Lightowlers S, Benedict S, Jefferies S J, Jena R, Harris F, Burton K E, Burnet N G
Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
Clin Oncol (R Coll Radiol). 2010 Jun;22(5):382-9. doi: 10.1016/j.clon.2010.02.006. Epub 2010 Mar 4.
Radiotherapy is an important treatment option for paraganglioma in the head and neck region. It seems to be highly effective and avoids important surgical morbidity, which can impair quality of life. The aim of this study was to evaluate the outcomes of radiotherapy for paraganglioma of the head and neck region in order to inform our future practice.
The cohort of patients for the present study comprised 21 patients who received radiotherapy between 1998 and 2008. Follow-up ranged from 6 to 132 months, median 55 months. The mean age was 48.7 years, range 20-78 years. The female:male ratio was 2 : 1. Two patients had confirmed familial tumour syndromes. The gross tumour volume in 20 cases ranged from 1.3 to 74 cm(3), mean 23.2 cm(3), median 14.7 cm(3). Five patients were treated with intensity-modulated radiotherapy. The median dose was 50 Gy in 30 fractions.
The crude 5-year local control rate was 95% (20/21), although the 5-year actuarial local control rate was 87%. The one patient who relapsed, at 45 months after radiotherapy, had a comparatively small tumour of 10.8 cm(3). A relationship between tumour volume and local control seems unlikely. It was possible to obtain details of side-effects from electronic records for 11 patients. Grade 3 headache, which resolved, was the most serious acute side-effect. One patient had three teeth extracted due to exacerbation of dental caries, and one had deterioration of hearing thought to be due to a combination of tumour and radiotherapy. There were two serious complications in patients who had embolisation, which we no longer use.
Our results show a high level of efficacy for fractionated external beam radiotherapy, with minimal toxicity, in keeping with other series. This should encourage the use of radiotherapy as primary treatment for paragangliomas of the head and neck region.
放射治疗是头颈部副神经节瘤的重要治疗选择。它似乎非常有效，且可避免会损害生活质量的重大手术并发症。本研究的目的是评估头颈部副神经节瘤放射治疗的效果，为我们未来的实践提供参考。
本研究的患者队列包括1998年至2008年间接受放射治疗的21例患者。随访时间为6至132个月，中位时间为55个月。平均年龄为48.7岁，范围为20至78岁。女性与男性比例为2∶1。2例患者确诊为家族性肿瘤综合征。20例患者的肿瘤总体积为1.3至74 cm³，平均23.2 cm³，中位14.7 cm³。5例患者接受调强放射治疗。中位剂量为50 Gy，分30次给予。
5年粗局部控制率为95%（20/21），尽管5年精算局部控制率为87%。1例在放疗后45个月复发的患者，肿瘤相对较小，为10.8 cm³。肿瘤体积与局部控制之间似乎没有关系。从11例患者的电子记录中可以获得副作用的详细信息。最严重的急性副作用是3级头痛，后来缓解。1例患者因龋齿加重拔除了3颗牙齿，1例患者听力下降，认为是肿瘤和放疗共同作用的结果。接受栓塞治疗的患者出现了2例严重并发症，我们已不再使用这种治疗方法。
我们的结果显示，分次外照射放疗疗效高、毒性小，与其他系列研究结果一致。这应鼓励将放射治疗作为头颈部副神经节瘤的主要治疗方法。
