New Strategies in the Treatment of Tympanojugular Paraganglioma

The high morbidity of surgery of tympanojugular (TJ) paraganglioma, the consistent rate of recurrences, and poor knowledge of the natural history of the tumor have been supporting the necessity to find alternative therapies and to assess new strategies of treatment. A more conservative and respectful attitude has been growing and radical surgery is no more to be considered the only feasible option. Radiotherapy has been making enormous progress, to be taken into account in the new methods of combined therapies. Moving from the concept that even radical surgery has a high rate of recurrences (which, in the different series, is strictly related to the adequacy of the follow-up) and that surgical morbidity is always worse and less tolerated than the natural tumor morbidity, our surgical attitude has been changing from radical surgery to deliberate incomplete removal combined with radiotherapy. We combined a critical revision of recent experiences, in the fields of both surgery and radiotherapy, with a retrospective review of the TJ paraganglioma operated in the years 1983 to 2003 at the ENT Department of Ospedali Riuniti in Bergamo. Each patient was investigated for recurrences and the fate of recurrences has been assessed. It was evident that even radical surgery developed recurrent tumor and that radical surgery regardless of morbidity is no longer the gold standard therapy. New guidelines have been arising throughout this time and since 2004 a new protocol has been adopted. In the present work the results of the analysis of the literature and of our experience are reported, and details of the new protocol are shown and explained.