脑部放疗,上午比下午敏感许多!
% B- d" G P0 ~
5 Y: o& p8 \" h( D* {# H9 |" K+ E6 B5 D4 [
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.2 u |7 o) A: W) o3 c& J4 U7 s% `
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?3 Z' E5 g( |9 r8 e$ Z$ W6 M: C
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.6 h/ g1 v7 F' l) O' x* Z+ M: b1 r
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
$ W: h- `$ _5 Y2 V; S$ D
' M( F$ Y9 ?7 {Abstract
0 g, {) ]! }% d' f# K! I2 \5 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.$ E% D |# r* e+ q
; D) l' A6 |/ O# a4 r8 o+ W
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.0 Y5 }0 y' ?" H$ s
7 G. F( q* A/ Z+ j) U
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).
. e: O! f* o$ h$ k+ J* C6 G: p, A- S/ P" m' N7 j, n6 Q
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.
! y$ h" N7 w E; @& N( D; x+ V# {5 x
|