[Radiotherapy of benign diseases: a pattern of care study in Germany].
[Radiotherapy of benign diseases: a pattern of care study in Germany].
复制标题
[良性疾病放射治疗：德国的护理研究模式]。
DOI：
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
E. Hassenstein
中科院分区：
文献类型：
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作者：
M. Seegenschmiedt;Alexander Katalinic;H. Makoski;W. Haase;G. Gademann;E. Hassenstein
背景
良性疾病放射治疗的讨论存在争议，在英美国家很少应用，而在世界其他地区，特别是中欧和东欧，通常对几种良性疾病进行放射治疗。与欧洲治疗放射学和肿瘤学协会的调查类似，德国也进行了一项护理模式研究。
方法
三年内（1994年、1995年、1996年）向德国所有放射设施邮寄了一份调查问卷，评估设备、适应症、患者数量和治疗概念。共有 134 家机构 (88%) 返回了所有请求的数据：东德 22 家，西德 112 家；大学中有 30 名，社区/私立医院有 104 名。对每个机构和所有机构的平均数据进行分析，了解不同地区和机构之间的频率和比率。
结果
每个机构平均有 2 个（范围 1 到 7）兆伏（Linac/Cobalt 60）和 1.4 个（范围 0 到 4）正电压单位； 32 所（24%）机构没有正电压设备。每年平均有 20,082 名患者接受治疗：456 名患者（2%）患有炎症性疾病（221 名汗腺炎、78 名甲床感染、23 名腮腺炎、134 名未指定），12,600 名患者（63%）患有退行性疾病（2,711 名肱肩胛周炎、1,555 名肱骨外上髁炎、1,382 名足跟骨刺、 2,434 例退行性骨关节炎，4,518 例未指定），927 例（5%）为肥厚性疾病（146 例掌腱膜挛缩症，382 例瘢痕疙瘩，155 例佩罗尼病，244 例未指定），1,210 例（6%）为功能性疾病（853 例格雷夫斯眼眶病，357 例未指定），以及4,889 (24%) 为其他疾病（例如 3,680 异位骨化预防）。在单变量分析中，炎症和退行性疾病放射治疗的使用存在显着的地理差异（西德与东德），肥厚性和功能性疾病放射治疗的使用存在机构差异（大学与社区/私立医院）（p < 0.05）。规定的剂量概念大多处于低剂量范围（< 10 Gy），但在地理区域和机构类型之间变化很大且不一致。
结论
在德国，放射治疗是一种被广泛接受且经常采用的治疗多种良性疾病的方法，但存在显着的地理和制度差异。随着正电压单元数量的减少，患者负荷的增加需要更多兆电压单元，这可能会损害这种治疗的成本效益。只有4%的临床机构参与对照临床试验。为了保持其他学科的高水平放射治疗服务，需要放射治疗指南、质量控制和继续医学教育。
BACKGROUND
Radiation therapy of benign diseases is controversially discussed and rarely applied in Anglo-American countries, while in other parts of the world, especially Central and East Europe, it is commonly practised for several benign disorders. Similar to the European Society of Therapeutic Radiology and Oncology survey, a patterns of care study was performed in Germany.
METHOD
A questionnaire was mailed in 3 years (1994, 1995, 1996) to all radiation facilities in Germany, which assessed equipment, indications, number of patients and treatment concepts. A total of 134 (88%) institutions returned all requested data: 22 in East and 112 in West Germany; 30 in university and 104 in community/private hospitals. The average data of each institution and of all institutions were analyzed for frequencies and ratios between different regions and institutions.
RESULTS
A mean of 2 (range 1 to 7) megavoltage (Linac/Cobalt 60) and 1.4 (range 0 to 4) orthovoltage units were available per institution; 32 (24%) institutions had no orthovoltage equipment. A mean of 20,082 patients were treated per year: 456 (2%) for inflammatory diseases (221 hidradenitis, 78 nail bed infection, 23 parotitis, 134 not specified), 12,600 (63%) for degenerative diseases (2,711 peritendinitis humeroscapularis, 1,555 epicondylitis humeri, 1,382 heel spur, 2,434 degenerative osteoarthritis, 4,518 not specified), 927 (5%) for hypertrophic diseases (146 Dupuytren's contracture, 382 keloids, 155 Peyronie's disease, 244 not specified), 1,210 (6%) for functional disorders (853 Graves' orbitopathy, 357 not specified), and 4,889 (24%) for other disorders (e.g. 3,680 heterotopic ossification prophylaxis). In univariate analysis, there were significant geographical (West vs East Germany) differences in the use of radiotherapy for inflammatory and degenerative disorders and institutional differences (university vs community/private hospitals) in the use of radiotherapy for hypertrophic and functional disorders (p < 0.05). The prescribed dose concepts were mostly in the low dose range (< 10 Gy), but varied widely and inconsistently within geographic regions and institution types.
CONCLUSION
Radiotherapy is a well accepted and frequently practised treatment for several benign diseases in Germany, however, there are significant geographical and institutional differences. As the number of orthovoltage units decreases, an increasing patient load is in demand of more megavoltage units, which may compromise the cost-effectiveness of this treatment. Only 4% of all clinical institutions are involved in controlled clinical trials. To maintain a high level of radiotherapy service to other disciplines, radiotherapy treatment guidelines, quality control and continuing medical education are required.