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

Purpose: To assess the impact of radiotherapy in paragangliomas (PGLs) with regard to overall survival, local control, volumetric response and particularly quality of life (QoL). Materials and methods: From 1985 to 2010, 130 cases of head and neck (H and 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 and N PGLs. QoL was evaluated for 20 patients by the EORTC QLQ-C30 and H and N35 questionnaires through a cross-sectional study. Results: The 5-year overall survival and local control were 95% and 96% respectively. QoL is altered following management of PGLs. The H and 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). Conclusion: 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