Miles Elizabeth A, Clark Catharine H, Urbano M Teresa Guerrero, Bidmead Margaret, Dearnaley David P, Harrington Kevin J, A'Hern Roger, Nutting Christopher M
Radiotherapy Department, Royal Marsden NHS Foundation Trust, London and Sutton, UK.
Radiother Oncol. 2005 Dec;77(3):241-6. doi: 10.1016/j.radonc.2005.10.011. Epub 2005 Nov 17.
Intensity modulated radiotherapy (IMRT) at the Royal Marsden Hospital London was introduced in July 2001. Treatment delivery was dynamic using a single-phase technique. Concerns were raised regarding increased clinical workload due to introduction of new technology. The potential increased use of resources was assessed.
IMRT patient selection was within guidelines of clinical trials and included patients undergoing prostate plus pelvic lymph node (PPN) irradiation and head and neck cancer (HNC) treatment. Patient planning, quality assurance and treatment times were collected for an initial IMRT patient group. A comparative group of patients with advanced HNC undergoing two- or three-phase conventional radiotherapy, requiring matched photon and electron fields, were also timed.
The median overall total planning time for IMRT was greater for HNC patients compared to the PPN cohort. For HNC the overall IMRT planning time was significantly longer than for conventional. The median treatment time for conventional two- or three-phase HNC treatments, encompassing similar volumes to those treated with IMRT, was greater than that for the IMRT HNC patient cohort. A reduction in radiographer man hours per patient of 4.8h was recorded whereas physics time was increased by 4.9h per patient.
IMRT currently increases overall planning time. Additional clinician input is required for target volume localisation. Physics time is increased, a significant component of this being patient specific QA. Radiographer time is decreased. For HNC a single phase IMRT treatment has proven to be more efficient than a multiple phase conventional treatment. IMRT has been integrated smoothly and efficiently into the existing treatment working day. This preliminary study suggests that IMRT could be a routine treatment with efficient use of current radiotherapy resources.
伦敦皇家马斯登医院于2001年7月引入调强放射治疗（IMRT）。治疗采用单相技术动态实施。新技术的引入引发了对临床工作量增加的担忧。对潜在的资源使用增加情况进行了评估。
IMRT患者的选择遵循临床试验指南，包括接受前列腺加盆腔淋巴结（PPN）照射和头颈癌（HNC）治疗的患者。收集了初始IMRT患者组的患者计划、质量保证和治疗时间。还对一组接受两阶段或三阶段传统放疗、需要匹配光子和电子野的晚期HNC患者进行了计时。
与PPN队列相比，HNC患者IMRT的总体中位总计划时间更长。对于HNC，IMRT的总体计划时间明显长于传统放疗。与IMRT治疗的HNC患者队列相比，涵盖与IMRT治疗相似体积的传统两阶段或三阶段HNC治疗的中位治疗时间更长。记录显示每位患者的放射技师工时减少了4.8小时，而物理师时间每位患者增加了4.9小时。
目前IMRT增加了总体计划时间。靶区定位需要额外的临床医生投入。物理师时间增加，其中很大一部分是针对患者的质量保证。放射技师时间减少。对于HNC，已证明单相IMRT治疗比多阶段传统治疗更有效。IMRT已顺利且高效地融入现有的治疗工作日。这项初步研究表明，IMRT可以在有效利用现有放疗资源的情况下成为常规治疗方法。
