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Objectives Head & Neck Paragangliomas have been historically relying on surgery mostly, with worsened quality of life and major sequelae. Conventional external radiation therapy seems to offer an equivalent control rate with a low toxicity profile. The aim of this study was to assess the safety and efficiency of intensity‐modulated radiation therapy in Head & Neck paragangliomas. Methods This is a retrospective monocentric study conducted in a referral center, including all patients treated with IMRT, whether as an exclusive or post‐operative treatment for a tympanic and jugular, carotid, or vagal paraganglioma. Data collection was performed through the manuscript and computerized medical files, including consultation, operative, imaging, pathological analyses, delineation, and treatment planning reports. Success was defined as the complete or partial regression or stabilization without progression, or relapse in accordance with the RECIST criteria. Acute toxicities and long‐term sequelae were assessed. Results Our cohort included 39 patients included between 2011 and 2021: 18 patients treated for a TJ PG (45.9%), 11 patients for a carotid PG (28.4%), and 9 for a vagal PG (23.1%). Twenty‐nine patients had IMRT as an exclusive treatment (74.4%), whereas 10 patients had a post‐operative complementary treatment (25.6%). Median follow‐up in our cohort was 2318 days (average = 2200 days, 237–5690, sd = 1281.9). Among 39 patients, 37 were successfully controlled with IMRT (94.8%), and the toxicity profile was low without any major toxicity. Conclusion IMRT seems an ideal treatment, whether exclusive or post‐operative for Head & Neck paragangliomas. Level of Evidence 3 Laryngoscope, 133:607–614, 2023

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