Stereotactic Body Radiation Therapy in the Management of Recurrent Unresectable Retroperitoneal Ganglioneuroma

Ganglioneuromas are rare, benign tumors arising from neural crest cells, typically managed with surgical resection. We present a unique case of a 35-year-old man with a history of ganglioneuroma resected in early childhood, who developed a recurrent retroperitoneal mass more than 30 years later. Imaging revealed a 12 cm lesion encasing critical structures, rendering it surgically unresectable. The patient underwent stereotactic body radiotherapy (SBRT), receiving 40 Gy in five fractions using volumetric modulated arc therapy (VMAT). Treatment was well-tolerated with no significant toxicity. Follow-up imaging over two years demonstrated stable disease without progression or symptom recurrence. To our knowledge, this is the first reported case of SBRT utilized for a retroperitoneal ganglioneuroma, highlighting its potential as a noninvasive alternative in cases where surgery is contraindicated. This case underscores the importance of long-term surveillance in patients with previously resected ganglioneuromas and suggests that SBRT may be a viable treatment option when surgical intervention poses significant risks.