頭頸癌病人放射治療毒性反應預測因素之研究

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

目標：放射治療產生之毒性反應，反映著治療品質之好壞，進而影響病人後續生活品質。本研究目的為探討頭頸癌病人放射治療毒性反應之預測因素。方法：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醫院2013年1月1日至2015年12月31日，共606名頭頸癌病人納入研究；本研究經人體試驗倫理委員會通過後執行。資料進行敘述性性統計、卡方檢定及多元羅吉斯回歸分析，找出影響放射治療口腔及皮膚治療毒性反應之預測因素。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、身體質量指數為口腔呈現輕微反應之預測因素，癌症部位則為口腔呈現輕微或嚴重反應之預測因素。結論：結果發現改變治療固定方式即能減少皮膚輕微或嚴重反應，由此可供臨床醫師擬定治療計畫時之參考運用，其他預測因素則可促進醫療照護人員對毒性反應之瞭解並提高治療期間對病人毒性反應之關注，能即時給予適當醫療照護處置，以降低毒性反應程度並藉此提升病人的放射治療品質。

Objectives: Toxicity from radiation therapy is a reflection of the quality of treatment, and will influence the quality of life of patients. The aim of this study was to investigate the effects of demographic, disease and radiotherapy factors on the toxicity of radiation therapy for patients with head and neck cancer. Methods: This was a 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 was approved by the institutional review board of E-DA hospital. Descriptive statistics and logistic regression analysis were used to analyze the factors associated with radiation therapy toxicity of the mouth and skin. Results: The results of multivariate logistic regression analysis showed that treatment fraction and immobilization techniques had a significant influence on the side effects on the skin to a mild or severe degree, age and body weight index had a significant influence on the side effects on the mouth to a mild degree, and tumor site had a significant influence on the side effects on the mouth to a mild or severe degree. Conclusions: Immobilization technique is a controllable factor in that changing the selection of immobilization technique can reduce the effects on the skin. This may provide valuable information for radiology physicians when they design a patient’s treatment plan. The results may also help medical care staff understand radiation side effects, provide immediate medical services, and improve the quality of radiation therapy. (Taiwan J Public Health. 2018;37(2):137-147).