脑部放疗,上午比下午敏感许多!
/ W0 g1 D# N% S; k& l5 c1 f: m9 J1 @0 L$ T" W1 Y1 ^# i8 L, I* \% v7 _
l \. O$ h K B6 @, G
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
7 Z9 x; M3 C! u! B9 f6 LGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
- q2 N. I7 _4 g) E; pRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
2 W- D$ Q3 a% s$ u, NSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
# V% h$ W3 m+ Z: c' G1 J$ O$ {% v& `8 ~) t1 O
Abstract
4 g9 U* a! U" e5 lBACKGROUND: 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.9 \; i% n# V" T( A4 j
7 y. ?* J; K; `& t" z
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.! Y) G( Z, d9 @
. v7 H3 O% R L. R/ e5 j0 c( L, xRESULTS: 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).
& q6 z. `' q$ _. U; _1 g( S3 G& |! Z. R" Q4 o0 x2 u
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.
7 s3 R7 u! I6 v6 D0 H$ |
; I8 t* ~, p( M0 \ q" \$ v9 f |