Parikh Rahul R, Goodman Robert R, Rhome Ryan, Sudentas Edward, Trichter Frieda, Harrison Louis B, Choi Walter
Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York.
Pract Radiat Oncol. 2016 Jan-Feb;6(1):e1-7. doi: 10.1016/j.prro.2015.09.001. Epub 2015 Sep 10.
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).
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.
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.
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.
本研究旨在评估使用基于直线加速器（LINAC）的无均整器射束进行三叉神经痛（TN）的消融性立体定向放射外科治疗（SRS）的临床安全性和治疗效果。
36例连续患者（34例不同患者）由一名神经外科医生随访并诊断为药物难治性单侧TN，接受了SRS治疗。其中左侧病例14例（41%），右侧病例20例（59%）。28例患者（82%）为1型TN，6例（18%）为2型TN。既往治疗情况如下：10例患者（29%）曾接受同侧TN的SRS治疗（8例使用伽玛刀，2例使用LINAC），4例（12%）接受过经皮神经根切断术，3例（9%）接受过微血管减压术。单次分割给予100%等剂量线的中位处方剂量为75 Gy（范围70 - 80 Gy）。在开始治疗前，影像引导验证立体定向框架放置、头部位置和最终等中心。接受≥10 Gy照射的脑干体积<0.5 cm³。每次随访时，患者使用巴罗神经学研究所（BNI）疼痛量表前瞻性报告治疗效果。
中位随访时间为3.1个月（范围0.6 - 24.3个月；平均5.5个月），无患者出现1级以上毒性反应。未出现与SRS相关的新的感觉异常、感觉减退或长期并发症。基线（SRS前）BNI评分中位数为5.0（平均4.7）。首次随访（中位时间1个月）时的临床评估显示BNI评分中位数为3.0（平均3.1）。按TN亚型分层时，1型和2型TN患者在首次随访时BNI评分中位数均为3.0。30例患者（88.2%）在首次随访时BNI评分降低，5例患者（15%）评分<3，这代表无药物缓解疼痛。第二次随访（平均6.3个月）时的BNI评分中位数为2.5。
我们报告了使用基于现代LINAC的无均整器射束进行TN的SRS治疗的经验。这种治疗方法似乎是一种安全有效的技术，尽管需要更长时间的随访来确认其持久性。这种治疗方式可能被证明是TN的一种可行治疗选择。
