Biologically Effective Dose and Dose Rate in Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis

作者：Jane Jomy, Ke Xin Lin, Radha Sharma, Rachel Lu, Sanchit Kaushal, Anna Santiago, Dana Keilty, David Shultz, Catherine Coolens, Michael D. Cusimano, Gelareh Zadeh, Mojgan Hodaie, Suneil K. Kalia, Farshad Nassiri, Ying Meng, Derek S. Tsang, Michael Yan · 发表于：Advances in Radiation Oncology · 年份：2025 · DOI：10.1016/j.adro.2025.101932 · 被引用次数：2 · 研究领域：Trigeminal Neuralgia and Treatments、Meningioma and schwannoma management、Advanced Radiotherapy Techniques

Purpose Gamma Knife radiosurgery (GKRS) is used in trigeminal neuralgia (TN) to deliver precise, focused ionizing radiation to the trigeminal nerve to reduce its ability to transmit pain signals. Understanding the impact of unique radiobiological parameters, such as biological effective dose (BED) and dose-rate in GKRS is essential to optimize treatment protocols and ensure predictable therapeutic outcomes. We conducted a systematic review and meta-analysis to evaluate how BED and dose-rate impact GKRS effectiveness and toxicity. Methods We searched medical and healthcare databases from inception to May 19, 2024, for publications that report on the impact of GKRS BED and/or dose-rate on TN outcomes. Following two rounds of screening conducted in duplicate, we used a random-effects meta-analysis and meta-regression to examine the association between dose-rate and pain relief. Results Of 6,950 citations identified, eight publications reported data on BED and dose-rate association with GKRS patient outcomes in TN. Eight cohorts reported on 2,596 patients in six countries. The "beam-on" time ranged from 27 to 171 minutes, with a prescription dose ranging from 62.5 to 95 Gy. The median BED 2.47 was 2,105 Gy (range: 1968-2675), median dose-rate was 2.2 Gy/min (2.06-2.81), and median maximum brainstem dose was 20.7 Gy (14.8-34.7). Meta-analysis suggested higher dose-rates may be associated with higher rates of pain relief (relative risk [95% CI] = 1.36 [1.10-1.67], p = 0.005). Meta-...