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Comparison of Treatment Outcome in Patients with Glomus Jugular Tumors after Surgery and Radiotherapy
Background: There are various treatments such as surgery, radiotherapy, embolization or combination therapies for glomus jugular tumors. Selecting an effective treatment for a glomus jugular tumor has been a challenging controversy for decades. We conducted a retrospective study to compare treatment success and complications after surgery or radiotherapy in patients with glomus jugular tumors.
Methods: We retrospectively studied 58 patients who received treatment for Types B, C, and D (Fisch classification) glomus jugular tumors from 2009 to 2019 at two institutions. Forty-three patients were treated with type A infratemporal fossa surgical approach. Of the 15 patients who received radiotherapy, 11 patients underwent 30 sessions of radiotherapy with a total cumulative dose of 5,520 cGy, one patient underwent 21 sessions with a total cumulative dose of 3,864, and 3 cases underwent 33 sessions with a total cumulative dose of 6,600 cGy.
Results: The mean follow-up period of patients in the surgical group was 26.74 ± 18.85 months and in the radiotherapy group was 26.8 ± 11.24. Postoperative local control rates for type B, C1, and C2 tumors were 100, 93, and 92%, respectively. Local control after radiotherapy for these tumors was 100%. The rates of cranial nerve injury in the surgery group for type B and C1 and C2 tumors were 0, 8, and 0%, respectively. This rate was 25 and 33% in radiotherapy groups for C1 and C2 tumors, respectively. Local control rates for tumors C3 and C2DeDi after surgery were 50 and 89%, respectively, and after radiotherapy were 66 and 60%, respectively. Cranial nerve injury was found in 66 and 33% in surgery group for type C3 and C2DeDi tumors. There was no cranial nerve damage after radiotherapy in these types of tumors. In types B, C1, and C2, the rate of cranial nerve complications was lower in the surgical group than in the radiotherapy group (p < 0.001). However, in more advanced types of the Fisch classification (C3 and C2DeDi), the rate of these complications was higher in the surgery group (p < 0.001). The extent of cranial nerve injury after radiotherapy did not depend on the classification, but in the surgical group, the more advanced the classification, the greater the complication rates are.
Conclusion: Surgery seems to be a suitable primary treatment method in the patients with types B, C1, and C2 glomus tumors, considering the appropriate local control and low cranial nerve injury rate. However, in type C3 and C2DeDi tumors, due to equal local control in surgery and radiotherapy and a higher rate of complications in surgery, radiotherapy can be suggested as the primary method of treatment.
Article published online:
12 February 2021
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