Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy†
Corresponding Author
Carlos Suárez MD, PhD
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, SpainSearch for more papers by this authorJuan P. Rodrigo MD, PhD
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
Search for more papers by this authorCarsten C. Bödeker MD
Department of Otorhinolaryngology – Head and Neck Surgery, University of Freiburg, Freiburg, Germany
Search for more papers by this authorJosé L. Llorente MD
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
Search for more papers by this authorCarl E. Silver MD
Departments of Surgery and Otolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Search for more papers by this authorJeroen C. Jansen MD, PhD
Department of Otolaryngology, University Medical Centre, Leiden, The Netherlands
Search for more papers by this authorRobert P. Takes MD, PhD
Department of Otolaryngology – Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Search for more papers by this authorPrimoẑ Strojan MD, PhD
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
Search for more papers by this authorPhillip K. Pellitteri DO
Department of Otolaryngology – Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
Search for more papers by this authorAlessandra Rinaldo MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg
ENT Clinic, University of Udine, Udine, Italy
Search for more papers by this authorWilliam M. Mendenhall MD
Department of Radiation Oncology, University of Florida, Gainesville, Florida
Search for more papers by this authorAlfio Ferlito MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP
ENT Clinic, University of Udine, Udine, Italy
Search for more papers by this authorCorresponding Author
Carlos Suárez MD, PhD
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, SpainSearch for more papers by this authorJuan P. Rodrigo MD, PhD
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
Search for more papers by this authorCarsten C. Bödeker MD
Department of Otorhinolaryngology – Head and Neck Surgery, University of Freiburg, Freiburg, Germany
Search for more papers by this authorJosé L. Llorente MD
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
Search for more papers by this authorCarl E. Silver MD
Departments of Surgery and Otolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Search for more papers by this authorJeroen C. Jansen MD, PhD
Department of Otolaryngology, University Medical Centre, Leiden, The Netherlands
Search for more papers by this authorRobert P. Takes MD, PhD
Department of Otolaryngology – Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Search for more papers by this authorPrimoẑ Strojan MD, PhD
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
Search for more papers by this authorPhillip K. Pellitteri DO
Department of Otolaryngology – Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
Search for more papers by this authorAlessandra Rinaldo MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg
ENT Clinic, University of Udine, Udine, Italy
Search for more papers by this authorWilliam M. Mendenhall MD
Department of Radiation Oncology, University of Florida, Gainesville, Florida
Search for more papers by this authorAlfio Ferlito MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP
ENT Clinic, University of Udine, Udine, Italy
Search for more papers by this authorThis article was written by members and invitees of the International Head and Neck Scientific Group.
Abstract
Background
The definitive treatment for head and neck paraganglioma (PG) is surgical excision. Unfortunately, surgery, particularly of vagal paraganglioma (VPG; “glomus vagale”) and foramen jugulare (“glomus jugulare”) tumors, may be complicated by injuries to the lower cranial nerves, a high price to pay for treatment for a benign tumor. Alternatively these tumors may be followed without treatment, or irradiated. The purpose of this review was to compare the existing evidence concerning the efficacy and safety of surgery, external beam radiotherapy (EBRT), and stereotactic radiosurgery (SRS), for jugular paragangliomas (JPGs) and VPGs.
Methods
Relevant articles were reviewed using strict criteria for systematic searches. Forty-one surgical studies met the criteria which included 1310 patients. Twenty articles including 461 patients treated with EBRT, and 14 radiosurgery studies comprising 261 patients were also evaluated. Results were compared between treatment modalities using analysis of variance (ANOVA) tests.
Results
A total of 1084 patients with JPGs and 226 VPGs were treated with different surgical procedures. Long-term control of the disease was achieved in 78.2% and 93.3% of patients, respectively. A total of 715 patients with JPG were treated with radiotherapy: 461 with EBRT and 254 with SRS. Control of the disease with both methods was obtained in 89.1% and 93.7% of the patients, respectively. The treatment outcomes of a JPG treated with surgery or radiotherapy were compared. Tumor control failure, major complication rates, and the number of cranial nerve palsies after treatment were significantly higher in surgical than in radiotherapy series. The results of SRS and EBRT in JPGs were compared and no significant differences were observed in tumor control. Because only 1 article reported on the treatment of 10 VPGs with radiotherapy, no comparisons with surgery could be made. Nevertheless, the vagus nerve was functionally preserved in only 11 of 254 surgically treated patients (4.3%).
Conclusion
There is evidence that EBRT and SRS offer a similar chance of tumor control with lower risks of morbidity compared with surgery in patients with JPGs. Although the evidence is based on retrospective studies, these results suggest that surgery should be considered only for selected cases, but the decision should be individual for every patient. © 2012 Wiley Periodicals, Inc. Head Neck, 2013
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