Radiation Therapy For Benign Head And Neck Paragangliomas: A 45-Year Experience

Paragangliomas of the head and neck are rare, slow-growing, generally benign tumors of neuroendocrine cells associated with the peripheral nervous system that commonly involve the carotid body, jugular bulb, vagal ganglia, and temporal bone. There have been multiple retrospective studies examining the main treatments for these tumors: radiation therapy and surgery. This article briefly reviews the pathology, clinical presentation, and treatment modalities of paragangliomas and recounts our 45-year institutional experience treating this malignancy. From January 1968 through March 2011, 131 patients with 156 benign paragangliomas of the temporal bone, carotid body, jugular bulb, or glomus vagale were treated with radiation therapy to a median dose of 45 Gy in 25 fractions. Mean and median follow-up times were 11.5 years and 8.7 years, respectively. The overall local control rates at 5 and 10 years were 99% and 96%. The cause-specific survival rates at 5 and 10 years were 98% and 97%. The distant-metastasis free survival rates at 5 and 10 years were 99% and 99%. The overall survival rates at 5 and 10 years were 91% and 72%. Fractionated radiation therapy for benign head and neck paragangliomas is a safe and efficacious treatment associated with a low incidence of mild morbidity. Surgery is reserved for patients in good health whose risk of associated morbidity is low. Otherwise, radiation therapy is the first-line treatment. Stereotactic surgery is a promising treatment modality whose data are still maturing. Watchful waiting may also be an appropriate management option for these benign tumors