Stergioula Anastasia, Moutsatsos Argyris, Pantelis Evaggelos
Radiotherapy Department, Iatropolis Clinic, Athens, Greece.
Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Clin Transl Radiat Oncol. 2024 Jul 25;48:100821. doi: 10.1016/j.ctro.2024.100821. eCollection 2024 Sep.
Radiosurgery has been extensively studied for its efficacy and safety in the management of trigeminal neuralgia (TN). However, among the plethora of relevant studies in the literature, only a restricted number have been conducted targeting an elongated trigeminal nerve segment with the CyberKnife radiosurgery (CKRS) system. Herein, we report long-term clinical outcomes of TN patients treated with CKRS.
Fifty patients treated with CKRS for medically refractory TN were analyzed. Pain response and sensory dysfunction post CKRS were assessed using the Barrow Neurological Institute (BNI) scale. Kaplan-Meier analysis was used to assess the maintenance of pain control and the risk of onset of facial numbness. The Cox proportional hazards regression model was employed for both univariate and multivariate analyses to identify predictive factors among the collected variables.
The median follow-up period was 63 months (range: 12-174 months). The median values of treated nerve volume, prescription dose, and integral dose were 59 mm, 60 Gy and 3.9 mJ, respectively. Pain control (BNI I-III) was achieved in 37 patients (74%). Among them, the actuarial freedom from pain (FFP) rate was 82%, 78% and 74% at 24, 36 and beyond 48 months post-CKRS, respectively. A correlation of FFP rate with patient gender, treated nerve volume, and mean dose was revealed in multivariate analysis. Twenty-three patients (62%) reported onset of new or aggravation of pre-existing, facial numbness with twenty-one of them (57%) characterizing it as "mild facial numbness, not bothersome" (BNI-II) and two (5%) as "somewhat bothersome" (BNI-III). We did not encounter any case with very bothersome facial numbness (BNI-IV).
Long-term results of this work contribute to the body of evidence supporting the safety and efficacy of CKRS in the treatment of TN patients, in view of excellent pain control for an acceptable toxicity profile.
放射外科治疗三叉神经痛（TN）的有效性和安全性已得到广泛研究。然而，在众多相关文献研究中，仅有有限数量的研究针对使用射波刀放射外科治疗系统（CKRS）对延长的三叉神经节段进行治疗。在此，我们报告接受CKRS治疗的TN患者的长期临床结果。
分析50例接受CKRS治疗的药物难治性TN患者。使用巴罗神经学研究所（BNI）量表评估CKRS治疗后的疼痛反应和感觉功能障碍。采用Kaplan-Meier分析评估疼痛控制的维持情况以及面部麻木发作的风险。采用Cox比例风险回归模型进行单因素和多因素分析，以确定所收集变量中的预测因素。
中位随访期为63个月（范围：12 - 174个月）。治疗神经节段体积、处方剂量和积分剂量的中位值分别为59mm、60Gy和3.9mJ。37例患者（74%）实现了疼痛控制（BNI I - III级）。其中，CKRS治疗后24个月、36个月和48个月以上的无疼痛生存率（FFP）分别为82%、78%和74%。多因素分析显示FFP率与患者性别、治疗神经节段体积和平均剂量相关。23例患者（62%）报告出现新的或原有面部麻木加重，其中21例（57%）将其描述为“轻度面部麻木，不困扰”（BNI-II级），2例（5%）描述为“有些困扰”（BNI-III级）。我们未遇到任何“非常困扰”的面部麻木病例（BNI-IV级）。
鉴于CKRS在可接受的毒性特征下能实现良好的疼痛控制，本研究的长期结果为支持CKRS治疗TN患者的安全性和有效性提供了更多证据。
