Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy

被引:141
作者
Suarez, Carlos [1 ,2 ]
Rodrigo, Juan P. [1 ,2 ]
Boedeker, Carsten C. [3 ]
Llorente, Jose L. [1 ,2 ]
Silver, Carl E. [4 ,5 ]
Jansen, Jeroen C. [6 ]
Takes, Robert P. [7 ]
Strojan, Primoz [8 ]
Pellitteri, Phillip K. [9 ]
Rinaldo, Alessandra [10 ]
Mendenhall, William M. [11 ]
Ferlito, Alfio [10 ]
机构
[1] Hosp Univ Cent Asturias, Dept Otolaryngol, Oviedo, Spain
[2] Inst Univ Oncol Principado Asturias, Oviedo, Spain
[3] Univ Freiburg, Dept Otorhinolaryngol Head & Neck Surg, D-79106 Freiburg, Germany
[4] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Surg, Bronx, NY 10467 USA
[5] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Otolaryngol Head & Neck Surg, Bronx, NY 10467 USA
[6] Univ Med Ctr, Dept Otolaryngol, Leiden, Netherlands
[7] Radboud Univ Nijmegen, Med Ctr, Dept Otolaryngol Head & Neck Surg, NL-6525 ED Nijmegen, Netherlands
[8] Inst Oncol, Dept Radiat Oncol, Ljubljana, Slovenia
[9] Geisinger Med Ctr, Dept Otolaryngol Head & Neck Surg, Danville, PA 17822 USA
[10] Univ Udine, ENT Clin, I-33100 Udine, Italy
[11] Univ Florida, Dept Radiat Oncol, Gainesville, FL USA
来源
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK | 2013年 / 35卷 / 08期
关键词
jugular paraganglioma; vagal paraganglioma; surgery; external beam radiotherapy; stereotactic radiosurgery; GAMMA-KNIFE RADIOSURGERY; GLOMUS-JUGULARE; TEMPORAL BONE; RADIATION-THERAPY; NECK PARAGANGLIOMAS; SURGICAL-MANAGEMENT; DEFINITIVE RADIOTHERAPY; GERMLINE MUTATIONS; TUMOR-CONTROL; ADVANCED AGE;
D O I
10.1002/hed.22976
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
BackgroundThe 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. MethodsRelevant 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. ResultsA 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%). ConclusionThere 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. (c) 2012 Wiley Periodicals, Inc. Head Neck, 2013
引用
收藏
页码:1195 / 1204
页数:10
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