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The relevance of biologically effective dose for pain relief and sensory dysfunction after Gamma Knife radiosurgery for trigeminal neuralgia: an 871-patient multicenter study

RE. Warnick, I. Paddick, D. Mathieu, E. Adam, C. Iorio-Morin, W. Leduc, A. Hamel, SE. Johnson, M. Bydon, A. Niranjan, LD. Lunsford, Z. Wei, K. Waite, S. Jose, S. Peker, MY. Samanci, E. Tek, G. Mantziaris, S. Pikis, JP. Sheehan, M. Tripathi, N....

. 2024 ; 141 (2) : 461-473. [pub] 20240216

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc24019617

OBJECTIVE: Recent studies have suggested that biologically effective dose (BED) is an important correlate of pain relief and sensory dysfunction after Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The goal of this study was to determine if BED is superior to prescription dose in predicting outcomes in TN patients undergoing GKRS as a first procedure. METHODS: This was a retrospective study of 871 patients with type 1 TN from 13 GKRS centers. Patient demographics, pain characteristics, treatment parameters, and outcomes were reviewed. BED was compared with prescription dose and other dosimetric factors for their predictive value. RESULTS: The median age of the patients was 68 years, and 60% were female. Nearly 70% of patients experienced pain in the V2 and/or V3 dermatomes, predominantly on the right side (60%). Most patients had modified BNI Pain Intensity Scale grade IV or V pain (89.2%) and were taking 1 or 2 pain medications (74.1%). The median prescription dose was 80 Gy (range 62.5-95 Gy). The proximal trigeminal nerve was targeted in 77.9% of cases, and the median follow-up was 21 months (range 6-156 months). Initial pain relief (modified BNI Pain Intensity Scale grades I-IIIa) was noted in 81.8% of evaluable patients at a median of 30 days. Of 709 patients who achieved initial pain relief, 42.3% experienced at least one pain recurrence after GKRS at a median of 44 months, with 49.0% of these patients undergoing a second procedure. New-onset facial numbness occurred in 25.3% of patients after a median of 8 months. Age ≥ 63 years was associated with a higher probability of both initial pain relief and maintaining pain relief. A distal target location was associated with a higher probability of initial and long-term pain relief, but also a higher incidence of sensory dysfunction. BED ≥ 2100 Gy2.47 was predictive of pain relief at 30 days and 1 year for the distal target, whereas physical dose ≥ 85 Gy was significant for the proximal target, but the restricted range of BED values in this subgroup could be a confounding factor. A maximum brainstem point dose ≥ 29.5 Gy was associated with a higher probability of bothersome facial numbness. CONCLUSIONS: BED and physical dose were both predictive of pain relief and could be used as treatment planning goals for distal and proximal targets, respectively, while considering maximum brainstem point dose < 29.5 Gy as a potential constraint for bothersome numbness.

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$a Warnick, Ronald E $u 1Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio
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$a OBJECTIVE: Recent studies have suggested that biologically effective dose (BED) is an important correlate of pain relief and sensory dysfunction after Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The goal of this study was to determine if BED is superior to prescription dose in predicting outcomes in TN patients undergoing GKRS as a first procedure. METHODS: This was a retrospective study of 871 patients with type 1 TN from 13 GKRS centers. Patient demographics, pain characteristics, treatment parameters, and outcomes were reviewed. BED was compared with prescription dose and other dosimetric factors for their predictive value. RESULTS: The median age of the patients was 68 years, and 60% were female. Nearly 70% of patients experienced pain in the V2 and/or V3 dermatomes, predominantly on the right side (60%). Most patients had modified BNI Pain Intensity Scale grade IV or V pain (89.2%) and were taking 1 or 2 pain medications (74.1%). The median prescription dose was 80 Gy (range 62.5-95 Gy). The proximal trigeminal nerve was targeted in 77.9% of cases, and the median follow-up was 21 months (range 6-156 months). Initial pain relief (modified BNI Pain Intensity Scale grades I-IIIa) was noted in 81.8% of evaluable patients at a median of 30 days. Of 709 patients who achieved initial pain relief, 42.3% experienced at least one pain recurrence after GKRS at a median of 44 months, with 49.0% of these patients undergoing a second procedure. New-onset facial numbness occurred in 25.3% of patients after a median of 8 months. Age ≥ 63 years was associated with a higher probability of both initial pain relief and maintaining pain relief. A distal target location was associated with a higher probability of initial and long-term pain relief, but also a higher incidence of sensory dysfunction. BED ≥ 2100 Gy2.47 was predictive of pain relief at 30 days and 1 year for the distal target, whereas physical dose ≥ 85 Gy was significant for the proximal target, but the restricted range of BED values in this subgroup could be a confounding factor. A maximum brainstem point dose ≥ 29.5 Gy was associated with a higher probability of bothersome facial numbness. CONCLUSIONS: BED and physical dose were both predictive of pain relief and could be used as treatment planning goals for distal and proximal targets, respectively, while considering maximum brainstem point dose < 29.5 Gy as a potential constraint for bothersome numbness.
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$a Paddick, Ian $u 2Queen Square Radiosurgery Centre, London, United Kingdom
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$a Mathieu, David $u 3Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Québec, Canada
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$a Adam, Elizabeth $u 3Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Québec, Canada
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$a Iorio-Morin, Christian $u 3Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Québec, Canada
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$a Leduc, William $u 3Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Québec, Canada
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$a Hamel, Andréanne $u 3Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Québec, Canada
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$a Johnson, Sarah E $u 4Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
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$a Bydon, Mohamad $u 4Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
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$a Niranjan, Ajay $u 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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$a Lunsford, L Dade $u 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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$a Wei, Zhishuo $u 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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$a Waite, Kaitlin $u 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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$a Jose, Shalini $u 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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$a Peker, Selcuk $u 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
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$a Samanci, Mustafa Yavuz $u 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
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$a Tek, Ece $u 7Department of Radiation Oncology, Acıbadem Altunizade Hospital, Istanbul, Turkey
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$a Mantziaris, Georgios $u 8Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Pikis, Stylianos $u 8Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Sheehan, Jason P $u 8Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Tripathi, Manjul $u Departments of9Neurosurgery and
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$a Kumar, Narendra $u 10Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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$a Alzate, Juan Diego $u Departments of11Neurosurgery and
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$a Bernstein, Kenneth $u 12Radiation Oncology, New York University Langone Medical Center, New York, New York
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$a Ahorukomeye, Peter $u 13Department of Neurological Surgery, Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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$a Kshettry, Varun R $u 13Department of Neurological Surgery, Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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$a Speckter, Herwin $u 14Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
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$a Hernandez, Wenceslao $u 14Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
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$a Urgošík, Dušan $u 15Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Liščák, Roman $u 15Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Yang, Andrew I $u 16Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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$a Lee, John Y K $u 16Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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$a Patel, Samir $u 17Division of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada; and
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$a Kusyk, Dorian M $u 18Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
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