脑部放疗，上午比下午敏感许多！3 R% V/ j4 R4 V" ~( ?
7 ]" c7 U3 C8 e' l+ }5 b4 u6 {
' S/ {+ U9 a2 I' i' \
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
' I/ }6 r) _' I4 GGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?- M6 Y7 q5 z6 p3 r( p* L9 F
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
# s7 D: n! ?. U! M aSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.5 h& \8 d& Q7 q
* D# t+ E7 C- ]4 A. ?
Abstract% r/ e6 A2 Z! U0 R+ Q1 r' v/ T! o
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.
0 C: N' Y4 E; e4 b C6 b: y+ [0 p8 x- ?- j, z9 ^
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.# c4 x: k, r4 J% `* J. }6 ] b
8 y/ F0 t0 U6 K- G S, m5 [( p$ E
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).
; {4 j1 i4 q5 }' Q* J6 [' n. ?6 D& L H
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.
q1 O* u0 }* g, x
1 u$ P% m; P, ?- x3 v |
显身卡
