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Journal of Radiation Oncology

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01-12-2015 | Original Research

The effect of dose and other parameters on outcomes in CyberKnife stereotactic radiosurgery for trigeminal neuralgia

Authors: Shane Lloyd, Dana H. Chung, Rovel J. Colaco, Isaac Goodrich, Francis S. Cardinale

Published in: Journal of Radiation Oncology | Issue 4/2015

Abstract

Objective

The optimal dose to maximize pain relief and minimize secondary numbness in the treatment of trigeminal neuralgia (TN) with CyberKnife stereotactic radiosurgery (SRS) is unknown.

Methods

Between 2008 and 2012, 56 patients were treated with 66 courses of CyberKnife SRS for classical (idiopathic) trigeminal neuralgia. Prescription doses of 70 Gy (Dmax 86 Gy, N = 22), 60 Gy (Dmax 74 Gy, N = 37), and 50 Gy (Dmax 62 Gy, N = 6) were used. We used logistic regression to test for correlations of clinical parameters including dose, gender, age, pre-treatment pain level, treatment order (first or second), and TN type, with the rates of pain relief, duration of response, and adverse effects.

Results

Median follow-up was 15 months. Overall, 86 % (N = 57) of patients experienced pain relief and 59 % (N = 39) reported complete pain relief. The actuarial median duration until any return or flare of pain was 21 months. There was no difference in the rate of pain relief between prescription doses of 70 Gy (21/22 patients, 95 %) and 60 Gy (30/37 patients, 81 %) (p = 0.15). In patients treated only once, the rate of any numbness at last follow-up in patients treated with 60 Gy was 11/25 (44 %) compared to 11/15 (73 %) in those treated with 70 Gy (p = 0.07). Among patients treated for the first time for type 1 TN, the optimal outcome of pain relief with no numbness at 1 year was more common in patients treated with 60 Gy (60 %) than with 70 Gy (25 %).

Conclusion

CyberKnife SRS achieved acceptable rates of pain relief and numbness that did not differ significantly based on dose and other factors in this cohort. A prescription dose of 60 Gy is reasonable to balance optimal pain relief and minimize numbness.

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Title: The effect of dose and other parameters on outcomes in CyberKnife stereotactic radiosurgery for trigeminal neuralgia
Authors: Shane Lloyd
Dana H. Chung
Rovel J. Colaco
Isaac Goodrich
Francis S. Cardinale
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Radiation Oncology / Issue 4/2015
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-015-0225-4

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Abstract

Objective

Methods

Results

Conclusion

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