Background: Circadian rhythms regulate critical cellular processes, including DNA repair and cell cycle dynamics, potentially influencing the effectiveness of radiotherapy (RT). This study evaluated whether RT timing impacts clinical outcomes and symptom burden in prostate cancer patients. Patients/Methods: This retrospective study (n= 336, median follow-up 55 months) included men who received curative intent external beam RT between 2010 and 2019 (median age 69, 69% black, median PSA 11.3, 40% with Gleason 8–10). Treatment times (TTs) were averaged and analyzed by quartile/median. Outcomes included freedom from biochemical failure (FFBF) and distant metastasis (FFDM), GI and GU toxicity, and quality of life (QOL). Subgroup analyses by race and hormone therapy status were performed. Results: Across the overall cohort, TT was not associated with FFBF or FFDM. However, in white men, earlier TTs were significantly associated with higher 5-year FFBF (89% vs. 67%,p= 0.0139) and FFDM (93% vs. 72%,p= 0.0268). In the multivariate analysis (MVA), TT was not associated with FFBF or FFDM for all men, but in white men, earlier TT was associated with improved FFBF (HR 2.8,p= 0.06) in a model also including risk category (p= 0.21). Overall, no significant differences were observed for grade 2–3+ toxicity and TT. Trends for inferior QOL, and worse grade 2+ (p= 0.2) and 3+ GU toxicity (p= 0.1) were observed for later TTs. In white men, bowel, urinary continence, and irritative/obstructive urinary QOL were worse with later TTs (p< 0.05). Conclusions: TT may influence clinical outcomes and symptom burden, particularly in white men. These findings underscore the potential of chronoradiotherapy as a personalized treatment strategy and highlight the need for prospective trials.
背景：昼夜节律调控着包括DNA修复和细胞周期动态在内的关键细胞过程，可能影响放射治疗（RT）的疗效。本研究评估了放疗时机是否影响前列腺癌患者的临床结局和症状负担。 患者与方法：这项回顾性研究（n=336，中位随访55个月）纳入了2010年至2019年间接受根治性外照射放疗的男性患者（中位年龄69岁，69%为黑人，中位PSA 11.3，40%格里森评分8-10分）。治疗时间（TTs）取平均值并按四分位数/中位数进行分析。结局指标包括无生化失败生存（FFBF）、无远处转移生存（FFDM）、胃肠道（GI）和泌尿生殖道（GU）毒性以及生活质量（QOL）。按种族和激素治疗状态进行了亚组分析。 结果：在整个队列中，治疗时间与FFBF或FFDM无显著关联。然而，在白人男性中，较早的治疗时间与较高的5年FFBF（89% vs. 67%，p=0.0139）和FFDM（93% vs. 72%，p=0.0268）显著相关。在多变量分析（MVA）中，对于所有男性，治疗时间与FFBF或FFDM无关，但在白人男性中，在同时包含风险类别（p=0.21）的模型中，较早的治疗时间与改善的FFBF相关（HR 2.8，p=0.06）。总体而言，未观察到2-3+级毒性与治疗时间存在显著差异。较晚的治疗时间观察到生活质量下降的趋势，以及更差的2+级（p=0.2）和3+级GU毒性（p=0.1）。在白人男性中，较晚的治疗时间与更差的肠道、尿控以及刺激性/梗阻性泌尿QOL相关（p<0.05）。 结论：治疗时间可能影响临床结局和症状负担，特别是在白人男性中。这些发现强调了时间放射治疗作为个体化治疗策略的潜力，并凸显了进行前瞻性试验的必要性。
肿瘤(癌症)患者之家