Purpose/Objective(s): Paragangliomas of the head and neck are generally benign and well controlled with definitive radiotherapy or surgery. We reviewed our institutional experience with these tumors managed with radiation therapy (RT) at initial presentation or recurrence.Materials/Methods: A retrospective review was performed of all patients treated definitively or adjuvantly for paragangliomas at the carotid body or jugular foramen from 2006 to 2013. Twenty-four patients were identified and 33 tumors treated, 10 classified as glomus jugulare and 23 as carotid body tumors. Median patient age at diagnosis was 49 (range 23-77) and at RT was 53 (range 23-77). Genders were equally distributed at 50%. All patients had imaging prior to therapy including MRI (25 tumors), CT (22), and PET/CT (6). Mean tumor volume was 42.1cc (range 2.8-314.6cc.) Sixteen patients (67%) had unilateral disease, 3 had bilateral disease, and 4 had glomus tumors at more than 2 sites. Six (25%) underwent resection at diagnosis, with 1 undergoing postoperative RT and 5 receiving treatment at recurrence for a median time to RT of 10.7 years. Biopsy was attempted in 5 patients (inconclusive in 2), and the remaining individuals were treated based on imaging alone. One patient was treated with 3D-CRT, and the remainder with IMRT to a median dose of 50 Gy (range 45-54 Gy.)Results: All patients completed therapy as planned. Surveillance imaging was available in 20 (83%) patients. Median follow up was 16.5 months (range 0.5 to 98 months). Stable disease without progression was found in 95% of patients with follow-up imaging. Disease stability was also clinically observed in 75% of patients without follow-up imaging. The one lesion with progression on imaging was treated to 50 Gy with IMRT and to this date has received no further therapy. This patient had a history of prior contralateral and ipsilateral glomus tumors, a pulmonary glomus lesion, and a malignant carotid body tumor. RT was well tolerated with 18 patients (75%) reporting grade 1-2 acute effects during treatment. Two patients (8%) experienced grade 3 mucositis. Two patients (8%) reported long-term effects including hearing loss, facial pain, xerostomia, and dysgeusia attributable to RT vs persistent tumor bulk. One patient had died without evidence of recurrence.Conclusions: The control rate for treatment-naïve and recurrent paragangliomas of the head and neck managed with RT was approximately 96%. RT is well tolerated with few late effects and manageable acute effects in most patients. RT remains the treatment of choice for inoperable lesions and is appropriate in the adjuvant setting when necessary. No differences were observed between definitive vs. salvage therapy.
Maymani, R,
Carotid Paragangliomas and Glomus Jugulare Tumors Managed with Definitive or Adjuvant Radiation. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL.
http://archive.rsna.org/2014/14041585.html
