脑部放疗,上午比下午敏感许多!
" @4 [& H& y- y3 F8 a1 d+ C6 h* ~ Y: v. a2 c4 r, ~5 }7 ~
8 h- d# |% y: T% l# F# I' M
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
- ^9 T! v# n6 T# @$ l0 YGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
: R; ?2 G$ m; ]+ cRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
3 Q$ Z& @5 p" eSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
% G& U" M% g5 f( G5 g- b6 T$ g* Q5 B1 M, ?5 }9 W( I( R
Abstract( w) e/ G% Z/ q& k
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.2 Z" y: W9 q* U% \; s5 n: T- W, t
% `& a8 b4 `5 J6 UMETHODS: 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." _; I- E% [6 N: n# }- H9 E* }$ f9 \
8 ^; x) { e; H( @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).
7 b* l$ t, t3 m* i4 g& }' B0 v! L% V* z" q8 u
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.4 Z& N) X/ u0 T' _* H, q+ f
# w4 T$ t% e& q2 g1 `2 u: k |