脑部放疗，上午比下午敏感许多！* ]$ u( p! G+ R, \
3 f9 ?: f! p6 i' \5 |
~1 z# n& M' K! f$ q" [Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.) I% a3 G* u% t7 }% n2 a
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
( y+ \2 F2 y2 kRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.# b- m- B( `1 b, O: l
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
1 Z K. [1 k- a) H' |& k7 R
: ?# u, I8 f/ _, ? S" TAbstract. n/ O1 J' Y# K0 w
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.
$ n- B* V- L1 U, ]$ h6 O
" g* @" ~& O* ]0 z# A# L! J$ PMETHODS: 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 X; m9 g8 D7 I. W( x+ N" E- z/ n5 i/ O+ B8 L: G# O' u
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).
! j; r$ F/ t/ q H) Y* z+ a! y3 [+ W! p3 H! b
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.+ M9 r0 G- ]& G2 y
/ B6 j/ h! W9 b- T6 B; }( m8 [
|
* I2 s; z/ ~( i- y& ]
显身卡
