脑部放疗,上午比下午敏感许多!
8 ~/ e6 n( J) ?$ D4 K4 N ~2 K% r9 j. a- i9 i
- }! [9 `, i9 H3 o6 ~6 CCancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.; ~* r, C1 J( V1 e7 V
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?; [* d/ I4 t4 c8 G% T9 ^0 d2 Y
Rahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.1 O1 p8 o5 I" Z$ H$ d3 M
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
+ X$ K; Y- }4 @' O
, P9 b8 t! }6 U) {Abstract( K3 K# V+ V" J, L' i
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 |! q! D' J, v% x$ ~
: s7 Z, z7 \% Y5 ^# KMETHODS: 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.
1 t/ D/ |4 @8 H8 q+ D) E3 s8 E4 i2 Z. z# `9 E5 w4 J( O
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).
+ Y# h9 f) b0 U7 D" z; T
+ ?, G& w5 x0 h& C) aCONCLUSIONS: 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.$ w2 b! V" O4 j1 |- a+ T- ?
~- n; e4 x$ ]5 p; O
|