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.
方法:这是一项来自13个GKRS中心的871例1型TN患者的回顾性研究。患者人口统计学,疼痛的特点,处理参数,并对结果进行了审查。将BED与处方剂量和其他剂量学因素进行了预测价值比较。
结果:患者的中位年龄为68岁,60%是女性。近70%的患者在V2和/或V3皮套中经历了疼痛,主要在右侧(60%)。大多数患者患有改良的BNI疼痛强度量表IV或V级疼痛(89.2%),并服用1或2种止痛药(74.1%)。中位处方剂量为80Gy(范围62.5-95Gy)。77.9%的病例靶向三叉神经近端,中位随访时间为21个月(6-156个月).在中位数为30天的81.8%的可评估患者中注意到初始疼痛缓解(改良的BNI疼痛强度量表等级I-IIIa)。在709名初步缓解疼痛的患者中,42.3%的患者在GKRS后经历了至少一次疼痛复发,中位时间为44个月,其中49.0%的患者接受第二次手术。中位时间为8个月后,有25.3%的患者出现新发面部麻木。年龄≥63岁与初始疼痛缓解和维持疼痛缓解的可能性较高相关。远端目标位置与初始和长期疼痛缓解的较高概率相关,而且感觉功能障碍的发生率也较高。BED≥2100Gy2.47可预测远端目标在30天和1年时疼痛缓解,而物理剂量≥85Gy对于近端目标是显著的,但本子组中BED值的限制范围可能是一个混杂因素.最大脑干点剂量≥29.5Gy与令人讨厌的面部麻木的可能性更高相关。
结论:BED和物理剂量均可预测疼痛缓解,可用作远端和近端目标的治疗计划目标。分别,同时考虑最大脑干点剂量<29.5Gy作为烦人麻木的潜在约束。