脑部放疗，上午比下午敏感许多！7 D: ?* d, ^, T: l
8 d, E8 _- u. m) J# u, q! L* _& r/ D" v1 q+ t) u* t- J- `
Cancer 2011 Jan 15;117(2):414-20. doi: 10.1002/cncr.25423. Epub 2010 Sep 9.1 h3 S2 ~3 ]- @: v% C
Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: is there a difference in outcome between morning and afternoon treatment?
# @) K, d$ N. u8 x" ]; x" ^; CRahn DA 3rd, Ray DK, Schlesinger DJ, Steiner L, Sheehan JP, O'Quigley JM, Rich T.- j* {) J O' _8 z
SourceDepartment of Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
$ o3 O; l8 M! f1 h) g3 d5 P6 I% K& Q" b7 o; S* o
Abstract/ j% @6 M; ^* n3 @9 m4 X- [
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.5 Q$ ?% z0 S+ t# B9 `
0 _' S8 r ]. b0 T6 [* N- b
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.
5 n" p5 O6 u8 _8 ]
" ?. a4 \& X. A9 Y/ QRESULTS: 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).
2 f) S1 B' e, U; ^+ o" ]0 W
6 d& g6 i; c' T; s; E7 G& J, DCONCLUSIONS: 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 |% R% H1 j0 e1 Q# V2 {7 [/ s
- X: l/ H0 x& m6 h& d |
显身卡
% ?* x. u9 M& ?
