脑部放疗,上午比下午敏感许多!
6 j) D* |8 T; ]- b" c4 e$ L$ E* c/ q3 d2 [
( D* [9 }$ Q" M+ Y F- K9 K9 JCancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.) c" \ N8 U! F* n; g
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
' B# p0 N' g Q8 B0 r3 Q+ |Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.! P5 |$ A" k \1 b1 s
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
" W# x* s* n5 ^3 ^# p* O+ S
9 {, j6 x) C& K9 F* cAbstract
" J9 Q) B6 I* y$ J& r/ p8 DBACKGROUND: 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.
! E& R; ^/ O a1 q; F5 j7 y4 J I) I6 j
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.! I1 |( g( s4 W# o ]; s
7 q( T8 P9 l6 J; J% J8 J6 vRESULTS: 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).
0 }; Q" {, o- f$ c9 Z7 w6 `! ]. K1 g
2 r# ^$ h0 v5 ^0 v, x: N9 FCONCLUSIONS: 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.4 h+ e1 i) ]8 r. s3 \
v& w/ f* G' F9 W
|