title: The role of wait-and-scan and the efficacy of radiotherapy in the treatment of temporal bone paragangliomas.
abstract: OBJECTIVE
  To define the role of wait-and-scan and radiotherapy (RT) in the treatment of temporal bone paragangliomas and to review the literature on the outcomes of RT as a treatment modality.
  
  
  METHODS
  This was a retrospective and literature review. The records of 381 patients with 382 tumors between 1988 and 2012 were analyzed. Patients who were subjected to initial wait-and-scan or primary RT were analyzed for tumor response, facial, and lower cranial nerve status on follow-up (FU).
  
  
  RESULTS
  None of the 145 patients (38%) with Class A and B tumors were subjected to wait-and-scan or RT and all were operated on. Of the 237 patients (62%) with Class C and D tumors, 47 (19.8%) were subjected to an initial wait-and-scan policy and 1 (0.4%) underwent primary RT. In 24 patients subjected to wait-and-scan with a FU of less than 3 years, tumor remained stable in 22 patients (92%). In 12 patients with a FU between 3 and 5 years, the tumor remained stable or regressed in 10 patients (83%). In 11 patients with a FU of more than 5 years, the tumor remained stable or regressed in 5 patients (45%). A literature review of the results of RT did not conclusively prove that it was effective as a primary modality of treatment for temporal bone paragangliomas.
  
  
  CONCLUSIONS
  In elderly patients with advanced tumors, a wait-and-scan approach is recommended, and RT is initiated only when fast-growing tumors are detected. There is insufficient evidence in literature to suggest that RT could be an effective alternative to surgery in Class C and D tumors.
authors.affiliation: *Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome; †Department of Clinical and Experimental Medicine, Otolaryngology Unit, University-Hospital of Parma, Parma; ‡Unit of General Pathology, Aging Research Center (Ce.S.I.), G. d'Annunzio University Foundation, Chieti; §Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University, Chieti; and ∥Department of Otolaryngology, University of Chieti, Italy.
authors.forename: Sampath Chandra
authors.initials: SC
authors.lastname: Prasad
authors.forename: Hassen Ait
authors.initials: HA
authors.lastname: Mimoune
authors.forename: Flavia
authors.initials: F
authors.lastname: D'Orazio
authors.forename: Marimar
authors.initials: M
authors.lastname: Medina
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacciu
authors.forename: Renato
authors.initials: R
authors.lastname: Mariani-Costantini
authors.forename: Paolo
authors.initials: P
authors.lastname: Piazza
authors.forename: Mario
authors.initials: M
authors.lastname: Sanna
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D013701:Temporal Bone / Q000473:pathology*; D016896:Treatment Outcome; D057832:Watchful Waiting