Treatment of paragangliomas with radiation therapy

Mendenhall, William M.; Hinerman, Russell W.; Amdur, Robert J.; Stringer, Scott P.; Antonelli, Patrick J.; Singleton, George T.; Cassisi, Nicholas J.

doi:10.1016/s0030-6665(05)70360-1

Cited by 26 publications

(23 citation statements)

References 36 publications

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“…Stereotactic radiosurgery and stereotactic radiotherapy are new additions in the treatment of PGs. Stereotactic RT implies fractionated RT that offers the advantages of the low dose per fraction associated with a conventional fractionation schedule with the precise localization and limited treatment volume of stereotactic radiosurgery [46]. Several institutions have treated PGs with stereotactic radiosurgery, in which a single dose of RT is delivered with a fields arrangement such that the prescription dose conforms to the radiographic tumor volume [47].…”

Section: Treatmentmentioning

confidence: 99%

Paragangliomas of the Head & Neck: the KMC experience

Prasad

Thada

Pallavi

et al. 2011

Indian J Otolaryngol Head Neck Surg

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To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin's Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.

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Section: Treatmentmentioning

confidence: 99%

Paragangliomas of the Head & Neck: the KMC experience

Prasad

Thada

Pallavi

et al. 2011

Indian J Otolaryngol Head Neck Surg

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“…This was coupled with clinical improvement in his blood pressure which rose to the normal range as dopamine hypersecretion abated. Paragangliomas usually remain stable in size or partially regress after successful radiotherapy (31). In our patient, the biochemical remission achieved despite minimal reduction in tumor size could be attributed to increased susceptibility of the secretory mechanisms of the tumor cells to damage by radiation in comparison to the apoptotic effects of radiation on the tumor cells.…”

Section: Management Of Dopamine-secreting Carotid Body Paragangliomasmentioning

confidence: 50%

“…Preoperative α-blockade can aggravate hypotension and may even cause cardiovascular collapse (30). The choice of treatment depends on various factors including the location and extent of the tumor, the presence of multiple tumors, the age and health of the patient, and the preference of the patient and attending physician (31).…”

Section: Management Of Dopamine-secreting Carotid Body Paragangliomasmentioning

confidence: 99%

“…Radiotherapy has been advocated for those with multiple paragangliomas to minimize the risks of multiple surgeries (31). In view of the high risk of operative morbidity and mortality as well as skull base involvement of the left-sided tumor in our patient, we elected for radiation therapy.…”

Section: Management Of Dopamine-secreting Carotid Body Paragangliomasmentioning

confidence: 99%

“…In view of the high risk of operative morbidity and mortality as well as skull base involvement of the left-sided tumor in our patient, we elected for radiation therapy. Overall, the rate of local tumoral control after radiotherapy has been estimated at 90% (31). All published series of head and neck paragangliomas treated with radiotherapy have reported on clinical response based on locoregional control and distant recurrences with no mention of the control of catecholamine hypersecretion (34)(35)(36)(37)(38)(39)(40)(41)(42).…”

Section: Management Of Dopamine-secreting Carotid Body Paragangliomasmentioning

confidence: 99%

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Dopamine-secreting Carotid Body Paragangliomas-Biochemical Control with Radiotherapy

Soh

Kek

2012

Intern. Med.

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Head and neck paragangliomas that are exclusively or predominantly dopamine-secreting are rare. Surgery and/or radiotherapy are modalities for locoregional tumoral control. Little is known about the efficacy of radiotherapy for biochemical control in such tumors. We report a 62-year-old Chinese man with bilateral carotid body tumors which were exclusively dopamine secreting. The left-sided tumor invaded the skull base and encased the left carotid artery. Surgery was not performed due to high risk of morbidity and mortality. The patient received external beam radiotherapy to bilateral neck regions. Progressive decline and eventual normalization of urinary dopamine excretion was seen together with a slight reduction in tumor size. This is the first report demonstrating the efficacy of radiotherapy for both biochemical and locoregional control of functioning carotid body paragangliomas.

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Surgical Resection of Cervical Schwannoma or Paraganglioma at a Single Institution: Speech and Swallow Outcomes

et al. 2011

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We conducted a retrospective study (1999 to 2009) at our tertiary care institution to evaluate speech and swallowing outcomes after the resection of cervical schwannoma or paraganglioma. Of 6 patients treated for schwannoma, 5 (83.3%) had immediate dysphonia and dysphagia. All patients with deficits received primary reinnervation (n = 2) or subsequent medialization laryngoplasty (n = 3). At 6 months, 4 patients (66.6%) still had dysphonia and dysphagia. At final follow-up (median: 10 months; range: 8 to 12 months), 4 patients (66.7%) had dysphonia and 2 (33.3%) had dysphagia. Of 10 patients treated for paraganglioma, 6 (60.0%) had immediate dysphonia and dysphagia. Four patients received subsequent medialization laryngoplasty; none had primary reinnervation. At 6 months, 3 (30%) still had dysphonia and dysphagia. At final follow-up (median: 15.5 months; range: 1.25 to 48 months), 2 (20.0%) had dysphonia and dysphagia. All patients with deficits received speech and swallowing therapy. We conclude that cervical schwannoma and paraganglioma resection was associated with high rates of immediate postoperative dysphonia and dysphagia. Schwannoma had higher initial rates and poorer recovery. Primary and/or subsequent laryngeal procedures combined with therapy led to symptom resolution in some patients.

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Treatment of paragangliomas with radiation therapy

Cited by 26 publications

References 36 publications

Paragangliomas of the Head & Neck: the KMC experience

Paragangliomas of the Head & Neck: the KMC experience

Dopamine-secreting Carotid Body Paragangliomas-Biochemical Control with Radiotherapy

Surgical Resection of Cervical Schwannoma or Paraganglioma at a Single Institution: Speech and Swallow Outcomes

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