Treatment of glomus jugulare tumors with gamma knife radiosurgery

Objective: Surgical resection, embolization, radiation therapy, and stereotactic radiosurgery have been used to treat glomus jugulare tumors (GJT). However, the optimal treatment of these tumors is still unclear. The authors report their data on treatment of GJTs with gamma knife radiosurgery (GKS). Design: Retrospective review and pooled analysis Methods: Fifteen patients (9 female, 6 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 post-treatment radiographic image and volumetric analysis was performed. A 15% change in tumor volume was required to be considered real. Pooled analysis was performed to compare with other series. Results: The mean total radiological follow-up was 43.2 months. The mean dose to the tumor margin was 14.6 Gy. The mean tumor size at presentation was 7.3 cc and 6.3 cc at last follow-up. After treatment, 7 tumors decreased (46.7%), 5 remained unchanged (33.3%), and 3 (20%) grew on imaging. Treatment failures received a mean marginal dose of 13.2 Gy compared with 15.1 Gy for treatment successes (p = 0.08). 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 periods will better define the benefits and risks of stereotactic radiosurgery in treating patients with GJT.