title: Initial radiographic tumor control is similar following single or multi-fractionated stereotactic radiosurgery for jugular paragangliomas.
abstract: OBJECTIVE
  To evaluate radiographic tumor control and treatment-related toxicity in glomus jugulare tumors treated with stereotactic radiosurgery (SRS).
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary academic referral center.
  
  
  METHODS
  Glomus jugulare tumors treated with SRS between 1998 and 2014 were identified. The data analysis only included patients with at least 18months of post-treatment follow up (FU).
  
  
  METHODS
  Patients were treated with either single fraction or fractionated SRS.
  
  
  METHODS
  Patient demographics and tumor characteristics were assessed. Radiographic control was determined by comparing pre and post treatment MRI, and was categorized as no change, regression, or progression.
  
  
  RESULTS
  Eighteen patients were treated with SRS, and 14 met inclusion criteria. Median age at treatment was 55years (range 35-79), and 71.4% of patients were female. 5 patients (35.7%) received single fraction SRS (dose range 15-18Gy), and 9 (64.3%) fractionated therapy (dose 3-7Gy×3-15 fractions). Median tumor volume was 3.78cm(3) (range 1.15-30.6). Median FU was 28.8months (range 18.6-56.1), with a mean of 31.7months. At their last recorded MRI, 7 patients (50%) had tumor stability, 6 (42.9%) had improvement, and 1 (7.1%) had progression. Disease improvement and progression rates in the single fraction group were 40% and 0%, and in the multiple-fraction group, 44.4% and 11.1%, respectively. There was no statistically significant difference in disease improvement (p=0.88) or progression (p=0.48) rates between groups (unpaired t-test).
  
  
  CONCLUSIONS
  At a median follow up of 28months, both single fraction and fractionated SRS appear to have comparable radiographic tumor control outcomes and toxicity profiles.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schuster
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Sweeney
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Stavas
authors.affiliation: College of Medicine, Meharry Medical College, Nashville, TN.
authors.forename: Kyrollos Y
authors.initials: KY
authors.lastname: Tawfik
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Albert
authors.initials: A
authors.lastname: Attia
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cmelak
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: george.wanna@vanderbilt.edu.
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
mesh_terms: D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D005925:Glomus Jugulare Tumor / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome