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

Shahed N. Badiyan, Daniel J. Ferraro, Sridhar Yaddanapudi, Robert E. Drzymala, Andrew Y. Lee, Shawgi A. Silver, Pawel Dyk, Todd DeWees, Joseph R. Simpson, Keith M. Rich, Clifford G. Robinson

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND This 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. METHODS At 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. RESULTS Receiver 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. CONCLUSIONS Although 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. The purpose of this study was to examine the role of time of day on outcomes for patients with non-small cell lung cancer treated with stereotactic radiosurgery. This series represents the largest series to date and fails to confirm previously reported findings that time of day of stereotactic radiosurgery is associated with local control or survival.

Original languageEnglish (US)
Pages (from-to)3563-3569
Number of pages7
JournalCancer
Volume119
Issue number19
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

Fingerprint

Radiosurgery
Non-Small Cell Lung Carcinoma
Brain Neoplasms
Neoplasm Metastasis
Survival
Matched-Pair Analysis
Confounding Factors (Epidemiology)
ROC Curve
Multivariate Analysis
Karnofsky Performance Status
Brain
Therapeutics
Tumor Burden
Regression Analysis

Keywords

  • brain metastases
  • chronobiology
  • circadian rhythm
  • Gamma Knife
  • local control
  • non-small cell lung cancer
  • radiosurgery
  • survival
  • time of day

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Badiyan, S. N., Ferraro, D. J., Yaddanapudi, S., Drzymala, R. E., Lee, A. Y., Silver, S. A., ... Robinson, C. G. (2013). Impact of time of day on outcomes after stereotactic radiosurgery for non-small cell lung cancer brain metastases. Cancer, 119(19), 3563-3569. https://doi.org/10.1002/cncr.28237

Impact of time of day on outcomes after stereotactic radiosurgery for non-small cell lung cancer brain metastases. / Badiyan, Shahed N.; Ferraro, Daniel J.; Yaddanapudi, Sridhar; Drzymala, Robert E.; Lee, Andrew Y.; Silver, Shawgi A.; Dyk, Pawel; DeWees, Todd; Simpson, Joseph R.; Rich, Keith M.; Robinson, Clifford G.

In: Cancer, Vol. 119, No. 19, 01.10.2013, p. 3563-3569.

Research output: Contribution to journalArticle

Badiyan, SN, Ferraro, DJ, Yaddanapudi, S, Drzymala, RE, Lee, AY, Silver, SA, Dyk, P, DeWees, T, Simpson, JR, Rich, KM & Robinson, CG 2013, 'Impact of time of day on outcomes after stereotactic radiosurgery for non-small cell lung cancer brain metastases', Cancer, vol. 119, no. 19, pp. 3563-3569. https://doi.org/10.1002/cncr.28237
Badiyan SN, Ferraro DJ, Yaddanapudi S, Drzymala RE, Lee AY, Silver SA et al. Impact of time of day on outcomes after stereotactic radiosurgery for non-small cell lung cancer brain metastases. Cancer. 2013 Oct 1;119(19):3563-3569. https://doi.org/10.1002/cncr.28237
Badiyan, Shahed N. ; Ferraro, Daniel J. ; Yaddanapudi, Sridhar ; Drzymala, Robert E. ; Lee, Andrew Y. ; Silver, Shawgi A. ; Dyk, Pawel ; DeWees, Todd ; Simpson, Joseph R. ; Rich, Keith M. ; Robinson, Clifford G. / Impact of time of day on outcomes after stereotactic radiosurgery for non-small cell lung cancer brain metastases. In: Cancer. 2013 ; Vol. 119, No. 19. pp. 3563-3569.
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abstract = "BACKGROUND This 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. METHODS At 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. RESULTS Receiver 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. CONCLUSIONS Although 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. {\circledC} 2013 American Cancer Society. The purpose of this study was to examine the role of time of day on outcomes for patients with non-small cell lung cancer treated with stereotactic radiosurgery. This series represents the largest series to date and fails to confirm previously reported findings that time of day of stereotactic radiosurgery is associated with local control or survival.",
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AU - Badiyan, Shahed N.

AU - Ferraro, Daniel J.

AU - Yaddanapudi, Sridhar

AU - Drzymala, Robert E.

AU - Lee, Andrew Y.

AU - Silver, Shawgi A.

AU - Dyk, Pawel

AU - DeWees, Todd

AU - Simpson, Joseph R.

AU - Rich, Keith M.

AU - Robinson, Clifford G.

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N2 - BACKGROUND This 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. METHODS At 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. RESULTS Receiver 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. CONCLUSIONS Although 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. The purpose of this study was to examine the role of time of day on outcomes for patients with non-small cell lung cancer treated with stereotactic radiosurgery. This series represents the largest series to date and fails to confirm previously reported findings that time of day of stereotactic radiosurgery is associated with local control or survival.

AB - BACKGROUND This 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. METHODS At 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. RESULTS Receiver 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. CONCLUSIONS Although 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. The purpose of this study was to examine the role of time of day on outcomes for patients with non-small cell lung cancer treated with stereotactic radiosurgery. This series represents the largest series to date and fails to confirm previously reported findings that time of day of stereotactic radiosurgery is associated with local control or survival.

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KW - chronobiology

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KW - local control

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KW - survival

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