Refractory trigeminal neuralgia treatment outcomes following CyberKnife radiosurgery

Radiation Oncology

Walter Jean⁶  Sean P Collins²  K William Harter²  Nathan Nair⁶  Christopher Kalhorn⁶  Ann Jay⁴  Abdul Rashid²  Edward J Bedrick³  Shilpa Bhatia¹  James W Snider⁵  Alexander Tai²  Sana D Karam¹ 

[1]Department of Radiation Oncology, University of Colorado Hospital, Aurora, CO, USA

[2]Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA

[3]Department of Biostatistics and Bioinformatics, University of Colorado, Aurora, CO, USA

[4]Department of Radiation Oncology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington 20007, DC, USA

[5]Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA

[6]Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA

关键词: Long term;    Cyberknife;    Radiosurgery;    Tic doloreux;    Trigeminal Neuralgia;   

Others  :  1228536
DOI  :  10.1186/s13014-014-0257-8

 received in 2014-08-04, accepted in 2014-11-06,  发布年份 2014

【 摘 要 】

Introduction

A handful of studies have reported outcomes with CyberKnife radiosurgery (CKRS) for the treatment of trigeminal neuralgia. However, the follow-up has been short with no minimum follow-up required and have included patients with short duration of symptoms. Here we report our institutional experience on patients with a minimum follow-up of 1 year and a median follow-up of 28 months (mean 38.84 months).

Methods

Twenty-five patients with medically and surgically intractable TN received CKRS with a mean marginal radiation dose of 64 Gy applied to an average isodose line of 86% of the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale with BNI I-III considered to be good outcomes and BNI IV-V considered as treatment failure. BNI facial numbness score was used to assess treatment complications.

Results

A large proportion of patients (42.9%) reported pain relief within 1 month following CKRS treatment. The mean time to recurrence of severe pain was 27.8 months (range 1–129 months). At median follow-up of 28 months (mean 38.84 months), actuarial rate of freedom from severe pain (BNI ≥ III) was 72%. At last follow-up 2 (8%) patients had freedom from any pain and no medications (BNI I) and the majority (48%) had some pain that was adequately controlled with medications. Seven patients (28%) had no response to treatment and continued to suffer from severe pain (BNI IV or V). Patient’s diabetic status and overall post-treatment BNI facial numbness scores were statistically significant predictors of treatment outcomes.

Conclusion

CKRS represents an acceptable salvage option for with medically and/or surgically refractory patients. Even patients with severely debilitating symptoms may experience significant and sustained pain relief after CKRS. Particularly, CKRS remains an attractive option in patients who are not good surgical candidates or possibly even failed surgical therapy. This data should help in setting realistic expectations for weighing the various available treatment options.

【 授权许可】

   
2014 Karam et al.; licensee BioMed Central.

【 图 表 】

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