脑部放疗,上午比下午敏感许多!7 s0 ? H3 c# k+ ^) x
, d# E( C N$ @
8 N; t) o; |4 w( }7 M8 @Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
5 |' Q' I+ D# Z* \& \ |% hGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?1 Y+ |1 ^# i, {4 y0 w" V2 u J# h
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.4 w+ X0 S$ l0 Z) y7 Z& _: y' l. j
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.+ H5 F: W/ z# F/ y
- G# k8 l" D1 c3 Q0 O- ^/ H
Abstract2 Y, T- ?# ]( P0 u/ F/ q1 i6 D
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.3 q1 t: Q3 U* W
$ J$ J) V' Y$ U ?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.! T& p6 D. I& B, g' }
( y- G( z! j( C6 w
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).
3 B) J2 J6 h& v7 s) D) s, T% ]5 s3 q7 Q( t) B5 t
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.
0 |6 }+ S6 d6 T- i6 O6 B. _- B9 I* L% Q3 g! ]
|