Delaney Geoff, Jacob Susannah, Barton Michael
Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia.
Cancer. 2005 Jun 1;103(11):2216-27. doi: 10.1002/cncr.21084.
Radiotherapy is used commonly in the treatment of patients with head and neck carcinoma. The benchmark radiotherapy utilization rates for head and neck carcinoma largely are unknown. The objective of the current study was to determine the optimal radiotherapy utilization rate for patients with head and neck carcinoma and to compare this optimal rate with actual utilization rates where actual utilization data were available.
An optimal radiotherapy utilization tree was constructed that depicted all patients with head and neck carcinoma in whom radiotherapy was indicated according to evidence-based treatment guidelines. The proportions of patients with clinical attributes that indicated possible benefit from radiotherapy were obtained from epidemiological data and were inserted into the utilization tree. The optimal proportion of patients with carcinoma of the head and neck who should receive radiotherapy was calculated by merging the evidence-based recommendations with the epidemiological data in the tree. Optimal rates of radiotherapy utilization were compared with actual rates obtained from population-based studies.
Radiotherapy was indicated at some point during their illness in 74% of all patients with head and neck carcinoma. By subsite, the optimal radiotherapy utilization rates were oral cavity, 74%; lip, 20%; larynx, 100%; oropharynx, 100%; salivary gland, 87%; hypopharynx, 100%; nasopharynx, 100%; paranasal sinuses, 100%; and unknown squamous cell carcinoma of the head and neck, 90%. All treatment recommendations were based on Level III or IV evidence. Assessment of actual radiotherapy utilization rates indicated an increased use of radiotherapy over time for head and neck carcinoma. However, there also were some decreases in the use of radiotherapy for some carcinoma subsites over the past 20 years, despite the lower actual rates compared with the optimal rates. The reasons for these reductions in use were not identified.
The actual radiotherapy utilization rate for patients with head and neck carcinoma corresponded reasonably closely to the optimal rate for some populations but also identified some shortfalls for other patient groups. The results of this study provide a way of assessing shortfalls in radiotherapy.
放射治疗常用于头颈部癌患者的治疗。头颈部癌的基准放射治疗利用率在很大程度上尚不清楚。本研究的目的是确定头颈部癌患者的最佳放射治疗利用率，并将这一最佳利用率与可获得实际利用数据的实际利用率进行比较。
构建了一个最佳放射治疗利用树，描绘了所有根据循证治疗指南表明需要放射治疗的头颈部癌患者。从流行病学数据中获取表明可能从放射治疗中获益的具有临床特征的患者比例，并将其插入利用树中。通过将循证建议与树中的流行病学数据相结合，计算出头颈部癌患者应接受放射治疗的最佳比例。将最佳放射治疗利用率与基于人群研究获得的实际利用率进行比较。
在所有头颈部癌患者中，74%在病程中的某个时间点需要放射治疗。按亚部位划分，最佳放射治疗利用率分别为：口腔，74%；唇，20%；喉，100%；口咽，100%；唾液腺，87%；下咽，100%；鼻咽，100%；鼻窦，100%；以及头颈部未知鳞状细胞癌，90%。所有治疗建议均基于III级或IV级证据。对实际放射治疗利用率的评估表明，头颈部癌的放射治疗使用量随时间增加。然而，尽管实际利用率低于最佳利用率，但在过去20年中，某些癌亚部位的放射治疗使用量也有所下降。这些使用量减少的原因尚不清楚。
头颈部癌患者的实际放射治疗利用率与某些人群的最佳利用率相当接近，但也发现了其他患者群体存在的一些不足。本研究结果提供了一种评估放射治疗不足的方法。
