The treatment of glomus tumors in the temporal bone by megavoltage radiation

Abstract

Forty‐five patients with glomus tumors in the temporal bone region were treated by radiation therapy. Only three patients had recurrence or progression of tumor during the follow‐up period of 3 to 23 years (median, 10 years). No patient died from uncontrolled glomus tumor. The majority of patients noted symptomatic relief after radiation, but objective neurologic deficits usually remained unchanged or showed only partial improvement. The most commonly used radiation dose was 3500 cGy tumor dose delivered in 15 fractions in 3 weeks by a homolateral wedge technique from megavoltage radiation apparatus. This dose is less than that usually recommended for glomus tumors. From these results and from review of the literature, it is suggested that a moderate radiation dose of 3500 cGy in 3 weeks is effective treatment for glomus tumors, even if complete tumor involution does not occur.

The management of head-and-neck paragangliomas

“…JTPGLs are intracranial tumours, and it is often difficult to delineate their site of origin: tympanic tumours may extend towards the jugular bulb and posterior fossa, while jugular tumours can involve the temporal bone and extend into the middle ear. Intracranial invasion and involvement of the CN adjacent to the jugular foramen can lead to pulsatile tinnitus, an ear mass, hearing loss, pain and vertigo as major presenting symptoms in JTPGLs and high VPGLs (Cummings et al 1984, Persky et al 2002, Offergeld et al 2012.…”

“…Partial/complete symptom relief in the months after treatment occurs in most (52-100%) cases affected by tinnitus, dizziness/vertigo or pain. As opposed to surgery, a CN deficit present at diagnosis generally improves or remains stable (Cummings et al 1984, de Jong et al 1995, Huy et al 2009). …”

“…The control rate decreases significantly with time: 95-96% at 5 years and 88-94% at 10 years, but only 73% at 25 years. Diseaserelated mortality after radiotherapy is low (0-5.1%; Cummings et al 1984, Hansen & Thomsen 1988, Powell et al 1992, Verniers et al 1992, Hinerman et al 2001, Chino et al 2009, Huy et al 2009, Lightowlers et al 2010, Suarez et al 2013a). …”

“…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.…”

Long-Term Results of Surgery for Temporal Bone Paraganglioma

“…Patient cure is provided only by surgical resection of the tumor and is connected with various degrees of postoperative morbidity.2 Radiotherapy, on the other hand, provides control of the disease by preventing further tumor growth. 3,4 While no controversy exists about the dominant role of surgery in the treatment of glomus tympanicum tumors,3'5'6 the advantage of surgery for glomus jugulare tumors, particularly those with intracranial extension, is challenged by radiotherapists. [3][4][5]7,8 They claim that radiation therapy is an effective treatment for glomus jugulare tumor with minimal late progression of disease in adequately treated patients (4500 to 5000 cGy) and no significant long-term complications.3…”