Nelson Nicolas G, Burke Sara E, Cappelli Louis, Matlack Lauren E, Smith Alexandria P, Francois Noelle, Lombardo Joseph F, Shah Yash B, Wen Kuang-Yi, Shafi Ayesha A, Simone Nicole L
Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Division of Population Health, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Clocks Sleep. 2024 Mar 21;6(1):200-210. doi: 10.3390/clockssleep6010014.
The circadian system, a vital temporal regulator influencing physiological processes, has implications for cancer development and treatment response. Our study assessed circadian timing's impact on whole-brain radiotherapy outcomes in brain metastases for personalized cancer therapy insights. The aim of the study was to evaluate circadian influence on radiation treatment timing and its correlation with clinical outcomes and to identify patient populations benefiting from interventions synchronizing circadian rhythms, considering subgroup differences and potential disparities. An IRB-approved retrospective analysis of 237 patients undergoing whole-brain radiotherapy for brain metastases (2017-2021), receiving over 80% of treatments in the morning or afternoon, was performed. Survival analyses utilized Kaplan-Meier curves. This was a single-institution study involving patients receiving whole-brain radiotherapy. Demographic, disease, and socioeconomic parameters from electronic medical records were collected. Morning treatment ( = 158) showed a trend toward improved overall survival vs. afternoon ( = 79); the median survival was 158 vs. 79 days ( = 0.20, HR = 0.84, CI 0.84-0.91). Subgroup benefits for morning treatment in females ( = 0.04) and trends in controlled primary disease ( = 0.11) and breast cancer metastases ( = 0.08) were observed. Black patients exhibited diminished circadian influence. The present study emphasized chronobiological factors' relevance in brain metastases radiation therapy. Morning treatment correlated with improved survival, particularly in specific subgroups. Potential circadian influence disparities were identified, laying a foundation for personalized cancer therapy and interventions synchronizing circadian rhythms for enhanced treatment efficacy.
昼夜节律系统是影响生理过程的重要时间调节器，对癌症的发生发展及治疗反应具有重要意义。我们的研究评估了昼夜节律对脑转移瘤全脑放疗结果的影响，以获得个性化癌症治疗的见解。本研究的目的是评估昼夜节律对放疗时间的影响及其与临床结果的相关性，并确定从同步昼夜节律的干预措施中获益的患者群体，同时考虑亚组差异和潜在的差异。对237例接受脑转移瘤全脑放疗（2017 - 2021年）且上午或下午接受超过80%治疗的患者进行了一项经机构审查委员会批准的回顾性分析。生存分析采用Kaplan - Meier曲线。这是一项涉及接受全脑放疗患者的单机构研究。收集了电子病历中的人口统计学、疾病和社会经济参数。与下午治疗（n = 79）相比，上午治疗（n = 158）显示出总体生存率提高的趋势；中位生存期分别为158天和79天（p = 0.20，HR = 0.84，CI 0.84 - 0.91）。观察到女性上午治疗的亚组获益（p = 0.04）以及原发疾病得到控制（p = 0.11）和乳腺癌转移（p = 0.08）的趋势。黑人患者的昼夜节律影响减弱。本研究强调了时间生物学因素在脑转移瘤放射治疗中的相关性。上午治疗与生存率提高相关，特别是在特定亚组中。确定了潜在的昼夜节律影响差异，为个性化癌症治疗以及同步昼夜节律以提高治疗效果的干预措施奠定了基础。
