Leiden University Medical Center, Leiden, The Netherlands.
Radiother Oncol. 2013 Feb;106(2):161-8. doi: 10.1016/j.radonc.2012.11.002. Epub 2013 Jan 16.
The primary treatment goal of radiotherapy for paragangliomas of the head and neck region (HNPGLs) is local control of the tumor, i.e. stabilization of tumor volume. Interestingly, regression of tumor volume has also been reported. Up to the present, no meta-analysis has been performed giving an overview of regression rates after radiotherapy in HNPGLs. The main objective was to perform a systematic review and meta-analysis to assess regression of tumor volume in HNPGL-patients after radiotherapy. A second outcome was local tumor control. Design of the study is systematic review and meta-analysis. PubMed, EMBASE, Web of Science, COCHRANE and Academic Search Premier and references of key articles were searched in March 2012 to identify potentially relevant studies. Considering the indolent course of HNPGLs, only studies with ≥ 12 months follow-up were eligible. Main outcomes were the pooled proportions of regression and local control after radiotherapy as initial, combined (i.e. directly post-operatively or post-embolization) or salvage treatment (i.e. after initial treatment has failed) for HNPGLs. A meta-analysis was performed with an exact likelihood approach using a logistic regression with a random effect at the study level. Pooled proportions with 95% confidence intervals (CI) were reported. Fifteen studies were included, concerning a total of 283 jugulotympanic HNPGLs in 276 patients. Pooled regression proportions for initial, combined and salvage treatment were respectively 21%, 33% and 52% in radiosurgery studies and 4%, 0% and 64% in external beam radiotherapy studies. Pooled local control proportions for radiotherapy as initial, combined and salvage treatment ranged from 79% to 100%. Radiotherapy for jugulotympanic paragangliomas results in excellent local tumor control and therefore is a valuable treatment for these types of tumors. The effects of radiotherapy on regression of tumor volume remain ambiguous, although the data suggest that regression can be achieved at least in some patients. More research is needed to identify predictors for treatment success.
头颈部副神经节瘤（HNPGL）放射治疗的主要治疗目标是局部控制肿瘤，即稳定肿瘤体积。有趣的是，也有报道称肿瘤体积有消退。截至目前，尚无荟萃分析全面概述 HNPGL 放疗后的消退率。主要目的是进行系统评价和荟萃分析，以评估 HNPGL 患者放疗后肿瘤体积的消退情况。第二个结果是局部肿瘤控制。研究设计为系统评价和荟萃分析。2012 年 3 月，检索了 PubMed、EMBASE、Web of Science、COCHRANE 和 Academic Search Premier 以及关键文章的参考文献，以确定潜在相关的研究。考虑到 HNPGL 生长缓慢，只有随访时间≥12 个月的研究才有资格纳入。主要结局是 HNPGL 初始、联合（即直接术后或栓塞后）或挽救治疗（即初始治疗失败后）放疗后的肿瘤消退和局部控制的汇总比例。使用具有随机效应的逻辑回归进行精确似然方法进行荟萃分析。以 95%置信区间（CI）报告汇总比例。纳入了 15 项研究，涉及 276 例患者的 283 例颈静脉鼓室副神经节瘤。在放射外科研究中，初始、联合和挽救治疗的肿瘤消退汇总比例分别为 21%、33%和 52%，在外部束放射治疗研究中分别为 4%、0%和 64%。初始、联合和挽救治疗的局部控制汇总比例范围为 79%至 100%。放射治疗颈静脉鼓室副神经节瘤可获得极好的局部肿瘤控制，因此是治疗此类肿瘤的有价值方法。放射治疗对肿瘤体积消退的影响仍存在争议，尽管数据表明至少在一些患者中可以实现消退。需要进一步研究以确定治疗成功的预测因素。
