Stevens G, Firth I
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Australas Radiol. 1996 Feb;40(1):47-54. doi: 10.1111/j.1440-1673.1996.tb00345.x.
This study aims to determine workload statistics and to document patterns of fractionation in a single centre in two time periods separated by 4 years. Patient, tumour and treatment-related data were collected for courses of radiation treatment that were commenced within two 6-month periods in both 1988 and 1993. In both time periods, 45-49% of patients were treated with curative intent. Of these, one-third were irradiated definitively and two-thirds in an adjuvant setting. Most of the remainder were treated with palliative intent. A few were treated for non-neoplastic conditions. The re-treatment rate in 1993 was 13%. In both time periods, breast and lung tumours represented approximately 20% each of the total treatment courses. Skin, head and neck, gynaecological, urological and haematological primary tumours accounted for 5-10% each. Treatment intents differed markedly for different primary sites. For example, in 1993 65% of patients with breast primaries were treated curatively compared with 6% of patients with lung primaries. Treatment schedules for curative intent were similar in both time periods and for the majority of treatment sites. Median fraction numbers were 25 (excluding skin primaries), reflecting conventional daily fractionation. Treatment schedules for palliation showed greater variation and there was a trend towards shorter treatment courses in 1993. For palliative treatment of bone, brain and lung, from either primary or metastatic disease, treatment schedules with 10-15 fractions were used most frequently in 1988. In 1993, however, the majority of patients received 1-5 fractions. In 1993, the breakdown of techniques according to treatment intent showed that for treatment with curative intent, single, parallel opposed and more complex field arrangements were used in 27% (includes skin primaries), 12% and 61% of treatment courses, respectively, compared with 29%, 59% and 12%, respectively, for palliative treatment courses. In 1993, one-third of patients receiving radiation treatment lived in the local health area. Patients living in areas with rural postcodes were more likely to receive palliative irradiation and had a higher incidence of melanoma than patients living in areas with Sydney metropolitan postcodes. As approximately 50% of patients were treated with palliative intent, changes in the fractionation patterns used can alter significantly the utilization and availability of megavoltage equipment. However, any reduction in attendances caused by hypofractionation for palliation may be offset by the trend to use hyperfractionation for curative treatments. The data support the hypothesis of reduced availability and use of radiation therapy in patients with cancer from rural areas.
本研究旨在确定工作量统计数据，并记录一个中心在两个相隔4年的时间段内的分割模式。收集了1988年和1993年两个6个月期间开始的放射治疗疗程的患者、肿瘤及治疗相关数据。在这两个时间段，45 - 49%的患者接受了根治性治疗。其中，三分之一接受了根治性放疗，三分之二接受了辅助放疗。其余大多数患者接受了姑息性治疗。少数患者接受了非肿瘤性疾病的治疗。1993年的再治疗率为13%。在这两个时间段，乳腺癌和肺癌肿瘤各占总治疗疗程的约20%。皮肤、头颈部、妇科、泌尿科和血液科原发性肿瘤各占5 - 10%。不同原发部位的治疗目的差异显著。例如，1993年，65%的乳腺癌原发患者接受了根治性治疗，而肺癌原发患者中这一比例为6%。两个时间段以及大多数治疗部位的根治性治疗计划相似。中位分割次数为25次（不包括皮肤原发肿瘤），反映了传统的每日分割。姑息性治疗计划的差异更大，1993年有治疗疗程缩短的趋势。对于骨、脑和肺的姑息性治疗，无论是原发性疾病还是转移性疾病，1988年最常采用10 - 15次分割的治疗计划。然而，在1993年，大多数患者接受了1 - 5次分割。1993年，根据治疗目的划分的技术情况显示，对于根治性治疗，单次、平行对置和更复杂的野排列分别用于27%（包括皮肤原发肿瘤）、12%和61%的治疗疗程，而姑息性治疗疗程的这一比例分别为29%、59%和12%。1993年，接受放射治疗的患者中有三分之一居住在当地卫生区域。居住在农村邮政编码地区的患者比居住在悉尼大都市邮政编码地区的患者更有可能接受姑息性放疗，且黑色素瘤发病率更高。由于约50%的患者接受了姑息性治疗，所用分割模式的变化可能会显著改变兆伏级设备的使用和可及性。然而，姑息性治疗采用大分割导致的就诊人数减少可能会被根治性治疗采用超分割的趋势所抵消。这些数据支持了农村地区癌症患者放射治疗可及性和使用减少的假设。
