脑部放疗，上午比下午敏感许多！. K& u5 A/ m" B- y1 d+ Z) U
$ b) v6 \; l5 P$ V' [2 ^
- G2 I% q' r5 o; S1 b- y# \1 I* O
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
% J8 Y% s/ n" w: MGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?' n& O( A) i) r+ {* r/ K% @
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
( c) J% R$ M& F$ \7 MSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.6 Y0 U3 ^0 c* }# B/ e
0 A- Q. P6 V& f0 T2 m0 LAbstract
2 A6 `& K7 k. d JBACKGROUND: 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.
( i. U. j6 O8 Q% H$ J4 f+ b+ n
6 H% k/ j; `) R6 ~: k4 p. F5 }2 eMETHODS: 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 k7 Y3 o) z+ I3 a* e
3 P8 H" w2 p/ u9 H# j7 [6 \" gRESULTS: 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).
# ]- N4 S: B5 E2 @( M3 Q) M& E& B/ c' d& F6 K) D
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.$ @9 S: |6 Z1 e# v* S
- q$ Y( P# \4 |* z% H
|
显身卡
