Loving Bailey A, Oyeniyi Jacob F, Ramanathan Siddharth, Lee Joseph S, Ye Hong, Ramdas Yastira, Grills Inga S, Fontanesi James F, Chinnaiyan Prakash, Fahim Daniel K, Michael Daniel B, Chen Peter Y
Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States.
Department of General Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States.
Clin Transl Radiat Oncol. 2025 Apr 29;53:100969. doi: 10.1016/j.ctro.2025.100969. eCollection 2025 Jul.
ObjectivesThis study evaluates the safety and efficacy of Gamma Knife Stereotactic Radiosurgery (GKSRS) retreatment (T2) for recurrent or refractory trigeminal neuralgia (TN) following an initial SRS treatment (T1).
We analyzed 53 patients who underwent T2 between 2012 and 2018 using a prospectively maintained single institution database. Baseline characteristics, treatment details, and toxicity data were assessed, with pain responses evaluated via Barrow Neurological Institute (BNI) pain intensity scores. Predictors of pain recurrence and chronic sensory toxicity were identified using univariate and multivariable analyses.
The median T2 maximum dose was 70 Gy, primarily targeting the cisternal segment (43 %) and retrogasserian zone (RGZ) (34 %). Following T2, 95 % experienced initial pain relief with a 1-month median time to response, and 1-, 2-, and 3-year freedom from pain recurrence of 51 %, 45 %, and 41 %, respectively. Chronic sensory deficits were observed in 62 % of patients, but motor toxicity remained rare (mastication deficit: 2.5 %; facial motor deficit: 5.1 %). RGZ targeting (HR = 3.84, p = 0.02) and single isocenter treatments (HR = 3.85, p = 0.04) were predictive of pain recurrence when compared to dorsal root entry zone (DREZ) targeting and two isocenters, respectively. Affected trigeminal nerve length <11.5 mm was associated with chronic sensory deficits (OR = 7.14, p = 0.02).
GKSRS provides effective pain relief and manageable toxicity in retreatment for refractory/recurrent TN. Optimizing parameters, including DREZ targeting and dual-isocenter strategies, can enhance outcomes, while balancing treatment length to mitigate chronic sensory toxicity. Future research should aim at optimizing treatment parameters to maximize pain relief while minimizing toxicity for these patients.
目的本研究评估伽玛刀立体定向放射外科（GKSRS）再次治疗（T2）对初次立体定向放射外科治疗（T1）后复发或难治性三叉神经痛（TN）的安全性和有效性。
我们使用前瞻性维护的单机构数据库分析了2012年至2018年间接受T2治疗的53例患者。评估了基线特征、治疗细节和毒性数据，并通过巴罗神经学研究所（BNI）疼痛强度评分评估疼痛反应。使用单变量和多变量分析确定疼痛复发和慢性感觉毒性的预测因素。
T2的中位最大剂量为70 Gy，主要针对脑池段（43%）和半月节后区（RGZ）（34%）。T2治疗后，95%的患者最初疼痛缓解，中位缓解时间为1个月，1年、2年和3年无疼痛复发率分别为51%、45%和41%。62%的患者出现慢性感觉缺陷，但运动毒性仍然罕见（咀嚼功能缺陷：2.5%；面部运动功能缺陷：5.1%）。与分别针对背根入髓区（DREZ）和两个等中心相比，靶向RGZ（HR = 3.84，p = 0.02）和单等中心治疗（HR = 3.85，p = 0.04）可预测疼痛复发。受累三叉神经长度<11.5 mm与慢性感觉缺陷相关（OR = 7.14，p = 0.02）。
GKSRS为难治性/复发性TN再次治疗提供了有效的疼痛缓解和可控制的毒性。优化参数，包括靶向DREZ和双等中心策略，可以改善治疗效果，同时平衡治疗时长以减轻慢性感觉毒性。未来的研究应致力于优化治疗参数，以使这些患者在毒性最小的情况下实现最大程度的疼痛缓解。
