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Clin Otolaryngol. 2018 Apr;43(2):652-661. doi: 10.1111/coa.13046. Epub 2018 Jan 3.

Results of a systematic literature review of treatment modalities for jugulotympanic paraganglioma, stratified per Fisch class.

Author information

1
Department of Otolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands.
2
Department of Endocrinology, Radboud Skull Base Centre, Radboudumc, Nijmegen, The Netherlands.
3
Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands.
4
Department of Otolaryngology and Head & Neck Surgery, Radboudumc Skull Base Centre, Radboudumc, Nijmegen, The Netherlands.

Abstract

OBJECTIVE:

Key for successful jugulotympanic paraganglioma management is a personalised approach aiming for the best practice for each individual patient. To this end, a systematic review is performed, evaluating the local control and complication rates for the different treatment modalities stratified by the broadly accepted Fisch classification.

DESIGN:

A systematic literature review according to the PRISMA statement was performed. A detailed overview of individual treatment outcomes per Fisch class is provided.

MAIN OUTCOME MEASURES:

Local control, cranial nerve damage, complications, function recovery.

RESULTS:

Eighteen studies were selected, resembling 83 patients treated with radiotherapy and 299 with surgery. Excellent local control was found post-surgery for class A and B tumours, and risk of cranial nerve damage was <1%. For class C1-4 tumours, local control was 80%-95% post-surgery (84% post-radiotherapy), and cranial nerve damage was found in 71%-76% (none post-radiotherapy; P < .05). There was no difference in treatment outcomes between tumours of different C class. For class C1-4De/Di tumours, local control was 38%-86% (98% post-radiotherapy; P < .05) and cranial nerve damage/complication rates were 67%-100% (3% post-radiotherapy; P < .05). C1-4DeDi tumours showed lesser local control and cranial nerve damage rates when compared to C1-4De tumours.

CONCLUSIONS:

An individual risk is constituted for surgery and radiotherapy, stratified per Fisch class. For class A and B tumours, surgery is a suitable treatment option. For class C and D tumours, radiotherapy results in lower complication rates and similar or better local control rates when compared to the surgical group.

KEYWORDS:

Fisch class; jugulotympanic; paraganglioma; review; treatment

PMID:
29222838
DOI:
10.1111/coa.13046
[Indexed for MEDLINE]

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