Growth of Head and Neck Paragangliomas

Objective: To optimize screening intervals and treatment strategies for head and neck paragangliomas, we estimated growth rate and assessed possible prognostic factors.

Methods: Patients with SDHD-related carotid and/or vagal body paragangliomas diagnosed from 2002 until September 2015 were eligible for inclusion. Tumor volume was estimated, based on three dimensions. A volume increase of at least 10% and 25% for carotid and vagal body paragangliomas respectively, was considered tumor progression.¹ Additionally, absolute and relative growth rates were calculated. The influence of 5 possible prognostic factors on tumor progression and relative growth rate was assessed.

Results: Thirty-nine patients with a total of 64 paragangliomas were included, of which 60.9% were located at the carotid body. Growth was observed in 66.7% of carotid body and 72.0% of vagal body tumors, after a median follow-up time of 6.34 years and 6.39 years respectively. A median relative growth rate per year of 5.81% for carotid body and 12.80% for vagal body paragangliomas was observed. Corresponding with a minimum observation time of 1.69 and 1.85 years to detect growth. Age at inclusion predicted the occurrence of growth and relative growth rate. With a hazard ratio of 0.69 (95% CI 0.52; 0.91, p = 0.008) and linear regression coefficient of -4.62 (95%CI -7.61; -1.63, p = 0.003) per ten years of age increase.

Conclusion: With long follow-up, growth will be observed in most paragangliomas albeit relatively slowly. With increasing age growth is less likely to occur and relative growth rate reduced. Considering this slow progression, screening intervals of 2 or more years may be sufficient, especially in older patients.

References

Reference

1 Heesterman BL, Verbist BM, van der Mey AG, et al. Measurement of head and neck paragangliomas: is volumetric analysis worth the effort? Clin Otolaryngol 2015;•••: 10.1111/coa.12562 [Epub ahead of print]