DEDICATED LINEAR ACCELERATOR RADIOSURGERY FOR TRIGEMINAL NEURALGIA: A SINGLE-CENTER EXPERIENCE IN 179 PATIENTS WITH VARIED DOSE PRESCRIPTIONS AND TREATMENT PLANS

作者：Smith Zachary A; Gorgulho Alessandra A; Bezrukiy Nikita; McArthur David; Agazaryan Nzhde; Selch Michael T; De Salles Antonio A F^*

来源：International Journal of Radiation Oncology, Biology, Physics, 2011, 81(1): 225-231.

DOI：10.1016/j.ijrobp.2010.05.058

• Dedicated linear accelerator
• Radiosurgery
• Trigeminal neuralgia
• Stereotactic

Purpose: Dedicated linear accelerator radiosurgery (D-LINAC) has become an important treatment for trigeminal neuralgia (TN). Although the use of gamma knife continues to he established, few large series exist using D-LINAC. The authors describe their results, comparing the effects of varied target and dose regimens.
Methods and Materials: Between August 1995 and January 2008, 179 patients were treated with D-LINAC radiosurgery. Ten patients (5.58%) had no clinical follow-up. The median age was 74.0 years (range, 32-90 years). A total of 39 patients had secondary or atypical pain, and 130 had idiopathic TN. Initially. 28 patients received doses between 70 and 85 Gy, with the 30% isodose line (IDL) touching the brainstem. Then, using 90 Gy, 82 consecutive patients were treated with a 30% IDL and 59 patients with a 50% IDL tangential to the pons.
Results: Of 169 patients, 134 (79.3%) experienced significant relief at a mean of 28.8 months (range, 5-142 months). Average time to relief was 1.92 months (range, immediate to 6 months). A total of 31 patients (19.0%) had recurrent pain at 13.5 months. Of 87 patients with idiopathic TN without prior procedures, 79 (90.8%) had initial relief. Among 28 patients treated with 70 Gy and 30% IDL, 18 patients (64.3%) had significant relief, and 10 (35.7%) had numbness. Of the patients with 90 Gy and 30% IDL at the brainstem, 59 (79.0%) had significant relief and 48.9% had numbness. Among 59 consecutive patients with similar dose but the 50% isodoseline at the brainstem, 49 patients (88.0%) had excellent/good relief. Numbness, averaging 2.49 on a subjective scale of 1 to 5, was experienced by 49.7% of the patients.
Conclusions: Increased radiation close and volume of brainstem irradiation may improve clinical outcomes with the trade-off of trigeminal dysfunction. Further study of the implications of close and target are needed to optimize outcomes and to minimize complications.

• 出版日期2011-9-1