Contemporary Radiotherapy for Fisch-Classified Jugulotympanic Paragangliomas - Does Tumor Category Matter? Outcomes From a 13-Year Experience

Abstract

<h3>Purpose/Objective(s)</h3> Jugulotympanic paragangliomas (JTPGs), recognized as slow-growing tumors, represent a treatment challenge because of their known vascular nature, tendency to be locally invasive, location near many vital structures, and their potential to cause very disabling symptoms. This study aimed to examine the outcomes of patients with Fisch-classified JTPGs treated with conventional radiotherapy including stereotactic radiosurgery. <h3>Materials/Methods</h3> Twenty-four consecutive patients with head and neck paragangliomas diagnosed between November 2003 and May 2017 were identified from the radiation oncology and radiosurgery databases and lists of patients presented for discussion at the weekly Department of Otolaryngology-Head and Neck Surgery multidisciplinary conference. After excluding individuals with carotid body glomus tumors or missing clinical and radiological follow-up information, 13 patients (with a mean age of 61.8 years; 6 glomus tympanicum and 7 glomus jugulare PGs; 10 women and 3 men;) composed the JTPG study participants. Non-invasive stereotactic radiosurgery or external beam radiotherapy was used to treat JTPGs in 11 patients and 2 patients, respectively. The investigation endpoints included subjective and objective responses to treatment (i.e., exhibited symptoms and signs of disease and the tumor) and observed toxicity. <h3>Results</h3> With regard to the risk designation of JTPGs, seven (54%) belonged to the Fisch A-B categories and six (46%) to C-D categories. During a median follow-up of 36 months (range 7-204) after-therapy, subjective responses consisted of eight patients (62%) who were symptom-free, and five individuals (38%) who did not improve. At a median radioimaging follow-up of 34 months (range 6-204), eight (62%) treated neoplasms were stable, two (15%) showed continued tumor growth, and three (23%) were smaller following radiation treatment. One participant (8%) experienced transient otalgia and tinnitus after external beam irradiation; no patient developed radiation oncogenesis. Long-term follow-up (from 75 to 204 months) was documented in six people (46%). Characterization and effects of treatment were not significantly different between the compared Fisch categorized groups of JTPGs. <h3>Conclusion</h3> The observed rates of tumor control (85%) and treatment-related toxicity (8%), and the long-term disease progression-free survival of some patients suggest that contemporary radiotherapy is efficacious and safe when applied for Fisch-classified JTPGs.