Delaney Geoff, Barton Michael, Jacob Susannah
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney, New South Wales, Australia.
Cancer. 2004 Mar 15;100(6):1293-301. doi: 10.1002/cncr.20092.
Radiotherapy is not used commonly in the treatment of patients with malignant melanoma. The benchmark optimal radiotherapy utilization rates for melanoma are largely unknown, despite the fact that melanoma is a very common cancer.
To develop an evidence-based benchmark for the optimal proportion of patients with melanoma who should receive radiotherapy, the authors reviewed major treatment guidelines for melanoma. A radiotherapy decision tree was constructed showing the clinical features of melanoma patients for whom radiotherapy was indicated based on evidence. The proportions of melanoma patients with indications for radiotherapy were obtained from epidemiologic data and were used to calculate the optimal proportion of melanoma patients who should receive radiotherapy.
The proportion of patients with melanoma for whom radiotherapy is indicated at some point in their illness, according to the best available evidence, was calculated at 23% of all melanoma patients. The utilization rates of radiotherapy for melanoma recorded in actual practice were 13% in New South Wales, 6% in data from the American College of Surgeons, and 1% according to Surveillance, Epidemiology, and End Results data.
Strategies for implementing the evidence-based guidelines are recommended to overcome the shortfall in the use of radiotherapy in the treatment of patients with melanoma.
放射疗法在恶性黑色素瘤患者的治疗中并不常用。尽管黑色素瘤是一种非常常见的癌症，但黑色素瘤的最佳放射治疗利用率基准在很大程度上尚不清楚。
为了制定基于证据的黑色素瘤患者接受放射治疗的最佳比例基准，作者回顾了黑色素瘤的主要治疗指南。构建了一个放射治疗决策树，展示了基于证据表明需要放射治疗的黑色素瘤患者的临床特征。从流行病学数据中获取有放射治疗指征的黑色素瘤患者比例，并用于计算应接受放射治疗的黑色素瘤患者的最佳比例。
根据现有最佳证据，在疾病的某个阶段有放射治疗指征的黑色素瘤患者比例计算为所有黑色素瘤患者的23%。实际实践中记录的黑色素瘤放射治疗利用率在新南威尔士州为13%，在美国外科医师学会的数据中为6%，根据监测、流行病学和最终结果数据为1%。
建议实施基于证据的指南的策略，以克服黑色素瘤患者治疗中放射治疗使用不足的问题。
