Price Stephen J, Whittle Ian R, Ashkan Keyoumars, Grundy Paul, Cruickshank Garth
Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Br J Neurosurg. 2012 Jun;26(3):331-5. doi: 10.3109/02688697.2012.673651. Epub 2012 Apr 6.
Multidisciplinary team (MDT) working in oncology aims to improve outcomes for patients with cancer. One role is to ensure the implementation of best practice and National Institute for Health and Clinical Excellence (NICE) guidance. In this study, we have assessed the role of MDT in implementing the TA121 appraisal of the use of carmustine wafers in high grade gliomas.
296 patients with high-grade glioma suitable for maximal resection were recruited from 17 Neurosurgical Centres. The number of patients treated with carmustine wafers and reasons for not using this were recorded. Complications at 48 hours post-operatively and at 6 weeks post-radiotherapy were recorded.
94/296 (32%) of suitable patients received carmustine wafers. In 55% of cases carmustine was not used due to either surgeon preference or a lack of an MDT decision. There was no increased complication rate with carmustine use at either 48 hours post-surgery or at 6 weeks post radiotherapy. Use of carmustine wafers did not decrease access to and use of chemoradiotherapy.
One third of patients suitable for carmustine wafers received them. Their use was neither associated with more frequent complications, nor decreased use of chemoradiotherapy. Implementation of NICE TA121 Guidance is extremely variable in different MDTs across the United Kingdom.
肿瘤学领域的多学科团队（MDT）工作旨在改善癌症患者的治疗效果。其中一个作用是确保最佳实践和英国国家卫生与临床优化研究所（NICE）指南的实施。在本研究中，我们评估了MDT在实施关于卡莫司汀晶片用于高级别胶质瘤的TA121评估中的作用。
从17个神经外科中心招募了296例适合进行最大程度切除的高级别胶质瘤患者。记录接受卡莫司汀晶片治疗的患者数量以及未使用该药的原因。记录术后48小时和放疗后6周的并发症情况。
94/296（32%）例适合的患者接受了卡莫司汀晶片治疗。在55%的病例中，未使用卡莫司汀是由于外科医生的偏好或缺乏MDT的决策。在术后48小时或放疗后6周，使用卡莫司汀并未增加并发症发生率。使用卡莫司汀晶片并未减少放化疗的可及性和使用率。
三分之一适合使用卡莫司汀晶片的患者接受了该药治疗。其使用既未导致更频繁的并发症，也未降低放化疗的使用率。在英国不同的MDT中，NICE TA121指南的实施差异极大。
