| 脑部放疗,上午比下午敏感许多!1 a& z' [0 \& L" Z3 c' a$ G; s . X2 o7 `0 F4 K! y& q! B
 
 6 x0 _1 u3 L$ r  G: `Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.6 P; r4 k3 m' C6 @
 Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
 9 l) K* ~' H( \  j( {: a, b  aRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
 2 Y8 J) n# a8 VSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA., Q7 \, Z0 b& X* V. W
 5 i( e; A+ C/ V' U$ N
 Abstract
 8 u: O1 O6 z( B% N% G" `' F! ^! q2 n/ xBACKGROUND: 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.
 6 v# j) {) h7 Y; \
 & ~- q$ T) U9 A* t) PMETHODS: 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.
 p% U4 y5 A/ ^( v8 v  x# k
 4 ]; m3 X+ o7 n8 m- m7 JRESULTS: 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).! c4 m. L& N- h! n9 i
 
 / E- M. s% r3 q5 UCONCLUSIONS: 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.0 S! u9 N5 f$ j
 
 M1 o+ [# n9 i; i
 |