Time course of pain response and toxicity after whole-nerve-encompassing LINAC-based stereotactic radiosurgery for trigeminal neuralgia—a prospective observational study; [Zeitverlauf von Schmerzansprechen und Toxizität nach LINAC-basierter stereotaktischer Radiochirurgie der gesamten Nervenzirkumferenz bei Trigeminusneuralgie – eine prospektive Beobachtungsstudie]

被引：0

作者：

Koca S. ^{[1
]}

Distel L. ^{[1
]}

Lubgan D. ^{[1
]}

Weissmann T. ^{[1
]}

Lambrecht U. ^{[1
]}

Lang-Welzenbach M. ^{[1
]}

Eyüpoglu I. ^{[2
]}

Bischoff B. ^{[2
]}

Buchfelder M. ^{[2
]}

Semrau S. ^{[1
]}

Fietkau R. ^{[1
]}

Lettmaier S. ^{[1
]}

Putz F. ^{[1
]}

机构：

[1] Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, Erlangen

[2] Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, Erlangen

来源：

Strahlentherapie und Onkologie | 2019年 / 195卷 / 8期

关键词：

Facial pain; Radiosurgery; SRS; Toxicity; Trigeminal neuralgia;

D O I：

10.1007/s00066-019-01450-9

中图分类号：

学科分类号：

摘要：

Purpose: To prospectively evaluate the time course of pain response and toxicity after linear accelerator-based whole-nerve-encompassing radiosurgery (LINAC-SRS) using a uniform treatment schedule for dosing and target volume definition in patients with refractory trigeminal neuralgia. Methods: From December 2012 to December 2016, 21 patients were treated using a standardized protocol. Patients received LINAC-SRS with 70 Gy to the cisternal portion while aiming for the 90% isodose to fully envelope the nerve in one cross-sectional plane. Data on pain, analgesics, and toxicity were gathered prospectively. Four time intervals (1–6, 6–12, 12–18, and 18–24 months) were defined and compared to baseline and each other. Results: The median follow-up from radiotherapy was 16 months. Freedom from pain was achieved at least once in 90.5, 81.0, and 85.7% of patients for everyday pain, rest pain, and pain peaks, respectively. At 1–6 months, pain was significantly reduced in everyday routine (mean VAS, 2.0/10 vs. 5.8/10; P = 0.004), at rest (1.5/10 vs. 4.0/10; P = 0.002), and for pain peaks (2.9/10 vs. 10/10; P < 0.001), as was the number of analgesics (mean 1.5 vs. 2.9; P < 0.001). No significant increase in pain or analgesics was observed for subsequent time intervals. At last follow-up, reduction in pain compared to baseline for everyday routine (2.1/10 vs. 5.8/10; P = 0.010) and for pain peaks (3.3/10 vs. 10/10; P < 0.001) was significant, whereas it was not for rest pain (1.8/10 vs. 3.9/10; P = 0.073). Most toxicities were related to trigeminal nerve impairment, with 42.9% reporting new-onset hypoesthesia at last follow-up. Conclusion: This study provides prospective data after whole nerve encompassing LINAC-SRS for trigeminal neuralgia. No significant pain relapse was observed. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

引用

页码：745 / 755

页数：10

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