Cyberknife radiosurgery in treating trigeminal neuralgia

Lazzara, Bryan M.; Ortiz, Orlando; Bordia, Ritu; Witten, M.R.; Haas, J.A.; Katz, Alan J.; Brown, Jeffrey A.

doi:10.1136/neurintsurg-2011-010125

Cited by 30 publications

(13 citation statements)

References 24 publications

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“…Results are reported for the 65 studies (6461 patients): 45 GKS studies (5687 patients [88%]), 8,9, 17, 21, 24, 25, 27, 28, 43, 44, 49, 53, 57, 59, 61-63, 66, 67, 74, 76, 77, 80, 82, 83, 85, 89, 90, 98, 100, 103, 106, 111, 112, 114, 117, 118, 120, 111, 132, 146, 137, 144, 145,149 11 LINAC RS studies (511 patients [8%]), 18,19,26,39,42,64,108,116,124,125,146 and 9 CKR RS studies (263 patients [4%]) 1,31,65,72,102,119,126,129,138 (Table 1). With the exception of 1 prospective study by Régis et al, 112 all other studies were retrospective.…”

Section: Reporting Resultsmentioning

confidence: 99%

Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

Tuleasca

Régis

Sahgal

et al. 2019

Journal of Neurosurgery

142

124

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OBJECTIVES The aims of this systematic review are to provide an objective summary of the published literature specific to the treatment of classical trigeminal neuralgia with stereotactic radiosurgery (RS) and to develop consensus guideline recommendations for the use of RS, as endorsed by the International Society of Stereotactic Radiosurgery (ISRS). METHODS The authors performed a systematic review of the English-language literature from 1951 up to December 2015 using the Embase, PubMed, and MEDLINE databases. The following MeSH terms were used in a title and abstract screening: "radiosurgery" AND "trigeminal." Of the 585 initial results obtained, the authors performed a full text screening of 185 studies and ultimately found 65 eligible studies. Guideline recommendations were based on level of evidence and level of consensus, the latter predefined as at least 85% agreement among the ISRS guideline committee members. RESULTS The results for 65 studies (6461 patients) are reported: 45 Gamma Knife RS (GKS) studies (5687 patients [88%]), 11 linear accelerator (LINAC) RS studies (511 patients [8%]), and 9 CyberKnife RS (CKR) studies (263 patients [4%]). With the exception of one prospective study, all studies were retrospective. The mean maximal doses were 71.1-90.1 Gy (prescribed at the 100% isodose line) for GKS, 83.3 Gy for LINAC, and 64.3-80.5 Gy for CKR (the latter two prescribed at the 80% or 90% isodose lines, respectively). The ranges of maximal doses were as follows: 60-97 Gy for GKS, 50-90 Gy for LINAC, and 66-90 Gy for CKR. Actuarial initial freedom from pain (FFP) without medication ranged from 28.6% to 100% (mean 53.1%, median 52.1%) for GKS, from 17.3% to 76% (mean 49.3%, median 43.2%) for LINAC, and from 40% to 72% (mean 56.3%, median 58%) for CKR. Specific to hypesthesia, the crude rates (all Barrow Neurological Institute Pain Intensity Scale scores included) ranged from 0% to 68.8% (mean 21.7%, median 19%) for GKS, from 11.4% to 49.7% (mean 27.6%, median 28.5%) for LINAC, and from 11.8% to 51.2% (mean 29.1%, median 18.7%) for CKR. Other complications included dysesthesias, paresthesias, dry eye, deafferentation pain, and keratitis. Hypesthesia and paresthesia occurred as complications only when the anterior retrogasserian portion of the trigeminal nerve was targeted, whereas the other listed complications occurred when the root entry zone was targeted. Recurrence rates ranged from 0% to 52.2% (mean 24.6%, median 23%) for GKS, from 19% to 63% (mean 32.2%, median 29%) for LINAC, and from 15.8% to 33% (mean 25.8%, median 27.2%) for CKR. Two GKS series reported 30% and 45.3% of patients who were pain free without medication at 10 years. CONCLUSIONS The literature is limited in its level of evidence, with only one comparative randomized trial (1 vs 2 isocenters) reported to date. At present, one can conclude that RS is a safe and effective therapy for drug-resistant trigeminal neuralgia. A number of consensus statements have been made and endorsed by the ISRS.

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Section: Reporting Resultsmentioning

confidence: 99%

Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

Tuleasca

Régis

Sahgal

et al. 2019

Journal of Neurosurgery

142

124

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“…Many investigators have already reported the utilization of Cyber knife for TN and the outcomes are comparable to LINAC-based SRS but with a longer average beam on time. The reduction of average BOT in FFF beams is an added advantage over Gamma Knife and Cyber knife treatments for TN [25][26][27][28]. Many studies have reported the advantage of using FFF beams for small target volumes in terms of treatment delivery and lower peripheral doses to OAR's [29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of 6 MV Flattening Filter Free and 6 MV Stereotactic Radiosurgery Beam Using 4 mm Conical Collimator for Trigeminal Neuralgia Radiosurgery

et al. 2018

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Background: The purpose of our study was to compare the dosimetric advantages of Flattening filter free (FFF) beams for trigeminal neuralgia patients using 4 mm conical collimators over previously treated patients with 6 MV SRS beam. Materials and Methods: A retrospective study was conducted for 5 TN patients who had been previously treated at our institution using frame-based, LINAC-based stereotactic radiosurgery (SRS) on Novalis Tx using 6 MV SRS beam were replanned on 6X FFF beams on Edge Linear accelerator with same beam angles and dose constraints using 4 mm conical collimator. The total number of monitor units along with the beam on time was compared for both Edge and Novalis Tx by redelivering the plans in QA mode of LINAC to compare the delivery efficiency. Plan quality was evaluated by homogeneity index (HI) and Paddick gradient index (GI) for each plan. We also analyzed the doses to brainstem and organ at risks (OARs). Results and Discussion: A 28% beam-on time reduction was achieved using 6X FFF when compared with 6X SRS beam of Novalis Tx. A sharp dose fall off with gradient index value of 3.4 ± 0.27 for 4 mm Varian conical collimator while 4.17 ± 0.20 with BrainLab cone. Among the 5 patients treated with a 4 mm cone, average maximum brainstem dose was 10.24 Gy for Edge using 6X FFF and 14.28 Gy for Novalis Tx using 6X SRS beam. Conclusion: The use of FFF beams improves delivery efficiency and conical collimator reduces dose to OAR' s for TN radiosurgery. Further investigation is warranted with larger sample patient data.

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“…These results seem to fall in line with the literature. Short-term response rates in studies utilizing CK SRS have historically ranged from 67% to 88% [ 20 - 22 ]. GK SRS studies have also demonstrated the proportion of patients experiencing pain relief fell between 58.5% to 88% [ 23 - 24 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery for Trigeminal Neuralgia: A Retrospective Multi-Institutional Examination of Treatment Outcomes

Singh

Davis

Sharma³

2016

Cureus

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ObjectivesThe purposes of this study are to assess the effectiveness of CyberKnife® stereotactic radiosurgery (SRS) in providing both initial and sustained pain relief for patients with both forms of trigeminal neuralgia (TN), assess potential prognostic factors, and examine treatment-related toxicities.Methods The RSSearch® Patient Registry was screened for TN cases from July 2007 to June 2015. We evaluated initial pain relief achieved by examining changes in the Visual Analog Scale (VAS) scores following SRS. Prognostic factors relating to initial pain relief and the relationship between maximum dose (Dmax) and toxicity incidence were analyzed via univariate logistic regressions. We evaluated prognostic factors relating to sustained pain relief using the Kaplan-Meier method and log-rank analysis.Results Our analysis included 125 TN1 patients and 38 TN2 patients with initial VAS scores ≥ 3 treated at 16 community radiotherapy centers. Median Dmax for both cohorts was 75 Gy with a larger range for TN1 cases (67.42 Gy - 110.29 Gy) as compared to TN2 cases (70.00 Gy - 78.48 Gy). At initial follow-up, mean VAS scores after SRS were significantly lower for TN1 and TN2 patients (p < 0.0001). The vast majority of TN1 (87.2%) and TN2 (86.8%) patients experienced initial pain relief. Higher initial VAS scores (p = 0.015) were correlated with a greater likelihood of initial treatment success for TN1 patients. We did not identify any treatment or patient characteristics that had significant effects on initial pain relief for TN2 patients. Of the TN1 cohort, 28 of 125 patients reported follow-ups one year or greater after SRS. Twenty-three of 28 TN1 patients (82%) reported VAS scores of 1 or less at one-year follow-up, and eight of 11 patients (72%) had VAS scores of 1 or less at the two-year follow-up. No potential prognostic factors for long-term pain relief were significant. Roughly 18% and 11% of TN1 and TN2 patients, respectively, experienced acute toxicities (all RTOG Grade 1 or 2), with the most common being sensory neuropathy, generalized pain, and nausea. Dmax > 75 Gy was not a predictor of toxicity incidence in TN1 cases (p = 0.597) but was significant for TN2 patients (p = 0.0009 following Fisher's exact test).ConclusionsSRS is an effective treatment option for TN patients in community settings. Initial pain relief following SRS was achieved in a vast majority of TN patients with associated minor toxicities observed in less than 20% of all patients.

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Cyberknife radiosurgery in treating trigeminal neuralgia

Abstract: Cyberknife radiosurgery is a viable treatment alternative in patients with TN with competitive efficacy demonstrated in our group of patients while minimizing adverse effects.

Cited by 30 publications

References 24 publications

Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

Dosimetric Comparison of 6 MV Flattening Filter Free and 6 MV Stereotactic Radiosurgery Beam Using 4 mm Conical Collimator for Trigeminal Neuralgia Radiosurgery

Stereotactic Radiosurgery for Trigeminal Neuralgia: A Retrospective Multi-Institutional Examination of Treatment Outcomes

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