85例鼻咽癌患者调强(适形)放疗与常规放疗获益因素比较

The comparison of causes of benefit for 85 cases nasopharyngeal carcinoma radiotherapy sufferers regard to conventional radiotherapy and intensity modulated radiotherapy

目的:分析调强放疗和普通放疗2种方法给医院和患者带来的获益因素。方法:对2008年3月～2010年10月两院收治的患者,按研究标准进行随机分组,共85例入组。其中,调强(适形)放疗组43例,普通放疗组42例。两组患者采用不同的方法治疗,然后对其不同方法治疗的患者从疗效、副作用、费用以及设备投入或操作过程等进行分析比较,找出相关的利弊因素,为临床选择治疗方法提供理论依据。结果:通过分析发现调强组、普放组、近期生存率、转移率无差别;副作用情况:调强组急性黏膜反应、溃疡较明显,普放组张口困难、听力下降较明显,其他口干、咽痛、食欲下降、皮肤改变、骨髓抑制等无明显差异,从总费用看,调强组是普放组的6倍左右。结论:两种方法不同,各有利弊因素,但从患者获益情况看,调强组疗程较短,治疗靶区精确,副作用相对较轻,远期疗效可能优于普通组,因此,多数患者还是可以接受的,从医院角度看,调强放疗增加技术员的工作量和设备投资,但经济收入明显增加,也符合"效—价—比"规律。因此,提出如果患者有经济实力,应提倡调强放疗。

Objective：To analyze the cause of benefit for hospital and patient by using conventional radiotherapy and intensity modulated radiotherapy（IMRT）.Methods：85 hospitalized patients from March 2008 to October 2010 were randomized into two groups which were intensity modulated radiotherapy （43 cases） and conventional radiotherapy （42 cases）.Different therapeutic methods were applied to the patients in each group.Thereafter,in order to figure out the advantage and disadvantage and to provide theory basis for clinical treatment,the analysis and comparison was presented by taking account of curative effect,side effect,expense,equipment investment and operational process.Results：Based on the analysis,it could be found that there was no difference in survival rate and transfer rate in the two groups.Acute mucosal side effects and ulcer could be discovered clearly in IMRT group,while inability to open the mouth and hearing loss could be found markedly in conventional radiotherapy group.There was no significant difference with pharyngalgia,anorexia,myelosuppression,skinchanges,xerostomia.The total expense of intensity modulated radiotherapy group was 6 times as much as that in conventional radiotherapy group.Conclusion：Each group has its own advantages and disadvantages.However,from the patients＇ point of view,IMRT has a shorter treatment,a precise treatment target and light side effects.Besides,the long-term curative effect was superior to conventional radiotherapy.Because of this,IMRT is acceptable to most patients.From hospital perspective,the workload of technician and equipment investment of IMRT was increased and the income was raised which were fitted with ＂potency ratio＂ rules.Consequently,IMRT is promoted if the patients are able to pay the cost.