The role of radiation therapy in the management of head and neck paragangliomas: impact of quality of life versus treatment response.

Abstract

To assess the impact of radiotherapy in paragangliomas (PGLs) with regard to overall survival, local control, volumetric response and particularly quality of life (QoL). From 1985 to 2010, 130 cases of head and neck (H&N) PGLs were managed at Bordeaux University Hospital. With a median follow-up of 7.6 years, we retrospectively present a cohort of 30 consecutive patients treated with radiation therapy for H&N PGLs. QoL was evaluated for 20 patients by the EORTC QLQ-C30 and H&N35 questionnaires through a cross-sectional study. The 5-year overall survival and local control were 95% and 96% respectively. QoL is altered following management of PGLs. The H&N35 score is lower after combined modality therapy (surgery±embolization and radiation therapy) for speech and hearing (p=0.004), trismus (p=0.003) and total score (p=0.01) than after radiotherapy alone. Tumor shrinkage was significant at 2 and 3 years after radiotherapy (p=0.018; p=0.043). Ultimate QoL should be a major goal of any treatment strategy for this benign disease. Definitive radiotherapy should be considered as a reasonable alternative to multimodality treatment as it provides comparable disease control with an apparent improvement in QoL.