Head and neck paragangliomas: 30-year experience.

Area of Science:

• Otolaryngology
• Neurosurgery
• Endocrinology

Background:

• Head and neck paragangliomas (HNPG) encompass a spectrum of neuroendocrine tumors.
• Management strategies for HNPG have evolved over recent decades.
• HNPGs present unique challenges due to their location and potential for morbidity.

Purpose of the Study:

• To review institutional experience with head and neck paraganglioma (HNPG) management.
• To identify trends in HNPG treatment over a 30-year period.
• To evaluate the efficacy of different treatment modalities for HNPG.

Main Methods:

• Retrospective review of 103 patients with HNPG treated between 1986 and 2017.
• Analysis of treatment outcomes for surgery, radiotherapy, and active surveillance.
• Stratification of data by decade to identify changes in management approaches.

Main Results:

• Surgery for carotid body tumors (CBT) resulted in cranial nerve deficits in 20% of cases.
• Non-CBTs had a significantly higher rate of cranial nerve deficits (95%) after surgery.
• Radiotherapy achieved growth control in all treated tumors (n=10); 70% of observed patients remained stable.
• A trend towards increased initial observation and decreased upfront surgery was noted over the decades.

Conclusions:

• Surgery is an effective treatment for carotid body tumors (CBT).
• Nonsurgical management, including active surveillance, should be considered for non-CBTs.
• Evolving trends favor less invasive approaches for select HNPGs, with no attributable deaths in the study cohort.