脑部放疗，上午比下午敏感许多！
/ r8 e( Z: F1 _2 O" X
$ _. F1 s0 [# m
8 W6 J, Y% M! ?, p% q) z1 NCancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.& }! m0 S; t& m% Z2 C
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
, C# X7 G q& {7 w8 wRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
; Y& S% v, _4 Q# q9 g2 tSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
, Z6 b0 H+ U2 V( r, b! q% T: Y/ J" i& t% I8 v: ?% U
Abstract
/ Q" e1 s Q( hBACKGROUND: 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.
7 h3 X. ], L) {" y1 n5 {# t' o9 c, B0 |9 }; ]; \
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." c$ U; K* B2 J- C
0 D+ \. }# N: J2 f4 E0 m0 ~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).
; w2 d, W2 c2 Q4 V0 j' N& Y1 j0 {4 M- Y1 X. }) n' e9 K: J& H5 c
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.( B# r! O. g& U6 Y8 u
' d3 D& b& Z% r! ?$ n0 p4 ]% J |
显身卡
