Department of Radiotherapy, Centre Hospitalier Princesse Grace, Monaco, Monaco.
Department of Radiation Oncology, Centre Hospitalier Princesse Grace, Monaco, 98000, Monaco.
J Headache Pain. 2023 May 11;24(1):51. doi: 10.1186/s10194-023-01583-4.
This study compares the outcome of patients suffering from medically refractory classical trigeminal neuralgia (TN) after treatment with radiosurgery using two different shot sizes (5- and 6-mm).
All patients included in this open, prospective, non-controlled study were treated in a single institution for TN (95 cases in 93 patients) with LINear ACcelerators (LINAC) single-dose radiosurgery using a 5-mm shot (43 cases) or 6-mm shot (52 cases). The target was positioned on the intracisternal part of the trigeminal nerve.
The mean Dmax (D0.035) to the brainstem was higher in the 6-mm group: 12.6 vs 21.3 Gy (p < 0.001). Pain relief was significantly better in the 6-mm group: at 12 and 24 months in the 6-mm group the rate of pain-free patients was 90.2 and 87.8%, respectively vs. 73.6 and 73.6% in the 5-mm group (p = 0.045). At 12 and 24 months post-radiosurgical hypoesthesia was more frequent in the 6-mm group: 47.0 and 58% vs.11.3 and 30.8% in the 5-mm group (p = 0.002). To investigate the effect of cone diameter and the dose to the brainstem on outcomes, patients were stratified into three groups: group 1 = 5-mm shot, (all Dmax < 25 Gy, 43 cases), group 2 = 6-mm shot, Dmax < 25 Gy (32 cases), group 3 = 6-mm shot Dmax > 25 Gy (20 cases). At 12 months the rates of hypoesthesia were 11.3, 33.5 and 76.0%, respectively in groups 1, 2 and 3 (p < 0.001) and the rates of recurrence of pain were 26.4, 16.5 and 5%, respectively, (p = 0.11).
LINAC treatment with a 6-mm shot provided excellent control of pain, but increased the rate of trigeminal nerve dysfunction, especially when the maximum dose to the brainstem was higher than 25 Gy.
本研究比较了使用两种不同准直器大小（5 毫米和 6 毫米）的放射外科治疗药物难治性经典三叉神经痛（TN）患者的结果。
本开放、前瞻性、非对照研究纳入了在单一机构接受 TN 治疗的所有患者（93 例患者中的 95 例），使用 LINAC 单剂量放射外科治疗，采用 5 毫米准直器（43 例）或 6 毫米准直器（52 例）。靶区定位在三叉神经颅内段。
6 毫米组脑干最大剂量（D0.035）更高：12.6 与 21.3 Gy（p<0.001）。6 毫米组疼痛缓解明显更好：6 毫米组在 12 和 24 个月时无痛患者的比例分别为 90.2%和 87.8%，而 5 毫米组分别为 73.6%和 73.6%（p=0.045）。在放射外科治疗后 12 和 24 个月时，6 毫米组更常出现感觉迟钝：47.0%和 58%，而 5 毫米组分别为 11.3%和 30.8%（p=0.002）。为了研究准直器直径和脑干剂量对结果的影响，将患者分为三组：组 1=5 毫米准直器（所有 Dmax<25 Gy，43 例），组 2=6 毫米准直器，Dmax<25 Gy（32 例），组 3=6 毫米准直器，Dmax>25 Gy（20 例）。在 12 个月时，组 1、组 2 和组 3 的感觉迟钝发生率分别为 11.3%、33.5%和 76.0%（p<0.001），疼痛复发率分别为 26.4%、16.5%和 5%（p=0.11）。
使用 6 毫米准直器的 LINAC 治疗可极好地控制疼痛，但增加了三叉神经功能障碍的发生率，尤其是当脑干最大剂量高于 25 Gy 时。
