S950
Clinical - Non-malignant & functional radiotherapy
ESTRO 2026
338, 261, and 205 per 10,000 at ages 20, 30, and 40, respectively (p < 0.001). In males, the corresponding LAR values were 299, 228, and 178 per 10,000 (p < 0.01). Similar trends were observed for other dose/fractionation schedules (32 GyE/5 fr, p < 0.02; 42 GyE/10 fr, p < 0.03). LARs for patients (age ≥ 30) were below 300. Conclusion: Patients aged ≥ 30 years receiving doses of 26.1 GyE/3 fractions, 32 GyE/5 fractions, or 42 GyE/10 fractions are acceptable candidates for PT. Among these, the 26.1 GyE/3 fractions schedule appears promising for subsequent clinical trials due to its short treatment schedule. Keywords: Hyperthyroidism, proton therapy Radiosurgery with frameless immobilization using LINAC for the treatment of refractory trigeminal neuralgia. Ovidio Hernando-Requejo 1 , Mercedes López González 1 , Raquel Ciervide Jurio 1 , Angel Montero Luis 1 , Virgilio Hernando 2 , Jeannette Valero 1 , Beatriz Álvarez 1 , Xin Chen 1 , Emilio Sánchez Saugar 1 , José Javier Jiménez Blázquez 3 , Mariola García Aranda 1 , Rosa Alonso Guitierrez 1 , Daniel Zucca Aparicio 4 , Pedro Fernández Leton 4 , Bruno Zambrana 1 , Raquel Sánchez 1 , Carmen Rubio Rodriguez 1 1 Radiation Oncology, HM Hospitales, Madrid, Spain. 2 Neurology, HM Hospitales, Madrid, Spain. 3 Medicine Department, CEU University, Madrid, Spain. 4 Radiation Physics, HM Hospitales, Madrid, Spain Digital Poster 2944 Purpose/Objective: To evaluate the efficacy, safety, and long-term outcomes of radiosurgery using linear accelerators (LINAC) for the treatment of refractory trigeminal neuralgia (TN). This study focuses on pain reduction, medication dependency, and patient characteristics that may predict treatment success. Material/Methods: We retrospectively analyzed data from 32 patients diagnosed with refractory TN, who underwent LINAC- based radiosurgery at HM Sanchinarro University Hospital from 2012 to 2024. Patients included in the study had failed pharmacological treatment or were unsuitable for conventional surgical procedures. Treatment was delivered using a frameless immobilization system with a dose of 70-90 Gy, depending on the patient’s clinical features. Patient demographics, pain characteristics, and prior treatment histories were collected (Table 1).
Statistical analysis was performed using descriptive statistics, Kaplan-Meier survival analysis for pain relief duration, and Cox proportional hazards models to identify factors influencing treatment outcomes. A p- value < 0.05 was considered statistically significant. Results: Out of the 32 patients, 97% experienced pain relief or complete resolution. Of these, 50% showed a significant reduction in both pain and medication use. The median time to maximum pain relief was 284 days (range: 150-420 days). Pain relief duration was significantly longer in patients under 70 years (p = 0.03) and those with fewer than two previous treatments (p = 0.04). Additionally, patients with V3 branch involvement had a higher rate of complete pain resolution (65%). Regarding safety, 6% of patients reported mild adverse effects, such as transient paresthesia and facial numbness, all of which resolved within three months. No severe complications, such as neural deficits or tumor formation, were observed. At the last follow-up, 89% of patients maintained at least partial pain relief. Kaplan-Meier analysis showed that 75% of patients retained significant pain relief at two years, with a recurrence rate of 15%. The median follow-up period was 24 months (range: 12-60 months). Conclusion: LINAC-based radiosurgery with frameless immobilization provides an effective and safe alternative for patients with refractory TN. The procedure offers substantial pain relief, with minimal adverse effects and reduced need for pharmacological management. Younger patients, those with fewer prior treatments, and patients with V3 branch involvement are more likely to experience favorable outcomes. These findings support the use of radiosurgery as a valuable option in the management of refractory TN, especially for patients who are not candidates for invasive surgical procedures. Long-term studies are needed to refine treatment protocols and assess the sustainability of pain relief. Keywords: Trigeminal Neuralgia, Radiosurgery, LINAC
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