Krych Aaron J, Foote Robert L, Brown Paul D, Garces Yolanda I, Link Michael J
Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1063-6. doi: 10.1016/j.ijrobp.2006.02.020. Epub 2006 May 6.
The management of paragangliomas is controversial. Observation, surgery, external-beam radiotherapy (EBRT), and stereotactic radiosurgery (SRS) may, alone or in combination, be appropriate, depending on the size and extent of the tumor, previous treatment, and patient age, general health, and neurologic condition. Few data exist regarding long-term tumor control and late effects after EBRT or SRS.
We performed a retrospective review of all patients treated with EBRT or SRS for paraganglioma at our institution between 1967 and 1994. The endpoints of the study were tumor control and late complications.
The 33 patients in this study had a median follow-up of 13 years (range, 4 months to 36 years). The 10-year tumor control rate was 92% (95% confidence interval, 75-98%). At the last follow-up visit, no patient had developed a radiation-induced malignancy.
External-beam RT and SRS are safe and effective for enlarging and/or symptomatic paragangliomas. The risk of developing a delayed radiation-induced malignancy after EBRT or SRS is low. This risk must be weighed against the significant immediate and permanent risk of cranial nerve deficits if the tumor is untreated or is surgically resected. This risk must also be weighed against the immediate but low risk of surgical mortality.
副神经节瘤的治疗存在争议。观察、手术、外照射放疗（EBRT）和立体定向放射外科治疗（SRS）单独或联合使用可能都是合适的，具体取决于肿瘤的大小和范围、既往治疗情况以及患者的年龄、一般健康状况和神经状况。关于EBRT或SRS后的长期肿瘤控制和晚期效应的数据很少。
我们对1967年至1994年间在本机构接受EBRT或SRS治疗副神经节瘤的所有患者进行了回顾性研究。研究的终点是肿瘤控制和晚期并发症。
本研究中的33例患者中位随访时间为13年（范围4个月至36年）。10年肿瘤控制率为92%（95%置信区间，75 - 98%）。在最后一次随访时，没有患者发生放射性诱发的恶性肿瘤。
外照射放疗和SRS对于增大和/或有症状的副神经节瘤是安全有效的。EBRT或SRS后发生延迟性放射性诱发恶性肿瘤的风险较低。如果肿瘤未治疗或接受手术切除，必须将这种风险与颅神经缺损的重大即时和永久性风险进行权衡。这种风险还必须与手术死亡率的即时但较低风险进行权衡。
