European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 1, pp 23–34

Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy

  • Carlos Suárez
  • Juan P. Rodrigo
  • William M. Mendenhall
  • Marc Hamoir
  • Carl E. Silver
  • Vincent Grégoire
  • Primož Strojan
  • Hartmut P. H. Neumann
  • Rupert Obholzer
  • Christian Offergeld
  • Johannes A. Langendijk
  • Alessandra Rinaldo
  • Alfio Ferlito
Review Article

DOI: 10.1007/s00405-013-2384-5

Cite this article as:
Suárez, C., Rodrigo, J.P., Mendenhall, W.M. et al. Eur Arch Otorhinolaryngol (2014) 271: 23. doi:10.1007/s00405-013-2384-5

Abstract

The definitive universally accepted treatment for carotid body tumors (CBT) is surgery. The impact of surgery on cranial nerves and the carotid artery has often been underestimated. Alternatively, a few CBTs have been followed without treatment or irradiation. The goal of this study is to summarize the existing evidence concerning the efficacy and safety of surgery and external beam radiotherapy (EBRT) for CBT. Relevant articles were identified using strict criteria for systematic searches. Sixty-seven articles met the criteria which included 2,175 surgically treated patients. On the other hand, 17 articles including 127 patients treated with EBRT were found. Long-term control of the disease was obtained in 93.8 % of patients who received surgical treatment and in 94.5 % of the radiotherapy group. Surgery resulted in 483 (483/2,175 = 22.2 %) new cranial nerve permanent deficits, whereas in the EBRT group, no new deficits were recorded (p = 0.004). The common/internal carotid artery was resected in 271 (12.5 %) patients because of injury or tumor encasement, with immediate reconstruction in 212 (9.7 %) patients. Three percent (60) of patients developed a permanent stroke and 1.3 % (26) died due to postoperative complications. The major complications rates and the mortality after completion of the treatment also were significantly higher in surgical series compared to EBRT series. This systematic analysis highlights evidence that EBRT offers a similar chance of tumor control with lower risk of morbidity as compared to surgery in patients with CBT. This questions the traditional notion that surgery should be the mainstay of treatment.

Keywords

Carotid paragangliomaCarotid body tumorJugular paragangliomaSurgeryExternal beam radiotherapy

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Carlos Suárez
    • 1
    • 2
  • Juan P. Rodrigo
    • 1
    • 2
  • William M. Mendenhall
    • 3
  • Marc Hamoir
    • 4
  • Carl E. Silver
    • 5
  • Vincent Grégoire
    • 6
  • Primož Strojan
    • 7
  • Hartmut P. H. Neumann
    • 8
  • Rupert Obholzer
    • 9
  • Christian Offergeld
    • 10
  • Johannes A. Langendijk
    • 11
  • Alessandra Rinaldo
    • 12
  • Alfio Ferlito
    • 12
  1. 1.Department of OtolaryngologyHospital Universitario Central de Asturias OviedoOviedoSpain
  2. 2.Instituto Universitario de Oncología del Principado de AsturiasOviedoSpain
  3. 3.Department of Radiation OncologyUniversity of FloridaGainesvilleUSA
  4. 4.Department of Head and Neck SurgerySt. Luc University Hospital and Cancer CenterBrusselsBelgium
  5. 5.Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of MedicineMontefiore Medical CenterBronxUSA
  6. 6.Radiation Oncology Department and Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de LouvainSt-Luc University HospitalBrusselsBelgium
  7. 7.Department of Radiation OncologyInstitute of OncologyLjubljanaSlovenia
  8. 8.Department of Nephrology and General Medicine, University Medical CenterAlbert-Ludwigs-UniversityFreiburgGermany
  9. 9.Department of OtolaryngologyGuy’s HospitalLondonUK
  10. 10.Department of Otorhinolaryngology-Head and Neck SurgeryUniversity of FreiburgFreiburgGermany
  11. 11.Department of Radiation Oncology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  12. 12.ENT ClinicUniversity of UdineUdineItaly