gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Stereotactic LINAC radiosurgery for the treatment of patients with glomus jugulare tumors

Meeting Abstract

  • F. El Majdoub - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
  • M. Hoevels - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
  • C. Bührle - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
  • R.P. Müller - Klinik für Strahlentherapie, Klinikum der Universität zu Köln
  • V. Sturm - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
  • M. Maarouf - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.03.06

DOI: 10.3205/11dgnc193, URN: urn:nbn:de:0183-11dgnc1936

Published: April 28, 2011

© 2011 El Majdoub et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: The optimal management of glomus jugulare tumors (GJTs) remains controversial. Surgical resection and fractionated external beam irradiation have been the best options but with a high morbidity rate. We evaluate the long-term efficacy of single-fraction stereotactic LINAC-Radiosurgery (LINAC-RS) for the treatment of GJTs.

Methods: Between May 1991 and June 2009, 27 consecutive patients (f:m = 20:7, median age: 60 years, range: 28.7 to 80 years) suffering from GJTs underwent LINAC-RS at our institution. Eleven patients underwent surgical resection at different institutions and eight of them underwent embolization prior to surgery. One patient received fractionated irradiation with a total dose of 64 Gy before LINAC-RS. The most common symptoms were pulsatile tinnitus (n=14), hyp-/anacusis (n=18), vertigo/dizziness (n=6) and weakness of cranial nerves V, VII, IX-XIII (n=21). A median therapeutic dose of 15 Gy (range: 11 to 20 Gy) was applied to the tumor surface. The median isodose was 70% (range 44 to 80%) and the median number of isocenters was 4 (range 1 to 7). Since 2002 13 patients underwent LINAC-RS with the Micro-Multi-Leaf Collimator. The tumor volume ranged from 4.4 to 51 cm3 (median: 10.8cm3).

Results: After a median follow-up of 96 months (range: 4.6 to 218.6 months, 12 patients with a follow-up greater than 10 years) 17 patients improved in their neurological status. One patient developed a permanent paresis of the facial nerve (House & Brackmann grade II). Two patients died, one due to old age and one due to sepsis after hip surgery. Follow-up MR images show a regression in tumor size in 13 patients and a stable disease in 14 patients.

Conclusions: Stereotactic LINAC-Radiosurgery can achieve excellent long-term tumor control with low risk morbidity in the treatment of GJTs. It should be used as an alternative therapy regime to surgical resection or fractionated external beam radiation.