为25(25%)、30(30%)、30例(30%),纵隔三维方向移位不同(P=0.007、<0.001、<0.001);X、Y、Z方向的纵隔移位与切除部位(P=0.355、0.239、0.256)、手术方式(P=0.241、0.110、0.064)均相近。全组纵隔移位>和≤临界值、放疗中程模拟(m-S)后修改和原计划放疗的比较分析显示PORT患者放射性食管炎(RE)、放射性肺炎发生率均相近(均 P>0.05);但m-S后修改计划病例≥3级RE的发生率显著低于原计划PORT患者,分别为0、7%(P<0.001)。结论 NSCLC根治术后N2期和/或R1-2切除病例的PORT流程中存在纵隔移位,20%~30%患者发生明显的移动,PORT流程中期重新定位并修改靶区和放疗计划对质量保证和质量控制有利。

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	张炜
	张毅
	洪卫
	欧阳伟炜
	苏胜发
	马筑
	李青松
	杨文刚
	陈霞霞
	刘杰
	卢冰

关键词 ：纵隔移动, 癌,非小细胞肺/术后放疗, 质量保证, 质量控制

Abstract：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.

Key words： Mediastinal displacement Carcinoma, non-small cell lung/postoperative radiotherapy Quality assurance Quality control

收稿日期: 2021-10-26

基金资助:2018年贵州省卫生计生委科学基金项目(gzwjkj2018-1-006)

通讯作者: 卢冰,Email:lbgymaaaa＠163.com

引用本文:

张炜,张毅,洪卫等. 非小细胞肺癌术后放射治疗纵隔移位研究[J]. 中华放射肿瘤学杂志, 2022, 31(3): 242-247.

Zhang Wei,Zhang Yi,Hong Wei et al. Study on quality control of mediastinal shift radiotherapy with target volume after operation for non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(3): 242-247.

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