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2005 年至 2007 年治疗宫颈癌未手术患者的放射治疗实践模式:放射肿瘤学质量研究。

Patterns of radiation therapy practice for patients treated for intact cervical cancer in 2005 to 2007: a quality research in radiation oncology study.

机构信息

Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

American College of Radiology Clinical Research Center, Philadelphia, Pennsylvania.

出版信息

Int J Radiat Oncol Biol Phys. 2014 Jun 1;89(2):249-56. doi: 10.1016/j.ijrobp.2013.11.228. Epub 2014 Jan 7.

Abstract

PURPOSE

To assess practice patterns and compliance with clinical performance measures for radiation therapy (RT) for patients with intact carcinoma of the cervix.

METHODS AND MATERIALS

Trained research associates reviewed the records of 261 randomly selected patients who received RT for cervix carcinoma between 2005 and 2007 from 45 facilities randomly selected after stratification by practice type. National estimates of patient and treatment characteristics were calculated from survey data using SUDAAN statistical software.

RESULTS

From the survey data, we estimated that only 8% of US facilities treated on average more than 3 eligible patients per year. No small or medium nonacademic facilities in the survey treated more than 3 eligible patients per year. Approximately 65.5% of patients began treatment in a facility that treated 3 or fewer eligible patients per year. Although 87.5% of patients had brachytherapy as part of their treatment, the proportion treated with external beam RT only was about double that estimated from the 1996 to 1999 survey. The use of high-dose-rate brachytherapy sharply increased, particularly in small nonacademic facilities. Overall, patients treated in nonacademic facilities were more likely to have incomplete or protracted treatment; 43% of patients treated in small nonacademic facilities did not have treatment completed within 10 weeks. Also, patients treated in facilities that treated 3 or fewer eligible patients per year were significantly less likely to receive concurrent chemotherapy than were patients treated in other facilities.

CONCLUSION

Survey results indicate a disturbingly high rate of noncompliance with established criteria for high-quality care of patients with cervical cancer. Noncompliance rates are particularly high in nonacademic facilities, especially those that treat relatively few patients with intact cervical cancer.

摘要

目的

评估接受完整宫颈癌放射治疗(RT)患者的治疗模式和临床绩效指标的依从性。

方法与材料

经过培训的研究助理对 2005 年至 2007 年期间从 45 家随机分层的实践类型机构中随机选择的 261 名接受 RT 治疗的宫颈癌患者的病历进行了回顾。使用 SUDAAN 统计软件从调查数据中计算了患者和治疗特征的全国估计值。

结果

根据调查数据,我们估计只有 8%的美国机构平均每年治疗超过 3 名合格患者。在调查中没有小或中等规模的非学术机构每年治疗超过 3 名合格患者。大约 65.5%的患者在每年治疗 3 名或更少合格患者的机构开始治疗。尽管 87.5%的患者接受了近距离放疗作为治疗的一部分,但仅接受外照射 RT 治疗的比例约为 1996 年至 1999 年调查的两倍。高剂量率近距离放疗的使用急剧增加,尤其是在小型非学术机构中。总体而言,在非学术机构中接受治疗的患者更有可能治疗不完整或延长;43%在小型非学术机构接受治疗的患者在 10 周内未完成治疗。此外,在每年治疗 3 名或更少合格患者的机构中接受治疗的患者接受同期化疗的可能性明显低于在其他机构中接受治疗的患者。

结论

调查结果表明,不遵守既定高质量宫颈癌患者治疗标准的情况令人不安地高。非学术机构,尤其是治疗相对较少完整宫颈癌患者的机构,不遵守率特别高。

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