- 學位論文
局限性攝護腺癌治療之SWOT分析-以高頻聚焦超音波為例
SWOT Analysis for Treatments of Localized Prostate Cancer- Using High-Intensity Focused Ultrasound as an Example
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摘要
攝護腺癌無論在發生率及死亡率在台灣都逐年增加。而早期攝護腺癌也約佔了所有病人的一半。早期攝護腺癌的治療傳統以手術切除(其中又包含了恥骨後攝護腺根除手術，腹腔鏡攝護腺根除手術及機器手臂腹腔鏡攝護腺根除手術)及放射線治療為主。由於攝護腺癌的發生集中在70至79歲的老年人，傳統治療往往造成過度治療及帶來尿失禁及性功能障礙等嚴重影響生活品質的後遺症。而氬氦刀冷凍治療及機器手臂海福刀則是屬微創手術。但由於很少機構同時可執行這些治療，並進行比較。在本研究中利用2008年以來，接受過早期攝護腺癌治療的病患，比較其腫瘤控制，併發症，並評估其國際勃起功能指標，國際攝護腺症狀量表，及生活品質量表，來評估以期找出早期攝護腺癌的最佳化治療方式。 海福刀是利用高強度超音波聚焦至病灶區以超音波脈衝波及所產生的高溫來破壞癌組織。作法是以超音波探頭置入直腸以電腦機器定位作微創治療。與手術切除，放射線治療及氬氦刀冷凍治療比較起來，在低危險及中危險群，腫瘤控制是相似的，但在高危險群中放射線的腫瘤控制則略遜一籌。在國際勃起功能指標，國際攝護腺症狀量表，及生活品質量表的評估則顯示海福刀在性功能的保留，術後排尿功能的改善及生活品質的維持表現最佳。 由於海福刀是法國公司開發，迄今尚未取得美國食品葯物管理局的通過，並在攝護腺癌病人數最多的美國上市。加上泌尿科醫師普遍對超音波的操作不熟悉，而放射影像醫師則熱衷於高利潤的放射線治療，使得海福刀一直未能普及。本研究以SWOT分析並提出行銷策略改善方式。 而高頻聚焦超音波這項新科技未來也可能運用在治療肝腫瘤，腦腫瘤及腎腫瘤。現代的醫療人員如何掌握新科技，改變人類的生活，創造藍海策略的藍天思考模式是值得探討的。
並列摘要
The incidence and mortality rate of prostate cancer are increasing in Taiwan. Nearly half of prostate cancer patients are classified into localized prostate cancer. The classical treatments for localized prostate cancer are surgeries including of retropubic radical prostatectomy, laparoscopic radical prostatectomy and robotic assisted laparoscopic radical prostatectomy) and radiotherapy. The age of most of the prostate cancer patients are between 70 and 79 years old. The traditional treatments often result in overtreatment and seriously adverse events such as incontinence and erectile dysfunction etc. Cryoablation and high intensity focused ultrasound (HIFU) are minimally invasive treatments for localized prostate cancer. However, it is very difficult to compare these treatment modalities in the same institute. In this study patients treated with these treatment modalities were collected for analysis of cancer control and adverse events to find the optimization of treatment for localized prostate cancer since 2008. The international index of erectile function (IIEF), international prostate symptom score (IPSS) and questionnaire for quality of life (QoL) were also used to evaluate the postoperative erectile function, urinary function and quality of life. The mechanism of HIFU is that focused transducer emits bursts of convergent high intensity ultrasound waves with creation of an intense temperature rise, which destroys the cells located in the target area without damage to the surround tissue. In comparison with surgery and cryoablation the cancer control is similar in low and intermediate risk groups. On the contrary, radiotherapy is inferior to other three treatment modalities in high risk group. The patients of HIFU had significantly better IIEF, IPSS and QoL in comparison with surgery, radiotherapy and cryoablation. The intracorporeal HIFU device was developed by EDAP TMS SA and is not approved by the US Food Drug Administration. The American prostate cancer market is the largest in the world. However, the urologists are not familiar with ultrasound and the radiologists are enthusiastic with high profit radiotherapy. These factors make HIFU not popular in the world. SWOT analysis and marketing strategy are proposed in this study. HIFU may be used in the treatment of renal tumor, liver tumor and brain tumor. The physicians or surgeons in the modern era should have the mind of blue sky thinking to create medicine model innovation blue ocean strategy.
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