Long‐Term Outcomes in Head and Neck Paragangliomas Managed with Intensity‐Modulated Radiotherapy

Abstract

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

Rare presentation of vagal paraganglioma in an early age: A case report and literature review

“…However, it can also have neurologic side effects and seldom can completely eradicate the tumour [ 9 , 39 ]. In general, older patients, extensive cranial involvement and large non-resectable tumours are treated with radiation therapy [ 40 ]. In order to prevent bilateral vagus nerve injury following contralateral surgery, monolateral radiation may be recommended.…”

Hereditary head and neck paraganglioma: from basics to practical consequences

“…Tumor control following gross complete resection is good (81–91%). However, radiation therapy (including stereotactic radiosurgery and proton therapy) provides similar local control rates (as high as 95%) [44,45 ▪ ] while sparing morbidity (lower cranial nerve deficits in up to 12% of cases) and relieving symptoms such as dysarthria or tinnitus [25]. These insights increasingly justify the use of radiation therapy as first-line treatment for jugular paragangliomas.…”