A prospective survey of radiotherapy in Sweden.
A prospective survey of radiotherapy in Sweden.
复制标题
瑞典放射治疗的前瞻性调查。
作者：
K. Takeda
对1992年秋季在瑞典开始放射治疗12周的患者进行了前瞻性调查。所有提供放射治疗的医院都参加了。目标是研究最常见的诊断，相当于大约80%的患者。对1992年在瑞典最大的单位斯德哥尔摩的Radiumhemmet开始放射治疗的所有患者进行的一项特别分析表明，目标已经实现。总体而言，评估显示数据具有代表性，质量良好。该分析包括2988例患者，其中2776例仅接受外部放射治疗，63例同时接受外部放射治疗和近距离放射治疗，其余149例仅接受近距离放射治疗。不出所料，最常见的两种诊断是乳腺癌和前列腺癌。为了评估1992年瑞典接受放射治疗的患者总数，研究结果与第8章中描述的1991年经济评估结果相关。评估显示，1992年瑞典约有13000名患者开始接受放射治疗，即几乎三分之一的癌症患者在其疾病过程中的某个时间接受放射治疗。放疗患者的平均年龄为64岁，55%的患者为女性。一半的患者接受了根治性治疗，另一半接受了姑息性治疗。治愈性治疗的比例在不同部门之间差异很大，从23%到86%。这一比例在县级部门为39%，在区域部门为52%，在妇科肿瘤部门为76%。姑息治疗通常采用不太复杂的方法，使用较少的分数和较少的字段。治疗部位占68%，治疗野占72%。治愈性治疗的比例在不同的诊断组之间也有很大差异，从头颈癌的82%到肺癌和前列腺癌的17%。在接受初级治疗的患者中，三分之一仅接受放射治疗，其余患者接受放射治疗和其他治疗（通常是手术）的结合治疗。33%的患者按照临床方案或研究进行治疗，其中妇科肿瘤科的患者比例略高。这些数字在胃肠道癌的82%和前列腺癌的11%之间变化。平均使用23次、2.6个野和49戈伊进行治愈性治疗。最高剂量、最多分数和最多射野用于前列腺癌和头颈癌。对恶性淋巴瘤给予最低剂量。姑息治疗的相应数字为11次，2.0场，30戈伊。在接受姑息治疗的患者中，60%接受了骨转移治疗。这些患者接受了8次、1.7个野和27戈伊的治疗。在治疗和姑息治疗方面，区域部门往往比县部门提供更多的分数和更高的剂量。除85岁以上的患者外，在分次数量、射野数量和剂量方面，性别或年龄无差异，其中较低的数字反映了较高的姑息治疗比例。只有一个例外，妇科癌症患者接受了近距离放射治疗。百分之七十的患者患有子宫体癌。他们平均接受了四次治疗，其中三次是接受外部放射治疗的人。近距离放射治疗的数量因科室而异。这可以用两种不同的治疗传统来解释：一种传统使用单位时间内辐射强度低的药物，导致治疗次数减少和时间延长，第二种传统使用单位时间内辐射强度高的药物，导致治疗次数增加，但时间缩短。
A prospective survey was conducted of patients who began radiotherapy in Sweden during 12 weeks in the autumn of 1992. All hospitals that provided radiotherapy participated. The goal was to study the most common diagnoses, corresponding to approximately 80% of the patients. A special analysis involving all patients who started radiotherapy in 1992 at Sweden's largest unit, Radiumhemmet in Stockholm, revealed that the goal had been achieved. Overall, the assessment showed the data to be representative and of good quality. The analysis included 2988 patients, of whom 2776 received external radiotherapy alone, 63 received both external radiotherapy and brachytherapy, and the remaining 149 received brachytherapy alone. As expected, the two most common diagnoses were breast cancer and prostate cancer. To evaluate the total number of patients receiving radiotherapy in Sweden in 1992, the results of the study were related to the results of the economic assessment from 1991 described in Chapter 8. The assessment shows that approximately 13000 patients began radiotherapy in Sweden in 1992, ie, almost one third of cancer patients receive radiotherapy at some time during the course of their disease. The mean age of radiotherapy patients was 64 years, and 55% of all patients were women. Half of the patients received curative treatment, and the other half palliative treatment. The proportion of curative treatments varied considerably among the departments, from 23% to 86%. The proportion was 39% at county departments, compared to 52% at regional departments, and 76% at the gynecologic oncology departments. Palliative treatment was usually provided by less complicated methods, using fewer fractions and fewer fields. The proportion of curative fractions was 68%, and the proportion of curative fields was 72%. The proportion of curative treatments also varied greatly among different diagnostic groups, from 82% for head and neck cancer to 17% for lung and prostate cancer. Of patients receiving primary treatment, one third received radiotherapy alone and the remainder received a combination of radiotherapy and other treatment, usually surgery. Thirty-three percent of the patients were treated in accordance with clinical protocols or studies, with a somewhat higher proportion of these patients at the gynecologic oncology departments. The figures varied between 82% for gastrointestinal cancer and 11% for prostate cancer. Curative treatment was delivered, on average, using 23 fractions, 2.6 fields, and 49 Gy. The highest dosage, most fractions, and most fields were delivered for prostate cancer and head and neck cancer. The lowest doses were given for malignant lymphoma. Corresponding figures for palliative treatment were 11 fractions, 2.0 fields and 30 Gy. Of patients receiving palliative therapy, 60% were treated for bone metastases. These patients were treated with 8 fractions, 1.7 fields, and 27 Gy. With regard to curative and palliative treatment alike, there was a tendency for regional departments to give more fractions and higher doses than the county departments. No differences in sex or age appeared regarding the number of fractions, the number of fields, and the dose, except in patients over age 85 years where lower figures reflected a higher proportion of palliative treatments. With one exception only, patients with gynecologic cancer were the ones who received brachytherapy. Seventy percent of the patients had cancer in the body of the uterus. They received an average of four treatments, three for those who also received external radiotherapy. The number of brachytherapy treatments varied widely by department. This can be explained by two different therapeutic traditions: one tradition uses agents with low radiation intensity per time unit, resulting in fewer and longer treatments, and the second tradition involves agents with high radiation intensity per time unit, resulting in more, although shorter, treatments.