2849 - Comparative Outcomes of CyberKnife Stereotactic Radiosurgery for Idiopathic and Multiple Sclerosis-Related Trigeminal Neuralgia: A Single-Institution Study
Presenter(s)
A. Roch-Zniszczol1, I. Debosz-Suwinska1, A. J. Namysl-Kaletka1, J. Wydmanski2, A. Misiorowska-Golosz1, D. Gräupner1, B. Goc1, L. Sroka3, A. Grzadziel3, and S. Blamek2; 1Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland, 2Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch., Gliwice, Poland, 3Radiotherapy Planning Department, Maria Sklodowska -Curie National Research Institute of Oncology, Gliwice, Poland
Purpose/Objective(s):
Trigeminal Neuralgia (TN) is among the most debilitating craniofacial pain syndromes, characterized by paroxysmal, shock-like facial pain. This study presents a single-institution retrospective analysis evaluating the clinical efficacy and safety of stereotactic radiosurgery (SRS) in the management of of idiopathic TN (ITN) and multiple sclerosis MS-associated TN (MS-TN).
Materials/Methods:
A retrospective analysis was conducted on 135 patients treated for TN at the Institute of Oncology in Gliwice, Poland, between 2014 and 2022. All procedures were performed using the CyberKnife system (Accuray Inc., Sunnyvale, CA). Fractionation schedules consisted of a single 60 Gy fraction (90% of patients) or 70 Gy delivered in two 35 Gy fractions (10% of patients). Therapeutic efficacy was assessed based on total or partial pain reduction utilizing the Numerical Rating Scale (NRS). Primary endpoints included the rate of pain relief, time to relief (latency period), time to recurrence, and late treatment-related toxicity.
Results:
The median follow-up period was 6 years (range: 0.5–12 years), with a median patient age of 64 years (range: 29–85 years). The cohort included 91 patients (67%) with idiopathic TN, 36 patients (27%) with multiple sclerosis-related TN (MS-TN), and 8 patients (6%) with TN secondary to adjacent tumors.
The median pre-treatment NRS score was 10 (range: 6–10). Following treatment, 82% of the total cohort achieved significant total or partial pain relief. The latency period for pain relief was as follows: 42% of patients experienced relief within one month, 27% within three months, and 10% after more than three months. Notably, MS-TN patients achieved faster pain relief, with 58% responding within one month, 25% within three months, and 5% after three months. Primary treatment failure (no pain relief) occurred only in 11% of Primary failure occurred in only 11% of MS-TN patients. The lowest response rate was observed in patients with adjacent tumors, 25% of whom failed to respond. The overall pain recurrence rate was 43%. Recurrence was significantly more frequent in the MS-TN group (56%) compared to the tumor group (37%).
Toxicity and Complications Treatment-related complications were observed in 14% of patients. These included mild facial hypoesthesia in 2%, transient pain flare-ups in 9%, and clinically insignificant paresthesias in 3%. No major neurological complications or cases of anesthesia dolorosa were reported.
Conclusion:
CyberKnife radiosurgery is a safe and effective minimally invasive treatment for TN, offering high rates of initial pain relief. While MS-TN patients experience a faster onset of relief, they also face a higher risk of recurrence compared to those with idiopathic TN. The worst outcome was observed with TN secondary to adjacent tumors. Identifying specific etiologies and anatomical factors remains crucial for optimizing long-term therapeutic outcomes.