脑部放疗,上午比下午敏感许多!- J; i: Y9 o/ p) v& u m7 x
9 s! L5 V2 ]2 i. g z7 }1 V
. F- S0 W) [3 s+ _# d- {
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.' e# ]$ s8 a7 p$ e
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?# O0 A6 L5 p7 O" s) V* f3 F. m
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.4 z; l4 A1 @9 J, m# z* N# R. T
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA." X2 E$ _! T) y
4 U4 A" l$ L8 n! |) J- \Abstract
- I7 V) W, k( C" |, wBACKGROUND: 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 M C0 V$ Z* I2 X6 X. u8 G1 m1 O
6 k* p6 b0 s* M! U) I3 X
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.
; c! A, m3 M6 q( ~# p, ]) G, `+ P& F* r3 ~; N9 ~; R" y3 c
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).6 j) Y$ K! [. V+ X
3 R) o ^" h. {! E5 J* p( @6 ECONCLUSIONS: 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.
6 q- H! m& X# S1 n3 s$ z, d0 s; z. [( h3 V
|