Debulking surgery prior to stereotactic radiotherapy for head and neck paragangliomas
Abstract
Background: Surgery has been used as standard treatment for head and neck paragangliomas. Stereotactic radiotherapy (SRT) has also been increasingly used for this disease. The results for combined modality are not well described. This analysis aims to describe the results for combined modality of debulking surgery and SRT for head and neck paragangliomas (HNP).
Materials and and methods: Retrospective cohort of patients treated in a large university hospital between 2008 and 2023.
Results: Fifty-one patients had their charts reviewed. Mean age was 56.3 years. Most were female (82.3%). Most lesions arose from the skull-base (84.3%) and not the inner ear. Most lesions were larger than 3 cm (51.0%) and mean lesion size was 4.4 cm. 36 (70.6%) were treated with radiotherapy alone while 15 (29.4%) were treated with combined modality treatment. Median follow-up was 42.5 months (7.1–112.8 months). There were no reported deaths nor disease progression. Debulking surgery did not impact response rate for SRT (52.8% vs. 47.2% for SRT alone and debulking surgery, respectively, p = 0.971). There was no impact on new neurological deficits after SRT (25.0 vs. 13.3%, respectively, p = 0.356).
Conclusion: Debulking surgery did not improve response rate for SRT. In our sample, it also did not impact new neurological deficits for SRT. Prospective data regarding HNP treatment is needed.
Keywords: paragangliomatumorcarotid bodystereotactic radiosurgery
References
- Miller JP, Semaan MT, Maciunas RJ, et al. Radiosurgery for glomus jugulare tumors. Otolaryngol Clin North Am. 2009; 42(4): 689–706.
- Campbell JC, Lee JW, Ledbetter L, et al. Systematic Review and Meta-analysis for Surgery Versus Stereotactic Radiosurgery for Jugular Paragangliomas. Otol Neurotol. 2023; 44(3): 195–200.
- Shapiro S, Kellermeyer B, Ramadan J, et al. Outcomes of Primary Radiosurgery Treatment of Glomus Jugulare Tumors: Systematic Review With Meta-analysis. Otol Neurotol. 2018; 39(9): 1079–1087.
- von Elm E, Altman DG, Egger M, et al. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596): 1453–1457.
- Patel AK, Rodríguez-López JL, Hirsch BE, et al. Long term outcomes with linear accelerator stereotactic radiosurgery for treatment of jugulotympanic paragangliomas. Head Neck. 2021; 43(2): 449–455.
- Lior U, Rotem H, Uzi N, et al. LINAC radiosurgery for glomus jugulare tumors: retrospective - cohort study of 23 patients. Acta Neurochir (Wien). 2020; 162(4): 839–844.
- Sallabanda K, Barrientos H, Isernia Romero DA, et al. Long-term outcomes after radiosurgery for glomus jugulare tumors. Tumori. 2018; 104(4): 300–306.
- Manzoor NF, Yancey KL, Aulino JM, et al. Contemporary Management of Jugular Paragangliomas With Neural Preservation. Otolaryngol Head Neck Surg. 2021; 164(2): 391–398.
- Ong V, Bourcier AJ, Florence TJ, et al. Stereotactic Radiosurgery for Glomus Jugulare Tumors: Systematic Review and Meta-Analysis. World Neurosurg. 2022; 162: e49–e57.
- Suárez C, Rodrigo JP, Bödeker CC, et al. Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy. Head Neck. 2013; 35(8): 1195–1204.
- Guss ZD, Batra S, Limb CJ, et al. Radiosurgery of glomus jugulare tumors: a meta-analysis. Int J Radiat Oncol Biol Phys. 2011; 81(4): e497–e502.
- Liscak R, Urgosik D, Chytka T, et al. Leksell Gamma Knife radiosurgery of the jugulotympanic glomus tumor: long-term results. J Neurosurg. 2014; 121 Suppl: 198–202.
- Dobberpuhl MR, Maxwell S, Feddock J, et al. Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery. Otol Neurotol. 2016; 37(9): 1406–1410.
- Winford TW, Dorton LH, Browne JD, et al. Stereotactic Radiosurgical Treatment of Glomus Jugulare Tumors. Otol Neurotol. 2017; 38(4): 555–562.
- Bianchi LC, Marchetti M, Brait L, et al. Paragangliomas of head and neck: a treatment option with CyberKnife radiosurgery. Neurol Sci. 2009; 30(6): 479–485.
- Sager O, Dincoglan F, Beyzadeoglu M. Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives. CNS Oncol. 2015; 4(2): 105–114.
- Hernandez YB, Gomez KV, Lopez AL, et al. Treatment of benign tumours and related pathologies with radiotherapy: experience of the General Hospital of Mexico. Rep Pract Oncol Radiother. 2022; 27(4): 684–690.
- Suárez C, Rodrigo JP, Mendenhall WM, et al. Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy. Eur Arch Otorhinolaryngol. 2014; 271(1): 23–34.
- Ma D, Liu L, Yao H, et al. A retrospective study in management of carotid body tumour. Br J Oral Maxillofac Surg. 2009; 47(6): 461–465.
- Casarim AL, Tincani AJ, Del Negro A, et al. Carotid body tumor: retrospective analysis on 22 patients. Sao Paulo Med J. 2014; 132(3): 133–139.
- Miller JP, Semaan M, Einstein D, et al. Staged Gamma Knife radiosurgery after tailored surgical resection: a novel treatment paradigm for glomus jugulare tumors. Stereotact Funct Neurosurg. 2009; 87(1): 31–36.
- Texakalidis P, Charisis N, Giannopoulos S, et al. Role of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis. World Neurosurg. 2019; 129: 503–513.e2.
- Abu-Ghanem S, Yehuda M, Carmel NN, et al. Impact of preoperative embolization on the outcomes of carotid body tumor surgery: A meta-analysis and review of the literature. Head Neck. 2016; 38 Suppl 1: E2386–E2394.
- Robertson V, Poli F, Hobson B, et al. A Systematic Review and Meta-Analysis of the Presentation and Surgical Management of Patients With Carotid Body Tumours. Eur J Vasc Endovasc Surg. 2019; 57(4): 477–486.
- Jansen TTG, Kaanders JH, Beute GN, et al. Results of a systematic literature review of treatment modalities for jugulotympanic paraganglioma, stratified per Fisch class. Clin Otolaryngol. 2018; 43(2): 652–661.
- Sharma M, Wang D, Ugiliweneza B, et al. Trends and Impact of Treatment Modalities (Surgery and Radiation Therapy) on Health Care Utilization in Patients With Glomus Jugulare Tumors (GJTs): An Inverse Probability of Treatment Weight Analysis. World Neurosurg. 2023; 175: e984–e993.
- Patel NS, Link MJ, Tombers NM, et al. Quality of Life in Jugular Paraganglioma Following Radiosurgery. Otol Neurotol. 2019; 40(6): 820–825.