Brainstem Dose Constraints in Nonisometric Radiosurgical Treatment Planning of Trigeminal Neuralgia: A Single-Institution Experience

Zhang, Michael; Lamsam, Layton; Schoen, Matthew K.; Mehta, Swapnil; Appelboom, Geoffrey; Adler, John; Soltys, Scott G.; Chang, Steven D.

doi:10.1016/j.wneu.2018.02.042

Cited by 11 publications

(10 citation statements)

References 29 publications

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“…However, for a 5‐mm field diameter with the Exradin A16 microchamber, a field output correction factor was not provided by TRS‐483; therefore, these data were not plotted in Figure 4. Frequently, 10‐mm or smaller fixed circular collimators are used for treatment planning for cerebral arteriovenous malformations and trigeminal neuralgia in CK 32,33 . The disagreements in the absolute doses between SRSMC and TPS calculation in the small fields were relatively larger than those for a field size of 12.5 mm or larger and may require careful consideration in the dose verification for treatment planning using many small fields.…”

Section: Discussionmentioning

confidence: 99%

Development of a high‐resolution two‐dimensional detector‐based dose verification system for tumor‐tracking irradiation in the CyberKnife system

Kawabata

Kamomae

Okudaira

et al. 2022

J Applied Clin Med Phys

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We aim to evaluate the basic characteristics of SRS MapCHECK (SRSMC) for CyberKnife (CK) and establish a dose verification system using SRSMC for the tumor-tracking irradiation for CK. The field size and angular dependence of SRSMC were evaluated for basic characterization. The output factors (OPFs) and absolute doses measured by SRSMC were compared with those measured using microDiamond and microchamber detectors and those calculated by the treatment planning system (TPS). The angular dependence was evaluated by comparing the SRSMC with a microchamber. The tumor-tracking dose verification system consists of SRSMC and a moving platform. The doses measured using SRSMC were compared with the doses measured using a microchamber and radiochromic film. The OPFs and absolute doses of SRSMC were within ±3.0% error for almost all field sizes, and the angular dependence was within ±2.0% for all incidence angles. The absolute dose errors between SRSMC and TPS tended to increase when the field size was smaller than 10 mm. The absolute doses of the tumor-tracking irradiation measured using SRSMC and those measured using a microchamber agreed within 1.0%, and the gamma pass rates of SRSMC in comparison with those of the radiochromic film were greater than 95%. The basic characteristics of SRSMC for CK presented acceptable results for clinical use. The results of the tumor-tracking dose verification system realized using SRSMC were equivalent to those of conventional methods, and this system is expected to contribute toward improving the efficiency of quality control in many facilities.

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Section: Discussionmentioning

confidence: 99%

Development of a high‐resolution two‐dimensional detector‐based dose verification system for tumor‐tracking irradiation in the CyberKnife system

Kawabata

Kamomae

Okudaira

et al. 2022

J Applied Clin Med Phys

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“…With a median follow-up of 10.75 months (range 4-25 months), clinical improvement was observed in 85.7% (range 70%-97.8%) and symptoms recurred in a median of 16.0% (range 6.9%-42.9%) of the patients following CK treatment of typical TN (Table 5). 29,[33][34][35][36][37][38]51 Only 1 included study performed CK for the management of atypical TN, 35 and clinical improvement was observed in 85.7% of the patients with a recurrence in 42.9% of the patients.…”

Section: Trigeminal Neuralgiamentioning

confidence: 99%

The Stanford stereotactic radiosurgery experience on 7000 patients over 2 decades (1999–2018): looking far beyond the scalpel

Fatima¹,

Meola²,

Ding³

et al. 2021

Journal of Neurosurgery

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OBJECTIVE The CyberKnife (CK) has emerged as an effective frameless and noninvasive method for treating a myriad of neurosurgical conditions. Here, the authors conducted an extensive retrospective analysis and review of the literature to elucidate the trend for CK use in the management paradigm for common neurosurgical diseases at their institution. METHODS A literature review (January 1990–June 2019) and clinical review (January 1999–December 2018) were performed using, respectively, online research databases and the Stanford Research Repository of patients with intracranial and spinal lesions treated with CK at Stanford. For each disease considered, the coefficient of determination (r2) was estimated as a measure of CK utilization over time. A change in treatment modality was assessed using a t-test, with statistical significance assessed at the 0.05 alpha level. RESULTS In over 7000 patients treated with CK for various brain and spinal lesions over the past 20 years, a positive linear trend (r2 = 0.80) in the system's use was observed. CK gained prominence in the management of intracranial and spinal arteriovenous malformations (AVMs; r2 = 0.89 and 0.95, respectively); brain and spine metastases (r2 = 0.97 and 0.79, respectively); benign tumors such as meningioma (r2 = 0.85), vestibular schwannoma (r2 = 0.76), and glomus jugulare tumor (r2 = 0.89); glioblastoma (r2 = 0.54); and trigeminal neuralgia (r2 = 0.81). A statistically significant difference in the change in treatment modality to CK was observed in the management of intracranial and spinal AVMs (p < 0.05), and while the treatment of brain and spine metastases, meningioma, and glioblastoma trended toward the use of CK, the change in treatment modality for these lesions was not statistically significant. CONCLUSIONS Evidence suggests the robust use of CK for treating a wide range of neurological conditions.

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“…The dose exposure of the adjacent brainstem is a critical factor in repeat SRS and related to post procedure facial numbness [ 45 ]. The total cumulative dose to the brainstem and cumulative doses to adjacent structures such as the temporal lobe must be carefully calculated [ 46 , 47 ]. Normally, the initial SRS dose with either GK or SRS varies between 70 to 90 Gy with most centers using a dose of 75 Gy [ 1 , 5 ].…”

Section: Reviewmentioning

confidence: 99%

“…However, the reported retreatment dose using the GK from large centers reporting hundreds of cases of trigeminal neuralgia varies from a low of 45 Gy to a high of 90 Gy combined with a determination to extend the target to the root entry zone in the second treatment if not done initially. Treating a longer segment of the trigeminal nerve may also allow lower dosing to be equally effective with less risk of facial numbness since radiation effect is dose and volume related [ 46 ]. The higher dose, both for initial and repeat treatment, is associated with a higher incidence of residual facial numbness varying from 12 to 30% [ 1 , 5 , 13 , 14 ].…”

Section: Reviewmentioning

confidence: 99%

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Berti¹,

Ibars²,

Wu³

et al. 2018

Cureus

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Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve. However, after 2000, non-isocentric SRS systems began to be used for treating trigeminal neuralgia including the CyberKnife (CK) (Accuray, Sunnyvale, California) as well as various linear accelerator (LINAC) based systems. This report specifically examines a series of recurrent trigeminal cases treated by the same group of physicians with the CK system. Similar doses and locations on the trigeminal nerve and/or the root entry zone were used for both initial and repeat SRS treatment regardless of system used. Although there are numerous series reporting the use of GK for recurrent treatment for recurrent trigeminal neuralgia, there are no series reviewing the results and long-term effectiveness using CK for repeat SRS for recurrent trigeminal pain. We reviewed 23 cases that had initial treatment for trigeminal neuralgia either surgically or with SRS with either the GK or CK and then a later second procedure only with CK. The follow-up after the second CK SRS ranged from three to 13 years found that the results are very similar to the multiple reports in the literature describing second or third SRS treatments with the GK. Results of repeat radiosurgery treatment of recurrent trigeminal neuralgia appear to be independent of the system used and are primarily based on proper target and dose to the trigeminal nerve.

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Brainstem Dose Constraints in Nonisometric Radiosurgical Treatment Planning of Trigeminal Neuralgia: A Single-Institution Experience

Cited by 11 publications

References 29 publications

Development of a high‐resolution two‐dimensional detector‐based dose verification system for tumor‐tracking irradiation in the CyberKnife system

Development of a high‐resolution two‐dimensional detector‐based dose verification system for tumor‐tracking irradiation in the CyberKnife system

The Stanford stereotactic radiosurgery experience on 7000 patients over 2 decades (1999–2018): looking far beyond the scalpel

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

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