Debulking surgery prior to stereotactic radiotherapy for head and neck paragangliomas.

Abstract

Background: Surgery has been used as standard treatment for head and neck paragangliomas. Stereotactic radiotherapy (SRT) has also been increasingly used for this disease. The results for combined modality are not well described. This analysis aims to describe the results for combined modality of debulking surgery and SRT for head and neck paragangliomas (HNP).

Materials and and methods: Retrospective cohort of patients treated in a large university hospital between 2008 and 2023.

Results: Fifty-one patients had their charts reviewed. Mean age was 56.3 years. Most were female (82.3%). Most lesions arose from the skull-base (84.3%) and not the inner ear. Most lesions were larger than 3 cm (51.0%) and mean lesion size was 4.4 cm. 36 (70.6%) were treated with radiotherapy alone while 15 (29.4%) were treated with combined modality treatment. Median follow-up was 42.5 months (7.1-112.8 months). There were no reported deaths nor disease progression. Debulking surgery did not impact response rate for SRT (52.8% vs. 47.2% for SRT alone and debulking surgery, respectively, p = 0.971). There was no impact on new neurological deficits after SRT (25.0 vs. 13.3%, respectively, p = 0.356).

Conclusion: Debulking surgery did not improve response rate for SRT. In our sample, it also did not impact new neurological deficits for SRT. Prospective data regarding HNP treatment is needed.