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。
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.