Leksell Gamma Knife radiosurgery of the jugulotympanic glomus tumor: long-term results

Abstract

ObjectGlomus tumors usually display indolent behavior, and the effectiveness of radiation in stopping their growth can be assessed after long-term follow-up. Currently only midterm results of radiosurgery are available, so the authors included patients treated by Gamma Knife at least 10 years ago in this study to obtain a perspective of long-term results.MethodsDuring the period from 1992 to 2003, the Gamma Knife was used to treat 46 patients with glomus tumors. The age of the patients ranged from 21 to 79 years (median 56 years). Gamma Knife radiosurgery was the primary treatment in 17 patients (37%). Open surgery preceded radiosurgery in 46% of cases, embolization in 17%, and fractionated radiotherapy in 4%. The volume of the tumor ranged from 0.2 to 24.3 cm3 (median 3.6 cm3). The minimal dose to the tumor margin ranged between 10 and 30 Gy (median 20 Gy).ResultsOne patient was lost for follow-up after radiosurgery. Clinical follow-up was available in 45 patients and 44 patients were followed with MRI in a follow-up period that ranged from 12 to 217 months (median 118 months). Neurological deficits improved in 19 (42%) of 45 patients and deteriorated in 2 patients (4%). Tumor size decreased in 34 (77%) of 44 patients with imaging follow-up, while an increase in volume was observed in 1 patient (2%) 182 months after radiosurgery and Gamma Knife treatment was repeated. One patient underwent another Gamma Knife treatment for secondary induced meningioma close to the glomus tumor 98 months after initial radiosurgical treatment. Seven patients died 22–96 months after radiosurgery (median 48 months), all for unrelated reasons.ConclusionsRadiosurgery has proved to be a safe treatment with a low morbidity rate and a reliable long-term antiproliferative effect.

Gamma Knife radiosurgery for glomus tumors: Long‐term results in a series of 30 patients

“…The overall reported tumor control rate ranges between 62.5% and 100% (Table 4). 35 In this series, we reported the second longest follow-up period, but with a higher mean tumor volume and a lower mean dose to the tumor. 9 However, data are not directly comparable because of different patients' selection criteria, radiosurgical treatment data, and different follow-up methods.…”

“…Gamma Knife radiosurgery seems to offer better results in terms of tumor control and toxicity, however, the treatment of these tumors has to be tailored on the patients' age and symptoms, tumor volume, and extension. 3,6,9,20,24,31,35,48,52,53 20,24,26,35,50,51 Based on these findings, Gamma Knife radiosurgery can be considered as a primary treatment in almost all cases of glomus tumor, except for those patients experiencing symptoms and signs of intracranial hypertension, or for those patients presenting with huge tumors with caudal extension, that cannot be easily approached only with a Gamma Knife radiosurgery treatment.…”

Endovascular Approach to Glomus Jugulare Tumors

“…Stereotactic radiosurgery may be applied as the treatment of choice [2,3,6,9]. In paragangliomas, this method results in lower morbidity than surgery with a possibility of clinical improvement [3].…”

“…It provides a good long-term tumor control, with 61% of the tumors stable in size [3]. Recent studies have shown a long-term neurological improvement in 42% of patients and aggravation of clinical symptoms in 4% of patients treated with stereotactic radiosurgery [9–11]. …”

Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery

“…On average, the decrease in size of tumors treated in our study was 37% is comparable to other centers that have studied tumor response to GKRS. 9,12,17,21–25 These are slow growing tumors and it is important to follow these tumors over longer periods of time to assess for control of growth.…”