Yeo Ryan, Campbell Trevor, Fairchild Alysa
Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.
Department of Radiation Oncology, Lethbridge Cancer Centre, Lethbridge, Alberta, Canada.
J Med Imaging Radiat Sci. 2012 Mar;43(1):38-42. doi: 10.1016/j.jmir.2011.08.001.
Patients presenting with an oncology emergency should be assessed and treated promptly to address symptoms, preserve function, and maintain quality of life. In some circumstances, this requires treatment of patients on weekends. The primary objective of this study was to review the delivery of urgent radiotherapy (RT) at our institution to determine the proportion of courses with a documented indication for which weekend RT could be justified based on comparison with published literature.
Patients undergoing RT on weekends (January 2009-July 2009) were reviewed retrospectively for demographics, disease site, functional status, and documented reason for after-hours treatment. Data were obtained from both the electronic and paper medical records and input into an Excel spreadsheet after being anonymized. Summary statistics were calculated. A literature search was conducted to supplement the Alberta Health Services Palliative Radiotherapy clinical practice guidelines, which included review of relevant publications from the Standards and Guidelines Evidence database.
A total of 108 patients (73 males, 35 females) received RT to 132 sites over this period, primarily on both Saturday and Sunday (87.8%). Of these, 37.9% had a lung primary, 97.0% were treated with palliative intent, and 46.2% received spine RT. On average, 18.9 weekend treatment courses took place each month (range, 2-12). 67.1% had a planned anteroposterior field arrangement, and the dose-fractionation schedule was 2000 cGy in five fractions in the majority (68.9%). Based on the reason documented for emergency RT, 72.1% of all after-hours treatments could be justified by comparison to published literature.
Given resource and technical considerations, delivery of RT during weekends requires specific clinical justification. Presently at our center, decision to institute after-hours RT is at the discretion of the treating radiation oncologist. The majority of indications for weekend treatment of these patients could be justified based on published evidence.
出现肿瘤急症的患者应及时接受评估和治疗，以缓解症状、保留功能并维持生活质量。在某些情况下，这需要在周末对患者进行治疗。本研究的主要目的是回顾我院紧急放疗（RT）的实施情况，通过与已发表文献比较，确定有记录指征的疗程中可证明周末放疗合理的比例。
对2009年1月至2009年7月在周末接受放疗的患者进行回顾性研究，收集其人口统计学资料、疾病部位、功能状态以及记录的非工作时间治疗原因。数据从电子和纸质病历中获取，并在匿名后输入Excel电子表格。计算总结统计数据。进行文献检索以补充艾伯塔省卫生服务姑息放疗临床实践指南，其中包括对标准和指南证据数据库中相关出版物的回顾。
在此期间，共有108例患者（73例男性，35例女性）接受了132个部位的放疗，主要在周六和周日（87.8%）。其中，37.9%的原发肿瘤位于肺部，97.0%为姑息性治疗，46.2%接受了脊柱放疗。平均每月进行18.9次周末治疗疗程（范围为2 - 12次）。67.1%采用前后野计划布置，大多数（68.9%）的剂量分割方案为2000 cGy分5次。根据记录的紧急放疗原因，与已发表文献比较，72.1%的非工作时间治疗是合理的。
考虑到资源和技术因素，周末进行放疗需要有特定的临床依据。目前在我们中心，实施非工作时间放疗的决定由主治放疗肿瘤学家自行决定。根据已发表的证据，这些患者周末治疗的大多数指征是合理的。
