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

Archives of oto-rhino-laryngology - Tập 271 - Trang 23-34 - 2013
Carlos Suárez1, Juan P. Rodrigo1,2, William M. Mendenhall3, Marc Hamoir4, Carl E. Silver5, Vincent Grégoire6, Primož Strojan7, Hartmut P. H. Neumann8, Rupert Obholzer9, Christian Offergeld10, Johannes A. Langendijk11, Alessandra Rinaldo12, Alfio Ferlito12
1Department of Otolaryngology, Hospital Universitario Central de Asturias Oviedo, Oviedo, Spain
2Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
3Department of Radiation Oncology, University of Florida, Gainesville, USA
4Department of Head and Neck Surgery, St. Luc University Hospital and Cancer Center, Brussels, Belgium
5Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
6Radiation Oncology Department and Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium
7Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
8Department of Nephrology and General Medicine, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
9Department of Otolaryngology, Guy’s Hospital, London, UK
10Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Freiburg, Germany
11Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
12ENT Clinic, University of Udine, Udine, Italy

Tóm tắt

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.

Tài liệu tham khảo

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