Barbera Lisa, Paszat Lawrence, Thomas Gillian, Covens Al, Fyles Anthony, Elit Laurie, Qiu Feng
Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2006 Apr 1;64(5):1389-94. doi: 10.1016/j.ijrobp.2005.09.046. Epub 2006 Jan 18.
In 1999, a series of clinical trials along with a clinical announcement from the National Cancer Institute (NCI) suggested that chemotherapy should be used concurrently with pelvic radiation in the management of cervical cancer. The purpose of this study is to examine the rate of chemotherapy use, in the province of Ontario, before and after these publications.
All incident cases of cervix cancer diagnosed between January 1, 1995, and March 31, 2001, were identified using the provincial cancer registry. These records were electronically linked to billing claims data and inpatient discharge abstract data. Patients receiving brachytherapy within 6 months of diagnosis were identified. The proportion receiving at least one injection of chemotherapy before brachytherapy was identified and compared in the "pre" and "post" publication group (April 1, 1999, cutoff).
We identified 1039 cases as receiving curative radiation. In the pre cohort, 9.4% of patients received chemotherapy (95% CI, 7.3-11.4%) vs. 67.4% in the post cohort (95% CI, 61.8-73.0%). The change occurred abruptly in the first quarter of 1999.
There was a significant increase in chemotherapy use after the publication of the NCI alert and related trials. Reasons for rapid uptake are discussed.
1999年，一系列临床试验以及美国国立癌症研究所（NCI）发布的一份临床声明表明，在宫颈癌治疗中，化疗应与盆腔放疗同时使用。本研究的目的是调查安大略省在这些出版物发表前后化疗的使用比例。
利用省级癌症登记处，确定了1995年1月1日至2001年3月31日期间诊断出的所有宫颈癌新发病例。这些记录与计费索赔数据和住院出院摘要数据进行了电子链接。确定了在诊断后6个月内接受近距离放疗的患者。确定并比较了在出版物发表“前”和“后”组（截止日期为1999年4月1日）中，在近距离放疗前接受至少一次化疗注射的患者比例。
我们确定了1039例接受根治性放疗的病例。在前一组中，9.4%的患者接受了化疗（95%可信区间，7.3 - 11.4%），而后一组为67.4%（95%可信区间，61.8 - 73.0%）。这种变化在1999年第一季度突然发生。
NCI警报及相关试验发表后，化疗的使用显著增加。讨论了快速采用化疗的原因。
