脑部放疗,上午比下午敏感许多!
* }+ s) @+ ?% V. @' a" }) O+ }% E
6 ?. J% S! r) U; @. N- P( j
c8 ^( v7 a& |1 u$ c( D! V3 Q' [Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.
) L4 h3 q/ f5 H, b5 L9 t0 [& WGamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
$ c: H6 x/ Y, BRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.
: Q6 m5 a H/ H% i; sSourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.1 e! h: \4 C- y" i( }
5 i8 ~/ V$ H$ t0 K% D7 X& o4 B
Abstract' a* v& `/ g% I) g
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.- v! x/ _- ~5 N& C
W, y. ?! i& a: r z3 Z3 O" YMETHODS: 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.
7 g3 C% z# z* W* q
' s+ Q$ s5 ?# k f! @% RRESULTS: 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)., B( x7 r. }/ ?/ H/ Y6 r
7 N2 U" ^! K" I8 U; GCONCLUSIONS: 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.( E; E( T' ?" e& |! |0 Q) C$ o
) H; h: J5 _: J; y4 K |