title: Experiences in the treatment of patients with multiple head and neck paragangliomas.
abstract: OBJECTIVE
  To analyze treatment results in the multidisciplinary management of patients with multiple head and neck paragangliomas (HNPs).
  
  
  METHODS
  Retrospective analysis including all patients with multiple HNPs (VP, vagal paraganglioma; JTP, jugulotympanic paraganglioma; CBT, carotid body tumor) treated between 2000 and 2013 at a tertiary referral center.
  
  
  RESULTS
  Ten patients (three men, seven women) had 25 HNPs (two VPs, eight JTPs, and 15 CBTs). The age range at diagnosis was 31-71 years (mean 40.9 years, median 37 years). Nine tumors (four CBTs, three JTPs, two VPs) were treated only with stereotactic radiotherapy (SRT; 50.4-56Gy, mean 55.3Gy) or in one case intensity-modulated radiotherapy (60 Gy). Nine tumors were treated with surgery alone (eight CBTs, one JTP) and three JTPs with subtotal surgery combined with adjuvant SRT. A "wait and scan" strategy was used in three cases (two CBTs, one JTP). The mean follow-up period was 4.3 years (range 0.1-13 years, median 4 years). The rate of tumor control with surgery and/or SRT was 100% (21/21). One patient with a wait-and-scan strategy for CBT had slow asymptomatic progression during a 13-year follow-up.
  
  
  CONCLUSIONS
  The treatment results in this series of patients with multiple HNPs show that a very high rate of long-term tumor control with low morbidity can be achieved using tailored and individualized approaches. All of the different treatment strategies available should be discussed with the patient. In particular, the treatment should involve a multidisciplinary team of experts in the fields of nuclear medicine, genetics, pathology, radiology, radio-oncology, and surgery.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany. Electronic address: julian.kuenzel@gmx.net.
authors.forename: Julian
authors.initials: J
authors.lastname: Künzel
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
authors.forename: Julie
authors.initials: J
authors.lastname: de Tristan
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mantsopoulos
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Koch
authors.affiliation: Department of Radiotherapy, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
authors.forename: Marcela
authors.initials: M
authors.lastname: Baussmerth
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Zenk
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Iro
mesh_terms: D000328:Adult; D000368:Aged; D002345:Carotid Body Tumor / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D010236:Paraganglioma, Extra-Adrenal / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016634:Radiosurgery; D050397:Radiotherapy, Intensity-Modulated; D016896:Treatment Outcome