脑部放疗，上午比下午敏感许多！( G2 `: D7 X+ P3 y& l* J5 q- i
4 _6 S) t3 P" Q, k) u% I6 P" q# o
5 z& Y# l; x5 ?% r( d1 SCancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
$ X% V5 _( t5 g% f. [Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?, q) D2 _; u7 p" D8 X5 S
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.0 a2 T( s9 B1 o4 l3 o1 G7 }: |
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.3 j7 Z! \/ I: v! L( S+ x( l2 b
) ^( t" p. u) J+ S3 QAbstract
/ N: P. z" I; y: p* Q( R2 }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.1 _0 E* k E( H6 i/ k4 z
1 E% ^% y8 ]; f* J; w! n8 z* Y, u. t8 Y9 RMETHODS: 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/ X; u2 [2 A) e
0 U+ S3 W- |; X9 z
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).4 T( u2 c2 Z5 x8 m C
9 m+ D" x& F$ B6 e1 _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.: q2 \% z/ a; k2 T5 N J
! h0 H. {: p/ Y! {1 Y4 Q: m |
显身卡
