Expósito José, Linares Isabel, Castillo Isabel, Martínez Miguel, Vargas Pilar, Herruzo Ismael, Medina José Antonio, Palacios Amalia, Bayo Eloísa, Peracaula Francisco, Jaén Javier, Sánchez José Antonio, Ortiz María José
Radiotherapy and Oncology Department, Granada General Hospital, Avda. fuerzas Armadas, s/n, 18014, Granada, Spain.
Radiotherapy and Oncology Department, Granada General Hospital, Calle Dr. Oloriz, 16, 18012, Granada, Spain.
Radiat Oncol. 2015 Dec 30;10:265. doi: 10.1186/s13014-015-0572-8.
Around 27,000 new cases of prostate cancer are diagnosed every year in Spain and 5400 die from this disease. Radiotherapy (RT), alone or combined, has proven to be effective as initial treatment in patients with localized disease. Our objective was to evaluate the use of external beam RT (EBRT) in our region, comparing the indication rate and irradiation rate and examining variability in its application among hospitals.
We conducted a review of RT guidelines and indication studies for prostate cancer (% expected irradiation). Data were gathered from all twelve public healthcare centers in Andalusia (Spain) on RT-treated prostate cancer patients during 2013 (% actual irradiation) and from nine of the centers on RT discharge reports. Information was classified according to type of hospital, tumor risk category and RT treatment (technique, dosage, volume, toxicity).
The estimated RT rate was 67 % (1289/1917), 43 % were aged > 70 years, 44.7 % had ECOG performance status of 0); 44.7 % had high-risk tumors; 57 % underwent RT associated with hormone therapy; 70 % of patients receiving RT were treated with 3D planning (30 % IGRT); and doses were 70-76 Gy in 70 % of cases and >76 Gy in 10.7 %. Acute gastrointestinal and genitourinary toxicities were < grade 2 in 79 and 89 % of patients, respectively. An irradiation rate significantly below the mean for the study was found in four provinces. There was a significant difference among provinces in the distribution of risk groups.
Underutilization of EBRT was estimated to be around 30 % in prostate cancer patients, with an elevated variability in irradiation rates among hospitals related to differences in available technology and in the distribution of patients with different risk levels. These data should be a matter of concern to regional health managers, given the negative and measurable impact on the survival of patients.
在西班牙，每年约有27000例前列腺癌新发病例，5400人死于该病。放射治疗（RT），单独使用或联合使用，已被证明是局部疾病患者初始治疗的有效方法。我们的目的是评估我们地区外照射放疗（EBRT）的使用情况，比较适应证率和照射率，并检查各医院在其应用中的差异。
我们对前列腺癌的放疗指南和适应证研究（预期照射百分比）进行了回顾。数据收集自安达卢西亚（西班牙）的所有12个公共医疗中心，关于2013年接受放疗的前列腺癌患者（实际照射百分比），以及9个中心的放疗出院报告。信息根据医院类型、肿瘤风险类别和放疗治疗（技术、剂量、体积、毒性）进行分类。
估计放疗率为67%（1289/1917），43%的患者年龄>70岁，44.7%的患者ECOG体能状态为0；44.7%的患者患有高危肿瘤；57%的患者接受了与激素治疗相关的放疗；70%接受放疗的患者采用三维计划治疗（30%为图像引导放疗）；70%的病例剂量为70-76 Gy，10.7%的病例剂量>76 Gy。79%和89%的患者急性胃肠道和泌尿生殖系统毒性分别<2级。在四个省份发现照射率显著低于研究平均值。各省份风险组分布存在显著差异。
估计前列腺癌患者中EBRT的使用不足约为30%，各医院之间的照射率差异很大，这与可用技术的差异以及不同风险水平患者的分布有关。鉴于对患者生存有负面且可测量的影响，这些数据应引起地区卫生管理人员的关注。
