脑部放疗，上午比下午敏感许多！& E% P2 d# g) s' L3 n: \$ T; X
( C( c8 T! E# R. N* J
# h5 e$ g, U9 nCancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
7 A0 e, R+ h3 ZGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
8 i7 [+ C, |% Q: d+ r% v' ERahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.3 @& M0 F8 ] |( A4 X
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.9 v7 a* ~ Q( b( A7 Z; Z, i
1 n) ^/ c3 X0 u! F
Abstract
7 A, g& U+ M% d& a, Q+ yBACKGROUND: Circadian cell-cycle progression causes fluctuating radiosensitivity in many tissues, which could affect clinical outcomes. The purpose of this study was to determine whether outcomes of single-session gamma knife radiosurgery (GKRS) for metastatic nonsmall cell lung cancer (NSCLC) differ based on treatment time.
- o5 @7 l8 y( u9 ?( h* [/ T
8 Z. j6 V5 n: p9 ~1 _ SMETHODS: Fifty-eight patients received GKRS between 10:00 am and 12:30 pm and 39 patients received GKRS between 12:30 pm and 3:00 pm. The mean peripheral dose was 18.6 Gy. The mean tumor size was 7.3 cm³. Magnetic resonance imaging was used to score local control at 3 months. Cause of death (COD) was categorized as central nervous system (CNS)-related or systemic.
. Y' F1 q l; v8 B# N7 e2 L7 X9 P9 J8 _' x
RESULTS: Demographic and disease characteristics of the 2 groups were similar. Local control at 3 months was achieved in 97% (35/36) of patients who underwent GKRS early in the day versus 67% (8/12) of patients who underwent GKRS later in the day (chi-square, P = .014). Early GKRS was associated with better survival (median 9.5 months) than late GKRS (median 5 months) (Kaplan-Meier log-rank test, P = .025). Factors contributing to better survival in a Cox regression model included early treatment time (P = .004) and recursive partition analysis class (P < .001). Cause of death in the early treatment group was CNS-related in 6% (3/47) of patients versus 24% (8/34) of patients in the late treatment group (chi-square test, P = .026).2 E* v) F& ^. X/ u: E5 J! T; q
$ v0 s* D1 S) I+ Z( }; I, |; v" D& H
CONCLUSIONS: GKRS for metastatic NSCLC had better local control, better survival, and a lower rate of CNS-related cause of death when given earlier in the day versus later in the day. These retrospective data should encourage future study in brain radiosurgery and non-CNS stereotactic body radiotherapy series.
" X* k+ l" U, l: T$ f# `% A
% n7 D% _9 C. L( ^4 L |
8 D8 I6 c! x( c4 |$ }- |% Q0 J
显身卡
