Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy

Suárez, Carlos; Rodrigo, Juan P.; Bödeker, Carsten C.; Llorente, José Luís; Silver, Carl E.; Jansen, Jeroen C.; Takes, Robert P.; Strojan, Primož; Pellitteri, Phillip K.; Rinaldo, Alessandra; Mendenhall, William M.; Ferlito, Alfio

doi:10.1002/hed.22976

Cited by 177 publications

(278 citation statements)

References 104 publications

(30 reference statements)

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“…In a large literature review on VPGLs and JTPGLs published in 2012, Suarez et al (2013a) described an average mortality rate of 1.3% with a GTR rate of 93.3%. However, the neurological risks are higher than those for CBTs: CN palsies are more common after surgery for JTPGLs and high-located VPGLs due to the tumoural involvement of the jugular foramen.…”

Section: Vagus Paragangliamentioning

confidence: 99%

“…An immediate postoperative CN palsy rate can be as high as 96 and 100% respectively for these tumours (Neskey et al 2011). The most affected component is the vagus nerve itself: in most series, a postoperative vagal deficit is almost universal (92-100%), by either paresis or necessary sacrifice during surgery (Urquhart et al 1994, Netterville et al 1998 (Suarez et al 2013a). The majority of patients need complex rehabilitation management regarding speech, swallowing and facial nerve deficits, but during follow-up, these deficits often recover partially (Netterville et al 1998).…”

Section: Vagus Paragangliamentioning

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: Vagus Paragangliamentioning

confidence: 99%

Section: Vagus Paragangliamentioning

confidence: 99%

The management of head-and-neck paragangliomas

Căpățînă

Ntali

Karavitaki

et al. 2013

Endocrine-Related Cancer

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“…The results of surgery, EBRT, and SRS have been analyzed in a systematic review including 2042 patients with JPG or VPG [4]. Tumor control failure rate, major complication rate, and the number of cranial nerve palsies after treatment were significantly higher in surgical than in radiotherapytreated patients.…”

Section: Treatment Of Jugular and Vagal Paragangliomasmentioning

confidence: 99%

“…Similar studies on the trends of treatment are lacking in HNPG. Systematic analysis of the literature has shown that most of the HNPG have been treated surgically, with no data on the impact of observation in the management of these tumors [4,5]. …”

mentioning

confidence: 99%

“…''Wait and see'' policy Likewise, due to prevailingly indolent nature HNPG with low growth potential the decision on optimal treatment in HNPG is delicate, even more in view of the facts that tumor growth in individual paraganglioma (PG) case cannot be predicted and mortality caused directly by the tumor is a rare event that occurs in only 1-4 % of patients [4]. According to Jansen et al [6], the median increase in size in a series of 48 HNPG was 0.83 mm/year.…”

mentioning

confidence: 99%

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Modern trends in the management of head and neck paragangliomas

Suárez

Fernández-Álvarez

Neumann³

et al. 2015

Eur Arch Otorhinolaryngol

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Head and neck paragangliomas (HNPG) are rare, mostly benign neoplasms that usually exhibit an indolent growth pattern although they can be associated with compression and infiltration of adjacent cranial nerves and, depending on the site of origin, also bone and intracranial structures. Less than 5 % of the tumors are considered malignant based on the presence of metastases and not local invasion. Carotid body tumors accounts for two-thirds of HNPG, whereas vagal paragangliomas are showing the highest tendency toward malignant character.Despite the usual treatment of benign tumors is surgery, the risks of the treatment-related complications and potential deterioration of quality of patient's live, however, should not be greater than the risk brought by the tumor in its natural course. Watchful waiting and radiotherapy are widely accepted in the management of vestibular schwannomas, a tumor that is usually indolent but, like HNPG, also has an unpredictable growth pattern. Review of different national tumor registry databases revealed that in the United States there has been a significant shift in management of vestibular schwannomas over a decade, with increasing tendency toward observation and radiotherapy, whereas the proportion of operated cases declined to near a half of the total [1][2][3]. Similar studies on the trends of treatment are lacking in HNPG. Systematic analysis of the literature has shown that most of the HNPG have been treated surgically, with no data on the impact of observation in the management of these tumors [4,5]. ''Wait and see'' policyLikewise, due to prevailingly indolent nature HNPG with low growth potential the decision on optimal treatment in HNPG is delicate, even more in view of the facts that tumor growth in individual paraganglioma (PG) case cannot be predicted and mortality caused directly by the tumor is a rare event that occurs in only 1-4 % of patients [4]. According to Jansen et al. [6], the median increase in size in a series of 48 HNPG was 0.83 mm/year. A volume increase of 20 % was noted in 60 % of the tumors, with a median increase in dimension in this subgroup of 1 mm/ year. In addition, tumor doubling time has been universally estimated as low, ranging between 4.2 and 13.8 years for HNPG [7,8].

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Paraganglioma

Byrd¹

2022

Essential Cases in Head and Neck Oncology

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Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy

Cited by 177 publications

References 104 publications

The management of head-and-neck paragangliomas

The management of head-and-neck paragangliomas

Modern trends in the management of head and neck paragangliomas

Paraganglioma

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