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Dedicated linear accelerator radiosurgery for trigeminal neuralgia: a single-center experience in 179 patients with varied dose prescriptions and treatment plans.
Int J Radiat Oncol Biol Phys. 2011 Sep 01; 81(1):225-31.IJ

Abstract

PURPOSE

Dedicated linear accelerator radiosurgery (D-LINAC) has become an important treatment for trigeminal neuralgia (TN). Although the use of gamma knife continues to be 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 dose and volume of brainstem irradiation may improve clinical outcomes with the trade-off of trigeminal dysfunction. Further study of the implications of dose and target are needed to optimize outcomes and to minimize complications.

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Authors+Show Affiliations

Smith ZA
Department of Neurosurgery, UCLA Medical Center, West Los Angeles Veteran's Administration Hospital, Los Angeles, CA, USA.
Gorgulho AA
No affiliation info available
Bezrukiy N
No affiliation info available
McArthur D
No affiliation info available
Agazaryan N
No affiliation info available
Selch MT
No affiliation info available
De Salles AA
No affiliation info available

MeSH

AdultAgedAged, 80 and overBrain StemFemaleHumansHypesthesiaMagnetic Resonance ImagingMaleMiddle AgedPonsRadiosurgeryRadiotherapy DosageRadiotherapy Planning, Computer-AssistedRecurrenceRemission InductionTime FactorsTomography, X-Ray ComputedTrigeminal Neuralgia

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21236592

Citation

Smith, Zachary A., et al. "Dedicated Linear Accelerator Radiosurgery for Trigeminal Neuralgia: a Single-center Experience in 179 Patients With Varied Dose Prescriptions and Treatment Plans." International Journal of Radiation Oncology, Biology, Physics, vol. 81, no. 1, 2011, pp. 225-31.
Smith ZA, Gorgulho AA, Bezrukiy N, et al. Dedicated linear accelerator radiosurgery for trigeminal neuralgia: a single-center experience in 179 patients with varied dose prescriptions and treatment plans. Int J Radiat Oncol Biol Phys. 2011;81(1):225-31.
Smith, Z. A., Gorgulho, A. A., Bezrukiy, N., McArthur, D., Agazaryan, N., Selch, M. T., & De Salles, A. A. (2011). Dedicated linear accelerator radiosurgery for trigeminal neuralgia: a single-center experience in 179 patients with varied dose prescriptions and treatment plans. International Journal of Radiation Oncology, Biology, Physics, 81(1), 225-31. https://doi.org/10.1016/j.ijrobp.2010.05.058
Smith ZA, et al. Dedicated Linear Accelerator Radiosurgery for Trigeminal Neuralgia: a Single-center Experience in 179 Patients With Varied Dose Prescriptions and Treatment Plans. Int J Radiat Oncol Biol Phys. 2011 Sep 1;81(1):225-31. PubMed PMID: 21236592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dedicated linear accelerator radiosurgery for trigeminal neuralgia: a single-center experience in 179 patients with varied dose prescriptions and treatment plans. AU - Smith,Zachary A, AU - Gorgulho,Alessandra A, AU - Bezrukiy,Nikita, AU - McArthur,David, AU - Agazaryan,Nzhde, AU - Selch,Michael T, AU - De Salles,Antonio A F, Y1 - 2011/01/13/ PY - 2010/02/08/received PY - 2010/05/04/revised PY - 2010/05/04/accepted PY - 2011/1/18/entrez PY - 2011/1/18/pubmed PY - 2011/9/29/medline SP - 225 EP - 31 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 81 IS - 1 N2 - PURPOSE: Dedicated linear accelerator radiosurgery (D-LINAC) has become an important treatment for trigeminal neuralgia (TN). Although the use of gamma knife continues to be 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 dose and volume of brainstem irradiation may improve clinical outcomes with the trade-off of trigeminal dysfunction. Further study of the implications of dose and target are needed to optimize outcomes and to minimize complications. SN - 1879-355X UR - https://www.unboundmedicine.com/medline/citation/21236592/Dedicated_linear_accelerator_radiosurgery_for_trigeminal_neuralgia:_a_single_center_experience_in_179_patients_with_varied_dose_prescriptions_and_treatment_plans_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(10)00805-9 DB - PRIME DP - Unbound Medicine ER -