目的:本研究旨在评估纵隔的移位模式,包括非小细胞肺癌(NSCLC)术后放疗(PORT)过程中的靶体积和等中心点,并观察辐射损伤的发生。此外,我们调查了在实施PORT过程中中期评估的重要性.
方法:我们根据骨骼解剖建立了坐标轴,并测量了纵隔的三维方向和等中心点在PORT过程中的位移。使用Wilcoxon进行统计分析,Kruskal-Wallis,和卡方检验。P<0.05被认为具有统计学意义。
结果:在这项研究中,对患者的分析显示,前纵隔和后纵隔的移位(X),左纵隔和右纵隔(Y),上纵隔和下纵隔(Z),前后等中心点(Xi),而PORT过程中左右等中心点(Yi)分别为0.04-0.53,0.00-0.84,0.00-1.27,0.01-0.86,0.00-0.66cm,分别。纵隔移位距离为Z>Y>X,等中心点的位移距离为Xi>Yi。根据ROC曲线,截止值分别为0.263、0.352、0.405、0.238和0.258,比25例(25%)的临界值更显著,30例(30%),30例(30%),17例(17%),15例(15%)。此外,纵隔和等中心点的移位存在显着差异(所有P=0.00)。Kruskal-Wallis检验显示纵隔移位与X,Y,和Z方向(P=0.355,P=0.239,P=0.256),手术方法(P=0.241,P=0.110,P=0.064)。PORT患者RE、RP发生率差异无统计学意义(P>0.05)。无III-IVRP发生。然而,M-S后改良计划病例中≥III级RE的发生率明显低于原始PORT患者,0%和7%,分别为(P=0.000)。
结论:结论:这项研究提供了证据,纵隔移位是NSCLC根治性切除术后N2期或R1-2期切除患者PORT过程中的潜在并发症.这种转变影响了大约20-30%的患者,表现为对正常组织的实际辐射损伤和降低局部控制率。因此,中期重新定位PORT,修订靶区和放射治疗计划有助于在NSCLC患者治疗期间维持QA和QC,并可能改善患者预后.
OBJECTIVE: This study aimed to assess the shifting patterns of the mediastinum, including the target volume and the isocenter point during the postoperative radiotherapy (PORT) process of non-small cell lung cancer (NSCLC), and to observe the occurrence of radiation injury. Additionally, we investigated the significance of mid-term assessment during the implementation of the PORT process.
METHODS: We established coordinate axes based on bone anatomy and measured the mediastinum\'s three-dimensional direction and the shift of the isocenter point\'s shift in the PORT process. Statistical analysis was performed using Wilcoxon, Kruskal-Wallis, and the Chi-square test. P<0.05 was considered statistically significant.
RESULTS: In this study, the analysis of patients revealed that the shift of anterior and posterior mediastinum (X), left and right mediastinum (Y), upper and lower mediastinum (Z), anterior and posterior isocenter point (Xi), and the left and right isocenter points (Yi) in the PORT process were 0.04-0.53, 0.00-0.84, 0.00-1.27, 0.01-0.86, and 0.00-0.66cm, respectively. The shift distance of the mediastinum was Z>Y>X, and the shift distance of the isocenter point was Xi>Yi. According to the ROC curve, the cut-off values were 0.263, 0.352, 0.405, 0.238, and 0.258, respectively, which were more significant than the cut-off values in 25 cases (25%), 30 cases (30%), 30 cases (30%), 17 cases (17%), and 15 cases (15%). In addition, there was a significant difference in the shift of the mediastinum and the isocenter point (all P=0.00). Kruskal-Wallis test showed no statistically significant difference between mediastinal shift and resection site in X, Y, and Z directions (P=0.355, P=0.239, P=0.256), surgical method (P=0.241, P=0.110, P=0.064). There was no significant difference in the incidence of RE and RP in PORT patients (P>0.05). No III-IV RP occurred. However, the incidence of ≥ grade III RE in the modified plan cases after M-S was significantly lower than in the original PORT patients, 0% and 7%, respectively (P=0.000).
CONCLUSIONS: In conclusion, this study provides evidence that mediastinal shift is a potential complication during the PORT process for patients with N2 stage or R1-2 resection following radical resection of NSCLC. This shift affects about 20-30% of patients, manifesting as actual radiation damage to normal tissue and reducing the local control rate. Therefore, mid-term repositioning of the PORT and revision of the target volume and radiation therapy plan can aid in maintaining QA and QC during the treatment of NSCLC patients and may result in improved patient outcomes.