A meta-analysis of tumor control rates and treatment-related morbidity for patients with glomus jugulare tumors

Clinical article

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Object

Because of the rarity of glomus jugulare tumors, a variety of treatment paradigms are currently used. There is no consensus regarding the optimal management to control tumor burden while minimizing treatment-related morbidity. In this study, the authors assessed data collected from 869 patients with glomus jugulare tumors from the published literature to identify treatment variables that impacted clinical outcomes and tumor control rates.

Methods

A comprehensive search of the English-language literature identified 109 studies that collectively described outcomes for patients with glomus jugulare tumors. Univariate comparisons of demographic information between treatment cohorts were performed to detect differences in the sex distribution, age, and Fisch class of tumors among various treatment modalities. Meta-analyses were performed on calculated rates of recurrence and cranial neuropathy after subtotal resection (STR), gross-total resection (GTR), STR with adjuvant postoperative radiosurgery (STR+SRS), and stereotactic radiosurgery alone (SRS).

Results

The authors identified 869 patients who met their inclusion criteria. In these studies, the length of follow-up ranged from 6 to 256 months. Patients treated with STR were observed for 72 ± 7.9 months and had a tumor control rate of 69% (95% CI 57%–82%). Those who underwent GTR had a follow-up of 88 ± 5.0 months and a tumor control rate of 86% (95% CI 81%–91%). Those treated with STR+SRS were observed for 96 ± 4.4 months and had a tumor control rate of 71% (95% CI 53%–83%). Patients undergoing SRS alone had a follow-up of 71 ± 4.9 months and a tumor control rate of 95% (95% CI 92%–99%). The authors' analysis found that patients undergoing SRS had the lowest rates of recurrence of these 4 cohorts, and therefore, these patients experienced the most favorable rates of tumor control (p < 0.01). Patients who underwent GTR sustained worse rates of cranial nerve (CN) deficits with regard to CNs IX–XI than those who underwent SRS alone; however, the rates of CN XII deficits were comparable.

Conclusions

The authors' analysis is limited by the quality and accuracy of these studies and may reflect source study biases, as it is impossible to control for the quality of the data reported in the literature. Finally, due to the diverse range of data presentation, the authors found that they were limited in their ability to study and control for certain variables. Some of these limitations should be minimized with their use of meta-analysis methods, which statistically evaluate and adjust for between-study heterogeneity. These results provide the impetus to initiate a prospective study, appropriately controlling for variables that can confound the retrospective analyses that largely comprise the existing literature.

Abbreviations used in this paper: CN = cranial nerve; GTR = gross-total resection; MOOSE = Meta-analysis Of Observational Studies in Epidemiology; SRS = stereotactic radiosurgery; STR = subtotal resection.

Article Information

Address correspondence to: Andrew T. Parsa, M.D., Ph.D., 505 Parnassus Avenue, M779 Box 0112, San Francisco, California 94117. email: parsaa@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online October 29, 2010; DOI: 10.3171/2010.9.JNS10699.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Forest plots depicting 95% CIs for tumor control rates in this analysis, and the pooled proportion calculated from our analysis. Individual studies are indicated by PubMed identification number at the left. Forest plots for patients undergoing GTR (A), STR (B), STR+SRS (C), and SRS alone (D).

References

  • 1

    Arthur K: Radiotheraphy in chemodectoma of the glomus jugulare. Clin Radiol 28:4154171977

  • 2

    Bickerstaff ERHowell JS: The neurological importance of tumours of the glomus jugulare. Brain 76:5765931953

  • 3

    Borba LAAle-Bark SLondon C: Surgical treatment of glomus jugulare tumors without rerouting of the facial nerve: an infralabyrinthine approach. Neurosurg Focus 17:2E82004

    • Search Google Scholar
    • Export Citation
  • 4

    Bordi LTCheesman ADSymon L: The surgical management of glomus jugulare tumours—description of a single-staged posterolateral combined otoneurosurgical approach. Br J Neurosurg 3:21301989

    • Search Google Scholar
    • Export Citation
  • 5

    Boyle JOShimm DSCoulthard SW: Radiation therapy for paragangliomas of the temporal bone. Laryngoscope 100:8969011990

  • 6

    Brown JS: Glomus jugulare tumors revisited: a ten-year statistical follow-up of 231 cases. Laryngoscope 95:2842881985

  • 7

    Bundgaard TTandrup OElbrønd ONordentoft AM: Treatment of glomus tumours. A retrospective survey. Clin Otolaryngol Allied Sci 14:1551601989

    • Search Google Scholar
    • Export Citation
  • 8

    Burres SAWilner HIJacobs JR: Nonsurgical management of a large recurrent glomus jugulare tumor. Otolaryngol Head Neck Surg 91:3123151983

    • Search Google Scholar
    • Export Citation
  • 9

    Cantrell RWKaplan MJAtuk NOWinn HRJahrsdoerfer RA: Catecholamine-secreting infratemporal fossa paraganglioma. Ann Otol Rhinol Laryngol 93:5835881984

    • Search Google Scholar
    • Export Citation
  • 10

    Cece JALawson WBiller HFEden ARParisier SC: Complications in the management of large glomus jugulare tumors. Laryngoscope 97:1521571987

    • Search Google Scholar
    • Export Citation
  • 11

    Cole DJ: Glomus jugulare tumours seen in Oxford 1960–1984. Clin Radiol 39:83861988

  • 12

    Cole JM: Panel discussion: glomus jugulare tumors of the temporal bone. Radiation of glomus tumors of the temporal bone. Laryngoscope 89:162316271979

    • Search Google Scholar
    • Export Citation
  • 13

    Dall'Igna CAntunes MBDall'Igna DP: Radiation therapy for glomus tumors of the temporal bone. Braz J Otorhinolaryngol 71:7527572005

    • Search Google Scholar
    • Export Citation
  • 14

    Dawes PJFilippou MWelch ARDawes JD: The management of glomus jugulare tumours. Clin Otolaryngol Allied Sci 12:15241987

  • 15

    DerSimonian R: Combining evidence from clinical trials. Anesth Analg 70:4754761990

  • 16

    DerSimonian R: Meta-analysis in the design and monitoring of clinical trials. Stat Med 15:123712521996

  • 17

    DerSimonian RCharette LJMcPeek BMosteller F: Reporting on methods in clinical trials. N Engl J Med 306:133213371982

  • 18

    DerSimonian RLaird N: Meta-analysis in clinical trials. Control Clin Trials 7:1771881986

  • 19

    Elshaikh MAMahmoud-Ahmed ASKinney SEWood BGLee JHBarnett GH: Recurrent head-and-neck chemodectomas: a comparison of surgical and radiotherapeutic results. Int J Radiat Oncol Biol Phys 52:9539562002

    • Search Google Scholar
    • Export Citation
  • 20

    Eustacchio SLeber KTrummer MUnger FPendl G: Gamma knife radiosurgery for glomus jugulare tumours. Acta Neurochir (Wien) 141:8118181999

    • Search Google Scholar
    • Export Citation
  • 21

    Farrior JB: Anterior hypotympanic approach for glomus tumor of the infratemporal fossa. Laryngoscope 94:101610211984

  • 22

    Farrior JB: Infratemporal approach to skull base for glomus tumors: anatomic considerations. Ann Otol Rhinol Laryngol 93:6166221984

    • Search Google Scholar
    • Export Citation
  • 23

    Fisch U: Infratemporal fossa approach for glomus tumors of the temporal bone. Ann Otol Rhinol Laryngol 91:4744791982

  • 24

    Fisch UMattox D: Microsurgery of the Skull Base New YorkThieme1988

  • 25

    Foote RLPollock BEGorman DASchomberg PJStafford SLLink MJ: Glomus jugulare tumor: tumor control and complications after stereotactic radiosurgery. Head Neck 24:3323392002

    • Search Google Scholar
    • Export Citation
  • 26

    Gabriel EMSampson JHDodd LGTurner DA: Glomus jugulare tumor metastatic to the sacrum after high-dose radiation therapy: case report. Neurosurgery 37:100110051995

    • Search Google Scholar
    • Export Citation
  • 27

    Gerosa MVisca ARizzo PForoni RNicolato ABricolo A: Glomus jugulare tumors: the option of gamma knife radiosurgery. Neurosurgery 59:5615692006

    • Search Google Scholar
    • Export Citation
  • 28

    Ghani GASung YFPer-Lee JH: Glomus jugulare tumors—origin, pathology, and anesthetic considerations. Anesth Analg 62:6866911983

    • Search Google Scholar
    • Export Citation
  • 29

    Gjuric MRüdiger Wolf SWigand MEWeidenbecher M: Cranial nerve and hearing function after combined-approach surgery for glomus jugulare tumors. Ann Otol Rhinol Laryngol 105:9499541996

    • Search Google Scholar
    • Export Citation
  • 30

    Gjuric MSeidinger LWigand ME: Long-term results of surgery for temporal bone paraganglioma. Skull Base Surg 6:1471521996

  • 31

    Glasscock MEJackson CG: Glomus tumors: diagnosis and surgery. Rev Laryngol Otol Rhinol (Bord) 100:1311361979

  • 32

    Goel APanchwagh JDesai K: Ossified glomus jugulare tumour: case report. Br J Neurosurg 11:3373401997

  • 33

    Green JD JrBrackmann DENguyen CDArriaga MATelischi FFDe la Cruz A: Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 104:9179211994

    • Search Google Scholar
    • Export Citation
  • 34

    Henzel MHamm KGross MWSurber GKleinert GFailing T: Fractionated stereotactic radiotherapy of glomus jugulare tumors. Local control, toxicity, symptomatology, and quality of life. Strahlenther Onkol 183:5575622007

    • Search Google Scholar
    • Export Citation
  • 35

    Holden PKLinthicum FH Jr: Glomus jugulare tumor. Otol Neurotol 26:3123132005

  • 36

    House JWFayad JN: Glomus jugulare. Ear Nose Throat J 83:8002004

  • 37

    Jordan JARoland PSMcManus CWeiner RLGiller CA: Stereotactic radiosurgery for glomus jugulare tumors. Laryngoscope 110:35382000

    • Search Google Scholar
    • Export Citation
  • 38

    Kim CSSuh MW: Skull base surgery for removal of temporal bone tumors. Acta Otolaryngol 127:Suppl 5584142007

  • 39

    Konefal JBPilepich MVSpector GJPerez CA: Radiation therapy in the treatment of chemodectomas. Laryngoscope 97:133113351987

  • 40

    Krych AJFoote RLBrown PDGarces YILink MJ: Long-term results of irradiation for paraganglioma. Int J Radiat Oncol Biol Phys 65:106310662006

    • Search Google Scholar
    • Export Citation
  • 41

    Larner JMHahn SSSpaulding CAConstable WC: Glomus jugulare tumors. Long-term control by radiation therapy. Cancer 69:181318171992

    • Search Google Scholar
    • Export Citation
  • 42

    Lim MGibbs ICAdler JR JrChang SD: Efficacy and safety of stereotactic radiosurgery for glomus jugulare tumors. Neurosurg Focus 17:2E112004

    • Search Google Scholar
    • Export Citation
  • 43

    Liscák RVladyka VWowra BKemeny AForster DBurzaco JA: Gamma Knife radiosurgery of the glomus jugulare tumour—early multicentre experience. Acta Neurochir (Wien) 141:114111461999

    • Search Google Scholar
    • Export Citation
  • 44

    Maarouf MVoges JLandwehr PBramer RTreuer HKocher M: Stereotactic linear accelerator-based radiosurgery for the treatment of patients with glomus jugulare tumors. Cancer 97:109310982003

    • Search Google Scholar
    • Export Citation
  • 45

    McCabe BFFletcher M: Selection of therapy of glomus jugulare tumors. Arch Otolaryngol 89:1561591969

  • 46

    Moore GRRobbins JPSeale DLFitz-Hugh GSConstable WC: Chemodectomas of the middle ear. A comparison of therapeutic modalities. Arch Otolaryngol 98:3303351973

    • Search Google Scholar
    • Export Citation
  • 47

    Murphy TPBrackmann DE: Effects of preoperative embolization on glomus jugulare tumors. Laryngoscope 99:124412471989

  • 48

    Newman HRowe JF JrPhillips TL: Radiation therapy of the glomus jugulare tumor. Am J Roentgenol Radium Ther Nucl Med 118:6636691973

    • Search Google Scholar
    • Export Citation
  • 49

    Ogura JHSpector GJGado M: Glomus jugulare and vagale. Ann Otol Rhinol Laryngol 87:6226291978

  • 50

    Pandya SKNagpal RDDesai APPurohit AV: Death following external carotid artery embolization for a functioning glomus jugulare chemodectoma. Case report. J Neurosurg 48:103010341978

    • Search Google Scholar
    • Export Citation
  • 51

    Pareschi RRighini SDestito DRaucci AFColombo S: Surgery of Glomus Jugulare Tumors. Skull Base 13:1491572003

  • 52

    Patel SJSekhar LNCass SPHirsch BE: Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases. J Neurosurg 80:102610381994

    • Search Google Scholar
    • Export Citation
  • 53

    Pollock BE: Stereotactic radiosurgery in patients with glomus jugulare tumors. Neurosurg Focus 17:2E102004

  • 54

    Poznanovic SACass SPKavanagh BD: Short-term tumor control and acute toxicity after stereotactic radiosurgery for glomus jugulare tumors. Otolaryngol Head Neck Surg 134:4374422006

    • Search Google Scholar
    • Export Citation
  • 55

    Rosenwasser H: Glomus jugulare tumors. I. Historical background. Arch Otolaryngol 88:1401968

  • 56

    Sanna MJain YDe Donato GRohit Lauda LTaibah A: Management of jugular paragangliomas: the Gruppo Otologico experience. Otol Neurotol 25:7978042004

    • Search Google Scholar
    • Export Citation
  • 57

    Sheehan JKondziolka DFlickinger JLunsford LD: Gamma knife surgery for glomus jugulare tumors: an intermediate report on efficacy and safety. J Neurosurg 102:Suppl2412462005

    • Search Google Scholar
    • Export Citation
  • 58

    Spector GJCompagno JPerez CAMaisel RHOgura JH: Glomus jugulare tumors: effects of radiotherapy. Cancer 35:131613211975

  • 59

    Springate SCWeichselbaum RR: Radiation or surgery for chemodectoma of the temporal bone: a review of local control and complications. Head Neck 12:3033071990

    • Search Google Scholar
    • Export Citation
  • 60

    Stroup DFBerlin JAMorton SCOlkin IWilliamson GDRennie D: Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283:200820122000

    • Search Google Scholar
    • Export Citation
  • 61

    Thedinger BAGlasscock ME IIICueva RAJackson CG: Postoperative radiographic evaluation after acoustic neuroma and glomus jugulare tumor removal. Laryngoscope 102:2612661992

    • Search Google Scholar
    • Export Citation
  • 62

    Thomsen KElbrønd OAndersen AP: Glomus jugulare tumours. (A series of 21 cases). J Laryngol Otol 89:111311211975

  • 63

    Watkins LDMendoza NCheesman ADSymon L: Glomus jugulare tumours: a review of 61 cases. Acta Neurochir (Wien) 130:66701994

  • 64

    Willen SNEinstein DBMaciunas RJMegerian CA: Treatment of glomus jugulare tumors in patients with advanced age: planned limited surgical resection followed by staged gamma knife radiosurgery: a preliminary report. Otol Neurotol 26:122912342005

    • Search Google Scholar
    • Export Citation

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