脑部放疗，上午比下午敏感许多！- l/ Z- M" p% M& p2 V# J! _
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Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.. o- b- g" l7 U$ P
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?/ L: P7 g9 T5 P6 F! t
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
: }# E" b0 G: o7 H5 oSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.7 X1 p$ e6 s7 g5 f0 q j
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Abstract
- h4 o4 e+ F0 j" b& r3 H/ 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.! M& l7 d7 O% `/ \4 s4 W: l* l
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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.+ M0 J% P& s3 f! T4 y ?& p1 g2 \3 U
7 e7 _2 t* X6 s! H9 G# ]2 f( M5 N$ x* eRESULTS: 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).7 W% d! z6 p- |1 J4 M
. @+ \! ? `9 M% g& r9 FCONCLUSIONS: 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.( z, k1 t& G& n1 c! q$ ^; q- H2 k
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