Received: 5 December 2016 Accepted: 30 March 2017 Published on: 24 May 2017
Robotic radiosurgery of head and neck paragangliomas:
a single institution experience
Radiation Oncology Division, Acıbadem
Bodrum Hospital, Mu
Department of Radiation Oncology, Acibadem
University, Istanbul, Turkey
IlkerTosun, OrtakentMah Gölba¸sı Sok No:11
48420, Bodrum – Mu
The study has not been previously presented.
is a robotic stereotactic radiotherapy system. The aim of this study is to eval-
uate the effectiveness and the safety of CyberKnife
on treating head and neck paragangliomas
and to report our results.
Methods: Between March 2009 and June 2014, 12 patients with head and neck paragangliomas
have been referred to our clinic: in three cases had jugular paragangliomas, ﬁve cases had carotid
body paragangliomas and three cases had tympanic paragangliomas. One patient had bilateral
neck paragangliomas (right neck; carotid body paraganglioma, left neck; jugular pargangliomas).
All of them received fractionated stereotactic radiotherapy with CyberKnife
up to a total
median dose of 24 Gy (reference isodose 67–90%). The median tumor volume was 35.5 cc (range,
5.3—113.8 cc). The median follow up was 30 months (range, 0–66 months). Local tumor control
was assessed according to RECIST criteria on follow-up imaging studies.
Results: There were no acute or late toxicity related with stereotactic radiotherapy after treat-
ment. No local tumor progression was observed on magnetic resonance imaging and none of our
patients showed progressive clinical status. Seven tumors shrinked in size (54%). Five tumors
(46%) had stable size during follow up. Local control rate was 100%.
Conclusion: Stereotactic radiotherapy is a good alternative to surgery for the treatment of
head and neck paragangliomas coming up with a clear beneﬁt of acute and late side effects.
seems to be a safe and efﬁcient system treating head and neck paragangliomas.
CyberKnife radiosurgery, glomus jugulare tumor, paraganglioma, radiosurgery, radiotherapy
Paragangliomas (PGLs) are rare neuroendocrine tumors, which are
derived from either parasympathetic or sympathetic paraganglia.
Parasympathetic ganglia-derived PGLs are mostly located at the neck
and skull base region.
Head and neck PGLs (HNPGLs), formerly
known as glomus tumors mostly occurs in the bifurcation of carotid
arteries (carotid body PGL), tympanic area (tympanic PGL), the dome
of internal jugular vein (jugular PGL) and along the vagal nerve (vagal
The speciﬁc incidence of PGLs are unknown as they are usu-
ally reported together with other pheochromocytomas. The annual
incidence of pheochromocytoma/PGLs has been estimated to be
0.8 per 100.000 person / year.
PGLs are mostly discovered in
the fourth and ﬁfth decades of life.
HNPGL patients tend to be
older than abdominal PGLs at the time of diagnosis (43 years vs.
36 years of age).
The male-to-female ratio of PGLs are usually
Most of PGLs have benign nature and have manageable size (the
average volume was 17.1 cm
for HNPGLs and 94.1 cm
A wait and scan approach is often advised as the majority
of HNGPLs have slow growing character.
Although HNPGLs are gen-
erally benign tumors, tumor bulk may result neurovascular structure
damage by cranial nerve deﬁcits and cause serious morbidity. The main
treatment options for HNPGLs are surgical resection and radiation
therapy (RT). Although tumors can be surgically resected it may lead
to neurovascular injury approximately in 60% of patients.
RT is an alternative treatment strategy for HNPGL patients.
HNPGLs can be treated by both conventionally fractionated RT
(CFRT) and stereotactic radiotherapy (SRT) approaches. Local
Asia-Pac J Clin Oncol. 2018;14:e3–e7.
2017 John Wiley & Sons Australia, Ltd e3wileyonlinelibrary.com/journal/ajco