脑部放疗,上午比下午敏感许多!
2 R8 s+ ]. a( s: Q& D
8 F, U' q! A) b$ [) O0 \& t
. v$ X1 a- y* {# Q) h2 fCancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.5 J) e+ m$ H- y& i* `
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?* G1 T' ~, U& ~
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.9 j @; J6 V; T5 Y1 E/ x
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
* H- L' p. L5 b
4 t0 D3 _- j: s7 DAbstract# {% j% d. Y0 M) n' W8 L
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.; U! p1 q! x3 N. o6 b5 F/ p
3 G6 e- w7 c* r6 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.
: P8 N- m: X, L
. A/ e r+ `7 MRESULTS: 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).
6 C2 `. b: ~4 F% g2 z, p2 L: [4 c! X' v2 I
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 R( e5 ~6 V& ^% V1 Y, E1 i- k" W! |
' I0 [" s6 Z: A( q5 I7 J. I0 R
|