脑部放疗,上午比下午敏感许多!; `: D# q) i: e5 \
% d9 r7 u! D0 h8 U5 z# @
3 v8 s% p7 C) Z% U- L& q% Y
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.% G# I1 F& o& t+ ?. h8 i
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?. Q2 U3 v5 y; ]2 O1 o4 h
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
3 x! m1 z( P* a+ nSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
/ {, S; ]0 Z* T5 a) D; G2 g. I* E3 e2 D+ y9 q- U" G* _+ S( x6 W6 y
Abstract
; B2 Z: h4 C/ B4 a: F6 t- iBACKGROUND: 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.
; p7 o0 w& W* U! [# C# W* R
: R0 b7 l/ I5 a+ d4 h1 }* WMETHODS: 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 C0 Q$ W! j- _* b1 C7 T$ B. q. ^
2 A$ [. A9 B8 w: g$ p3 ^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).
$ Z# H% o8 l( p% @
9 ?5 E7 K) a# G9 u8 bCONCLUSIONS: 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.
6 o# E' y; e$ A' W, m; [
. C: Z! J' h3 L+ O* K$ F" h* f( s |