脑部放疗,上午比下午敏感许多!( k+ I" _# k- P0 L% N! Y( N6 f$ x
0 Q! z) u8 g5 ^$ ]9 F1 S* ~
3 G" Z+ W! A6 E# y+ m- n& n
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
' h; @. ]6 \# ^0 MGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
5 w l. F* E6 b. QRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
) z6 F5 \/ T8 }( \( y* ?( D; ?SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
, M% o, \. c8 Y' n, _
2 `. U; s# X$ \! R& yAbstract8 z% X) w6 i: p2 h1 W r e. K: L* X* T
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.
! _; ?7 u3 v$ [( R- Q6 {
8 @1 y! b: h3 U4 c5 Y- k( p8 yMETHODS: 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.
" c" ^: @- x' o3 U1 x: _5 O* `/ _ T' U: I, g& p" |. w6 k
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).2 H# B0 i, [- S9 R
1 ?5 @% G% i/ n& `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.# S' l- U8 C2 y$ H( P2 w" @
1 V' q9 U- i( d1 ]8 {; S9 V7 k% J
|