ESTRO 2024 - Abstract Book

S944

Clinical - CNS

ESTRO 2024

2733

Digital Poster

Radiosurgery for trigeminal neuralgia: outcomes using Exactrac Dynamic

Uriel Alexander Corro Verde 1 , Jose Ignacio Raba Diez 2 , Paola Andrea Navarrrete Solano 1 , Jose Andres Vazquez Rodriguez 2 , Rosa Fabregat Borras 2 , Verónica Cañon Garcia 1 , Jose Antonio Blanco Rodriguez 1 , Javier Albendea Roch 1 , Rodrigo Astudillo Olalla 2 , Frandeina Pinto Guevara 1 , Marina Gutierrez 2 , Mara Garcia Lamela 1 , Jorge Alonso Muriedas 2 , Maria Teresa Pacheco Baldor 2 , Pedro Jose Prada Gomez 1 1 Hospital Universitario Marques de Valdecilla, Servicio de Oncologia radioterápica, Santander, Spain. 2 Hospital Universitario Marques de Valdecilla, Servicio de Radiofisica, Santander, Spain

Purpose/Objective:

The trigeminal neuralgia (TN) is a chronic, episodic, and disabling facial pain syndrome. Has a prevalence of 0.1-0.2 per thousand and an incidence ranging from about 4-5/100,000/year up to 20/100,000/year after age 60. The female-to-male ratio is about 3:2. There is a wide selection of studies concerning this issue. This study details our experience treating TN in a Varian TrueBeam ™ STX LINAC and Perfect Pitch ™ 6 DOF patient support couch, using Brainlab´s Exactrac-Dynamic System®. We evaluated dosimetry, pain relief and morbidity after SRS.

Material/Methods:

Eight patients median age of 62 years were treated, all of them affected by multirefractory idiopathic (4), demyelinating (2), postherpetic (1) and teeth origin TN. A single isocenter point, focused on the intracisternal portion of the trigeminal nerve 3-4mm anterior to the pons. The prescription dose was 90Gy with at least 70-80% isodose-line covering all thickness of the nerve. The mean radiation dose delivered to 0.1cc of brainstem, brain and facial nerve were 23.62, 13,80 and 3.8Gy respectively. Immobilization system with thermoplastic mask 4pi (Brainlab®). Positioning with stereoscopic X-ray after each couch movement and intrafraction monitoring with X-Ray and thermal camera with accuracy less than 0.3mm and 1mm respectively. The treatment plan consists in 10 arc radiotherapy ipsilateral to the affected nerve, all with the same weight collimated with 4mm SRS-cone and coach movement every 10 grades.

Results:

Mean follow-up after SRS was 15 months (range 1-33 months). Pain relief was achieved for seven patients with a mean of 48.75% of pain improve based on analgesic pain scale before and after SRS in the follow up. Two patients suffer pain relapse after a mean of 11.4 months. Only two patients suffer side effects one numbness and other paresthesia ipsilateral to the treated nerve.

Conclusion: