Artikel
Stereotactic LINAC radiosurgery for the treatment of patients with glomus jugulare tumors
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Autoren
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F. El Majdoub
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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M. Hoevels
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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C. Bührle
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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R.P. Müller
- Klinik für Strahlentherapie, Klinikum der Universität zu Köln
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V. Sturm
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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M. Maarouf
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
| Veröffentlicht: | 28. April 2011 |
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Gliederung
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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.
