JRSBRT 10.3, p. 207-218 (PDF)

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Tumor control, symptom trajectories, and toxicity outcomes of 46 head and neck paragangliomas treated with radiosurgery: A single-institution experience
Sreelakshmi, Ajay Sasidharan, Sruthi Kalavagunta, Devika Saju and Debnarayan Dutta

Objective: Single institution, ambispective analysis of head and neck paragangliomas treated with stereotactic radiosurgery/stereotactic radiotherapy.

Methods: Between January 2017 and October 2025, 46 patients [Female 72%, mean age 50.5 years, mean tumour volume 9.03 cm3] with 47 tumours were treated with robotic radiosurgery (CyberKnife M6, Multiplan). Clinical assessments were done at 3 months, 6 months, 1 year and annually thereafter. Radiological response assessment was according to RECIST v1.1, and 3D volume segmentation of serial follow-up magnetic resonance imaging scans. Toxicities were reported as per CTCAE V5.0.

Results: At median follow-up of 48.1 months, radiological local control was attained in 46 of 47 tumours (98%). Prescribed doses ranged from 13–18 Gy for single fraction, 18–24 Gy for 3 fractions, and 20–25 Gy for 5 fractions. At 6 months follow-up, early clinical improvement was observed in 91% of evaluable patients. At the last follow-up, 21 patients (46%) had symptom resolution, while 25 (54%) had improvement or stability. Tinnitus improved in 24 of 29 patients (83%); hearing function and cranial nerve deficits remained unchanged; no new or progressive neurological deficits occurred. Volumetric assessment revealed tumour shrinkage in 26 of 32 evaluable lesions (81%), with the best response occurring at a median of 24 months (p < 0.001). Treatment-related adverse events (grade 1–2) occurred in 12 (26%) patients. No grade ≥3 toxicity was observed; 4 (9%) required prolonged steroid therapy.

Conclusion: Robotic radiosurgery provides 98% radiological local control at 48 months median follow up, 81% patients had significant volume shrinkage and 26% had minimal toxicity (grade 1–2), with no grade 3 toxicity.

Keywords: head and neck paraganglioma; glomus tumour, CyberKnife; stereotactic radiosurgery, SRS, volumetric response, symptom response, treatment toxicity