Tran Ba Huy P
2, rue Saint-Petersbourg, 75010 Paris, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2014 Sep;131(4):223-6. doi: 10.1016/j.anorl.2014.01.003. Epub 2014 Jun 5.
Surgery has been long considered to be the treatment of choice for glomus jugulare paragangliomas, as it is the only modality able to totally eradicate the tumour. However, despite considerable progress in interventional radiology and nerve monitoring, surgery is associated with an unacceptably high complication rate for a benign tumour, explaining the growing place of radiotherapy in the management of these tumours. This review of the literature confirms the efficacy of conformal radiotherapy with or without intensity modulation and stereotactic radiotherapy, which both achieve tumour control rates ranging from 90% to almost 100% of cases, but for different tumour volumes, almost constant stabilization or even improvement of symptoms, and a considerably lower rate of adverse effects than with surgery. However, radiotherapy remains contraindicated in the presence of intracranial invasion or extensive osteomyelitis. In the light of these results, together with the improved quality of life and a better knowledge of the natural history of this disease, many authors propose radiotherapy as first-line treatment for all glomus jugulare paragangliomas regardless of their size, particularly in patients with no preoperative deficits.
长期以来，手术一直被视为颈静脉球副神经节瘤的首选治疗方法，因为它是唯一能够完全根除肿瘤的方式。然而，尽管介入放射学和神经监测取得了显著进展，但对于一种良性肿瘤而言，手术相关的并发症发生率高得令人难以接受，这也解释了放射治疗在这些肿瘤管理中所占比重日益增加的原因。这篇文献综述证实了适形放疗（无论有无调强）和立体定向放疗的疗效，这两种放疗方式在90%至几乎100%的病例中都能实现肿瘤控制率，但针对不同肿瘤体积，症状几乎能持续稳定甚至改善，且不良反应发生率远低于手术。然而，对于存在颅内侵犯或广泛骨髓炎的情况，放射治疗仍属禁忌。鉴于这些结果，再加上生活质量的提高以及对该疾病自然史的更深入了解，许多作者建议将放射治疗作为所有颈静脉球副神经节瘤的一线治疗方法，无论其大小如何，特别是对于术前无功能缺损的患者。
