脑部放疗,上午比下午敏感许多!
2 ?8 c+ c' ^- x0 e+ K. A
: p* U; f3 Z' @$ ]! a, N8 J' H7 a/ A0 C% @! {' U
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.) }# `4 T6 D/ l4 D7 F" R9 g
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
. H3 ?' o! |0 XRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
* P2 {2 J. ]- F1 _+ q. D* L& I, jSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
! G1 V4 |& `8 |( s5 }0 L
+ A6 e+ l- Z) m5 ^Abstract2 w) S# U+ b& Z
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.
# T1 R' \2 k& E$ V9 c' F; u6 o( S& S% f0 R
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.
. ~2 J" F! U7 ^/ Q: D G G0 s) i+ [" w$ 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).
4 z$ @$ E0 c2 L- U+ \5 |" |. D- f
! |3 g' b# y6 F' F9 O4 ~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.
) r5 b+ ~" W2 ?$ p7 @. i: d; b3 }& W1 H0 x; n; W
|