Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor

Radiation therapy for temporal bone paragangliomas has been advocated by many authors, but remains controversial. Radiation has little direct effect on the tumor cells, and diminution in tumor size is seldom seen. The main reason radiation therapy is recommended over surgical management of glomus tumors is its purported lower complication rate. We report a case of a lethal radiation-induced fibrosarcoma presenting 15 years following irradiation for a benign glomus jugulare tumor. Radiation-induced malignancies are rare, but are lethal when they occur. In experienced hands, surgical removal of glomus jugulare tumors carries a limited morbidity and virtually no mortality. In our opinion, the possibility of inducing a secondary life-threatening malignancy must be seriously considered when discussing therapeutic options with otherwise healthy individuals who are expected to survive 10 or more years after treatment.