Surgery, radiotherapy or a combined modality for jugulotympanic paraganglioma of Fisch class C and D

Clin Otolaryngol. 2018 Dec;43(6):1566-1572. doi: 10.1111/coa.13216. Epub 2018 Sep 26.


Objectives: To identify the risks associated with surgery, radiotherapy or a combined treatment approach for Fisch class C and D jugulotympanic paraganglioma, in order to develop an individualised approach for each patient depending on Fisch class, age, mutation presence, tumour size growth rate and presenting symptoms.

Design: A retrospective multicenter cohort study with all patient records of patients with a head and neck paraganglioma in the Radboudumc, Nijmegen and the St. Elisabeth Hospital, Tilburg, the Netherlands.

Main outcome measures: Local control, cranial nerve damage, complications, function recovery.

Results: We found highest local control rates after tumour debulking with postoperative radiotherapy in case of residual tumour growth, referred to as the combined treatment group, (100%; n = 19), which was significantly higher than the surgical group (82%; n = 17; P = 0.00), but did not differ from the radiotherapy group (90%; n = 29). There were significantly less complications in the radiotherapy group, when compared to surgery (63 vs 27%; P = 0.002) and the combined group (44 vs 27%; P = 0.016). Furthermore,: using a logistic regression model, we found that pretreatment tumour growth was a negative predictor for post-treatment cranial nerve function recovery (OR = 50.178, P = 0.001), reducing the chance of symptom recovery (67.3% vs 35.7%) post-treatment.

Conclusions: Radiotherapy should be the treatment of choice for the elderly. For younger patients, tumour debulking should be considered, with potential radiotherapy in case of residual tumour growth.

Keywords: debulking; jugulotympanic; paraganglioma; radiotherapy; surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Combined Modality Therapy / methods
  • Ear Neoplasms / diagnosis
  • Ear Neoplasms / epidemiology
  • Ear Neoplasms / therapy*
  • Female
  • Follow-Up Studies
  • Glomus Jugulare Tumor / diagnosis
  • Glomus Jugulare Tumor / epidemiology
  • Glomus Jugulare Tumor / therapy*
  • Head and Neck Neoplasms / diagnosis
  • Head and Neck Neoplasms / epidemiology
  • Head and Neck Neoplasms / therapy*
  • Hearing / physiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Otologic Surgical Procedures / methods*
  • Paraganglioma / diagnosis
  • Paraganglioma / epidemiology
  • Paraganglioma / therapy*
  • Radiotherapy, Adjuvant / methods
  • Recovery of Function
  • Retrospective Studies
  • Young Adult