(P041) Clinical Outcomes of Gamma Knife Stereotactic Radiosurgery (GK-SRS) for Painful Trigeminal Neuropathy (TNP) 

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

SRS is both safe and efficacious for PTN. Additionally, prior to treatment, PTN patients who characterize their facial pain as dull and not exacerbated by daily activities are more likely to receive therapeutic benefit, with a mean response time of 1 month.

David Zaenger, MD, M.N. Woodall, MD, Bryan M. Rabatic, PhD, MD, John R. Vender, MD, Waleed F. Mourad, MD, PhD, Joseph Kaminski, MD; Georgia Regents University

PURPOSE: Painful trigeminal neuropathy (PTN) is a rare variant of trigeminal neuralgia (TN) that necessitates prior trigeminal nerve injury, in addition to facial pain. While the evidence supporting the safety and efficacy of Gamma Knife stereotactic radiosurgery (GK-SRS) for medically refractory TN is well established, there is a limited body of literature concerning SRS for medically refractory PTN. We report our long-term clinical outcomes using GK-SRS for medically refractory PTN.

METHODS: This is a single-institution retrospective study of 320 patients treated with GK-SRS for TN between 2000 and 2013. From this cohort, 20 XRT-naive patients with PTN were identified. All patients failed initial treatment with medications, and seven (35%) received other invasive treatment (eg, microvascular decompression, rhizotomy) prior to SRS. All patients underwent frame-based single-fraction GK-SRS. Mean age was 61 years (range: 38–80 yr), and 75% of patients were female. Fifteen patients (80%) were Caucasian, four (15%) were African American, and one (5%) was Asian. Mean dose was 80 Gy (range: 80–90 Gy) to the 100% isodose line in a single fraction to the root entry zone of the involved trigeminal nerve (2–3 mm from the anterolateral surface of the pons). Complete response (CR), near-CR, and partial response (PR) were defined as being pain-free without medication, being pain-free with medication, and having reduced pain with medication, respectively.

RESULTS: With a median follow-up of 20 months (range: 3–70 mo), the overall response was 60%. Specifically, CR, near-CR, and PR rates were 27%, 20%, and 13%, respectively. No response (NR) was seen in 40% of patients, who had persistent, unchanged pain. For the 60% of patients who responded to GK-SRS, the mean time latency from SRS to response was 1 month (range: 0–2 mo). The pattern of pretreatment pain in the responders group was described as being dull rather than sharp compared with nonresponders. Additionally, when compared with the NR group, the CR group was significantly less likely to be exacerbated by daily activities pretreatment (0/4 [0%] vs 5/6 [83%]). No GK-SRS-induced grade ≥ 2 toxicities were reported.

CONCLUSIONS: SRS is both safe and efficacious for PTN. Additionally, prior to treatment, PTN patients who characterize their facial pain as dull and not exacerbated by daily activities are more likely to receive therapeutic benefit, with a mean response time of 1 month.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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