Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia

Nida, Adrian M.; Isom, Scott; Marshall, Kopriva; Bourland, John D.; Laxton, Adrian W.; Tatter, Stephen B.; Chan, Michael D.

doi:10.1016/J.IJROBP.2014.01.023

Title: Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia

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Abstract

Purpose: To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN). Methods and Materials: Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals. Results: Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2%more »« less

Authors:

Nida, Adrian M. ^[1]; Isom, Scott ^[2]; Marshall, Kopriva ^[3]; Bourland, John D. ^[4]; Laxton, Adrian W.; Tatter, Stephen B. ^[5]; Chan, Michael D. ^[4]

Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina (United States)
Department of Biostatistical Sciences, Section of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States)
Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States)

Publication Date:: Thu May 01 00:00:00 EDT 2014

OSTI Identifier:: 22416554

Resource Type:: Journal Article

Journal Name:: International Journal of Radiation Oncology, Biology and Physics

Additional Journal Information:: Journal Volume: 89; Journal Issue: 1; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016

Country of Publication:: United States

Language:: English

Subject:: 62 RADIOLOGY AND NUCLEAR MEDICINE; MEDICAL RECORDS; MULTIVARIATE ANALYSIS; NOMOGRAMS; PAIN; PATIENTS; RADIATION DOSES; SURGERY

Citation Formats


                    Lucas, John T., E-mail: johnthomas75@gmail.com, Nida, Adrian M., Isom, Scott, Marshall, Kopriva, Bourland, John D., Laxton, Adrian W., Tatter, Stephen B., and Chan, Michael D. Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia.  United States: N. p., 2014. 
        Web.  doi:10.1016/J.IJROBP.2014.01.023.

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                    Lucas, John T., E-mail: johnthomas75@gmail.com, Nida, Adrian M., Isom, Scott, Marshall, Kopriva, Bourland, John D., Laxton, Adrian W., Tatter, Stephen B., & Chan, Michael D. Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia.  United States.  https://doi.org/10.1016/J.IJROBP.2014.01.023

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                    Lucas, John T., E-mail: johnthomas75@gmail.com, Nida, Adrian M., Isom, Scott, Marshall, Kopriva, Bourland, John D., Laxton, Adrian W., Tatter, Stephen B., and Chan, Michael D. 2014.  
        "Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia".  United States.  https://doi.org/10.1016/J.IJROBP.2014.01.023.

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@article{osti_22416554,

  title        = {Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia},

  author       = {Lucas, John T., E-mail: johnthomas75@gmail.com and Nida, Adrian M. and Isom, Scott and Marshall, Kopriva and Bourland, John D. and Laxton, Adrian W. and Tatter, Stephen B. and Chan, Michael D.},

  abstractNote = {Purpose: To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN). Methods and Materials: Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals. Results: Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P<.0001), type 1 (vs type 2) TN (HR, 0.6; P=.02), and improved post-SRS BNI score at 6 months (HR, 0.009; P<.0001) were predictive of a durable pain response. Conclusions: The durability of SRS for TN depends on the presenting Burchiel pain type, the post-SRS BNI score, and the presence of post-SRS facial numbness. The durability of pain relief can be estimated pre- and posttreatment by using our nomogram for situations when the potential of relapse may guide the decision for initial intervention.},

  doi          = {10.1016/J.IJROBP.2014.01.023},

  url          = {https://www.osti.gov/biblio/22416554},
  journal      = {International Journal of Radiation Oncology, Biology and Physics},

  issn         = {0360-3016},

  number       = 1,

  volume       = 89,

  place        = {United States},

  year         = {Thu May 01 00:00:00 EDT 2014},

  month        = {Thu May 01 00:00:00 EDT 2014}

}

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