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Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy

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Abstract

The definitive universally accepted treatment for carotid body tumors (CBT) is surgery. The impact of surgery on cranial nerves and the carotid artery has often been underestimated. Alternatively, a few CBTs have been followed without treatment or irradiation. The goal of this study is to summarize the existing evidence concerning the efficacy and safety of surgery and external beam radiotherapy (EBRT) for CBT. Relevant articles were identified using strict criteria for systematic searches. Sixty-seven articles met the criteria which included 2,175 surgically treated patients. On the other hand, 17 articles including 127 patients treated with EBRT were found. Long-term control of the disease was obtained in 93.8 % of patients who received surgical treatment and in 94.5 % of the radiotherapy group. Surgery resulted in 483 (483/2,175 = 22.2 %) new cranial nerve permanent deficits, whereas in the EBRT group, no new deficits were recorded (p = 0.004). The common/internal carotid artery was resected in 271 (12.5 %) patients because of injury or tumor encasement, with immediate reconstruction in 212 (9.7 %) patients. Three percent (60) of patients developed a permanent stroke and 1.3 % (26) died due to postoperative complications. The major complications rates and the mortality after completion of the treatment also were significantly higher in surgical series compared to EBRT series. This systematic analysis highlights evidence that EBRT offers a similar chance of tumor control with lower risk of morbidity as compared to surgery in patients with CBT. This questions the traditional notion that surgery should be the mainstay of treatment.

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Acknowledgments

Grant support: Carlos Suárez is supported by grants from the FIS (PI08/0531 and PI11/00929) and Red Tematica de Investigacion Cooperativa en Cancer (RD12/0036/0015). We thank Pablo Camblor (PhD) for his help in the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Hospital Universitario Central de Asturias Oviedo, Oviedo, Spain

    Carlos Suárez & Juan P. Rodrigo

  2. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain

    Carlos Suárez & Juan P. Rodrigo

  3. Department of Radiation Oncology, University of Florida, Gainesville, FL, USA

    William M. Mendenhall

  4. Department of Head and Neck Surgery, St. Luc University Hospital and Cancer Center, Brussels, Belgium

    Marc Hamoir

  5. Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Carl E. Silver

  6. Radiation Oncology Department and Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium

    Vincent Grégoire

  7. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia

    Primož Strojan

  8. Department of Nephrology and General Medicine, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany

    Hartmut P. H. Neumann

  9. Department of Otolaryngology, Guy’s Hospital, London, UK

    Rupert Obholzer

  10. Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Freiburg, Germany

    Christian Offergeld

  11. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Johannes A. Langendijk

  12. ENT Clinic, University of Udine, Piazzale S. Maria della Misericordia, I-33100, Udine, Italy

    Alessandra Rinaldo & Alfio Ferlito

Authors
  1. Carlos Suárez
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  2. Juan P. Rodrigo
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  3. William M. Mendenhall
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  4. Marc Hamoir
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  5. Carl E. Silver
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  6. Vincent Grégoire
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  7. Primož Strojan
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  8. Hartmut P. H. Neumann
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  9. Rupert Obholzer
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  10. Christian Offergeld
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  11. Johannes A. Langendijk
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  12. Alessandra Rinaldo
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  13. Alfio Ferlito
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Corresponding author

Correspondence to Alfio Ferlito.

Additional information

This paper was written by members and invitees of the International Head and Neck Scientific Group (http://www.IHNSG.com).

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Suárez, C., Rodrigo, J.P., Mendenhall, W.M. et al. Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy. Eur Arch Otorhinolaryngol 271, 23–34 (2014). https://doi.org/10.1007/s00405-013-2384-5

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  • DOI: https://doi.org/10.1007/s00405-013-2384-5

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