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Pontoriero A, Critelli P, Zeppieri M, Angileri FF, Ius T. Treatment for paraganglioma with stereotactic radiotherapy. World J Clin Cases 2024; 12:0-0. [DOI: 10.12998/wjcc.v12.i16.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/10/2024] Open
Abstract
BACKGROUND Paragangliomas (PG) are rare neoplasms of neuroendocrine origin that tend to be highly vascularized, slow-growing, and usually sporadic. To date, common treatment options are surgical resection (SR), with or without radiation therapy (RT), and a watch-and-wait approach.
AIM To evaluate the local control and effectiveness of exclusive fractionated stereotactic RT (FSRT) treatment in unresectable PG (uPG).
METHODS We retrospectively evaluated patients with uPG (medically inoperable or refused SR) treated with FSRT with a Cyberknife System (Accuray Incorporated, Sunnyvale, California). Toxicity and initial efficacy were evaluated.
RESULTS From May 2009 to January 2023, 6 patients with a median age of 68 (range 20-84) were treated with FSRT. The median delivered dose was 21 Gy (range 20-30 Gy) at a median isodose line of 75.5% (range 70%-76%) in 4 fractions (range 3-5 fractions). The median volume was 13.6 mL (range 12.4-65.24 mL). The median cumulative biological effective dose and equivalent dose in 2-Gy fractions were 70 Gy and 37.10 Gy respectively. Site of origin involved were the timpa-nojugular glomus (4/6), temporal bone, and cervical spine. In 1 of the 6 patients, the follow-up was insufficient; 5 of 6 patients showed a 5-year overall survival and 5-year progression-free survival of 100%. We observed negligible toxicities during and after RT. The majority of patients showed stable symptoms during follow-up. Only 1 patient developed spine metastases.
CONCLUSION Our preliminary results on this small cohort of patients suggest that FSRT could be an effective and safe alternative to SR.
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Affiliation(s)
- Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina 98125, Italy
| | - Paola Critelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina 98125, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Filippo Flavio Angileri
- Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina 98125, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine 33100, Italy
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2
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Pontoriero A, Critelli P, Zeppieri M, Angileri FF, Ius T. Treatment for paraganglioma with stereotactic radiotherapy. World J Clin Cases 2024; 12:2729-2737. [PMID: 38899289 PMCID: PMC11185345 DOI: 10.12998/wjcc.v12.i16.2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Paragangliomas (PG) are rare neoplasms of neuroendocrine origin that tend to be highly vascularized, slow-growing, and usually sporadic. To date, common treatment options are surgical resection (SR), with or without radiation therapy (RT), and a watch-and-wait approach. AIM To evaluate the local control and effectiveness of exclusive fractionated stereotactic RT (FSRT) treatment in unresectable PG (uPG). METHODS We retrospectively evaluated patients with uPG (medically inoperable or refused SR) treated with FSRT with a Cyberknife System (Accuray Incorporated, Sunnyvale, California). Toxicity and initial efficacy were evaluated. RESULTS From May 2009 to January 2023, 6 patients with a median age of 68 (range 20-84) were treated with FSRT. The median delivered dose was 21 Gy (range 20-30 Gy) at a median isodose line of 75.5% (range 70%-76%) in 4 fractions (range 3-5 fractions). The median volume was 13.6 mL (range 12.4-65.24 mL). The median cumulative biological effective dose and equivalent dose in 2-Gy fractions were 70 Gy and 37.10 Gy respectively. Site of origin involved were the timpa-nojugular glomus (4/6), temporal bone, and cervical spine. In 1 of the 6 patients, the follow-up was insufficient; 5 of 6 patients showed a 5-year overall survival and 5-year progression-free survival of 100%. We observed negligible toxicities during and after RT. The majority of patients showed stable symptoms during follow-up. Only 1 patient developed spine metastases. CONCLUSION Our preliminary results on this small cohort of patients suggest that FSRT could be an effective and safe alternative to SR.
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Affiliation(s)
- Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina 98125, Italy
| | - Paola Critelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina 98125, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Filippo Flavio Angileri
- Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina 98125, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine 33100, Italy
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3
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Darrat M, Lau L, Leonard C, Cooke S, Shahzad MA, McHenry C, McCance DR, Hunter SJ, Mullan K, Lindsay JR, Graham U, Bailie N, Hampton S, Rajendran S, Houghton F, Conkey D, Morrison PJ, Johnston PC. Clinical management and outcome of head and neck paragangliomas (HNPGLs): A single centre retrospective study. Clin Endocrinol (Oxf) 2024. [PMID: 38696538 DOI: 10.1111/cen.15070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/02/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
CONTEXT Head and neck paragangliomas (HNPGLs) are rare, usually benign, slow-growing tumours arising from neural crest-derived tissue. Definitive management pathways for HNPGLs have yet to be clearly defined. OBJECTIVE To review our experience of the clinical features and management of these tumours and to analyse outcomes of different treatment modalities. METHODS Demographic and clinical data were obtained from The Northern Ireland Electronic Care Record (NIECR) as well from a prospectively maintained HNPGL database between January 2011 through December 2023. RESULTS There were 87 patients; 50 females: 37 males with a mean age of 52.3 ± 14.2 years old (range 17-91 years old). 58.6% (n = 51) of patients had carotid body tumours, 25.2% (n = 22) glomus vagal tumours, 6.8% (n = 6) tumours in the middle ear, 2.2% (n = 2) in the parapharyngeal space and 1.1% (n = 1) in the sphenoid sinus. 5.7% (n = 5) of patients had multifocal disease. The mean tumour size at presentation was 3.2 ± 1.4 cm (range 0.5-6.9 cm). Pathogenic SDHD mutations were identified in 41.3% (n = 36), SDHB in 12.6% (n = 11), SDHC in 2.2% (n = 2) and SDHA in 1.1% (n = 1) of the patients. Overall treatment modalities included surgery alone in 51.7% (n = 45) of patients, radiotherapy in 14.9% (n = 13), observation in 28.7% (n = 25), and somatostatin analogue therapy with octreotide in 4.5% (n = 4) of patients. Factors associated with a significantly higher risk of recurrence included age over 60 years (p = .04), tumour size exceeding 2 cm (p = .03), positive SDHx variants (p = .01), and vagal and jugular tumours (p = .04). CONCLUSION The majority of our patients underwent initial surgical intervention and achieved disease stability. Our results suggest that carefully selected asymptomatic or medically unfit patients can be safely observed provided lifelong surveillance is maintained. We advocate for the establishment of a UK and Ireland national HNPGL registry, to delineate optimal management strategies for these rare tumours and improve long term outcomes.
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Affiliation(s)
- Milad Darrat
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Louis Lau
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Colin Leonard
- Department of Otolaryngology, Royal Victoria Hospital, Belfast, UK
| | - Stephen Cooke
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, UK
| | - Muhammad A Shahzad
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Claire McHenry
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Steven J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Karen Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - John R Lindsay
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Neil Bailie
- Department of Otolaryngology, Royal Victoria Hospital, Belfast, UK
| | - Susie Hampton
- Department of Otolaryngology, Royal Victoria Hospital, Belfast, UK
| | - Simon Rajendran
- Department of Pathology, Royal Victoria Hospital, Belfast, UK
| | | | - David Conkey
- Department of Oncology, Belfast City Hospital, Belfast, UK
| | | | - Philip C Johnston
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
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Ehret F, Ebner DK, McComas KN, Gogineni E, Andraos T, Kim M, Lo S, Schulder M, Redmond KJ, Muacevic A, Shih HA, Kresl J. The Radiosurgery Society Case-Based Discussion of the Management of Head and Neck or Skull Base Paragangliomas with Stereotactic Radiosurgery and Radiotherapy. Pract Radiat Oncol 2024; 14:225-233. [PMID: 38237891 DOI: 10.1016/j.prro.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used for the treatment of head and neck or skull base paraganglioma for a considerable time, demonstrating promising local control rates and a favorable safety profile compared with surgical approaches. Nevertheless, the choice of treatment must be carefully tailored to each patient's preferences, tumor location, and size, as well as anticipated treatment-related morbidity. This case-based review serves as a practical and concise guide for the use of SRS and FSRT in the management of head and neck or skull base paragangliomas, providing information on the diagnosis, treatment, follow-up considerations, and potential pitfalls.
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Affiliation(s)
- Felix Ehret
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; European Radiosurgery Center Munich, Munich, Germany.
| | - Daniel K Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kyra N McComas
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Therese Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Minsun Kim
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | | | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John Kresl
- Radiation Oncology and Radiosurgery, Phoenix CyberKnife & Radiation Oncology Center, Phoenix, Arizona
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5
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Curry SD, Kocharyan A, Lekovic GP. Multi-Disciplinary Approach to Skull Base Paragangliomas. Brain Sci 2023; 13:1533. [PMID: 38002493 PMCID: PMC10669609 DOI: 10.3390/brainsci13111533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of skull base paragangliomas has moved towards the use of cranial nerve preservation strategies, using radiation therapy and subtotal resection in instances when aiming for gross total resection would be expected to cause increased morbidity compared to the natural history of the tumor itself. The goal of this study was to analyze the role of surgery in patients with skull base paragangliomas treated with CyberKnife stereotactic radiosurgery (SRS) for definitive tumor control. A retrospective review identified 22 patients (median age 65.5 years, 50% female) treated with SRS from 2010-2022. Fourteen patients (63.6%) underwent microsurgical resection. Gross total resection was performed in four patients for tympanic paraganglioma (n = 2), contralateral paraganglioma (n = 1), and intracranial tumor with multiple cranial neuropathies (n = 1). Partial/subtotal resection was performed for the treatment of pulsatile tinnitus and conductive hearing loss (n = 6), chronic otitis and otorrhea (n = 2), intracranial extension (n = 1), or episodic vertigo due to perilymphatic fistula (n = 1). Eighteen patients had clinical and imaging follow-up for a mean (SD) of 4.5 (3.4) years after SRS, with all patients having clinical and radiological tumor control and no mortalities. Surgery remains an important component in the multidisciplinary treatment of skull base paraganglioma when considering other outcomes besides local tumor control.
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Affiliation(s)
- Steven D. Curry
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Armine Kocharyan
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Gregory P. Lekovic
- House Clinic, Los Angeles, CA 90017, USA
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
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6
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Taïeb D, Wanna GB, Ahmad M, Lussey-Lepoutre C, Perrier ND, Nölting S, Amar L, Timmers HJLM, Schwam ZG, Estrera AL, Lim M, Pollom EL, Vitzthum L, Bourdeau I, Casey RT, Castinetti F, Clifton-Bligh R, Corssmit EPM, de Krijger RR, Del Rivero J, Eisenhofer G, Ghayee HK, Gimenez-Roqueplo AP, Grossman A, Imperiale A, Jansen JC, Jha A, Kerstens MN, Kunst HPM, Liu JK, Maher ER, Marchioni D, Mercado-Asis LB, Mete O, Naruse M, Nilubol N, Pandit-Taskar N, Sebag F, Tanabe A, Widimsky J, Meuter L, Lenders JWM, Pacak K. Clinical consensus guideline on the management of phaeochromocytoma and paraganglioma in patients harbouring germline SDHD pathogenic variants. Lancet Diabetes Endocrinol 2023; 11:345-361. [PMID: 37011647 PMCID: PMC10182476 DOI: 10.1016/s2213-8587(23)00038-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 04/05/2023]
Abstract
Patients with germline SDHD pathogenic variants (encoding succinate dehydrogenase subunit D; ie, paraganglioma 1 syndrome) are predominantly affected by head and neck paragangliomas, which, in almost 20% of patients, might coexist with paragangliomas arising from other locations (eg, adrenal medulla, para-aortic, cardiac or thoracic, and pelvic). Given the higher risk of tumour multifocality and bilaterality for phaeochromocytomas and paragangliomas (PPGLs) because of SDHD pathogenic variants than for their sporadic and other genotypic counterparts, the management of patients with SDHD PPGLs is clinically complex in terms of imaging, treatment, and management options. Furthermore, locally aggressive disease can be discovered at a young age or late in the disease course, which presents challenges in balancing surgical intervention with various medical and radiotherapeutic approaches. The axiom-first, do no harm-should always be considered and an initial period of observation (ie, watchful waiting) is often appropriate to characterise tumour behaviour in patients with these pathogenic variants. These patients should be referred to specialised high-volume medical centres. This consensus guideline aims to help physicians with the clinical decision-making process when caring for patients with SDHD PPGLs.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, Aix-Marseille University, La Timone University Hospital, Marseille, France
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maleeha Ahmad
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Charlotte Lussey-Lepoutre
- Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer, Paris, France; Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Nancy D Perrier
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Svenja Nölting
- Svenja Nölting, Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Laurence Amar
- Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer, Paris, France; Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, UTHealth Houston, McGovern Medical School, Memorial Hermann Hospital Heart and Vascular Institute, Houston, TX, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Erqi Liu Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lucas Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Ruth T Casey
- Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cancer Research UK Cambridge Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Frédéric Castinetti
- Department of Endocrinology, Aix-Marseille University, Conception University Hospital, Marseille, France; INSERM U1251, Aix-Marseille University, Conception University Hospital, Marseille, France
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia; Cancer Genetics Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Eleonora P M Corssmit
- Department of Endocrinology, Center of Endocrine Tumors Leiden, Leiden University Medical Centre, Leiden, Netherlands
| | - Ronald R de Krijger
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hans K Ghayee
- Division of Endocrinology and Metabolism, Department of Medicine, Malcom Randall VA Medical Center, University of Florida, Gainesville, FL, USA
| | - Anne-Paule Gimenez-Roqueplo
- Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer, Paris, France; Département de Médecine Génomique des Tumeurs et des Cancers, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ashley Grossman
- Green Templeton College, University of Oxford, Oxford, UK; NET Unit, Royal Free Hospital, London, UK
| | - Alessio Imperiale
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe, IPHC, UMR 7178, CNRS, University of Strasbourg, Strasbourg, France
| | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, Netherlands
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Michiel N Kerstens
- Department of Endocrinology, University Medical Center Groningen, Groningen, Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology and Head & Neck Surgery, Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Otolaryngology and Head & Neck Surgery, Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center, Maastricht, Netherlands
| | - James K Liu
- Department of Neurosurgical Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Eamonn R Maher
- Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cancer Research UK Cambridge Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Daniele Marchioni
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Leilani B Mercado-Asis
- Section of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine & Surgery, University of Santo Tomas Hospital, University of Santo Tomas, Manila, Philippines
| | - Ozgur Mete
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Endocrine Pathology Society, Toronto, ON, Canada
| | - Mitsuhide Naruse
- Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frédéric Sebag
- Department of Endocrine Surgery, Aix-Marseille University, Conception University Hospital, Marseille, France
| | - Akiyo Tanabe
- Division of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jiri Widimsky
- Third Department of Medicine, Department of Endocrinology and Metabolism of the First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Leah Meuter
- Department of Physician Assistant Studies, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jacques W M Lenders
- Department of Medicine ΙΙI, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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7
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Sandow L, Thawani R, Kim MS, Heinrich MC. Paraganglioma of the Head and Neck: A Review. Endocr Pract 2023; 29:141-147. [PMID: 36252779 PMCID: PMC9979593 DOI: 10.1016/j.eprac.2022.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To review the epidemiology, presentation, diagnosis, and management of head and neck paragangliomas. METHODS A literature review of english language papers with focus on most current literature. RESULTS Paragangliomas (PGLs) are a group of neuroendocrine tumors that arise in the parasympathetic or sympathetic ganglia. Head and neck PGLs (HNPGLs) comprise 65% to 70% of all PGLs and account for 0.6% of all head and neck cancers. The majority of HNPGLs are benign, and 6% to 19% of all HNPGLs develop metastasis outside the tumor site and significantly compromise survival. PGLs can have a familial etiology with germline sequence variations in different susceptibility genes, with the gene encoding succinate dehydrogenase being the most common sequence variation, or they can arise from somatic sequence variations or fusion genes. Workup includes biochemical testing to rule out secretory components, although it is rare in HNPGLs. In addition, imaging modalities, such as computed tomography and magnetic resonance imaging, help in monitoring in surgical planning. Functional imaging with DOTATATE-positron emission tomography, 18F-fluorodeoxyglucose, or 18F-fluorohydroxyphenylalanine may be necessary to rule out sites of metastases. The management of HNPGLs is complex depending on pathology, location, and aggressiveness of the tumor. Treatment ranges from observation to resection to systemic treatment. Similarly, the prognosis ranges from a normal life expectancy to a 5-year survival of 11.8% in patients with distant metastasis. CONCLUSION Our review is a comprehensive summary of the incidence, mortality, pathogenesis, presentation, workup and management of HNPGLs.
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Affiliation(s)
- Lyndsey Sandow
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Rajat Thawani
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
| | - Myung Sun Kim
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Michael C Heinrich
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
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8
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Pokhrel D, Mallory R, Bush M, St Clair W, Bernard ME. Feasibility Study of Stereotactic Radiosurgery Treatment of Glomus Jugulare Tumors via HyperArc VMAT. Med Dosim 2022; 47:307-311. [PMID: 35717426 DOI: 10.1016/j.meddos.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/08/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
This study aims to report on the clinical validation and feasibility of utilizing a novel fully automated treatment planning and delivery system, HyperArc VMAT stereotactic radiosurgery (SRS) for glomus jugulare tumors (GJT). Independent dose verification of the HyperArc module via the MD Anderson's SRS head phantom irradiation and credentialing results showed compliance with the SRS treatment requirements per IROC MD Anderson's standard. Following the Alliance clinical trial, AAPM, RTOG protocols, and QUENTAC requirements, utilizing selected three-partial arc geometry of HyperArc module on TrueBeam Linac with 6MV-FFF beam, GJT SRS plans were generated for nine previously treated Gamma Knife (GK) radiosurgery patients using advanced Acuros-based algorithm to account for tissue inhomogeneity corrections and frameless immobilization with Q-fix mask and Encompass device insert. HyperArc VMAT produced highly conformal SRS dose distributions to GJT, a steep dose gradient around the GJT, and spared adjacent critical organs including the spinal cord (< 3.0 Gy). Due to faster patient setup and less MLC modulation through the target (average beam-on time, 6.2 minutes), the HyperArc VMAT plan can deliver a single high-dose of 18 Gy to the GJT in less than 15 minutes overall treatment time, significantly improving patient comfort and clinic workflow. Pretreatment portal dosimetry quality assurance results and independent dose verification via Monte Carlo-based physics second check met our clinical SRS protocol's requirements for treatment. Due to the highly conformal dose distribution, rapid dose fall-off, excellent sparing of adjacent critical organs, and highly precise and accurate treatment, clinical implementation of frameless HyperArc VMAT for GJT patients who may not have access to nor tolerate frame-based GK SRS treatment are underway.
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Affiliation(s)
- Damodar Pokhrel
- Department of Radiation Medicine, University of Kentucky, Lexington KY, 40536, USA.
| | - Richard Mallory
- Department of Radiation Medicine, University of Kentucky, Lexington KY, 40536, USA
| | - Matthew Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington KY, 40536, USA
| | - William St Clair
- Department of Radiation Medicine, University of Kentucky, Lexington KY, 40536, USA
| | - Mark E Bernard
- Department of Radiation Medicine, University of Kentucky, Lexington KY, 40536, USA
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Graham NJ, Smith JD, Else T, Basura GJ. Paragangliomas of the head and neck: a contemporary review. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:R153-R162. [PMID: 37435464 PMCID: PMC10259325 DOI: 10.1530/eo-22-0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 07/13/2023]
Abstract
Head and neck paragangliomas (HNPGLs) are slow-growing, vascular, typically benign tumors whose growth may induce significant lower cranial nerve deficits. While most tumors arise sporadically, a significant portion is associated with defined genetic syndromes. While surgical resection has historically been the gold standard, management strategies have evolved with acknowledgement of high surgical morbidity, slow tumor growth rates, and technological advances. Conservative management approaches via observation and newer radiation therapy techniques have become more common. This review seeks to provide an update on contemporary management strategies for HNPGLs and future directions.
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Affiliation(s)
- Nathan J Graham
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gregory J Basura
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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10
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Yadav MP, Ballal S, Sahoo RK, Bal C. Efficacy and safety of 225Ac-DOTATATE targeted alpha therapy in metastatic paragangliomas: a pilot study. Eur J Nucl Med Mol Imaging 2021; 49:1595-1606. [PMID: 34837103 PMCID: PMC8626283 DOI: 10.1007/s00259-021-05632-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE In this study, we aim to evaluate the efficacy and safety of 225AC-DOTATATE targeted alpha therapy in advanced-stage paragangliomas (PGLs). METHODS Nine (6 males and 3 females) consecutive patients with histologically proven PGLs were treated with 225Ac-DOTATATE targeted alpha therapy (TAT) and concomitant radiosensitizer, capecitabine, at 8-weekly intervals up to a cumulative activity of ~ 74 MBq. The primary endpoint included evaluating therapy response and disease control rate (DCR) using the RECIST 1.1 criteria. Additional secondary endpoints comprised clinical response assessment using EORTC QLQ-H&N35 questionnaire, Karnofsky Performance Scale (KPS), Eastern Cooperative Oncology Group performance status (ECOG), analgesic score (AS), dose alterations of anti-hypertensive drugs (anti-HTN), and the safety and side-effect profile evaluation as per CTCAE criteria version 5.0. RESULTS Following 225Ac-DOTATATE treatment, morphological response revealed partial response in 50%, stable disease in 37.5%, and disease progression in 12.5%, with a DCR of 87.5%. Similarly, the symptomatic response was remarkable, and anti-HTN drugs were stopped in 25% and reduced in 37.5%. Another significant finding in our study revealed a morphologic DCR of 66.6% (2/3) in patients who failed previous lutetium-177 peptide receptor radionuclide therapy (177Lu-PRRT). Regarding the KPS, ECOG, and AS performance scores, a notable improvement was observed post-225Ac-DOTATATE treatment. The QLQ-H&N35 symptom scores evaluated in seven H&N PGL patients showed significant improvement in all aspects. No improvement in sexual function was noted (P = 0.3559). Despite the significant reduction in the analgesic score post-treatment (P = 0.0031), the QLQ-H&N35 revealed only marginal significance concerning the intake of pain killers (P = 0.1723). No grade III/IV hematological, renal, and hepatological toxicities were noted. CONCLUSION The evidence from this study suggests 225Ac-DOTATATE therapy is effective and safe in the treatment of advanced-stage PGLs and also reports a clear benefit even in patient's refractory to the previous 177Lu-PRRT.
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Affiliation(s)
- Madhav Prasad Yadav
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, BR Ambedkar Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Hong S, Kagawa K, Sato K, Ichi S. The Long-Term Outcome of CyberKnife-Based Stereotactic Radiotherapy for Head and Neck Paragangliomas: A Single-Center Experience. World Neurosurg 2021; 155:e382-e390. [PMID: 34425292 DOI: 10.1016/j.wneu.2021.08.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess long-term outcomes of hypofractionated stereotactic radiotherapy (hSRT) for head and neck paragangliomas (HNPGs). METHODS Patients who underwent hSRT with CyberKnife for HNPGs from 2010 to 2019 were retrospectively reviewed. RESULTS A total of 34 HNPGs in 29 patients were identified. Mean patient age was 50 ± 16 years, and 15 patients (52%) were female. Fifteen patients (55%) had undergone previous procedures. Four cases (14%) were functional in hormone production. According to the Fisch classification, 1 (3%) case was B, 12 (42%) cases were C, 14 (48%) cases were D, and 2 (7%) cases were unclassified.1 The median prescribed dose covering 95% of the planning target volume was 2500 cGy (interquartile range 2100-2600 cGy), and the median target volume was 10 cm3 (interquartile range 6.0-18.3 cm3). The local control rate was 97%. The median progression-free survival was 66 months (interquartile range 28-95 months), and 96% of patients were free of tumor progression at 8 years. During follow-up, 1 case (3%) resulted in permanent facial nerve palsy (House-Brackmann grade II), and another case (3%) resulted in asymptomatic cerebellar radiation necrosis. Univariate and multivariate analysis showed that no previous surgical history (odds ratio 8.58, 95% confidence interval 1.2-59.7, P = 0.03) was a positive predictor of symptomatic improvement. CONCLUSIONS hSRT for HNPGs was an effective treatment with minimal side effects over the long term and may have a role as first-line therapy, especially for symptomatic nonfunctional HNPGs, for better symptom control.
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Affiliation(s)
- Sukwoo Hong
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.
| | - Kenji Kagawa
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kengo Sato
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
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12
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Patel AK, Rodríguez-López JL, Hirsch BE, Burton SA, Flickinger JC, Clump DA. Long term outcomes with linear accelerator stereotactic radiosurgery for treatment of jugulotympanic paragangliomas. Head Neck 2020; 43:449-455. [PMID: 33047436 DOI: 10.1002/hed.26497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/29/2020] [Accepted: 09/22/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Data supporting linear accelerator (linac) stereotactic radiosurgery (SRS) for jugulotympanic paragangliomas (JTPs) come from small series with minimal follow-up. Herein, we report a large series of JTPs with extended follow-up after frameless linac-based SRS. METHODS JTPs treated with linac-based SRS from 2002 to 2019 with 1+ follow-up image were reviewed for treatment failure (radiographic or clinical progression, or persistent symptoms after SRS requiring intervention) and late toxicities (CTCAE v5.0). RESULTS Forty JTPs were identified; 30 were treated with a multifraction regimen. Median clinical and radiographic follow-up was 79.7 (interquartile range [IQR] 31.7-156.9) and 54.4 months (IQR 17.9-105.1), respectively, with a median 4.5 follow-up scans (IQR 2-9). Seven-year progression-free survival (PFS) was 97.0% (95% confidence interval 91.1%-100.0%). PFS was similar between single- and multifraction regimens (log rank P = .99). Toxicity was seen in 7.7% (no grade III). CONCLUSIONS With extended clinical and radiographic follow-up, frameless linac-based SRS provides excellent local control with mild toxicity <8%.
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Affiliation(s)
- Ankur K Patel
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joshua L Rodríguez-López
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Barry E Hirsch
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Steven A Burton
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John C Flickinger
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David A Clump
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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13
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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Schichor C, Lehrke R, Fichte S, Senger C, Bleif M, Rueß D, Ruge M, Tonn JC, Muacevic A, Hempel JM. Image-guided robotic radiosurgery for glomus jugulare tumors-Multicenter experience and review of the literature. Head Neck 2020; 43:35-47. [PMID: 32851752 DOI: 10.1002/hed.26439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Glomus jugulare tumors (GJTs) are challenging to treat due to their vascularization and location. This analysis evaluates the effectiveness and safety of image-guided robotic radiosurgery (RRS) for GJTs in a multicenter study and reviews the existing radiosurgical literature. METHODS We analyzed outcome data from 101 patients to evaluate local control (LC), changes in pretreatment deficits, and toxicity. Moreover, radiosurgical studies for GJTs have been reviewed. RESULTS After a median follow-up of 35 months, the overall LC was 99%. Eighty-eight patients were treated with a single dose, 13 received up to 5 fractions. The median tumor volume was 5.6 cc; the median treatment dose for single-session treatments is 16 Gy, and for multisession treatments is 21 Gy. Fifty-six percentage of patients experienced symptom improvement or recovered entirely. CONCLUSIONS RRS is an effective primary and secondary treatment option for GJTs. The available literature suggests that radiosurgery is a treatment option for most GJTs.
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Affiliation(s)
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Christian Schichor
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
| | | | | | - Carolin Senger
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Bleif
- Radiochirurgicum/CyberKnife Südwest, Göppingen, Germany
| | - Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
| | | | - John-Martin Hempel
- Department of Otorhinolaryngology and Head and Neck Surgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
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14
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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Schichor C, Tonn JC, Muacevic A, Hempel JM. Single-session image-guided robotic radiosurgery and quality of life for glomus jugulare tumors. Head Neck 2020; 42:2421-2430. [PMID: 32394483 DOI: 10.1002/hed.26231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Limited data are available on the efficacy and impact on the quality of life (Qol) of single-session image-guided robotic radiosurgery (RRS) for glomus jugulare tumors (GJTs). This study investigates the role of RRS in the management of GJTs and reviews the RRS literature. METHODS We analyzed 53 GJT patients treated with RRS to evaluate the safety, local control, clinical outcome, and Qol assessed by the SF12v2. RESULTS The local control was 98% at a median follow-up of 38 months. The median tumor volume was 4.3 cc and tumors were treated with a median dose of 16.5 Gy. At the last follow-up, 35 patients had recovered from their symptoms or experienced symptom improvement. Qol analyses showed no significant decline while bodily pain significantly decreased. CONCLUSIONS RRS is a safe and efficient tool for the treatment of GJTs. Qol of patients after treatment is stable and tends to improve over time.
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Affiliation(s)
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Christian Schichor
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - John-Martin Hempel
- Department of Otorhinolaryngology and Head and Neck Surgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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15
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Fatima N, Pollom E, Soltys S, Chang SD, Meola A. Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:741-752. [PMID: 32318920 DOI: 10.1007/s10143-020-01292-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Head and neck paragangliomas (HNPs) are rare, usually benign hyper vascularized neuroendocrine tumors that traditionally have been treated by surgery, with or without endovascular embolization, or, more recently stereotactic radiosurgery (SRS). The aim of our study is to determine the clinical and radiographic effectiveness of SRS for treatment of HNPs. A systematic search of electronic databases was performed, and 37 articles reporting 11,174 patients (1144 tumors) with glomus jugulare (GJT: 993, 86.9%), glomus tympanicum (GTT: 94, 8.2%), carotid body tumors (CBTs: 28, 2.4%), and glomus vagale (GVT: 16, 1.4%) treated with SRS definitively or adjuvantly were included. The local control (LC) was estimated from the pooled analysis of the series, and its association with SRS technique as well as demographic and clinical factors was analyzed. The median age was 56 years (44-69 years). With a median clinical and radiological follow-up of 44 months (9-161 months), LC was 94.2%. Majority of the patients (61.0%) underwent Gamma Knife Radiosurgery (GKS), but there was no statistically significant difference in LC depending upon the SRS technique (p = 0.9). Spearmen's correlation showed that LC was strongly and negatively correlated with multiple parameters, which included female gender (r = - 0.4, p = 0.001), right-sided tumor (r = - 0.3, p = 0.03), primary SRS (r = - 0.5, p ≤ 0.001), and initial clinical presentation of hearing loss (r = - 0.4, p = 0.001). To achieve a LC ≥ 90%, a median marginal dose (Gy) of 15 (range, 12-30 Gy) was required. The results corroborate that SRS in HNPs is associated with good clinical and radiological outcome.
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Affiliation(s)
- Nida Fatima
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA.
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
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16
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Safety and Efficacy of Primary Multisession Dose Fractionated Gamma Knife Radiosurgery for Jugular Paragangliomas. World Neurosurg 2019; 131:e136-e148. [DOI: 10.1016/j.wneu.2019.07.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
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Lassen‐Ramshad Y, Ozyar E, Alanyali S, Poortmans P, Van Houtte P, Sohawon S, Esassolak M, Krengli M, Villa S, Miller RC, Demiroz C, Akyurek S, Aggerholm‐Pedersen N, Thariat J. Reply to “Proper tumor classification and growth rate are key elements when considering indications and results of radiotherapy for head and neck paragangliomas”. Head Neck 2019; 41:2837-2838. [DOI: 10.1002/hed.25800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yasmin Lassen‐Ramshad
- Danish Centre for Particle TherapyAarhus University Hospital Aarhus Denmark
- Department of OncologyAarhus University Hospital Aarhus Denmark
| | - Enis Ozyar
- Acibadem M.A. Aydinlar UniversitySchool of Medicine, Department of Radiation Oncology Turkey
| | - Senem Alanyali
- Department of Radiation OncologyFaculty of Medicine, Ege University Turkey
| | | | - Paul Van Houtte
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Schoeb Sohawon
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Mustafa Esassolak
- Department of Radiation OncologyFaculty of Medicine, Ege University Turkey
| | - Marco Krengli
- Department of RadiotherapyUniversity of Piemonte Orientale Novara Italy
| | - Salvador Villa
- Department of Radiation OncologyCatalan Institute of Oncology Badalona Spain
| | - Robert C. Miller
- Department of Radiation OncologyMayo Clinic Jacksonville Florida
| | - Candan Demiroz
- Uludag University Faculty of MedicineRadiation Oncology Clinical Division Turkey
| | - Serap Akyurek
- Department of RadiotherapyAnkara University School of Medicine Ankara Turkey
| | | | - Juliette Thariat
- Radiation Oncology DepartmentCentre Francois Baclesse Caen France
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Gleeson M. Technical Challenges in Temporal Bone Paraganglioma Surgery: a Clinical Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Lassen‐Ramshad Y, Ozyar E, Alanyali S, Poortmans P, Houtte P, Sohawon S, Esassolak M, Krengli M, Villa S, Miller R, Demiroz C, Akyurek S, Aggerholm‐Pedersen N, Thariat J. Paraganglioma of the head and neck region, treated with radiation therapy, a Rare Cancer Network study. Head Neck 2019; 41:1770-1776. [DOI: 10.1002/hed.25611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/29/2018] [Accepted: 12/10/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
- Yasmin Lassen‐Ramshad
- Danish Centre for Particle TherapyAarhus University Hospital Aarhus Denmark
- Department of OncologyAarhus University Hospital Aarhus Denmark
| | - Enis Ozyar
- Acibadem M.A. Aydinlar University, School of MedicineDepartment of Radiation Oncology Turkey
| | - Senem Alanyali
- Department of Radiation OncologyEge University Faculty of Medicine Turkey
| | | | - Paul Houtte
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Schoeb Sohawon
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Mustafa Esassolak
- Department of Radiation OncologyEge University Faculty of Medicine Turkey
| | - Marco Krengli
- Department of RadiotherapyUniversity of Piemonte Orientale Novara Italy
| | - Salvador Villa
- Department of Radiation OncologyCatalan Institute of Oncoloy Badalona Spain
| | - Robert Miller
- Department of Radiation Oncology, Mayo Clinic Jacksonville FL USA
| | - Candan Demiroz
- Uludag University Faculty of MedicineRadiation Oncology Clinical Division Turkey
| | - Serap Akyurek
- Department of RadiotherapyAnkara University School of Medicine Turkey
| | | | - Juliette Thariat
- Radiation Oncology DepartmentCentre Francois Baclesse Caen France
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21
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Sager O, Beyzadeoglu M, Dincoglan F, Gamsiz H, Demiral S, Uysal B, Oysul K, Dirican B, Sirin S. Evaluation of Linear Accelerator-based Stereotactic Radiosurgery in the Management of Glomus Jugulare Tumors. TUMORI JOURNAL 2018; 100:184-8. [DOI: 10.1177/030089161410000211] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Although mostly benign and slow-growing, glomus jugulare tumors have a high propensity for local invasion of adjacent vascular structures, lower cranial nerves and the inner ear, which may result in substantial morbidity and even mortality. Treatment strategies for glomus jugulare tumors include surgery, preoperative embolization followed by surgical resection, conventionally fractionated external beam radiotherapy, radiosurgery in the form of stereotactic radiosurgery or fractionated stereotactic radiation therapy, and combinations of these modalities. In the present study, we evaluate the use of linear accelerator (LINAC)-based stereotactic radiosurgery in the management of glomus jugulare tumors and report our 15-year single center experience. Methods and Study Design Between May 1998 and May 2013, 21 patients (15 females, 6 males) with glomus jugulare tumors were treated using LINAC-based stereotactic radiosurgery at the Department of Radiation Oncology, Gulhane Military Medical Academy. The indication for stereotactic radiosurgery was the presence of residual or recurrent tumor after surgery for 5 patients, whereas 16 patients having growing tumors with symptoms received stereotactic radiosurgery as the primary treatment. Results Median follow-up was 49 months (range, 3–98). Median age was 55 years (range, 24–77). Of the 21 lesions treated, 13 (61.9%) were left-sided and 8 (38.1%) were right-sided. Median dose was 15 Gy (range, 10–20) prescribed to the 85%-100% isodose line encompassing the target volume. Local control defined as either tumor shrinkage or the absence of tumor growth on periodical follow-up neuroimaging was 100%. Conclusions LINAC-based stereotactic radiosurgery offers a safe and efficacious management strategy for glomus jugulare tumors by providing excellent tumor growth control with few complications.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kaan Oysul
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Sait Sirin
- Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey
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Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery. Otol Neurotol 2017; 37:1406-10. [PMID: 27466892 DOI: 10.1097/mao.0000000000001160] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives were to evaluate the audiological outcomes, response of symptoms, and response of tumor volume in patients with glomus jugulare tumors treated solely with single fraction gamma knife radiosurgery. STUDY DESIGN Single institution retrospective review. SETTING Academic, tertiary referral center. PATIENTS The diagnosis code for glomus jugulare was used to identify patients. Only those who underwent gamma knife radiosurgery were included. Those previously treated with any modality were excluded. A total of 12 patients were included for the tumor response and symptom response data and 7 of those were included in the audiometric analysis. MAIN OUTCOMES MEASURES Audiometric data at most recent follow-up compared with presentation, subjective improvement in pulsatile tinnitus, and change in tumor volume at most recent follow-up compared with pretreatment. RESULTS The average time to most recent follow-up was 27.6 months. There was no significant change in pure-tone average or word recognition. Pulsatile tinnitus completely resolved or improved in 80% of patients. Cranial neuropathies were stable or improved. A single patient experienced facial nerve paresis 2 years after treatment, which resolved with steroid treatment. Tumor control was 100% and the average change in tumor volume was a decrease of 37%. CONCLUSION Single modality gamma knife radiosurgery treatment of glomus jugulare tumors seems to be safe. Treatment results in decreased tumor volume and improved pulsatile tinnitus in most patients. There was no significant progression of hearing loss after treatment. Lower cranial nerve function remains stable in all patients.
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Abstract
Background Commonly occurring in the head and neck, paragangliomas are typically benign, highly vascular neoplasms embryologically originating from the extra-adrenal paraganglia of the neural crest. Frequently, these tumors are associated with the vagus, tympanic plexus nerve, the carotid artery, or jugular bulb. Their clinical presentation can vary across a wide spectrum of signs and symptoms. Methods We reviewed and compared standard treatment approaches for paragangliomas of the head and neck. Results In general, surgery is the first-line choice of therapy for carotid body tumors, whereas radiotherapy is the first-line option for jugular and vagal paragangliomas. Conclusions Because of the complexity of clinical scenarios and treatment options for paragangliomas, a multidisciplinary algorithmic approach should be used for treating paragangliomas. The approach should emphasize single-modality treatment that yields excellent rates of tumor control, low rates of severe, iatrogenic morbidity, and the preservation of long-term function in this patient population.
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Affiliation(s)
- Kenneth Hu
- Departments of Radiation Oncology (KH) and Otolaryngology-Head and Neck Surgery (MSP), New York University Langone Medical Center, New York, New York
| | - Mark S. Persky
- Departments of Radiation Oncology (KH) and Otolaryngology-Head and Neck Surgery (MSP), New York University Langone Medical Center, New York, New York
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Heesterman B, Verbist B, van der Mey A, Bayley J, Corssmit E, Hes F, Jansen J. Measurement of head and neck paragangliomas: is volumetric analysis worth the effort? A method comparison study. Clin Otolaryngol 2016; 41:571-8. [DOI: 10.1111/coa.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 01/26/2023]
Affiliation(s)
- B.L. Heesterman
- Department of Otolaryngology; Leiden University Medical Center; Leiden the Netherlands
| | - B.M. Verbist
- Department of Radiology; Leiden University Medical Center; Leiden the Netherlands
| | - A.G.L. van der Mey
- Department of Otolaryngology; Leiden University Medical Center; Leiden the Netherlands
| | - J.P. Bayley
- Department of Human Genetics; Leiden University Medical Center; Leiden the Netherlands
| | - E.P.M. Corssmit
- Department of Endocrinology; Leiden University Medical Center; Leiden the Netherlands
| | - F.J. Hes
- Department of Clinical Genetics; Leiden University Medical Center; Leiden the Netherlands
| | - J.C. Jansen
- Department of Otolaryngology; Leiden University Medical Center; Leiden the Netherlands
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Ertz-Archambault NM, Van Gompel JJ, Neff BA, Kasperbauer JL, Shamoun FE. What happens in vagus: a case of recurrent paraganglioma with malignant transformation and an updated treatment algorithm†. J Surg Case Rep 2016; 2016:rjw012. [PMID: 26858176 PMCID: PMC4744899 DOI: 10.1093/jscr/rjw012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paragangliomas (PGLs) are rare, extra-adrenal tumors, originating from neural crest cells and can occur anywhere from the skull base to the pelvic floor. Although these tumors are often benign, a fraction of malignant cases exist. Few isolated cases of malignant head and neck PGL are reported in the literature. Treatment algorithms rely heavily on retrospective case studies and institutional experience. We report an unusual case of an extensive, hereditary PGL, with invasive characteristics, that was refractory to radiation therapy. An operative approach was selected for recurrent disease in the setting of critical neurovascular structure compromise. Six months postoperatively, the patient was recovering as expected and had no evidence of recurrent disease. We propose a modified treatment algorithm based on an updated literature review that encompasses the spectrum of PGL, from benign and asymptomatic to invasive and malignant disease.
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Affiliation(s)
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian A Neff
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA Department of Anatomy, Mayo Clinic, Rochester, MN, USA
| | - Fadi E Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
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Sager O, Dincoglan F, Beyzadeoglu M. Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives. CNS Oncol 2015; 4:105-14. [PMID: 25768334 DOI: 10.2217/cns.14.56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Military Medical Academy, Gn. Tevfik Saglam Cad. 06018, Etlik, Kecioren, Ankara, Turkey
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Prasad SC, Mimoune HA, Khardaly M, Piazza P, Russo A, Sanna M. Strategies and long-term outcomes in the surgical management of tympanojugular paragangliomas. Head Neck 2015; 38:871-85. [PMID: 26343411 DOI: 10.1002/hed.24177] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to share our review of surgical strategies and long-term outcomes in the management of tympanojugular paragangliomas. METHODS This was a retrospective study with a literature review. The records of 184 patients with 185 tympanojugular paragangliomas were analyzed for tumor class, surgical procedure, preoperative vascular management, and perioperative sequelae. RESULTS Of class C1, C2, C3, and C4 tumors, we found 46 (24.9%), 95 (51.3%), 41 (22.2%), and 3 (1.6%), respectively. One hundred four (56.2%) tumors had intracranial extensions and 8 (4.3%) involved the vertebral artery. A single-stage procedure was adopted in 158 (85.4%) tumors. The infratemporal fossa type A approach was used in all cases. In 17 patients (9.7%), an intra-arterial stenting of the internal carotid artery was performed. Gross-total tumor removal was achieved in 166 cases (89.7%) and 4 (2.4%) among them developed a recurrence. CONCLUSION A thorough understanding of skull base techniques and a logical decision-making process in the management of tympanojugular paragangliomas can achieve a high rate of success in terms of recurrences and complications. © 2015 Wiley Periodicals, Inc. Head Neck 38: 871-885, 2016.
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Affiliation(s)
| | - Hassen Ait Mimoune
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mohsen Khardaly
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.,King Fahad Central Hospital, Jizan, Kingdom of Saudi Arabia
| | - Paolo Piazza
- Department of Radiology, University of Parma, Parma, Italy
| | - Alessandra Russo
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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Szymańska A, Szymański M, Czekajska-Chehab E, Gołąbek W, Szczerbo-Trojanowska M. Diagnosis and management of multiple paragangliomas of the head and neck. Eur Arch Otorhinolaryngol 2015; 272:1991-9. [PMID: 24920325 PMCID: PMC4472946 DOI: 10.1007/s00405-014-3126-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/22/2014] [Indexed: 11/29/2022]
Abstract
Paragangliomas (PGs) are slowly growing, usually benign neoplasms. The aim of the study was to analyze the incidence, diagnostic and therapeutic management of patients with multiple paragangliomas of the head and neck. A retrospective review of the records of 84 patients with head and neck PGs, diagnosed and treated in our institution was performed for the years 1983-2013 to identify patients with multiple tumors. Fourteen (16.6 %) patients developed multiple PGs, synchronous or metachronous, within 4-21 years of follow-up. Clinical data of these patients were reviewed to evaluate the diagnosis, location, stage and management strategy. There was a total number of 37 tumors in 14 patients. There were 20/37 (54.0 %) carotid PGs, 9/37 (24.3 %) jugular PGs and 8/37 (21.7 %) vagal PGs. Carotid PGs were observed in 12/14 (86 %) patients and in 8/14 (57 %) cases bilateral tumors occurred. Vagal PGs developed in 7/14 (50 %) patients and bilateral tumors were found in 1/14 (7 %) case. Jugular PGs occurred in 9/14 (64 %) patients. There were 30 synchronous tumors and seven metachronous PGs diagnosed 2-18 years after removal of the first tumor. Single metachronous mediastinal PG occurred. All patients had at least one tumor removed, with histopathological confirmation of the diagnosis. One patient had positive history of familial PGs. Carotid PGs are most common multiple paragangliomas. Radiological survey of the head and neck is required to detect multicentric tumors. Metachronous mediastinal and abdominal tumors may occur. Regular, prolonged follow-up is essential to identify metachronous PGs and possible postoperative gradual ICA occlusion.
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Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8, 20-154 Lublin, Poland
| | - Marcin Szymański
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Lublin, Jaczewskiego 8, 20-154 Lublin, Poland
| | - Elżbieta Czekajska-Chehab
- Department of General Radiology, Medical University of Lublin, Jaczewskiego 8, 20-154 Lublin, Poland
| | - Wiesław Gołąbek
- Professor Emeritus, Department of Otolaryngology, Head and Neck Surgery, Medical University of Lublin, Jaczewskiego 8, 20-154 Lublin, Poland
| | - Małgorzata Szczerbo-Trojanowska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8, 20-154 Lublin, Poland
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Taïeb D, Kaliski A, Boedeker CC, Martucci V, Fojo T, Adler JR, Pacak K. Current approaches and recent developments in the management of head and neck paragangliomas. Endocr Rev 2014; 35:795-819. [PMID: 25033281 PMCID: PMC4167435 DOI: 10.1210/er.2014-1026] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors belonging to the family of pheochromocytoma/paraganglioma neoplasms. Despite advances in understanding the pathogenesis of these tumors, the growth potential and clinical outcome of individual cases remains largely unpredictable. Over several decades, surgical resection has long been the treatment of choice for HNPGLs. However, increasing experience in various forms of radiosurgery has been reported to result in curative-like outcomes, even for tumors localized in the most inaccessible anatomical areas. The emergence of such new therapies challenges the traditional paradigm for the management of HNPGLs. This review will assist and guide physicians who encounter patients with such tumors, either from a diagnostic or therapeutic standpoint. This review will also particularly emphasize current and emerging knowledge in genetics, imaging, and therapeutic options as well as the health-related quality of life for patients with HNPGLs.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine (D.T.), La Timone University Hospital, CERIMED, Aix-Marseille Univ, F-13385 Marseille, France; Department of Radiation Oncology (A.K.), Besançon University Hospital, F-25030 Besançon, France; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), HELIOS Hanseklinikum Stralsund, D-18435 Stralsund, Germany; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), University Hospital, Freiburg, Germany; Program in Reproductive and Adult Endocrinology (V.M., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development and Medical Oncology Branch (T.F.), National Institutes of Health, Bethesda, Maryland 20892; Department of Neurosurgery (J.R.A.), Stanford Hospital and Clinics, Stanford University, Stanford, California 94305
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Radiotherapy for glomus jugulare paraganglioma. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:223-6. [DOI: 10.1016/j.anorl.2014.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/30/2014] [Indexed: 11/15/2022]
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31
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Hayashi T, Mete O. Head and neck paragangliomas: what does the pathologist need to know? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Gilbo P, Morris CG, Amdur RJ, Werning JW, Dziegielewski PT, Kirwan J, Mendenhall WM. Radiotherapy for benign head and neck paragangliomas: a 45-year experience. Cancer 2014; 120:3738-43. [PMID: 25060724 DOI: 10.1002/cncr.28923] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Paragangliomas of the head and neck are rare, slow-growing, generally benign tumors of neuroendocrine cells associated with the peripheral nervous system that commonly involve the carotid body, jugular bulb, vagal ganglia, and temporal bone. Treatment options include surgery, radiotherapy (RT), stereotactic radiosurgery (SRS), and observation. This article briefly reviews our 45-year institutional experience treating this neoplasm with RT. METHODS From January 1968 through March 2011, 131 patients with 156 benign paragangliomas of the temporal bone, carotid body, jugular bulb, or glomus vagale were treated with RT at a median dose of 45 Gy in 25 fractions. The mean and median follow-up times were 11.5 years and 8.7 years, respectively. RESULTS Five tumors (3.2%) recurred locally after RT, all within 10 years of treatment. The overall local control rates at 5 and 10 years were 99% and 96%, respectively. The cause-specific survival rates at 5 and 10 years were 98% and 97%, respectively. The distant-metastasis free survival rates at 5 and 10 years were 99% and 99%, respectively. The overall survival rates at 5 and 10 years were 91% and 72%, respectively. There were no severe complications. CONCLUSION RT for benign head and neck paragangliomas is a safe and efficacious treatment associated with minimal morbidity. Surgery is reserved for patients in good health whose risk of associated morbidity is low. SRS may be suitable for patients with skull base tumors <3 cm where RT is logistically unsuitable. Observation is a reasonable option for asymptomatic patients with a limited life expectancy.
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Affiliation(s)
- Philip Gilbo
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
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Kiziltan HS, Ozucer B, Eris AH, Veyseller B. Bilateral carotid paraganglioma: surgery and radiotherapy. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:53-7. [PMID: 25057243 PMCID: PMC4085101 DOI: 10.4137/ccrep.s14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paragangliomas are relatively rare vascular tumors that develop from the neural crest cells of carotid bifurcation. They usually present as slow-growing, painless unilateral neck masses; bilateral presentation is rare and is mostly associated with familial forms. Bilateral total resection is not always possible for high-grade bilateral tumors, and radiotherapy is a good alternative, with cure rates similar to surgery. CASE REPORT A 35-year-old female patient was admitted with a chief complaint of a bilateral, painless mass located on her neck. Subsequent magnetic resonance imaging (MRI) and angiographic imaging revealed bilateral hypervascular masses surrounding her carotid at 360°, and they were interpreted as stage 3 carotid paragangliomas according to the Shamblin classification protocol. Surgery was carried out on the left carotid paraganglioma and the mass was totally resected. It was thought that the patient could not tolerate bilateral surgery. Primary radiotherapy was planned on the right carotid paraganglioma: 59.8 gray (Gy) conformal, Linac-based multileaf collimator radiotherapy with a 180 cGy daily dosage, and five fractions per week were planned. RESULTS Follow-up at 3 months following the conclusion of radiotherapy revealed no significant regression. A follow-up MRI 6 months and 24 months later revealed 59% regression. Grade 2 esophagitis and minimal neck edema were the only complications noted during the course of radiotherapy and during the 24-month follow-up period. No complications or relapse were observed except for edema following neck surgery.
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Affiliation(s)
- Huriye S Kiziltan
- Department of Radiation Oncology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Berke Ozucer
- Department of Otorhinolaryngology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Ali H Eris
- Department of Radiation Oncology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Bayram Veyseller
- Department of Otorhinolaryngology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
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Affiliation(s)
- Jay Shah
- College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Arpita Vyas
- Assistant Professor, Department of Pediatrics, Adjunct Professor, Institute of International Health, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Dinesh Vyas
- Assistant Professor, Department of Surgery, Advanced Robotic and GI Surgeon, Adjunct Professor, Institute of International Health, Director, MS Surgery Clerkship, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912,
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Subedi N, Prestwich R, Chowdhury F, Patel C, Scarsbrook A. Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management. Cancer Imaging 2013; 13:407-22. [PMID: 24240099 PMCID: PMC3830426 DOI: 10.1102/1470-7330.2013.0034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Neuroendocrine tumours (NETs) of the head and neck are rare neoplasms and can be of epithelial or non-epithelial differentiation. Although the natural history of NETs is variable, it is crucial to establish an early diagnosis of these tumours as they can be potentially curable. Conventional anatomical imaging and functional imaging using radionuclide scintigraphy and positron emission tomography/computed tomography can be complementary for the diagnosis, staging and monitoring of treatment response. This article describes and illustrates the imaging features of head and neck NETs, discusses the potential future role of novel positron-emitting tracers that are emerging into clinical practice and reviews contemporary management of these tumours. Familiarity with the choice of imaging techniques and the variety of imaging patterns and treatment options should help guide radiologists in the management of this rare but important subgroup of head and neck neoplasms.
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Affiliation(s)
- Navaraj Subedi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abstract
Paragangliomas (PGLs) are tumours originating from neural crest-derived cells situated in the region of the autonomic nervous system ganglia. Head-and-neck PGLs (HNPGLs) originate from the sympathetic and parasympathetic paraganglia, most frequently from the carotid bodies and jugular, tympanic and vagal paraganglia, and are usually non-catecholamine secreting. Familial PGLs are considered to be rare, but recently genetic syndromes including multiple PGLs and/or phaeochromocytomas have been more thoroughly characterised. Nowadays, genetic screening for the genes frequently implicated in both familial and sporadic cases is routinely being recommended. HNPGLs are mostly benign, generally slow-growing tumours. Continuous growth leads to the involvement of adjacent neurovascular structures with increased morbidity rates and treatment-related complications. Optimal management mostly depends on tumour location, local involvement of neurovascular structures, estimated malignancy risk, patient age and general health. Surgery is the only treatment option offering the chance of cure but with significant morbidity rates, so a more conservative approach is usually considered, especially in the more difficult cases. Radiotherapy (fractionated or stereotactic radiosurgery) leads to tumour growth arrest and symptomatic improvement in the short term in many cases, but the long-term consequences are unclear. Early detection is essential in order to increase the chance of cure with a lower morbidity rate. The constant improvement in diagnostic imaging, surgical and radiation techniques has led to a safer management of these tumours, but there are still many therapeutic challenges, and no treatment algorithm has been agreed upon until now. The management of HNPGLs requires a multidisciplinary effort addressing the genetic, surgical, radiotherapeutic, oncological, neurological and endocrinological implications. Further progress in the understanding of their pathogenesis will lead to more effective screening and earlier diagnosis, both critical to successful treatment.
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Affiliation(s)
- Cristina Capatina
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
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Ngwenya LB, Chiocca EA. Treatment for paragangliomas: passing the test of time. World Neurosurg 2012; 77:639-41. [PMID: 22818170 DOI: 10.1016/j.wneu.2011.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 05/02/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Laura B Ngwenya
- Department of Neurological Surgery, James Cancer Hospital, and the Ohio State University Medical Center, Columbus, Ohio, USA
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Misra BK. Management strategy in paragangliomas. World Neurosurg 2012; 77:642-3. [PMID: 22818171 DOI: 10.1016/j.wneu.2011.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 05/13/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Basant Kumar Misra
- Department of Neurosurgery and Gamma Knife Centre, P. D. Hinduja National Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, India
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