脑部放疗,上午比下午敏感许多!0 i7 d& X6 F0 K Y" v4 J
) f3 O3 t; p _0 q( v; T
% y7 ]: Q& S- @2 Q& G2 r* |
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
+ L! ]! [7 t- G' c( }$ P4 Y' |) XGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?. x* q1 i3 @4 Z% z
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.' c! G6 V3 d C) {
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
/ ~- C: O4 n/ Q G1 N8 W1 I+ @) ]3 r5 `
Abstract4 U# ^! P- e- [( j
BACKGROUND: 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.
* t( w& a) r' m5 @* O/ s+ D3 c) I; r- X8 v {: n/ |4 k0 e3 @+ V
METHODS: 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.
1 F: j6 P# Y2 _. }4 _; U1 [- N/ q2 }! m5 _0 M* ~5 F
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).$ E1 `5 E* q i8 R; v
]" L6 D. E2 S# l- O( s) cCONCLUSIONS: 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.2 t$ g3 z# f# `% c9 i" B
% e3 W( L) d- _+ `4 [) M/ w/ } |