Long term outcomes with linear accelerator stereotactic radiosurgery for treatment of jugulotympanic paragangliomas

Abstract

Background: Data supporting linear accelerator (linac) stereotactic radiosurgery (SRS) for jugulotympanic paragangliomas (JTPs) come from small series with minimal follow-up. Herein, we report a large series of JTPs with extended follow-up after frameless linac-based SRS. Methods: JTPs treated with linac-based SRS from 2002 to 2019 with 1+ follow-up image were reviewed for treatment failure (radiographic or clinical progression, or persistent symptoms after SRS requiring intervention) and late toxicities (CTCAE v5.0). Results: Forty JTPs were identified; 30 were treated with a multifraction regimen. Median clinical and radiographic follow-up was 79.7 (interquartile range [IQR] 31.7-156.9) and 54.4 months (IQR 17.9-105.1), respectively, with a median 4.5 follow-up scans (IQR 2-9). Seven-year progression-free survival (PFS) was 97.0% (95% confidence interval 91.1%-100.0%). PFS was similar between single-and multifraction regimens (log rank P = .99). Toxicity was seen in 7.7% (no grade III). Conclusions: With extended clinical and radiographic follow-up, frameless linac-based SRS provides excellent local control with mild toxicity <8%.

Comparison of surgical outcomes between early and advanced class of jugular paragangliomas following application of our modified surgical techniques

“…In recent years, radiotherapy has become popular as the first-line treatment for JPs due to its high tumor control and low morbidity compared with the surgical management of JPs 5 , 22 , 34 . Recently, Patel and colleagues reported a series of 40 cases with JPs treated by linear accelerator stereotactic radiosurgery 22 .…”

“…In recent years, radiotherapy has become popular as the first-line treatment for JPs due to its high tumor control and low morbidity compared with the surgical management of JPs 5 , 22 , 34 . Recently, Patel and colleagues reported a series of 40 cases with JPs treated by linear accelerator stereotactic radiosurgery 22 . Similar to the results of previous radiotherapy studies, the authors did not classify tumors according to the Fisch classification but preferred to report them based on tumor size.…”

The Comparison of Surgical Outcomes Between Early and Advanced Class of Jugular Paragangliomas Following Application of Our Modified Surgical Techniques

“…The Fisch class A and B tumors can be treated surgically by skillful otologists with standard approaches with almost no complications, preserving the FN and inner ear function and offering the patient a complete cure 15,18 . Management of the Fisch class C and D tumors has remained controversial, and there are still various opinions, such as surgery, radiotherapy or wait-and-scan 3,6,[19][20][21][22][23][24] . This study retrospectively analyzed the clinical e cacy of surgical treatment of Fisch class C and D tumors in our institution in the past 10 years following application of our modi ed surgical techniques and concluded that surgical treatment of JPs is a safe and effective strategy, especially for C1 and C2 tumors.…”

“…In recent years, radiotherapy has become popular as the rst-line treatment for JPs due to its high tumor control and low morbidity compared with the surgical management of JPs 5,20,31 . Recently, Patel and colleagues reported a series of 40 cases with JPs treated by linear accelerator stereotactic radiosurgery 20 .…”

“…With improvements in surgical techniques and perioperative management, the incidence of cranial nerve injury and serious complications caused by surgical treatment has gradually decreased. However, the unique complications of radiotherapy cannot be avoided, such as temporal bone necrosis, brain necrosis, secondary malignancy and pituitary/hypothalamic insu ciency 20 .…”