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Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves.

Publication ,  Journal Article
Cuneo, KC; Zagar, TM; Brizel, DM; Yoo, DS; Hoang, JK; Chang, Z; Wang, Z; Yin, FF; Das, SK; Green, S; Ready, N; Bhatti, MT; Kaylie, DM ...
Published in: Technol Cancer Res Treat
June 2012

Involvement of a cranial nerve caries a poor prognosis for many malignancies. Recurrent or residual disease in the trigeminal or facial nerve after primary therapy poses a challenge due to the location of the nerve in the skull base, the proximity to the brain, brainstem, cavernous sinus, and optic apparatus and the resulting complex geometry. Surgical resection caries a high risk of morbidity and is often not an option for these patients. Stereotactic radiosurgery and radiotherapy are potential treatment options for patients with cancer involving the trigeminal or facial nerve. These techniques can deliver high doses of radiation to complex volumes while sparing adjacent critical structures. In the current study, seven cases of cancer involving the trigeminal or facial nerve are presented. These patients had unresectable recurrent or residual disease after definitive local therapy. Each patient was treated with stereotactic radiation therapy using a linear accelerator based system. A multidisciplinary approach including neuroradiology and surgical oncology was used to delineate target volumes. Treatment was well tolerated with no acute grade 3 or higher toxicity. One patient who was reirradiated experienced cerebral radionecrosis with mild symptoms. Four of the seven patients treated had no evidence of disease after a median follow up of 12 months (range 2-24 months). A dosimetric analysis was performed to compare intensity modulated fractionated stereotactic radiation therapy (IM-FSRT) to a 3D conformal technique. The dose to 90% (D90) of the brainstem was lower with the IM-FSRT plan by a mean of 13.5 Gy. The D95 to the ipsilateral optic nerve was also reduced with IM-FSRT by 12.2 Gy and the D95 for the optic chiasm was lower with FSRT by 16.3 Gy. Treatment of malignancies involving a cranial nerve requires a multidisciplinary approach. Use of an IM-FSRT technique with a micro-multileaf collimator resulted in a lower dose to the brainstem, optic nerves and chiasm for each case examined.

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Published In

Technol Cancer Res Treat

DOI

EISSN

1533-0338

Publication Date

June 2012

Volume

11

Issue

3

Start / End Page

221 / 228

Location

United States

Related Subject Headings

  • Trigeminal Nerve
  • Risk Assessment
  • Remission Induction
  • Radiotherapy, Intensity-Modulated
  • Radiosurgery
  • Radiography
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans
 

Citation

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Cuneo, K. C., Zagar, T. M., Brizel, D. M., Yoo, D. S., Hoang, J. K., Chang, Z., … Kirkpatrick, J. P. (2012). Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves. Technol Cancer Res Treat, 11(3), 221–228. https://doi.org/10.7785/tcrt.2012.500290
Cuneo, K. C., T. M. Zagar, D. M. Brizel, D. S. Yoo, J. K. Hoang, Z. Chang, Z. Wang, et al. “Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves.Technol Cancer Res Treat 11, no. 3 (June 2012): 221–28. https://doi.org/10.7785/tcrt.2012.500290.
Cuneo KC, Zagar TM, Brizel DM, Yoo DS, Hoang JK, Chang Z, et al. Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves. Technol Cancer Res Treat. 2012 Jun;11(3):221–8.
Cuneo, K. C., et al. “Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves.Technol Cancer Res Treat, vol. 11, no. 3, June 2012, pp. 221–28. Pubmed, doi:10.7785/tcrt.2012.500290.
Cuneo KC, Zagar TM, Brizel DM, Yoo DS, Hoang JK, Chang Z, Wang Z, Yin FF, Das SK, Green S, Ready N, Bhatti MT, Kaylie DM, Becker A, Sampson JH, Kirkpatrick JP. Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves. Technol Cancer Res Treat. 2012 Jun;11(3):221–228.
Journal cover image

Published In

Technol Cancer Res Treat

DOI

EISSN

1533-0338

Publication Date

June 2012

Volume

11

Issue

3

Start / End Page

221 / 228

Location

United States

Related Subject Headings

  • Trigeminal Nerve
  • Risk Assessment
  • Remission Induction
  • Radiotherapy, Intensity-Modulated
  • Radiosurgery
  • Radiography
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans