Impact of time of day on outcomes after stereotactic radiosurgery for non–small cell lung cancer brain metastases

Cancer - Tập 119 Số 19 - Trang 3563-3569 - 2013
Shahed N. Badiyan1, D.J. Ferraro1, S Yaddanapudi1, Robert E. Drzymala1, Andrew Y. Lee1, Shawgi A. Silver1, Pawel Dyk1, T.A. DeWees1, Joseph R. Simpson1, Keith M. Rich2, Clifford G. Robinson1
1Department of Radiation Oncology Mallinckrodt Institute of Radiology Washington University in St. Louis St. Louis Missouri
2Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri

Tóm tắt

BACKGROUNDThis study tested the hypothesis that time of day of treatment with stereotactic radiosurgery (SRS) has an effect on local control (LC) and overall survival (OS) in a large cohort of patients with non–small cell lung cancer (NSCLC) brain metastases.METHODSAt Washington University in St. Louis, 437 patients with NSCLC were treated with SRS for NSCLC brain metastases. Receiver operating characteristics analysis was used to identify an optimal cut‐point for OS relative to time of day. Kaplan‐Meier log‐rank statistics, and Cox regression univariate and multivariate analysis were employed to isolate any independent effect of treatment time on OS and LC. Matched‐pair analysis was performed to isolate any independent effect of time on OS and LC of day while controlling for confounding variables.RESULTSReceiver operating characteristics analysis identified a cut‐point of 11:41 AM as providing the highest predictive value for OS. On univariate analysis, late SRS was associated with decreased OS, as was age, Karnofsky performance status, risk‐stratification schemes, extracranial disease status, and overall burden of brain metastases. On univariate analysis for LC, late SRS was associated with decreased LC, as was burden of brain metastases. On multivariate analysis, only Graded Prognostic Assessment remained predictive of OS, and total number of targets and total tumor volume remained predictive of LC. Matched‐pair analysis demonstrated no significant effect of time of day on LC or OS.CONCLUSIONSAlthough earlier treatment appears to be associated with improved LC and OS, treatment time fails to remain significant when accounting for confounding variables. Cancer 2013;119:3563–3569.. © 2013 American Cancer Society.

Từ khóa


Tài liệu tham khảo

10.1016/S0140-6736(04)16250-8

10.1016/S1470-2045(09)70263-3

10.1001/jama.295.21.2483

10.1016/j.ijrobp.2005.08.035

10.1093/jnci/87.1.34

10.1016/0360-3016(92)90706-N

Kim DG, 2000, Gamma knife radiosurgery for brain metastases: prognostic factors for survival and local control, J Neurosurg., 93, 23, 10.3171/jns.2000.93.supplement_3.0023

10.1200/JCO.2011.38.0527

10.1016/S0360-3016(96)00619-0

10.1016/S0360-3016(99)00549-0

10.1200/JCO.2006.09.2536

10.1200/JCO.2004.00.1768

10.1016/j.ijrobp.2012.11.042

10.1126/science.1203430

10.1016/j.ijrobp.2004.03.005

10.2307/3572419

10.1080/09553008814551091

10.1016/0300-9629(84)90633-9

10.1080/09553009014551521

10.1080/09553008214551791

10.1002/cncr.25423

Williams BA, 2006, Finding optimal cutpoints for continuous covariates with binary and time‐to‐event outcomes. Mayo Foundation Technical Report Series, no. 79

10.1016/j.ijrobp.2008.07.009

10.1002/cncr.24867

Thông tin
Thông tin xuất bản

Cancer

Tập 119 Số 19

3563-3569

Thông tin tác giả