The Role of Wait-and-Scan and the Efficacy of Radiotherapy in the Treatment of Temporal Bone Paragangliomas

Objective: To define the role of wait-and-scan and radiotherapy (RT) in the treatment of temporal bone paragangliomas and to review the literature on the outcomes of RT as a treatment modality. Materials and Methods: This was a retrospective and literature review. The records of 381 patients with 382 tumors between 1988 and 2012 were analyzed. Patients who were subjected to initial wait-and-scan or primary RT were analyzed for tumor response, facial, and lower cranial nerve status on follow-up (FU). Results and Observations: None of the 145 patients (38%) with Class A and B tumors were subjected to wait-and-scan or RT and all were operated on. Of the 237 patients (62%) with Class C and D tumors, 47 (19.8%) were subjected to an initial wait-and-scan policy and 1 (0.4%) underwent primary RT. In 24 patients subjected to wait-and-scan with a FU of less than 3 years, tumor remained stable in 22 patients (92%). In 12 patients with a FU between 3 and 5 years, the tumor remained stable or regressed in 10 patients (83%). In 11 patients with a FU of more than 5 years, the tumor remained stable or regressed in 5 patients (45%). A literature review of the results of RT did not conclusively prove that it was effective as a primary modality of treatment for temporal bone paragangliomas. Conclusion: In elderly patients with advanced tumors, a wait-and-scan approach is recommended, and RT is initiated only when fast-growing tumors are detected. There is insufficient evidence in literature to suggest that RT could be an effective alternative to surgery in Class C and D tumors. Otol Neurotol 35: 922-931, 2014.