早期 NSCLC 治疗对气候的影响:利用生命周期评估对放射治疗和外科手术进行比较。

IF 4.9 1区 医学 Q1 ONCOLOGY Radiotherapy and Oncology Pub Date : 2024-10-30 DOI:10.1016/j.radonc.2024.110601
Jochem Kaas , Marit Verbeek , Wilson W.L. Li , Stefan M. van der Heide , Ad F.T.M. Verhagen , René Monshouwer , Hugo R.W. Touw , Johan Bussink , Erik van der Bijl , Tim Stobernack
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引用次数: 0

摘要

导言:医疗系统是二氧化碳排放的主要来源,占荷兰排放量的 7%。了解医疗的环境足迹有助于发现减少气候影响的机会。我们评估了立体定向体外放射治疗(SBRT)和视频辅助胸腔手术(VATS)在治疗T1-2N0M0非小细胞肺癌(NSCLC)时对气候的影响:我们使用生命周期评估(LCA)来评估气候影响(以千克二氧化碳当量为单位)。我们对VATS和SBRT的护理轨迹进行了盘点,路径的起点和终点相同。我们通过直接测量(问卷调查和废物审计)或回顾性记录分析,分析了一系列造成气候影响的因素,如患者和工作人员的出行、能源消耗、一次性用品和药物。按照生命周期评估的惯例,现有基础设施不在分析范围之内。此外,还对可受个别部门影响的减排量进行了建模:利用生命周期评估,我们计算了 NSCLC 两种治疗方法的所有分类贡献的影响。VATS 每次治疗共产生约 547 千克二氧化碳当量 (CO2e),而 SBRT 每次治疗产生 172 千克二氧化碳当量。对于 SBRT 来说,最大的二氧化碳排放源是医院的能源使用(占总量的 52%),其中 22% 来自直列加速器,以及病人的交通(23%)。对于 VATS,主要是医院能源使用(52%)和一次性用品(23%)。通过低分量治疗、减少直列加速器的闲置时间和患者旅行的影响,可将气候影响降低20%(SBRT),通过快速恢复和减少一次性耗材,可将气候影响降低13%(VATS):结论:在治疗 T1-2N0M0 NSCLC 时,手术比 SBRT 对气候的影响更大。两种方式都有可能减少对气候的影响。
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Climate impact of early-stage NSCLC treatment: A comparison between radiotherapy and surgery using Life Cycle Assessment

Introduction

Healthcare systems contribute significantly to CO2 emissions, accounting for 7 % of emissions in the Netherlands. Understanding the environmental footprint of medical treatments can help identify opportunities for reducing climate impact. We evaluated the climate impact of stereotactic body radiotherapy (SBRT) and Video-Assisted Thoracic Surgery (VATS) when treating T1-2N0M0 Non-Small Cell Lung Cancer (NSCLC).

Materials and methods

We used life cycle assessment (LCA) to evaluate climate impact in emissions of kilograms of CO2 equivalent. Care trajectories were inventoried for both VATS and SBRT with the same entry and end point of the paths. We analyzed a range of factors contributing to climate impact, such as patient and staff travel, energy consumption, disposables and medication using direct measurements: questionnaires and waste audits, or retrospective record analysis. As is common in LCA, existing infrastructure was excluded from the analysis. Reductions that can be influenced by individual departments were also modeled.

Results

Using LCA we calculated the impact of all categorized contributions for two treatments for NSCLC. In total, VATS generates approximately 547 kg CO2 equivalent (CO2e), whereas SBRT generates 172 kg CO2e per treatment. For SBRT, the largest contributors were energy use in the hospital (52 % of total), of which 22 % is from the linac, and patient travel (23 %). For VATS, major contributions were hospital energy use (52 %) and disposables (23 %). Climate impact could be reduced by 20 % (SBRT) by hypofractionation, reduced linac idle time and patient travel impact, and 13 % (VATS) with fast track recovery and a reduction of disposables.

Conclusion

When treating T1-2N0M0 NSCLC, surgery has a larger climate impact than SBRT. For both modalities reductions are possible.
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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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