Treatment of glomus jugulare tumors with gamma knife radiosurgery.

OBJECTIVE: Surgical resection, preoperative embolization, radiation therapy, and stereotactic radiosurgery have been used to treat glomus jugulare tumors (GJT). However, the optimal treatment of these tumors remains unclear. The authors report their data on treatment of GJTs with gamma knife radiosurgery (GKS).

DESIGN: Retrospective review and pooled analysis.

METHODS: Fifteen patients (nine female, six male) were treated with GKS at a single tertiary care institution for GJTs over a 14-year period. Criteria for selection included GKS followed by at least one posttreatment radiographic image, and volumetric analysis was performed. A required 15% change in tumor volume was considered real. Pooled analysis was performed to compare outcomes with other series.

RESULTS: The mean total radiologic follow-up was 43.2 months. The mean dose-to-the tumor margin was 14.6 Gy. The mean tumor size at treatment was 7.3 cc and 6.3 cc at last follow-up. After treatment, seven tumors decreased (46.7%), five remained unchanged (33.3%), and three (20%) grew on imaging. Treatment failures received a mean marginal dose of 13.2 Gy compared with 15.1 Gy for treatment successes (P =.08). Overall tumor control rate after GKS in the existing literature with inclusion of the present study is 90.5%.

CONCLUSIONS: GKS is an effective treatment option for patients with GJTs, including those with prior surgical resection. Marginal radiation doses greater than 13 Gy may be optimal for tumor control. Longer follow-up will better define the benefits and risks of stereotactic radiosurgery in treating patients with GJT.