Skip to main content
SpringerLink
Log in

Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis

  • Review
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Head and neck paragangliomas (HNPs) are rare, usually benign hyper vascularized neuroendocrine tumors that traditionally have been treated by surgery, with or without endovascular embolization, or, more recently stereotactic radiosurgery (SRS). The aim of our study is to determine the clinical and radiographic effectiveness of SRS for treatment of HNPs. A systematic search of electronic databases was performed, and 37 articles reporting 11,174 patients (1144 tumors) with glomus jugulare (GJT: 993, 86.9%), glomus tympanicum (GTT: 94, 8.2%), carotid body tumors (CBTs: 28, 2.4%), and glomus vagale (GVT: 16, 1.4%) treated with SRS definitively or adjuvantly were included. The local control (LC) was estimated from the pooled analysis of the series, and its association with SRS technique as well as demographic and clinical factors was analyzed. The median age was 56 years (44–69 years). With a median clinical and radiological follow-up of 44 months (9–161 months), LC was 94.2%. Majority of the patients (61.0%) underwent Gamma Knife Radiosurgery (GKS), but there was no statistically significant difference in LC depending upon the SRS technique (p = 0.9). Spearmen’s correlation showed that LC was strongly and negatively correlated with multiple parameters, which included female gender (r = − 0.4, p = 0.001), right-sided tumor (r = − 0.3, p = 0.03), primary SRS (r = − 0.5, p ≤ 0.001), and initial clinical presentation of hearing loss (r = − 0.4, p = 0.001). To achieve a LC ≥ 90%, a median marginal dose (Gy) of 15 (range, 12–30 Gy) was required. The results corroborate that SRS in HNPs is associated with good clinical and radiological outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

References

  1. Bacciu A, Medina M, Ait Mimoune H, D’Orazio F, Pasanisi E, Peretti G, Sanna M (2015) Lower cranial nerves function after surgical treatment of Fisch Class C and D tympanojugular paragangliomas. Eur Arch Oto-Rhino-Laryngol. https://doi.org/10.1007/s00405-013-2862-9

  2. Baguley DM, Irving RM, Hardy DG, Harada T, Moffat DA (1994) Audiological findings in glomus tumours. Br J Audiol. https://doi.org/10.3109/03005369409077313

  3. Bari ME, Kemeny AA, Forster DM, Radatz MW (2003) Radiosurgery for the control of glomus jugulare tumours. J Pak Med Assoc 53:147–151

    CAS  PubMed  Google Scholar 

  4. Biller HF, Som P, Lawson W, Rosenfeld R (1989) Glomus vagale tumors. Ann Otol Rhinol Laryngol. https://doi.org/10.1177/000348948909800105

  5. Bitaraf MA, Alikhani M, Tahsili-Fahadan P, Motiei-Langroudi R, Zahiri A, Allahverdi M, Salmanian S (2006) Radiosurgery for glomus jugulare tumors: experience treating 16 patients in Iran. J Neurosurg. https://doi.org/10.3171/sup.2006.105.7.168

  6. Boedeker CC, Ridder GJ, Maier W, Schipper J, Neumann HPH (2004) Diagnosis and management of cervical paragangliomas: the Freiburg experience. Laryngorhinootologie. https://doi.org/10.1055/s-2004-814466

  7. Dobberpuhl MR, Maxwell S, Feddock J, Clair WS, Bush ML (2016) Treatment outcomes for single modality management of glomus jugulare tumors with stereotactic radiosurgery. Otol. Neurotol.

  8. El Majdoub F, Hunsche S, Igressa A, Kocher M, Sturm V, Maarouf M (2015) Stereotactic LINAC-radiosurgery for glomus jugulare tumors: a long-term follow-up of 27 patients. PLoS One. https://doi.org/10.1371/journal.pone.0129057

  9. Elshaikh MA, Mahmoud-Ahmed AS, Kinney SE, Wood BG, Lee JH, Barnett GH, Suh JH (2002) Recurrent head-and-neck chemodectomas: a comparison of surgical and radiotherapeutic results. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/S0360-3016(01)02751-1

  10. Eustacchio S, Trummer M, Unger F, Schröttner O, Sutter B, Pendl G (2002) The role of gamma knife radiosurgery in the management of glomus jugulare tumours. Acta Neurochir Suppl. https://doi.org/10.1007/978-3-7091-6117-3_11

  11. Fatima N, Meola A, Pollom E, Chaudhary N, Soltys S, Chang SD (2019) Stereotactic radiosurgery in large intracranial meningiomas: a systematic review. World Neurosurg 129. https://doi.org/10.1016/j.wneu.2019.06.064

  12. Fatima N, Meola A, Pollom EL, Soltys SG, Chang SD (2019) Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. Neurosurg Focus 46. https://doi.org/10.3171/2019.3.FOCUS1970

  13. Feigl GC, Horstmann GA (2006) Intracranial glomus jugulare tumors: volume reduction with Gamma Knife surgery. J Neurosurg. https://doi.org/10.3171/sup.2006.105.7.161

  14. Gandía-González ML, Kusak ME, Moreno NM, Sárraga JG, Rey G, Álvarez RM (2014) Jugulotympanic paragangliomas treated with Gamma Knife radiosurgery: a single-center review of 58 cases. J Neurosurg. https://doi.org/10.3171/2014.5.JNS131880

  15. Ganz JC, Abdelkarim K (2009) Glomus jugulare tumours: certain clinical and radiological aspects observed following Gamma Knife radiosurgery. Acta Neurochir (Wien). https://doi.org/10.1007/s00701-009-0268-7

  16. Gerosa M, Visca A, Rizzo P, Foroni R, Nicolato A, Bricolo A (2006) Glomus jugulare tumors: the option of gamma knife radiosurgery. Neurosurgery. https://doi.org/10.1227/01.NEU.0000228682.92552.CA

  17. Gupta A, Kale S, Agrawal D, Mahapatra A, Sharma B, Sharma M (2008) Gamma knife radiosurgery for glomus jugulare tumors: therapeutic advantages of minimalism in the skull base. Neurol India. https://doi.org/10.4103/0028-3886.33299

  18. Guss ZD, Batra S, Limb CJ, Li G, Sughrue ME, Redmond K, Rigamonti D, Parsa AT, Chang S, Kleinberg L, Lim M (2011) Radiosurgery of glomus jugulare tumors: a meta-analysis. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2011.05.006

  19. Hafez RFA, Morgan MS, Fahmy OM, Hassan HT (2018) Long-term effectiveness and safety of stereotactic gamma knife surgery as a primary sole treatment in the management of glomus jagulare tumor. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2018.02.037

  20. Hinerman RW, Amdur RJ, Morris CG, Kirwan J, Mendenhall WM (2008) Definitive radiotherapy in the management of paragangliomas arising in the head and neck: A 35-year experience. Head Neck. https://doi.org/10.1002/hed.20885

  21. Huo M, Sahgal A, Pryor D, Redmond K, Lo S, Foote M (2017) Stereotactic spine radiosurgery: review of safety and efficacy with respect to dose and fractionation. Surg Neurol Int

  22. Hurmuz P, Cengiz M, Ozyigit G, Yazici G, Akyol F, Yildiz F, Gurkaynak M, Zorlu F (2013) Robotic stereotactic radiosurgery in patients with unresectable glomus jugulare tumors. Technol Cancer Res Treat. https://doi.org/10.7785/tcrt.2012.500303

  23. Ibrahim R, Ammori MB, Yianni J, Grainger A, Rowe J, Radatz M (2017) Gamma Knife radiosurgery for glomus jugulare tumors: a single-center series of 75 cases. J Neurosurg. https://doi.org/10.3171/2016.4.JNS152667

  24. Ivan ME, Sughrue ME, Clark AJ, Kane AJ, Aranda D, Barani IJ, Parsa AT (2011) A meta-analysis of tumor control rates and treatment-related morbidity for patients with glomus jugulare tumors. J Neurosurg. https://doi.org/10.3171/2010.9.JNS10699

  25. Jackson CG (2001) Glomus tympanicum and glomus jugulare tumors. Otolaryngol Clin North Am. https://doi.org/10.1016/S0030-6665(05)70356-X

  26. Jansen JC, Van Den Berg R, Kuiper A, Van Der Mey AGL, Zwinderman AH, Cornelisse CJ (2000) Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal. Cancer. https://doi.org/10.1002/1097-0142(20000615)88:12<2811::AID-CNCR21>3.0.CO;2-7

  27. Jawad MS, Grills IS, Naumann I, Bojrab D, Marvin K, Chen PY, Kartush JM, Pieper DR (2011) Outcomes and toxicities following Gamma Knife radiosurgery with or without surgical resection for glomus tumors. Int J Radiat Oncol. https://doi.org/10.1016/j.ijrobp.2011.06.1789

  28. Kaylie DM, O’Malley M, Aulino JM, Jackson CG (2007) Neurotologic surgery for glomus tumors. Otolaryngol. Clin. North Am.

  29. Kirkpatrick JP, Soltys SG, Lo SS, Beal K, Shrieve DC, Brown PD (2017) The radiosurgery fractionation quandary: single fraction or hypofractionation? Neuro Oncol. https://doi.org/10.1093/neuonc/now301

  30. Kollert M, Minovi A, Mangold R, Hendus J, Draf W, Bockmühl U (2006) Paragangliome des kopf-hals-bereiches - Tumorkontrolle, funktioneile ergebnisse und lebensqualität nach operation. Laryngorhinootologie. https://doi.org/10.1055/s-2006-925,234

  31. Krych AJ, Foote RL, Brown PD, Garces YI, Link MJ (2006) Long-term results of irradiation for paraganglioma. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2006.02.020

  32. Künzel J, Iro H, Hornung J, Koch M, Brase C, Klautke G, Zenk J (2012) Function-preserving therapy for jugulotympanic paragangliomas: a retrospective analysis from 2000 to 2010. Laryngoscope.

  33. Künzel J, Koch M, Brase C, Fietkau R, Iro H, Zenk J (2014) Treatment of cervical paragangliomas: is surgery the only way? Am J Otolaryngol Head Neck Med Surg

  34. Lee CC, Pan DHC, Wu JC, Chung WY, Wu HM, Yang HC, Du Liu K, Guo WY, Shih YH (2011) Gamma knife radiosurgery for glomus jugulare and tympanicum. Stereotact Funct Neurosurg. https://doi.org/10.1159/000328890

  35. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol

  36. Lieberson RE, Adler JR, Soltys SG, Choi C, Gibbs IC, Chang SD (2012) Stereotactic radiosurgery as the primary treatment for new and recurrent paragangliomas: is open surgical resection still the treatment of choice? World Neurosurg

  37. Lim JY, Kim J, Kim SH, Lee S, Lim YC, Kim JW, Choi EC (2010) Surgical treatment of carotid body paragangliomas: outcomes and complications according to the shamblin classification. Clin Exp Otorhinolaryngol. https://doi.org/10.3342/ceo.2010.3.2.91

  38. Liscak R, Urgosik D, Chytka T, Simonova G, Novotny J, Vymazal J, Guseynova K, Vladyka V (2014) Leksell Gamma Knife radiosurgery of the jugulotympanic glomus tumor: long-term results. J Neurosurg. https://doi.org/10.3171/2014.7.GKS14923

  39. Magno De Andrade E, Brito J, Mario S, Maymone De Melo S, Benabou S (2013) Stereotactic radiosurgery for the treatment of glomus jugulare tumors. Surg Neurol Int. https://doi.org/10.4103/2152-7806.121629

  40. Marchetti M, Pinzi V, Tramacere I, Bianchi LC, Ghielmetti F, Fariselli L (2017) Radiosurgery for paragangliomas of the head and neck: another step for the validation of a treatment paradigm. World Neurosurg. https://doi.org/10.1016/j.wneu.2016.10.132

  41. Martín IT, Ávila RDM, Herrera MZ, Arregui G, Osorio-Ceballos JL, Rojas ES, Almansa ÁH, Arrebola JP, Rull JP, Hernández JE, Ramírez EL (2016) Role of radiosurgery in the management of glomus tumors. Head Neck. https://doi.org/10.1002/hed.24103

  42. Mei L, Khurana A, Al-Juhaishi T, Faber A, Celi F, Smith S, Boikos S (2019) Prognostic factors of malignant pheochromocytoma and paraganglioma: a combined SEER and TCGA databases review. Horm Metab Res. https://doi.org/10.1055/a-0851-3275

  43. Michałowska I, Ćwikła JB, Michalski W, Wyrwicz LS, Prejbisz A, Szperl M, Nieć D, Neumann HPH, Januszewicz A, Pȩczkowska M (2017) Growth rate of paragangliomas related to germline mutations of the SDHx genes. Endocr Pract. https://doi.org/10.4158/EP161377.OR

  44. Miller JP, Semaan MT, Maciunas RJ, Einstein DB, Megerian CA (2009) Radiosurgery for glomus jugulare tumors. Otolaryngol Clin North Am 42:689–706. https://doi.org/10.1016/j.otc.2009.04.004

    Article  PubMed  Google Scholar 

  45. Navarro Martín A, Maitz A, Grills IS, Bojrab D, Kartush J, Chen PY, Hahn J, Pieper D (2010) Successful treatment of glomus jugulare tumours with gamma knife radiosurgery: clinical and physical aspects of management and review of the literature. Clin Transl Oncol. https://doi.org/10.1007/s12094-010-0467-y

  46. Offergeld C, Brase C, Yaremchuk S, Mader I, Rischke HC, Gläsker S, Schmid KW, Wiech T, Preuss SF, Suárez C, Kopeć T, Patocs A, Wohllk N, Malekpour M, Boedeker CC, Neumann HPH (2012) Head and neck paragangliomas: clinical and molecular genetic classification. Clinics.

  47. Oxman AD (2004) Grading quality of evidence and strength of recommendations. Br Med J

  48. Patel NS, Carlson ML, Pollock BE, Driscoll CLW, Neff BA, Foote RL, Lohse CM, Link MJ (2019) Long-term tumor control following stereotactic radiosurgery for jugular paraganglioma using 3D volumetric segmentation. J Neurosurg. https://doi.org/10.3171/2017.10.JNS17764

  49. Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO, Shaha AR, Netterville JL, Manni JJ, Ferlito A (2004) Paragangliomas of the head and neck. Oral Oncol.

  50. Poznanovic SA, Cass SP, Kavanagh BD (2006) Short-term tumor control and acute toxicity after stereotactic radiosurgery for glomus jugulare tumors. Otolaryngol Head Neck Surg. https://doi.org/10.1016/j.otohns.2005.10.040

  51. Sager O, Beyzadeoglu M, Dincoglan F, Gamsiz H, Demiral S, Uysal B, Oysul K, Dirican B, Sirin S (2014) Evaluation of linear accelerator-based stereotactic radiosurgery in the management of glomus jugulare tumors. Tumori. https://doi.org/10.1700/1491.16409

  52. Sallabanda K, Barrientos H, Romero DAI, Vargas C, Diaz JAG, Peraza C, del Campo ER, Praena-Fernandez JM, López-Guerra JL (2018) Long-term outcomes after radiosurgery for glomus jugulare tumors. Tumori 104:300–306. https://doi.org/10.1177/0300891618765576

    Article  PubMed  Google Scholar 

  53. Sanna M, Jain Y, De Donato G, Rohit LL, Taibah A (2004) Management of jugular paragangliomas: the Gruppo Otologico experience. Otol Neurotol

  54. Saringer W, Khayal H, Ertl A, Schoeggl A, Kitz K (2001) Efficiency of Gamma Knife radiosurgery in the treatment of glomus jugulare tumors. Minim Invasive Neurosurg. https://doi.org/10.1055/s-2001-18,162

  55. Scheick SM, Morris CG, Amdur RJ, Bova FJ, Friedman WA, Mendenhall WM (2018) Long-term outcomes after radiosurgery for temporal bone paragangliomas. Am J Clin Oncol Cancer Clin Trials. https://doi.org/10.1097/COC.0000000000000255

  56. Schipper J (2004) Paragangliome im Kopf-/Halsbereich. HNO 52:569–574

    CAS  PubMed  Google Scholar 

  57. Schuster D, Sweeney AD, Stavas MJ, Tawfik KY, Attia A, Cmelak AJ, Wanna GB (2016) Initial radiographic tumor control is similar following single or multi-fractionated stereotactic radiosurgery for jugular paragangliomas. Am J Otolaryngol Head Neck Med Surg. https://doi.org/10.1016/j.amjoto.2016.01.002

  58. Sharma M, Gupta A, Kale S, Agrawal D, Mahapatra A, Sharma B (2008) Gamma knife radiosurgery for glomus jugulare tumors: therapeutic advantages of minimalism in the skull base. Neurol India

  59. Sharma M, Meola A, Bellamkonda S, Jia X, Montgomery J, Chao ST, Suh JH, Angelov L, Barnett GH (2018) Long-term outcome following stereotactic radiosurgery for glomus jugulare tumors: a single institution experience of 20 years. Clin Neurosurg. https://doi.org/10.1093/neuros/nyx566

  60. Sheehan JP, Tanaka S, Link MJ, Pollock BE, Kondziolka D, Mathieu D, Duma C, Young AB, Kaufmann AM, McBride H, Weisskopf PA, Xu Z, Kano H, Yang HC, Lunsford LD (2012) Gamma Knife surgery for the management of glomus tumors: a multicenter study - Clinical article. J Neurosurg. https://doi.org/10.3171/2012.4.JNS11214

  61. Smith JD, Harvey RN, Darr OA, Prince ME, Bradford CR, Wolf GT, Else T, Basura GJ (2017) Head and neck paragangliomas: a two-decade institutional experience and algorithm for management. Laryngoscope Investig Otolaryngol. https://doi.org/10.1002/lio2.122

  62. Spina A, Boari N, Gagliardi F, Bailo M, Del Vecchio A, Bolognesi A, Mortini P (2018) Gamma Knife radiosurgery for glomus tumors: long-term results in a series of 30 patients. Head Neck. https://doi.org/10.1002/hed.25517

  63. Tran Ba Huy P, Kania R, Duet M, Dessard-Diana B, Mazeron JJ, Benhamed R (2009) Evolving concepts in the management of jugular paraganglioma: a comparison of radiotherapy and surgery in 88 cases. Skull Base. https://doi.org/10.1055/s-0028-1,103,125

  64. Wakefield DV, Venable GT, Vanderwalde NA, Michael LM, Sorenson JM, Robertson JH, Cunninghan D, Ballo MT (2017) Comparative neurologic outcomes of salvage and definitive Gamma Knife radiosurgery for glomus jugulare: a 20-year experience. J Neurol Surg B Skull Base

  65. Wang ML, Hussey DH, Doornbos JF, Vigliotti AP, Wen BC (1988) Chemodectoma of the temporal bone: a comparison of surgical and radiotherapeutic results. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/0360-3016(88)90084-3

  66. Wegner RE, Rodriguez KD, Heron DE, Hirsch BE, Ferris RL, Burton SA (2010) Linac-based stereotactic body radiation therapy for treatment of glomus jugulare tumors. Radiother Oncol. https://doi.org/10.1016/j.radonc.2010.09.004

  67. Winford TW, Dorton LH, Browne JD, Chan MD, Tatter SB, Oliver ER (2017) Stereotactic radiosurgical treatment of glomus jugulare tumors. Otol Neurotol. https://doi.org/10.1097/MAO.0000000000001336

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA

    Nida Fatima, Steven D. Chang & Antonio Meola

  2. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA

    Erqi Pollom & Scott Soltys

Authors
  1. Nida Fatima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erqi Pollom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott Soltys
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven D. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Meola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nida Fatima.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable.

Informed consent

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 63 kb)

ESM 2

(DOCX 70 kb)

ESM 3

(DOC 64 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fatima, N., Pollom, E., Soltys, S. et al. Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurg Rev 44, 741–752 (2021). https://doi.org/10.1007/s10143-020-01292-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-020-01292-5

Keywords

Search

Navigation