頭頸部がん患者の放射線療法に伴う急性期有害事象に関するプロトコルの検討

Examination of Protocol to Head and Neck Cancer Patient's Acute Adverse Events by Radiation Therapy

要旨

　本研究は，頭頸部がん患者の放射線療法に伴う急性期有害事象に対するプロトコルを評価することを目的とした．本プロトコルは，Eilers口腔アセスメントガイドなどにより，定期的に口腔内評価を行うことによって，皮膚炎を含む急性期有害事象の重症度に応じたケアを実践するために作成した．

　対象者は，頭頸部がんの化学放射線療法を受けた患者で，プロトコル導入前群12名，導入後群12名の計24名である．平均年齢は66.8歳であった．プロトコル導入後，リドカイン入りの含嗽水の使用開始が6.9 日（p＜0.05），食事形態の変更は3.2日早まった（p＝0.44）．口腔や咽頭痛に対するNSAIDs（非ステロイド性消炎鎮痛薬）使用は2.0日遅くなった（p＝0.68）．体重減少率は，導入前群8.1％，導入後群6.5％だった（p＝0.54）．皮膚炎に対する軟膏使用開始時期は，導入後群で6.6日早まった（p＜0.05）．照射30回目の皮膚炎グレード3は，導入前群66％から導入後群33％に減少した（p＝0.16）．プロトコル導入によって，定期的に急性期有害事象の観察が行われ，点数化されたことで，早期介入につながった．その結果，4日以上の休止期間を生じさせることなく治療完遂できた．

　The purpose of this study is to evaluate the protocol for acute adverse events associated with the radiation therapy of head and neck cancer patients.

　This protocol was created to treat the patient according to the severity of acute adverse events including dermatitis through the assessment of the periodic oral cavity according to Eilers Oral Assessment Guide.

　Subjects consisted of patients undergoing chemoradiotherapy for head and neck cancer. There were 24 patients in total, 12 before introduction of the protocol and 12 after the introduction. The average age was 66.8 years. After the protocol was introduced, water for gargling containing lidocaine started to be used 6.9 days earlier (p＜0.05) and meal type was modified 3.2 days earlier. On the other hand, the use of non-steroidal anti-inflammatory drugs (NSAIDs) for oral pain and sore throat began 2.0 days later (p=0.68). The rate of weight loss was 8.1% for the pre-protocol group and 6.5% for the post-protocol group (p=0.54). Ointments to treat dermatitis were used 6.6 days earlier in the post-protocol group (p＜0.05). The percentage of patients with Grade 3 dermatitis with 30 fractions of radiation decreased to 33% in the post-protocol group, compared to 66% for the pre-protocol group (p=0.16).

　After the introduction of the protocol, regular observation and scoring of acute adverse events were performed, which led to earlier interventions. Consequently, we could complete radiotherapy with an interval of four days or less.