脑部放疗,上午比下午敏感许多!+ X5 j$ V) x7 i- q7 Z
3 b D) Z) ^+ ]! t
" Z, A* U+ y) Z" ]) L" ]$ v& M
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.& r" m9 G8 @' C8 ?- r
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
, n" D$ J4 M# Q8 u4 M7 T* qRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.2 R% Z/ D4 `; ?- M% ~
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
# a G4 Q9 {6 m# _1 \, w: a$ [& u) ^) ~8 A+ N5 K% y$ {5 Z M3 @. Y
Abstract
% W3 t3 {* @- D) o# cBACKGROUND: 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.% Q! f3 k M4 J3 g: Y; H, P( ~
% m3 o. Z& D4 ^2 @" DMETHODS: 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.' T5 _8 G( Y# N2 g! M: Z& ^
0 S3 J' z0 b4 r* o& r bRESULTS: 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)./ L* I, S( m7 n" P
2 m7 w- @( N+ E1 W) ?& N, Y' Q1 x9 ~
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 I2 L5 U1 ]( j. |7 c- A+ `
' k. M3 _6 B$ ^; Y0 X6 v& H |