脑部放疗，上午比下午敏感许多！3 [2 I3 {& O; l( C$ I
" Q& z T- p5 T" K \! b- A: \' U( q4 ?& b/ V) v0 k
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
$ {2 s2 }6 b8 IGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
# k% G5 K* k- [- y& YRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
% I* n4 {+ U8 xSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
1 K7 G# x1 E3 D! E. W3 {3 c/ P% B |5 n- E/ E
Abstract
' U# l, w7 i y, Z" D$ GBACKGROUND: 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.0 A2 @" X9 U$ A: T" I
: R! j2 S2 C: J; J. m ]; }0 K
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.+ r" H$ X" [* q5 z% k- g
' j) `( H9 m6 t% a# @/ w3 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).
6 Z: D7 G) s$ ^1 E1 j! ^) L/ R0 m# P
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.
# Y. Q0 W# z/ R- v4 O4 y
6 I/ e9 p. ?. b, }4 M: r1 v |
( q# E3 M \: D( g; i$ c3 P2 f
显身卡
