title: Treatment of head and neck paragangliomas with external beam radiation therapy.
abstract: OBJECTIVE
  To retrospectively assess the outcomes of radiation therapy in patients with head and neck paragangliomas.
  
  
  METHODS
  From 1990 to 2009, 66 patients with 81 head and neck paragangliomas were treated by conventional external beam radiation therapy in 25 fractions at a median dose of 45 Gy (range, 41.4-68 Gy). One case was malignant. The median gross target volume and planning target volume were 30 cm(3) (range, 0.9-243 cm(3)) and 116 cm(3) (range, 24-731 cm(3)), respectively. Median age was 57.4 years (range, 15-84 years). Eleven patients had multicentric lesions, and 8 had family histories of paraganglioma. Paragangliomas were located in the temporal bone, the carotid body, and the glomus vagal in 51, 18, and 10 patients, respectively. Forty-six patients had exclusive radiation therapy, and 20 had salvage radiation therapy. The median follow-up was 4.1 years (range, 0.1-21.2 years).
  
  
  RESULTS
  One patient had a recurrence of temporal bone paraganglioma 8 years after treatment. The actuarial local control rates were 100% at 5 years and 98.7% at 10 years. Patients with multifocal tumors and family histories were significantly younger (42 years vs 58 years [P=.002] and 37 years vs 58 years [P=.0003], respectively). The association between family predisposition and multifocality was significant (P<.001). Two patients had cause-specific death within the 6 months after irradiation. During radiation therapy, 9 patients required hospitalization for weight loss, nausea, mucositis, or ophthalmic zoster. Two late vascular complications occurred (middle cerebral artery and carotid stenosis), and 2 late radiation-related meningiomas appeared 15 and 18 years after treatment.
  
  
  CONCLUSIONS
  Conventional external beam radiation therapy is an effective and safe treatment option that achieves excellent local control; it should be considered as a first-line treatment of choice for head and neck paragangliomas.
authors.affiliation: Department of Radiotherapy, Comprehensive Cancer Center, Institut Bergonié, Bordeaux, France. Electronic address: c.dupin@bordeaux.unicancer.fr.
authors.forename: Charles
authors.initials: C
authors.lastname: Dupin
authors.affiliation: Department of Radiotherapy, Pitié Salpétrière, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lang
authors.affiliation: Department of Radiotherapy, Hopital Européen Georges Pompidou, Paris, France.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Dessard-Diana
authors.affiliation: Department of Radiotherapy, Pitié Salpétrière, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Simon
authors.affiliation: Department of Radiotherapy, Pitié Salpétrière, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cuenca
authors.affiliation: Department of Radiotherapy, Pitié Salpétrière, Paris, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Mazeron
authors.affiliation: Department of Radiotherapy, Pitié Salpétrière, Paris, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Feuvret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002345:Carotid Body Tumor / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005918:Glomus Tumor / Q000473:pathology / Q000532:radiotherapy*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D010236:Paraganglioma, Extra-Adrenal / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000150:complications; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D012888:Skull Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D013701:Temporal Bone / Q000473:pathology; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult