Definitive radiotherapy in the management of paragangliomas arising in the head and neck: A 35‐year experience

Hinerman, Russell W.; Amdur, Robert J.; Morris, Christopher G.; Kirwan, Jessica; Mendenhall, William M.

doi:10.1002/hed.20885

Cited by 140 publications

(122 citation statements)

References 69 publications

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“…Mild complications (mucositis, nausea, xerostomia and otitis media/externa) occur occasionally, but are of limited significance (Cummings et al 1984, Verniers et al 1992, Hinerman et al 2008. The most important concerns, especially in young patients, are those regarding serious late effects.…”

Section: Radiotherapymentioning

confidence: 99%

“…Bone necrosis is also correlated with massive radiation doses or concurrent infection (Sharma et al 1984). Currently, the usual dose is 45 Gy (Hinerman et al 2008, Huy et al 2009, and larger doses are no longer used, except for the treatment of malignant tumours, where the response is very poor even then (Hinerman et al 2008, Moskovic et al 2010. The radiation-induced malignancy rate is difficult to assess, due to the variable follow-up durations and inconsistency of its ascertainment.…”

Section: Radiotherapymentioning

confidence: 99%

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The management of head-and-neck paragangliomas

Căpățînă

Ntali

Karavitaki

et al. 2013

Endocrine-Related Cancer

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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 longterm 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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Section: Radiotherapymentioning

confidence: 99%

Section: Radiotherapymentioning

confidence: 99%

The management of head-and-neck paragangliomas

Căpățînă

Ntali

Karavitaki

et al. 2013

Endocrine-Related Cancer

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“…HNPs are usually benign and grow slowly, causing symptoms by compressing adjacent structures. In contrast to paragangliomas at other sites, only 1%-3% of HNPs secrete catecholamines (4). More importantly, approximately 6%-19% of HNPs are malignant, as evidenced by the presence of regional or distant metastases (3).…”

mentioning

confidence: 99%

⁶⁸Ga-DOTANOC PET/CT for Baseline Evaluation of Patients with Head and Neck Paraganglioma

Sharma

Thakar

et al. 2013

J Nucl Med

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The purpose of this study was to evaluate the role of 68 Ga-labeled DOTANOC PET/CT for baseline evaluation of patients with head and neck paragangliomas (HNPs). Methods: The data for 26 patients (mean age 6 SD, 34.3 6 10.4 y; 50% men) with known or suspected HNPs who underwent 68 Ga-DOTANOC PET/CT for staging were retrospectively analyzed. PET/CT was performed after intravenous injection of 132-222 MBq of 68 Ga-DOTANOC. The images were evaluated by 2 experienced nuclear medicine physicians in consensus, both qualitatively and quantitatively. The PET/CT findings were grouped as HNPs, paraganglioma at other sites (non-HNPs), and metastatic disease. The size and maximum standardized uptake values (SUVmax) were measured for all lesions. All of the patients also underwent whole-body 131 I-metaiodobenzylgunanidine ( 131 I-MIBG) scintigraphy and conventional imaging (CT/MR imaging) of the head and neck region. Their results were compared with those of 68 Ga-DOTANOC PET/CT. Results: 68 Ga-DOTANOC PET/CT findings were positive in all 26 patients, and 78 lesions were detected. PET/CT imaging demonstrated 45 HNPS, 10 non-HNPs, and 23 metastatic sites. Fifteen patients (57.6%) had more than one site of disease on PET/ CT. Among 45 HNPs, 26 were carotid body tumors (CBTs), 15 glomus jugulare, 3 glomus tympanicum, and 1 laryngeal paraganglioma. A positive correlation was seen between size and SUVmax of HNPs (r 5 0.323; P 5 0.030). The SUVmax of the CBTs was higher than that of jugulotympanic paragangliomas (P 5 0.026). No correlation was seen between size and SUVmax (r 5 0.069; P 5 0.854) of non-HNPs. The size and SUVmax of non-HNPs were significantly less than those of HNPs (P 5 0.029 and 0.047, respectively). 131 I-MIBG scintigraphy showed only 30 of the 78 lesions and was inferior to PET/CT (P , 0.0001). Conventional imaging (CT/MR imaging) was positive for 42 of 49 head and neck lesions and was inferior to PET/CT on direct comparison (P 5 0.015). A combination of CT/MR imaging and 131 I-MIBG scintigraphy detected only 53 of 78 (67.9%) lesions and was also inferior to PET/CT (P , 0.0001). Conclusion: 68 Ga-DOTANOC PET/CT is useful for the baseline evaluation of patients with HNPs and can demonstrate synchronous paragangliomas at other sites and distant metastases. It is superior to 131 I-MIBG scintigraphy and conventional imaging (CT/MR imaging) for this purpose.

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“…Surgery remained the preferred management especially for localized and/or symptomatic tumors in otherwise healthy and fit patients. Less invasive approaches such as radiotherapy (RT) can be offered if surgical intervention deemed risky and has detrimental outcome [13,14]. This approach helps slow down the tumor growth and provides comfort care in symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Carotid Body Tumor With Malignant Behavior in a Patient in His Eighth Decade

2017

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Carotid body tumors (CBTs) are rare neoplasms with rare malignant potential. These tumors are usually parasympathetic ganglia-derived lesions which located in the neck at the bifurcation of the external and internal carotid arteries. In contrary to sympathetic-derived tumors, they are often non-secretory. However, about 5% of these tumors may still secrete some of the catecholamine-related compounds. Most of these lesions are diagnosed in the third to fifth decades of life, with more cases revealed during autopsy examinations. Although it is considered a disease of middle age, elderly people are not immune. We report a case of an elderly patient in his eighth decade, who presented with a mass-like lesion in the right side of his neck during routine medical examination. Imaging study showed an enhancing mass in the carotid artery bifurcation with pressure effect and lymphadenopathy. The patient underwent surgery and tumor was removed uneventfully. The pathology report later confirmed ovalshaped cells with positive neuroendocrine markers consistent with carotid body paraganglioma. We believe these tumors are overlooked and yet may be missed without proper medical examination. We report this case for two reasons, being a very rare tumor with malignant potential in an elderly patient and to raise the awareness among medical practitioners.

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Definitive radiotherapy in the management of paragangliomas arising in the head and neck: A 35‐year experience

Abstract: Fractionated RT offers a high probability of tumor control with minimal risks for patients with paragangliomas of the temporal bone and neck.

Cited by 140 publications

References 69 publications

The management of head-and-neck paragangliomas

The management of head-and-neck paragangliomas

⁶⁸Ga-DOTANOC PET/CT for Baseline Evaluation of Patients with Head and Neck Paraganglioma

Carotid Body Tumor With Malignant Behavior in a Patient in His Eighth Decade

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Definitive radiotherapy in the management of paragangliomas arising in the head and neck: A 35‐year experience

Abstract: Fractionated RT offers a high probability of tumor control with minimal risks for patients with paragangliomas of the temporal bone and neck.

Cited by 140 publications

References 69 publications

The management of head-and-neck paragangliomas

The management of head-and-neck paragangliomas

68Ga-DOTANOC PET/CT for Baseline Evaluation of Patients with Head and Neck Paraganglioma

Carotid Body Tumor With Malignant Behavior in a Patient in His Eighth Decade

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⁶⁸Ga-DOTANOC PET/CT for Baseline Evaluation of Patients with Head and Neck Paraganglioma