title: Successful treatment of glomus jugulare tumours with gamma knife radiosurgery: clinical and physical aspects of management and review of the literature.
abstract: OBJECTIVE
  To demonstrate the feasibility of treatment and early outcomes for patients treated with gamma knife radiosurgery (GKR), with or without surgical resection, for glomus jugulare tumours.
  
  
  METHODS
  Between January 2007 and November 2008, 10 patients with glomus jugulare tumours were treated with GKR. Eight had prior surgical resection, seven subtotal resection and one total resection. In two cases GKR was the only definitive therapy. Baseline neurological deficits were prospectively recorded and present in 90% prior to GKR. The median tumour size and volume were 4 cc (0.7-10.9 cc). The median marginal tumour dose was 14 Gy (12-16 Gy). Clinical and radiographic outcomes are reported with a median follow-up of 9.7 months.
  
  
  RESULTS
  Stereotactic frame placement allowed treatment of all 10 lesions, although 3-point fixation was sometimes required to avoid collisions. No patients developed worsening of symptoms or new neurological complaints after GKR; symptom relief was achieved in 50% of cases. No cases of clinical or radiographic progression were identified. Radiographically, 80% of lesions were stable and 20% showed significant shrinkage.
  
  
  CONCLUSIONS
  GKR is an excellent option for patients with glomus jugulare tumours after complete or subtotal resection or at recurrence. Appropriately planned frame placement allows successful treatment delivery without difficulty. GKR improved symptoms, prevented neurological progression and achieved radiographic stability or regression in all cases.
authors.affiliation: Radiation Oncology Department, Hospital Duran i Reynals (ICO), Hospitalet de Llobregat, Barcelona, Spain. anavarro@iconcologia.net
authors.forename: Arturo
authors.initials: A
authors.lastname: Navarro Martín
authors.forename: Ann
authors.initials: A
authors.lastname: Maitz
authors.forename: Inga S
authors.initials: IS
authors.lastname: Grills
authors.forename: Dennis
authors.initials: D
authors.lastname: Bojrab
authors.forename: Jack
authors.initials: J
authors.lastname: Kartush
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Chen
authors.forename: Joav
authors.initials: J
authors.lastname: Hahn
authors.forename: Daniel
authors.initials: D
authors.lastname: Pieper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005925:Glomus Jugulare Tumor / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012008:Recurrence; D013238:Stereotaxic Techniques; D016896:Treatment Outcome