Non-malignant

PV QA 3 - Poster Viewing Q&A 3

TU_33_3009 - Re-Irradiation of Trigeminal Neuralgia with LINAC-Based Stereotactic Radiosurgery

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Re-Irradiation of Trigeminal Neuralgia with LINAC-Based Stereotactic Radiosurgery
J. T. Binks1, G. M. Lemole2, and B. Stea1; 1University of Arizona Department of Radiation Oncology, Tucson, AZ, 2University of Arizona Division of Neurosurgery, Tucson, AZ

Purpose/Objective(s): Stereotactic radiosurgery (SRS) is an effective non-invasive treatment option for trigeminal neuralgia (TGN). If TGN pain recurs after SRS, re-irradiation with SRS can be considered. While there is published data regarding re-treatment with gamma-knife radiosurgery, little has been published regarding the safety and efficacy of retreatment with LINAC-based SRS.

Materials/Methods: Between July 2007 and July 2017, there were 22 cases of repeat SRS for recurrent TGN to 21 patients (one patient had bilateral re-irradiation) available for analysis. Initial treatment consisted of 90 Gy to the isocenter using frameless LINAC SRS equipped with a 6D robotic table and for re-treatment 60 Gy was used to the root entry zone of CN V. Outcomes were categorized as excellent (minimal to no pain while still taking smaller amounts or fewer medications), good (pain controlled with medical management), and refractory (uncontrolled pain). Toxicity data was also collected and scored using CTCAE v4.0.

Results: The median follow up after re-irradiation was 7.5 months with a range of 1-72 months. The median time between SRS sessions was 16 months with a range of 5 to 76 months. Nine out of the twenty-two cases (40.9%) experienced an excellent outcome, six out of the twenty-two (27.3%) cases experienced a good outcome, and seven out twenty-two cases (31.8%) had a refractory outcome. Regarding toxicity from re-irradiation, there was only one episode of mild and non-bothersome unilateral facial numbness. For those 15 cases who had an excellent/good response to SRS, three (20%) had further recurrence of the TGN pain at a median interval of sixteen months from the second SRS (8-18 months).

Conclusion: Re-irradiation of TGN with frameless LINAC based SRS appears to be both safe and effective with 68% of cases in this series responding to re-treatment along with minimal toxicity.

Author Disclosure: J.T. Binks: None. G.M. Lemole: Consultant; Sony - Olympus Medical. Board Member; yet.2.com. B. Stea: Stock Options; Salutaris MD.

Joshua Binks, MD

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