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Paragangliomas of the Head and Neck

Local Control and Functional Outcome Following Fractionated Stereotactic Radiotherapy

Weissmann, Thomas Dr med*; Lettmaier, Sebastian Dr med*; Roesch, Johannes Dr med*; Mengling, Veit MSc*; Bert, Christoph Dr rer nat*; Iro, Heinrich Dr med; Hornung, Joachim Dr med; Janka, Rolf Dr med; Semrau, Sabine PD, Dr med*; Fietkau, Rainer Dr med*; Putz, Florian Dr med*

American Journal of Clinical Oncology: November 2019 - Volume 42 - Issue 11 - p 818–823
doi: 10.1097/COC.0000000000000614
Original Articles: Head and Neck

Objectives: To investigate local control and functional outcome following state-of-the-art fractionated stereotactic radiotherapy (FSRT) for paragangliomas of the head and neck.

Methods: In total, 40 consecutive patients with paragangliomas of the head and neck received conventionally FSRT from 2003 to 2016 at the Department of Radiation Oncology of the University Hospital Erlangen. Local control, toxicities, and functional outcome were examined during follow-up. In total, 148 magnetic resonance imaging studies were subjected to longitudinal volumetric analysis using whole tumor segmentation in a subset of 22 patients.

Results: A total of 80.0% (32/40) of patients received radiotherapy as part of their primary treatment. In 20.0% (8/40) of patients, radiation was used as salvage treatment after tumor recurrence in patients initially treated with surgery alone. The median dose applied was 54.0 Gy (interdecile range, 50.4 to 56.0 Gy) in single doses of 1.8 or 2 Gy. Local control was 100% after a median imaging follow-up of 52.2 months (range, 0.8 to 152.9 mo). The volumetric analysis confirmed sustained tumor control in a subset of 22 patients and showed transient enlargement (range, 129.6% to 151.2%) in 13.6% of cases (3/22). After a median volumetric follow-up of 24.6 months mean tumor volume had diminished to 86.1% compared with initial volume. In total, 52.5% (21/40) of patients reported improved symptoms after radiotherapy, 40% (16/40) observed no subjective change with only 7.5% (3/40) reporting significant worsening.

Conclusions: State-of-the-art FSRT provides excellent control and favorable functional outcome in patients with paragangliomas of the head and neck. The volumetric analysis provides improved evidence for sustained tumor control.

Departments of *Radiation Oncology

Otorhinolaryngology—Head and Neck Surgery

Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany

The authors declare no conflicts of interest.

Reprints: Florian Putz, Dr med, Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054 Erlangen, Germany. E-mail:

Online date: October 4, 2019

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