Radiosurgery for glomus jugulare tumors: experience treating 16 patients in Iran

Abstract

ObjectGlomus jugulare tumors (GJT) have traditionally been treated by surgery or fractionated external-beam radiotherapy. The aim of this retrospective study was to determine the tumor control rate, clinical outcome, and short-term complications of stereotactic radiosurgery in subsets of patients who are poor candidates for these procedures, based on age, medical problems, tumor size, or prior treatment failure.MethodsThe Leksell Gamma Knife was used to treat 16 patients harboring symptomatic, residual, recurrent, or unresectable GJTs. The age of the patients ranged from 12 to 77 years (median 46.5 years). Gamma Knife surgery (GKS) was performed as primary treatment in five patients (31.3%). Microsurgery preceded radiosurgery in 10 patients (62.5%) and fractionated radiotherapy in three patients (18.8%). The median tumor volume was 9.8 cm3 (range 1.7–20.6 cm3). The median marginal dose applied to a mean isodose volume of 50% (range 37–70%) was 18 Gy (range 14–20 Gy).Neurological follow-up examinations revealed improved clinical status in 10 patients (62.5%), a stable neurological status in six (37.5%), and no complications. After radiosurgery, follow-up imaging was conducted in 14 patients; the median interval from GKS to the last follow up was 18.5 months (range 4–28 months). Tumor size had decreased in six patients (42.9%), and the volume remained unchanged in the remaining eight (57.1%). None of the tumors increased in volume during the observation period.Conclusions According to the authors' experience, GKS represents a useful therapeutic option to control symptoms and may be safely conducted in patients with primary or recurrent GJTs with no death and no acute morbidity. Because of the tumor's naturally slow growth rate, however, long-term follow-up data are needed to establish a cure rate after radiosurgery.

Treatment of glomus jugulare tumors with gamma knife radiosurgery

“…However, their challenging location at the skull base has made optimal treatment a controversial issue. Previous series presented control rates after GKS ranging from 76% to 100%,2, 6–8, 10, 12–15, 24, 27–30 and our data are consistent with these results. One difference between our study and previously published studies is that in our pooled analysis we considered any patient lost to follow‐up as a treatment failure, whereas other authors excluded these patients from their calculations.…”

“…We excluded patients with glomus tympanicum tumors as well as those treated using CyberKnife and LINAC. This search identified a total of 14 studies which were published between 1997 and 2009 2, 6–8, 10, 12–15, 24, 27–30. Three of these were follow‐up studies with updates on previously published data 7, 10, 28.…”

“…Glomus jugulare tumors (GJT) arising from paraganglionic tissue of the jugular bulb are a rare subset having an incidence of roughly 1:1 million but, together with glomus tympicanum tumors, remain the most common neoplasm of the middle ear and the second most common neoplasm of the temporal bone 3, 5. They are two to five times more common in females, with a mean age at presentation between 40 and 60 years 3, 5–15. These tumors are generally considered to be benign, nonsecreting tumors with 1% to 5% of paragangliomas showing malignancy and 1% to 2% secreting catecholamines 16, 17.…”

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

“…[6][7][8][9]12,13,18,19,[24][25][26] Glomus tumors treatment has gradually shifted to a multimodal approach through the use of radiation techniques, addressing surgery to symptomatic patient with intracranial hypertension or brainstem compression. 1,4,6,13,14,[26][27][28][29][30][31][32][33] Gamma Knife radiosurgery was used to overcome the potential morbidity related to surgery and RT, by virtue of the focused high-dose radiation that can be delivered to the target in a single session if compared to RT. 1,4,6,13,14,[26][27][28][29][30][31][32][33] Gamma Knife radiosurgery was used to overcome the potential morbidity related to surgery and RT, by virtue of the focused high-dose radiation that can be delivered to the target in a single session if compared to RT.…”

The Role of Wait-and-Scan and the Efficacy of Radiotherapy in the Treatment of Temporal Bone Paragangliomas

“…Moreover, regarding the timing of RT, some studies have evaluated its use as a primary treatment modality (8,10), whereas some others as a secondary modality after surgery or embolization (7,9,30,54). Bitaraf et al (28) have reported that all the patients in whom they documented a decrease in the size of the tumor were from the subset of patients in whom previous microsurgery had been performed and no decrease in tumor size was observed in patients where SRS was the primary treatment. Table 3 shows that, in almost all the reports, a section of patients (21%Y69%) had received previous treatment interventions.…”