国产与进口精确放射治疗设备治疗淋巴瘤的疗效及毒性反应分析

目的 通过对比国产精确放射治疗设备和进口精确放射治疗设备治疗淋巴瘤的临床疗效，明确国产精确放射治疗设备的优势与不足。方法 对使用国产和进口医用直线加速器的不同层级医院在治疗淋巴瘤方面进行调研并将其分为国产组和进口组，回顾性分析两组患者的资料，对比两组放射治疗设备品牌、近期疗效及急性毒性反应、危及器官剂量学参数及放射治疗费用的差异。结果 共收集到10家医院101例进行放射治疗的淋巴瘤患者资料，进口组77例、国产组24例。进口组和国产组总有效率均较高，分别为88.3%（68/77）、87.5%（21/24），差异无统计学意义（P=1.00）。进口组和国产组血液学毒性（>2级）发生率均较低，分别为1.3%（1/77）和8.3%（2/24），差异无统计学意义（P=0.14）。对两组结外鼻型NK/T细胞淋巴瘤的危及器官剂量学参数和急性毒性反应进行亚组分析，两组的晶体最大剂量（D_max）、视神经D_max和腮腺平均剂量（D_mean）差异均无统计学意义（P均>0.05），但双侧腮腺D_mean国产组较进口组有升高趋势［左侧（2 306.53±1 119.66）cGy vs（1 279.44±1 026.95）cGy，P=0.16；右侧（2 328.35±1 009.76）cGy vs （1 303.79±1 116.79）cGy，P=0.17）］；2级口干发生率国产组较进口组有增加趋势，但差异无统计学意义［50.0%（2/4）vs 14.3%（1/7），P>0.05）］。在放射治疗费用［（26 743.9±8 061.2）元vs （42 428.7±14 744.7）元］和总住院费用［（36 702.1±12 225.8）元vs（50 192.7±15 494.4）元］方面，国产组均较进口组低（P均<0.01）。结论 国产精确放射治疗设备较进口精确放射治疗设备在治疗淋巴瘤的近期疗效方面未见明显差异，而且治疗费用相对较低。但进口精确放射治疗设备危及器官受量更低，急性毒性反应更少。

Efficacy and toxicity analysis of domestic and imported precision radiotherapy equipment in the treatment of lymphoma

Objective To clarify the advantages and disadvantages of domestic precision radiotherapy equipment by comparing the clinical efficacies of domestic and imported precision radiotherapy equipments in the treatment of lymphoma. Methods We investigated the treatments of lymphoma in hospitals of different levels using domestic and imported medical linear accelerators and divided them into domestic and imported groups. The data of patients in the two groups were retrospectively analyzed, and the radiotherapy equipment brand, short-term efficacy, acute toxicity, dosimetric parameters of organs at risk and the costs of radiation therapy were compared between the two groups. Results A total of 101 cases receiving radiation therapy for lymphoma in 10 hospitals were collected, including 77 cases in the imported group and 24 cases in the domestic group. The overall response rates were high in both groups, being 88.3% (68/77) in the imported group and 87.5% (21/24) in the domestic group, with no significant difference (P=1.00). The incidences of hematological toxicity (>grade 2) were low in both groups, being 1.3% (1/77) vs 8.3% (2/24), with no significant difference (P=0.14). Subgroup analysis was performed on the dosimetric parameters of organs at risk and acute toxicity of the two groups for extranodal nasal type NK/T cell lymphoma, and there were no significant differences in the maximal dose (D_max) of the lens, D_max of the optic nerve, or mean dose (D_mean) of the parotid gland between the two groups (all P>0.05). However, there was an increasing trend in the domestic group compared with the imported group for D_mean of bilateral parotid gland (left:2 306.53±1 119.66] cGy vs1 279.44±1 026.95] cGy, P=0.16; right:2 328.35±1 009.76] cGy vs1 303.79±1 116.79]cGy, P=0.17). The incidence of grade 2 xerostomia in the domestic group was higher than that in the imported group, but the difference was not statistically significant (50.0%2/4] vs 14.3%1/7], P>0.05). The domestic group had significantly lower radiotherapy cost (26 743.9±8 061.2] yuan vs42 428.7±14 744.7] yuan) and total hospitalization cost (36 702.1±12 225.8] yuan vs50 192.7±15 494.4] yuan) than the imported group (both P<0.01). Conclusion There is no significant difference in the short-term efficacy of lymphoma treatment between the domestic radiotherapy equipment and the imported radiotherapy equipment, while the treatment cost of the domestic radiotherapy equipment is relatively low. However, the dosimetric parameters of organs at risk of imported radiotherapy equipment is lower and the acute toxicity is less.