Chan Stephanie, Zhang Liying, Rowbottom Leigha, McDonald Rachel, Bjarnason Georg A, Tsao May, Barnes Elizabeth, Danjoux Cyril, Popovic Marko, Lam Henry, DeAngelis Carlo, Chow Edward
Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Ann Palliat Med. 2017 Jan;6(1):14-25. doi: 10.21037/apm.2016.09.07. Epub 2016 Oct 19.
Previous studies have observed how the time of radiotherapy delivery can impact toxicities and outcomes. The goal of this study was to determine whether treatment time influenced radiotherapy response for bone metastases.
Patients who received radiation treatment to painful bone metastases from January 2000 to December 2010 were included in our analysis. Demographic and treatment information including performance status, primary site, treatment dose and fraction, and response were collected prospectively. Treatment times were extracted from patient medical records. Patients were allocated to 8:00 AM-11:00 AM, 11:01 AM-2:00 PM, or 2:01 PM-5:00 PM cohorts based on their treatment times. To compare treatment response between the three cohorts, the Fisher exact test was used. A two-sided P value of <0.05 was considered statistically significant. Analysis was repeated with males and females separately.
A total of 194 patients were included. The median age was 68 years and 55.5% of patients responded to treatment. The dose and fraction of radiation received differed significantly between treatment cohorts using all allocation methods. Females in the 11:01 AM-2:00 PM cohort exhibited a significantly higher response rate (P=0.02) and differing proportions of response types (P=0.03) compared to the 8:00 AM- 11:00 AM and 2:01 PM-5:00 PM cohorts when allocated using all treatment times. No significant differences in response were seen between cohorts when all patients were analysed together or analysed for males only.
Treatment time may affect response in female patients receiving radiotherapy for painful bone metastases. Subsequent chronotherapy studies in radiation should investigate these gender differences.
以往研究观察了放射治疗的时间如何影响毒性和治疗结果。本研究的目的是确定治疗时间是否会影响骨转移瘤的放射治疗反应。
纳入2000年1月至2010年12月接受疼痛性骨转移瘤放射治疗的患者进行分析。前瞻性收集人口统计学和治疗信息，包括体能状态、原发部位、治疗剂量和分割次数以及反应情况。从患者病历中提取治疗时间。根据治疗时间将患者分为上午8:00 - 11:00、上午11:01 - 下午2:00或下午2:01 - 下午5:00三组。为比较三组之间的治疗反应，采用Fisher精确检验。双侧P值<0.05被认为具有统计学意义。分别对男性和女性进行重复分析。
共纳入194例患者。中位年龄为68岁，55.5%的患者对治疗有反应。使用所有分组方法时，各治疗组接受的放射剂量和分割次数存在显著差异。当使用所有治疗时间进行分组时，上午11:01 - 下午2:00组的女性与上午8:00 - 11:00组和下午2:01 - 下午5:00组相比，反应率显著更高（P = 0.02），反应类型比例也不同（P = 0.03）。当对所有患者一起分析或仅对男性进行分析时，各队列之间的反应无显著差异。
治疗时间可能会影响接受疼痛性骨转移瘤放射治疗的女性患者的反应。后续关于放射治疗的时间疗法研究应调查这些性别差异。
