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Linear accelerator-based flattening-filter-free stereotactic radiosurgery for trigeminal neuralgia: Feasibility and patient-reported outcomes.
Pract Radiat Oncol. 2016 Jan-Feb; 6(1):e1-7.PR

Abstract

PURPOSE

The purpose of this study was to assess the safety and outcomes of the clinical use of LINAC (linear accelerator)-based flattening-filter-free beams for delivering ablative stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN).

METHODS AND MATERIALS

Thirty-six consecutive patients (34 unique patients) followed up by a single neurosurgeon and diagnosed with medically refractory unilateral TN were treated with SRS. There were 14 left-sided cases (41%) and 20 right-sided cases (59%). Twenty-eight of the patients (82%) had type 1 TN, and 6 (18%) had type 2 TN. Previous treatments were as follows: 10 patients (29%) had SRS to the ipsilateral TN (8 with Gamma Knife, 2 with LINAC), 4 (12%) had percutaneous rhizotomy, and 3 (9%) had microvascular decompression. A median prescription dose of 75 Gy (range, 70-80 Gy), prescribed to the 100% isodose line, was delivered in a single fraction. Before treatment delivery, image guidance verified stereotactic frame placement, head position, and final isocenter. The volume of brainstem receiving ≥10 Gy was <0.5 cm(3). At each visit, patients prospectively reported outcomes using the Barrow Neurological Institute (BNI) pain scale.

RESULTS

With a median follow-up of 3.1 months (range, 0.6-24.3; mean, 5.5 months), no patient experienced grade 1+ toxicities. There were no new episodes of dysesthesia, hypoesthesia, or long-term complications related to SRS. Median baseline (pre-SRS) BNI score was 5.0 (mean, 4.7). Clinical assessment at first follow-up (median, 1 month) demonstrated a median BNI score of 3.0 (mean, 3.1). When stratified by TN subtype, both type 1 and type 2 TN patients had a median BNI score of 3.0 at first follow-up. Thirty patients (88.2%) achieved a reduction in their BNI at their first follow-up, and 5 patients (15%) achieved a score <3, which represents medication-free pain relief. The median BNI at second follow-up (average, 6.3 months) was 2.5.

CONCLUSIONS

We report our experience with modern LINAC-based SRS using flattening-filter-free beams for TN. This treatment appears to be a safe and effective technique, although longer follow-up is needed to confirm durability. This modality may prove to be a viable treatment alternative for TN.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Parikh RR
Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: parikhrr@gmail.com.
Goodman RR
Department of Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York.
Rhome R
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Sudentas E
Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York.
Trichter F
Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York.
Harrison LB
Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
Choi W
Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York.

MeSH

AdultAgedAged, 80 and overFeasibility StudiesFemaleFollow-Up StudiesHumansMaleMiddle AgedPain MeasurementParticle AcceleratorsPatient Outcome AssessmentProspective StudiesRadiosurgeryTreatment OutcomeTrigeminal Neuralgia

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

26577003

Citation

Parikh, Rahul R., et al. "Linear Accelerator-based Flattening-filter-free Stereotactic Radiosurgery for Trigeminal Neuralgia: Feasibility and Patient-reported Outcomes." Practical Radiation Oncology, vol. 6, no. 1, 2016, pp. e1-7.
Parikh RR, Goodman RR, Rhome R, et al. Linear accelerator-based flattening-filter-free stereotactic radiosurgery for trigeminal neuralgia: Feasibility and patient-reported outcomes. Pract Radiat Oncol. 2016;6(1):e1-7.
Parikh, R. R., Goodman, R. R., Rhome, R., Sudentas, E., Trichter, F., Harrison, L. B., & Choi, W. (2016). Linear accelerator-based flattening-filter-free stereotactic radiosurgery for trigeminal neuralgia: Feasibility and patient-reported outcomes. Practical Radiation Oncology, 6(1), e1-7. https://doi.org/10.1016/j.prro.2015.09.001
Parikh RR, et al. Linear Accelerator-based Flattening-filter-free Stereotactic Radiosurgery for Trigeminal Neuralgia: Feasibility and Patient-reported Outcomes. Pract Radiat Oncol. 2016 Jan-Feb;6(1):e1-7. PubMed PMID: 26577003.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Linear accelerator-based flattening-filter-free stereotactic radiosurgery for trigeminal neuralgia: Feasibility and patient-reported outcomes. AU - Parikh,Rahul R, AU - Goodman,Robert R, AU - Rhome,Ryan, AU - Sudentas,Edward, AU - Trichter,Frieda, AU - Harrison,Louis B, AU - Choi,Walter, Y1 - 2015/09/10/ PY - 2015/06/11/received PY - 2015/08/24/revised PY - 2015/09/04/accepted PY - 2015/11/19/entrez PY - 2015/11/19/pubmed PY - 2016/10/14/medline SP - e1 EP - 7 JF - Practical radiation oncology JO - Pract Radiat Oncol VL - 6 IS - 1 N2 - PURPOSE: The purpose of this study was to assess the safety and outcomes of the clinical use of LINAC (linear accelerator)-based flattening-filter-free beams for delivering ablative stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). METHODS AND MATERIALS: Thirty-six consecutive patients (34 unique patients) followed up by a single neurosurgeon and diagnosed with medically refractory unilateral TN were treated with SRS. There were 14 left-sided cases (41%) and 20 right-sided cases (59%). Twenty-eight of the patients (82%) had type 1 TN, and 6 (18%) had type 2 TN. Previous treatments were as follows: 10 patients (29%) had SRS to the ipsilateral TN (8 with Gamma Knife, 2 with LINAC), 4 (12%) had percutaneous rhizotomy, and 3 (9%) had microvascular decompression. A median prescription dose of 75 Gy (range, 70-80 Gy), prescribed to the 100% isodose line, was delivered in a single fraction. Before treatment delivery, image guidance verified stereotactic frame placement, head position, and final isocenter. The volume of brainstem receiving ≥10 Gy was <0.5 cm(3). At each visit, patients prospectively reported outcomes using the Barrow Neurological Institute (BNI) pain scale. RESULTS: With a median follow-up of 3.1 months (range, 0.6-24.3; mean, 5.5 months), no patient experienced grade 1+ toxicities. There were no new episodes of dysesthesia, hypoesthesia, or long-term complications related to SRS. Median baseline (pre-SRS) BNI score was 5.0 (mean, 4.7). Clinical assessment at first follow-up (median, 1 month) demonstrated a median BNI score of 3.0 (mean, 3.1). When stratified by TN subtype, both type 1 and type 2 TN patients had a median BNI score of 3.0 at first follow-up. Thirty patients (88.2%) achieved a reduction in their BNI at their first follow-up, and 5 patients (15%) achieved a score <3, which represents medication-free pain relief. The median BNI at second follow-up (average, 6.3 months) was 2.5. CONCLUSIONS: We report our experience with modern LINAC-based SRS using flattening-filter-free beams for TN. This treatment appears to be a safe and effective technique, although longer follow-up is needed to confirm durability. This modality may prove to be a viable treatment alternative for TN. SN - 1879-8519 UR - https://www.unboundmedicine.com/medline/citation/26577003/Linear_accelerator_based_flattening_filter_free_stereotactic_radiosurgery_for_trigeminal_neuralgia:_Feasibility_and_patient_reported_outcomes_ DB - PRIME DP - Unbound Medicine ER -