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Abstract：
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 (n = 158) showed a trend toward improved overall survival vs. afternoon (n = 79); the median survival was 158 vs. 79 days (p = 0.20, HR = 0.84, CI95% 0.84-0.91). Subgroup benefits for morning treatment in females (p = 0.04) and trends in controlled primary disease (p = 0.11) and breast cancer metastases (p = 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.
摘要：
昼夜节律系统，影响生理过程的重要时间调节器，对癌症发展和治疗反应有影响。我们的研究评估了昼夜节律时间对脑转移瘤全脑放疗结果的影响，以获得个性化的癌症治疗见解。该研究的目的是评估昼夜节律对放射治疗时机的影响及其与临床结果的相关性，并确定受益于同步昼夜节律的干预措施的患者人群。考虑亚组差异和潜在差异。IRB批准的237例脑转移瘤全脑放疗患者（2017-2021）的回顾性分析，在上午或下午接受超过80％的治疗，已执行。生存分析利用Kaplan-Meier曲线。这是一项单机构研究，涉及接受全脑放疗的患者。人口统计,疾病,并从电子病历中收集社会经济参数。早晨治疗（n=158）显示出改善总体生存率的趋势。下午（n=79）；中位生存期为158vs.79天（p=0.20，HR=0.84，CI95%0.84-0.91）。观察到女性早晨治疗的亚组益处（p=0.04）以及控制的原发疾病（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。本研究强调了脑转移放射治疗中时间生物学因素的相关性。早晨治疗与生存率提高相关，特别是在特定的子组中。确定了潜在的昼夜节律影响差异，为个性化癌症治疗和干预措施同步昼夜节律以提高治疗疗效奠定基础。
