Radiosurgery for Paragangliomas of the Head and Neck: Another Step for the Validation of a Treatment Paradigm.
BACKGROUND
Paragangliomas are highly vascular and predominantly benign neoplasms that traditionally have been treated by surgery, embolization, and/or external beam radiotherapy. The aim of this study was to evaluate long-term local tumor control and the safety of radiosurgery for head and neck paragangliomas.


METHODS
Data were obtained from prospectively maintained databases of patients affected by brain tumors treated with radiosurgery at our institution. The inclusion criteria were histologically proven or radiologic-suspected diagnosis of paragangliomas; a follow-up period of at least 12 months, an magnetic resonance imaging-based tumor growth control analysis and a signed written consent. Twenty patients (21 paragangliomas) met the eligibility criteria and were included in the present study. All patients were clinically and radiologically evaluated before and after treatment.


RESULTS
The mean follow-up at the time of the present analysis was 46 months. Seven patients had a follow-up longer than 60 months. Seven lesions underwent a single-session radiosurgery with a mean dose of 12.2 Gy (range 11-13 Gy). Fourteen lesions underwent multisession radiosurgery with a mean dose of 25.7 Gy (range 20-30 Gy) delivered in 3-5 fractions. The mean tumor volume for single-session radiosurgery was 4 cc (range 1.4-9.2). The mean volume for multisession radiosurgery was 18.9 cc (range 1.3-50.9). None of the lesions showed progression on radiology during the follow-up period. Neurologic conditions generally are maintained or improved.


CONCLUSIONS
Both single and multisession radiosurgery were confirmed as a safe and effective treatment modality for paragangliomas. Multisession radiosurgery appears effective to treat large lesions.
Radiotherapy Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy. Electronic address: Marcello.Marchetti@istituto-besta.it.
Marcello
M
Marchetti
Radiotherapy Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
Valentina
V
Pinzi
Neuroepidemiology Unit, Health Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
Irene
I
Tramacere
CyberKnife Center, Centro Diagnostico Italiano (CDI), Milan, Italy.
Livia Corinna
LC
Bianchi
Health Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
Francesco
F
Ghielmetti
Radiotherapy Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
Laura
L
Fariselli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome
CyberKnife; Head and neck; Hypofraction; Paraganglioma; Radiosurgery