title: Malignant head and neck paragangliomas: is there an optimal treatment strategy?
abstract: BACKGROUND
  Little is known about management and prognosis for malignant head & neck paragangliomas. We reviewed records of these patients to determine optimal treatment strategies.
  
  
  METHODS
  We reviewed 113 cases of head & neck paragangliomas treated at our institution from 1970 to 2005. Nineteen patients were included in the study. All had primary surgical treatment at another institution. Metastatic disease was treated with radiation, chemotherapy, or both. Survival and complications were evaluated. P values were determined by Fischer's exact test.
  
  
  RESULTS
  All patients treated with chemotherapy and radiation age ≥ 40 years had disease progression. Of the patients < 40, two had stable disease; one had regression of disease with treatment. Patients without disease progression had better prognosis and were alive at last follow-up.
  
  
  CONCLUSIONS
  Clinical benefit was derived from aggressive treatment. However, careful consideration of the risks of observation versus intensive therapy should be undertaken when managing these patients.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Moskovic
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Smolarz
authors.forename: Douglas
authors.initials: D
authors.lastname: Stanley
authors.forename: Camilo
authors.initials: C
authors.lastname: Jimenez
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Williams
authors.forename: Ehab Y
authors.initials: EY
authors.lastname: Hanna
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kupferman
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002138:Calibration; D002985:Clinical Protocols / Q000592:standards*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010235:Paraganglioma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult