脑部放疗，上午比下午敏感许多！/ n+ j( m _3 o2 c9 g) r4 V
: ?0 G! b7 r, | n; h
, c0 N( j/ D" u* e% [; M% }5 ?Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.' A- U5 B& Y* R8 M" _
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
- r% U% c# h. E1 t+ iRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
5 X1 W7 G! W: _9 ~' wSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
$ f, t& w9 u2 p- O# F: j$ h
1 \* F) l! K; W& s7 I4 h+ YAbstract
% Y8 A m3 h2 {$ jBACKGROUND: 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.
. {4 I9 q C- r, L! ]+ j9 I4 d1 d0 D7 R6 D
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.
" X; G( g X$ R0 H% e: g: a* F
- |5 O, e+ k \, _2 X y$ \0 qRESULTS: 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).
. g# Y# k" c5 F2 n# T! q% Q j5 }% L; \1 c) n" v$ w
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.
3 ~4 ?( R/ v5 |; a+ F5 D' r3 a2 I7 ?6 W6 X
|
& c* R; o6 I; L" u: P/ {: C
显身卡
