题名

頭頸癌病人放射治療品質影響因素之研究

并列篇名

Predictors of radiation therapy quality in patients with head and neck cancer

作者

林佩蓉

关键词

放射治療 ； 頭頸癌 ； 放射治療副作用 ； radiation therapy ； head and neck cancer ； radiation side effects

期刊名称

義守大學醫務管理學系學位論文

卷期/出版年月

2017年

学位类别

碩士
导师

馬震中
内容语文

繁體中文
中文摘要

目的：放射治療產生之副作用，反映著治療品質之好壞，進而影響病人後續生活品質。本研究目的為探討人口學、疾病與放射治療相關因素對於頭頸癌放射治療品質之影響。 方法：本研究採回溯性研究設計，以病歷回顧方式收集資料，個案來源為台灣南部某區域教學醫院2013年1月1日至2015年12月31日，總計共606名頭頸癌病人納入研究樣本；本研究經人體試驗倫理委員會通過後執行(計畫編號:EMRP-105-125)。資料進行描述性統計、卡方檢定及多元羅吉斯回歸進行分析，找出影響放射治療品質(口腔、皮膚治療副作用反應)之預測因素。 結果：男性546人(90.1%)，女性60人(9.9%)，平均年齡54.0歲，經卡方檢定結果以性別、癌症部位、合併化學治療、治療整體劑量、治療次數及治療計畫模式與頭頸癌放射治療皮膚反應具有統計上顯著差異；年齡、癌症部位、腫瘤期數、癌症期數、治療計畫模式、治療前影像驗證技術及治療固定方式與頭頸癌放射治療口腔反應具有統計上顯著差異。經多元羅吉斯迴歸分析結果以治療次數、治療固定方式為頭頸癌放射治療皮膚呈現輕微或嚴重反應之預測因素；年齡、身體質量指數為頭頸癌放射治療口腔呈現輕微反應之預測因素，癌症部位為頭頸癌放射治療口腔呈現輕微或嚴重反應之預測因素。 結論：本研究結果發現治療固定方式為所有結果中可控制的部分，只要改變固定方式之選擇，就能減少皮膚輕微或嚴重反應，因此可供臨床醫師擬定治療計畫時之參考，其他預測因素則可促進醫療照護人員對副作用反應之瞭解以增進治療期間對病人副作用反應之關注，能即時給予適當醫療照護處置，以降低副作用反應程度並藉此提升病人的放射治療品質。
英文摘要

Introduction：Side effects of radiation therapy will reflect the quality of treatment and influence the follow-up quality of life of patients. The aim of this study was to investigate the effects of demographic, disease and radiotherapy on the quality of radiation therapy with head and neck cancer. Materials and Methods：The design of this study is retrospective study with secondary data analysis. A total of 606 head and neck cancer patients were enrolled in this study from January 1, 2013 to December 31, 2015 in a regional hospital in Southern Taiwan. This study has approved by the institutional review board of E-DA hospital (Program No.: EMRP-105-125). The descriptive statistics and the logistic regression analysis were used to analyze the influencing factors that affect the quality of radiation therapy (radiation side effects of oral, skin ). Results：The results of multivariate logistic regression analysis showed that treatment fraction and immobilization techniques have significant influences on the skin radiation side effects of a mild or severe response；age and body weight index have significant influences on the oral radiation side effects of a mild response；tumor site have significant influences on the oral radiation side effects of a mild or severe response. Conclusion：The results of this study were found that the immobilization technique is a controllable factor, changing the immobilization technique selection can reduce the skin mild or severe response.Therefore the result can provide information for radiology physician when they designed patient's treatment planning guidelines. The results of this study may help medical care staff understand radiation side effects, provide immediately medical service and improve the quality of radiation therapy.
主题分类 醫藥衛生 > 醫院管理與醫事行政
醫學院 > 醫務管理學系
社會科學 > 管理學
参考文献
  1. 江淑華、林佳靜(2010)。頭頸癌病人術後接受放射化學治療之症狀困擾與生活干擾程度探討。新臺北護理期刊，12(2)，17-26。doi:10.6540/ntjn.2010.2.003。
    連結：
  2. 李雅雯、林招膨、陳俊佑、李良明、林克勳、溫玉清、. . . 吳思遠(2014)。前列腺癌影像導引放射治療擺位誤差之劑量評估。放射治療與腫瘤學， 21(4)，305-315。doi:10.6316/tro/201421(4)305。
    連結：
  3. 林曜祥、任益民、李日清、林釗正與王炳龍(2002)。台灣地區頭頸癌概況。中華民國耳鼻喉科醫學雜誌，37(3)，176-182。
    連結：
  4. 黃梅月、楊位娟、蘇靜如、熊淑娟、王重榮、陳惠君、. . . 黃郁傑(2015)。營養照會與病患衛教是頭頸部腫瘤病患完成放射治療最重要的介入措施。放射治療與腫瘤學，22(1)，25-39。doi:10.6316/tro/201522(1)25。
    連結：
  5. 楊惠卿、王麗斐、張東杰與方富民(2013)。頭頸癌患者身心社會調適與生活品質之縱貫性研究。護理雜誌， 60(5)，41-52。 doi:10.6224/jn.60.5.41。
    連結：
  6. 劉義誠、劉煥彰、陳柏元、陳臣苑、張安進、程言鼎、. . . 洪志宏(2010)。利用影像導引放射治療技術來評估擺位誤差對於計劃靶體積包覆率的影響。放射治療與腫瘤學，17(2)，125-135。 doi:10.6316/tro/201017(2)125。
    連結：
  7. 鍾娜娜、王博民、許維中與張金堅(2013)。乳癌放射治療的演進。臺灣醫界，56(12)，25-30。
    連結：
  8. Bessell, A., Glenny, A.-M., Furness, S., Clarkson, J. E., Oliver, R., Conway, D. I., . . . Worthington, H. V. (2011). Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database of Systematic Reviews(9). doi:10.1002/14651858.CD006205.pub3
    連結：
  9. Bentzen, S. M., & Trotti, A. (2007). Evaluation of Early and Late Toxicities in Chemoradiation Trials. Journal of Clinical Oncology, 25(26), 4096-4103. doi:10.1200/JCO.2007.13.3983
    連結：
  10. Bossi, P., Bergamini, C., Miceli, R., Cova, A., Orlandi, E., Resteghini, C., . . . Rivoltini, L. Salivary Cytokine Levels and Oral Mucositis in Head and Neck Cancer Patients Treated With Chemotherapy and Radiation Therapy. International Journal of Radiation Oncology*Biology*Physics. doi:http://dx.doi.org/10.1016/j.ijrobp.2016.08.047
    連結：
  11. Busetto, M., Fusco, V., Corbella, F., Bolzan, M., Pavanato, G., Bonetti, B., . . . Lastrucci, L. (2013). Predictive factors for oropharyngeal mycosis during radiochemotherapy for head and neck carcinoma and consequences on treatment duration. Results of mycosis in radiotherapy (MIR): A prospective longitudinal study. Radiotherapy and Oncology, 109(2), 303-310. doi:https://doi.org/10.1016/j.radonc.2013.05.040
    連結：
  12. Cooper , J. S., Pajak , T. F., Forastiere , A. A., Jacobs , J., Campbell , B. H., Saxman , S. B., . . . Fu , K. K. (2004). Postoperative Concurrent Radiotherapy and Chemotherapy for High-Risk Squamous-Cell Carcinoma of the Head and Neck. New England Journal of Medicine, 350(19), 1937-1944. doi:doi:10.1056/NEJMoa032646
    連結：
  13. Cox, J. D., Stetz, J., & Pajak, T. F. (1995). Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). International Journal of Radiation Oncology*Biology*Physics, 31(5), 1341-1346. doi:http://dx.doi.org/10.1016/0360-3016(95)00060-C
    連結：
  14. Duprez, F., Berwouts, D., Madani, I., Bonte, K., Boterberg, T., De Gersem, W., . . . De Neve, W. (2014). High-dose reirradiation with intensity-modulated radiotherapy for recurrent head-and-neck cancer: Disease control, survival and toxicity. Radiotherapy and Oncology, 111(3), 388-392. doi:http://dx.doi.org/10.1016/j.radonc.2014.04.018
    連結：
  15. Edge, S. B., & Compton, C. C. (2010). The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM. Annals of Surgical Oncology, 17(6), 1471-1474. doi:10.1245/s10434-010-0985-4
    連結：
  16. Edwards, B. K., Howe, H. L., Ries, L. A. G., Thun, M. J., Rosenberg, H. M., Yancik, R., . . . Feigal, E. G. (2002). Annual Report to the Nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer, 94(10), 2766-2792. doi:10.1002/cncr.10593
    連結：
  17. Guntinas-Lichius, O., Wendt, T. G., Kornetzky, N., Buentzel, J., Esser, D., Böger, D., . . . Schmalenberg, H. (2014). Trends in epidemiology and treatment and outcome for head and neck cancer: A population-based long-term analysis from 1996 to 2011 of the Thuringian cancer registry. Oral Oncology, 50(12), 1157-1164. doi:http://dx.doi.org/10.1016/j.oraloncology.2014.09.015
    連結：
  18. Gupta, T., Agarwal, J., Jain, S., Phurailatpam, R., Kannan, S., Ghosh-Laskar, S., . . . D’Cruz, A. (2012). Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: A randomized controlled trial. Radiotherapy and Oncology, 104(3), 343-348. doi:http://dx.doi.org/10.1016/j.radonc.2012.07.001
    連結：
  19. Hammerlid, E., Silander, E., Hornestam, L., & Sullivan, M. (2001). Health-related quality of life three years after diagnosis of head and neck cancer--a longitudinal study. Head Neck, 23(2), 113-125.
    連結：
  20. Haddad , R. I., & Shin , D. M. (2008). Recent Advances in Head and Neck Cancer. New England Journal of Medicine, 359(11), 1143-1154. doi:10.1056/NEJMra0707975
    連結：
  21. International Commission on Radiation Units and Measurements (ICRU) ICRU Report 62.(1999). Bethesda: ICRU. Prescribing, Recording and Reporting Photon Beam Therapy (supplement to ICRU Report 50)
    連結：
  22. Jellema, A. P., Slotman, B. J., Doornaert, P., Leemans, C. R., & Langendijk, J. A. (2007). Impact of Radiation-Induced Xerostomia on Quality of Life After Primary Radiotherapy Among Patients With Head and Neck Cancer. International Journal of Radiation Oncology*Biology*Physics, 69(3), 751-760. doi:http://dx.doi.org/10.1016/j.ijrobp.2007.04.021
    連結：
  23. Jilani, O. K., Singh, P., Wernicke, A. G., Kutler, D. I., Kuhel, W., Christos, P., . . . Parashar, B. (2012). Radiation therapy is well tolerated and produces excellent control rates in elderly patients with locally advanced head and neck cancers. Journal of Geriatric Oncology, 3(4), 337-343. doi:http://dx.doi.org/10.1016/j.jgo.2012.05.001
    連結：
  24. Lee, A. W. M., Ng, W. T., Chan, L. L. K., Hung, W. M., Chan, C. C. C., Sze, H. C. K., . . . Yeung, R. M. W. (2014). Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era. Radiotherapy and Oncology, 110(3), 377-384. doi:http://dx.doi.org/10.1016/j.radonc.2014.02.003
    連結：
  25. Martra, F., Kunos, C., Gibbons, H., Zola, P., Galletto, L., DeBernardo, R., & von Gruenigen, V. (2008). Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study. American Journal of Obstetrics and Gynecology, 198(1), 89.e81-89.e88. doi:http://dx.doi.org/10.1016/j.ajog.2007.06.023
    連結：
  26. Meyer, F., Fortin, A., Wang, C. S., Liu, G., & Bairati, I. (2012). Predictors of Severe Acute and Late Toxicities in Patients With Localized Head-and-Neck Cancer Treated With Radiation Therapy. International Journal of Radiation Oncology*Biology*Physics, 82(4), 1454-1462. doi:http://dx.doi.org/10.1016/j.ijrobp.2011.04.022
    連結：
  27. Mortensen, H. R., Overgaard, J., Specht, L., Overgaard, M., Johansen, J., Evensen, J. F., . . . Grau, C. (2012). Prevalence and peak incidence of acute and late normal tissue morbidity in the DAHANCA 6&7 randomised trial with accelerated radiotherapy for head and neck cancer. Radiotherapy and Oncology, 103(1), 69-75. doi:http://dx.doi.org/10.1016/j.radonc.2012.01.002
    連結：
  28. Nevens, D., Duprez, F., Daisne, J. F., Dok, R., Belmans, A., Voordeckers, M., . . . Nuyts, S. Reduction of the dose of radiotherapy to the elective neck in head and neck squamous cell carcinoma; a randomized clinical trial. Effect on late toxicity and tumor control. Radiotherapy and Oncology. doi:http://dx.doi.org/10.1016/j.radonc.2016.08.009
    連結：
  29. Palazzi, M., Tomatis, S., Orlandi, E., Guzzo, M., Sangalli, C., Potepan, P., . . . Olmi, P. (2008). Effects of Treatment Intensification on Acute Local Toxicity During Radiotherapy for Head and Neck Cancer: Prospective Observational Study Validating CTCAE, Version 3.0, Scoring System. International Journal of Radiation Oncology*Biology*Physics, 70(2), 330-337. doi:http://dx.doi.org/10.1016/j.ijrobp.2007.06.022
    連結：
  30. Peng, G., Wang, T., Yang, K.-y., Zhang, S., Zhang, T., Li, Q., . . . Wu, G. (2012). A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiotherapy and Oncology, 104(3), 286-293. doi:http://dx.doi.org/10.1016/j.radonc.2012.08.013
    連結：
  31. Pezzuto, F., Buonaguro, L., Caponigro, F., Ionna, F., Starita, N., Annunziata, C., . . . Tornesello, M. L. (2015). Update on Head and Neck Cancer: Current Knowledge on Epidemiology, Risk Factors, Molecular Features and Novel Therapies. Oncology, 89(3), 125-136.
    連結：
  32. Pow, E. H. N., Kwong, D. L. W., McMillan, A. S., Wong, M. C. M., Sham, J. S. T., Leung, L. H. T., & Leung, W. K. (2006). Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial. International Journal of Radiation Oncology*Biology*Physics, 66(4), 981-991. doi:http://dx.doi.org/10.1016/j.ijrobp.2006.06.013
    連結：
  33. Sanguineti, G., Sormani, M. P., Marur, S., Gunn, G. B., Rao, N., Cianchetti, M., . . . Forastiere, A. (2012). Effect of Radiotherapy and Chemotherapy on the Risk of Mucositis During Intensity-Modulated Radiation Therapy for Oropharyngeal Cancer. International Journal of Radiation Oncology*Biology*Physics, 83(1), 235-242. doi:http://dx.doi.org/10.1016/j.ijrobp.2011.06.2000
    連結：
  34. Sanguineti, G., Rao, N., Gunn, B., Ricchetti, F., & Fiorino, C. (2013). Predictors of PEG dependence after IMRT ± chemotherapy for oropharyngeal cancer. Radiotherapy and Oncology, 107(3), 300-304. doi:http://dx.doi.org/10.1016/j.radonc.2013.05.021
    連結：
  35. Schild, S. E., Mandrekar, S. J., Jatoi, A., McGinnis, W. L., Stella, P. J., Deming, R. L., . . . for the North Central Cancer Treatment, G. (2007). The value of combined-modality therapy in elderly patients with stage III nonsmall cell lung cancer. Cancer, 110(2), 363-368. doi:10.1002/cncr.22780
    連結：
  36. Sharp, L., Lewin, F., Johansson, H., Payne, D., Gerhardsson, A., & Rutqvist, L. E. (2005). Randomized trial on two types of thermoplastic masks for patient immobilization during radiation therapy for head-and-neck cancer. International Journal of Radiation Oncology*Biology*Physics, 61(1), 250-256. doi:http://dx.doi.org/10.1016/j.ijrobp.2004.04.047
    連結：
  37. Siegel, R., Ma, J., Zou, Z., & Jemal, A. (2014). Cancer statistics, 2014. CA: A Cancer Journal for Clinicians, 64(1), 9-29. doi:10.3322/caac.21208
    連結：
  38. Sun, X., Su, S., Chen, C., Han, F., Zhao, C., Xiao, W., . . . Lu, T. (2014). Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: An analysis of survival and treatment toxicities. Radiotherapy and Oncology, 110(3), 398-403. doi:http://dx.doi.org/10.1016/j.radonc.2013.10.020
    連結：
  39. Trotti, A., Bellm, L. A., Epstein, J. B., Frame, D., Fuchs, H. J., Gwede, C. K., . . . Zilberberg, M. D. (2003). Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiotherapy and Oncology, 66(3), 253-262. doi:http://dx.doi.org/10.1016/S0167-8140(02)00404-8
    連結：
  40. Walsh, L., Gillham, C., Dunne, M., Fraser, I., Hollywood, D., Armstrong, J., & Thirion, P. (2011). Toxicity of cetuximab versus cisplatin concurrent with radiotherapy in locally advanced head and neck squamous cell cancer (LAHNSCC). Radiotherapy and Oncology, 98(1), 38-41. doi:http://dx.doi.org/10.1016/j.radonc.2010.11.009
    連結：
  41. Worster, A., & Haines, T. (2004). Advanced statistics: Understanding Medical Record Review (MRR) Studies. Academic Emergency Medicine, 11(2), 187-192. doi:10.1111/j.1553-2712.2004.tb01433.x
    連結：
  42. Vera-Llonch, M., Oster, G., Hagiwara, M., & Sonis, S. (2006). Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer, 106(2), 329-336. doi:10.1002/cncr.21622
    連結：
  43. Verbakel, W. F. A. R., Cuijpers, J. P., Hoffmans, D., Bieker, M., Slotman, B. J., & Senan, S. (2009). Volumetric Intensity-Modulated Arc Therapy Vs. Conventional IMRT in Head-and-Neck Cancer: A Comparative Planning and Dosimetric Study. International Journal of Radiation Oncology*Biology*Physics, 74(1), 252-259. doi:http://dx.doi.org/10.1016/j.ijrobp.2008.12.033
    連結：
  44. Vergeer, M. R., Doornaert, P. A. H., Rietveld, D. H. F., Leemans, C. R., Slotman, B. J., & Langendijk, J. A. (2009). Intensity-Modulated Radiotherapy Reduces Radiation-Induced Morbidity and Improves Health-Related Quality of Life: Results of a Nonrandomized Prospective Study Using a Standardized Follow-Up Program. International Journal of Radiation Oncology*Biology*Physics, 74(1), 1-8. doi:http://dx.doi.org/10.1016/j.ijrobp.2008.07.059
    連結：
  45. Vissink, A., Jansma, J., Spijkervet, F. K., Burlage, F. R., & Coppes, R. P. (2003). Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med, 14(3), 199-212.
    連結：
  46. Yathiraj, P. H., Ghosh-Laskar, S., Datta, D., Rangarajan, V., Purandare, N., Gupta, T., . . . Agarwal, J. P. (2014). Randomized Controlled Trial to Compare 3-Dimensional Conformal Radiation Therapy (3DCRT) to Intensity Modulated Radiation Therapy (IMRT) in Head and Neck Squamous Cell Carcinoma. International Journal of Radiation Oncology*Biology*Physics, 90(1, Supplement), S98. doi:http://dx.doi.org/10.1016/j.ijrobp.2014.05.503
    連結：
  47. 台灣癌症防治網(2016)。認識頭頸癌。取自http://cisc.twbbs.org/lib/project/ books / book01.php。
  48. 吳明隆(2008)。SPSS操作與應用-多變量分析實務。臺北市：五南。
  49. 張寶樹(2004)。放射治療物理學。臺北市：合記。
  50. 衛生福利部國民健康署(2011)。97年癌症登記年報。取自http://tcr.cph.ntu.edu.tw/uploadimages/Y97-ALL.pdf。
  51. 衛生福利部國民健康署(2016)。102年癌症登記年報。取自http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx?No=201604210001。
  52. 衛生福利部衛生福利部(2016)。104年死因統計年報。取自http://www.mohw.gov.tw/CHT/DOS/Statistic.aspxf_list_no=312&fod_list_no=6201。
  53. Den, R. B., Doemer, A., Kubicek, G., Bednarz, G., Galvin, J. M., Keane, W. M., . . . Machtay, M. (2010). Daily Image Guidance With Cone-Beam Computed Tomography for Head-and-Neck Cancer Intensity-Modulated Radiotherapy: A Prospective Study. International Journal of Radiation Oncology*Biology*Physics, 76(5), 1353-1359. doi:http://dx.doi.org/10.1016/j.ijrobp.2009.03.059
  54. Filho, M. R. d. M., Rocha, B. A., Pires, M. B. d. O., Fonseca, E. S., Freitas, E. M. d., Junior, H. M., & Santos, F. B. G. (2013). Quality of life of patients with head and neck cancer. Brazilian Journal of Otorhinolaryngology, 79(1), 82-88. doi:https://doi.org/10.5935/1808-8694.20130014
  55. Elting, L. S., Cooksley, C. D., Chambers, M. S., & Garden, A. S. (2007). Risk, Outcomes, and Costs of Radiation-Induced Oral Mucositis Among Patients With Head-and-Neck Malignancies. International Journal of Radiation Oncology*Biology*Physics, 68(4), 1110-1120. doi:http://dx.doi.org/10.1016/j.ijrobp.2007.01.053
  56. Sapir, E., Bredfeldt, J., Schipper, M., Masi, K., Matuszak, M. M., & Eisbruch, A. (2015). Acute Radiation Dermatitis in Head and Neck Patients Treated With VMAT Versus IMRT. International Journal of Radiation Oncology*Biology*Physics, 93(3, Supplement), E617. doi:http://dx.doi.org/10.1016/j.ijrobp.2015.07.2122
  57. Studenski, M. T., Bar-Ad, V., Siglin, J., Cognetti, D., Curry, J., Tuluc, M., & Harrison, A. S. (2013). Clinical experience transitioning from IMRT to VMAT for head and neck cancer. Medical Dosimetry, 38(2), 171-175. doi:http://dx.doi.org/10.1016/j.meddos.2012.10.009
  58. Trotti, A. (2000). Toxicity in head and neck cancer: a review of trends and issues. International Journal of Radiation Oncology*Biology*Physics, 47(1), 1-12. doi:http://dx.doi.org/10.1016/S0360-3016(99)00558-1
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