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Five-year survival is 60% for malignant head and neck paraganglioma
PROGNOSIS
Five-year survival is 60% for malignant head and neck paraganglioma Abstracted from: Lee J, Barich F, Karnell L, Robinson R, Zhen W, Gantz B, Ho¡man H, from the American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 2002; 94: 730^737.
BACKGROUND Paraganglia arise from cells of neural crest origin. Paraganglioma are also known as chemodectoma or glomus tumors. Malignant paraganglioma of the head and neck are rare. Previous studies have included fewer than nine participants. OBJECTIVE To assess treatment and survival of people with malignant paraganglioma of the head and neck. SETTING USA; diagnosis 1985 to 1996. METHOD Analysis of National Cancer Database. PARTICIPANTS Fifty-nine people withveri¢ed metastatic spread from paraganglioma of the head and neck. ANALYSIS Institutions across the United States voluntarily provide standardized cancer registry data to the National Cancer Database each year. Cases of malignant paraganglioma of the head and neck were extracted from the database. OUTCOMES Survival.
1363- 4054/02/$ - see front matter & 2002 Elsevier Science Ltd. All rights reserved doi:10.1054/ebon.21, available online at http://www.idealibrary.com.on
MAIN RESULTS 355,019 people with head and neck cancer were listed on the National Cancer Database between 1985 and 1996. Of these, 59 had paraganglioma with documented metastatic disease in lymph nodes or distant sites. Median age at diagnosis was 44 years. Forty-nine percent were men. Eighty-one percent were white. Surgery was the most common treatment (76%). Five-year survival was 59.5% (77% for those with regionally con¢ned carcinoma and 12% for distant metastases). People who received adjuvant irradiation had longer median survival (45 months) than those who received surgery alone (12 months). AUTHORS’ CONCLUSIONS Metastatic spread of malignant paraganglioma may be benign when restricted to the site of origin. Metastases are usually regionally con¢ned. Primary tumor and lymph nodes should be surgically removed. Postoperative radiation may slow disease progression. METHOD NOTES Database depends on voluntary contributions. Selection bias may be present. Sources offunding: Not Speci¢ed. Correspondenceto: Henry Ho¡man, MD, Departmentof Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA. (E-mail: henry-ho¡[email protected]).
Evidence-based Oncology (2002) 3,139^140
139
Commentary
Literature cited
Malignant head and neck paraganglioma are extremely rare. As a consequence, we have almost no knowledge of them. The information we do have is based on clinical case studies or small numbers of participants.This analysis by Lee and colleagues provides more homogeneous and updated information than anything previously available.1 Lee and colleagues highlight the high proportion of cervical lymph node metastases and an increasing tendency to use radiotherapy in recent years. The authors remark the possible beneficial effect of radiotherapy under specific circumstances as incomplete resection, rejection of surgery or contraindication to surgery. This observation is in relation with the conclusions of other articles suggesting that exclusive radiotherapy can be used with benign head and neck paragangliomas of several locations.2,3. The topographical classification used could be more specific. Considering the number of cases available, paraganglioma malignancy rates could also have been updated for different locations and compared with previous studies.
1. Glenner GG, Grimley PM. Tumors of the Extra-adrenal Paraganglion System (Including Chemoreceptors). Washington, DC: Armed Forces Institute of Pathology,1974. 2. Evenson LJ, Mendenhall WM, Parsons JT, Cassini NJ. Radiotherapy in the management of chemodectomas of the carotid body and glomus vagale. Head Neck 1998; 20: 609-- 613. 3. Hinerman RW, Mendenhall WM, Amdur RJ, Stringer SP, Antonelli PJ, Cassini NJ. Definitive radiotherapy in the management of chenodctomas arising in the temporal bone, carotid body and glomus vagale. Head Neck 2001; 23: 363--371.
Quality assessment (scale 1 = fair, 4 = excellent) Relevance 1 Validity 2 Applicability 2 Feasibility 3 Impact 1 Knowledge context 2 Dr Adolfo G. Hinojar Hospital Universitario de la Princesa, Madrid, Spain
140
Evidence-based Oncology (2002) 3,139^140
Level and Quality of Evidence: 4C
Five-year survival is 60% for malignant head and neck paraganglioma Abstracted from: Lee J, Barich F, Karnell L, Robinson R, Zhen W, Gantz B, Ho¡man H, from the American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 2002; 94: 730^737.
BACKGROUND Paraganglia arise from cells of neural crest origin. Paraganglioma are also known as chemodectoma or glomus tumors. Malignant paraganglioma of the head and neck are rare. Previous studies have included fewer than nine participants. OBJECTIVE To assess treatment and survival of people with malignant paraganglioma of the head and neck. SETTING USA; diagnosis 1985 to 1996. METHOD Analysis of National Cancer Database. PARTICIPANTS Fifty-nine people withveri¢ed metastatic spread from paraganglioma of the head and neck. ANALYSIS Institutions across the United States voluntarily provide standardized cancer registry data to the National Cancer Database each year. Cases of malignant paraganglioma of the head and neck were extracted from the database. OUTCOMES Survival.
1363- 4054/02/$ - see front matter & 2002 Elsevier Science Ltd. All rights reserved doi:10.1054/ebon.21, available online at http://www.idealibrary.com.on
MAIN RESULTS 355,019 people with head and neck cancer were listed on the National Cancer Database between 1985 and 1996. Of these, 59 had paraganglioma with documented metastatic disease in lymph nodes or distant sites. Median age at diagnosis was 44 years. Forty-nine percent were men. Eighty-one percent were white. Surgery was the most common treatment (76%). Five-year survival was 59.5% (77% for those with regionally con¢ned carcinoma and 12% for distant metastases). People who received adjuvant irradiation had longer median survival (45 months) than those who received surgery alone (12 months). AUTHORS’ CONCLUSIONS Metastatic spread of malignant paraganglioma may be benign when restricted to the site of origin. Metastases are usually regionally con¢ned. Primary tumor and lymph nodes should be surgically removed. Postoperative radiation may slow disease progression. METHOD NOTES Database depends on voluntary contributions. Selection bias may be present. Sources offunding: Not Speci¢ed. Correspondenceto: Henry Ho¡man, MD, Departmentof Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA. (E-mail: henry-ho¡[email protected]).
Evidence-based Oncology (2002) 3,139^140
139
Commentary
Literature cited
Malignant head and neck paraganglioma are extremely rare. As a consequence, we have almost no knowledge of them. The information we do have is based on clinical case studies or small numbers of participants.This analysis by Lee and colleagues provides more homogeneous and updated information than anything previously available.1 Lee and colleagues highlight the high proportion of cervical lymph node metastases and an increasing tendency to use radiotherapy in recent years. The authors remark the possible beneficial effect of radiotherapy under specific circumstances as incomplete resection, rejection of surgery or contraindication to surgery. This observation is in relation with the conclusions of other articles suggesting that exclusive radiotherapy can be used with benign head and neck paragangliomas of several locations.2,3. The topographical classification used could be more specific. Considering the number of cases available, paraganglioma malignancy rates could also have been updated for different locations and compared with previous studies.
1. Glenner GG, Grimley PM. Tumors of the Extra-adrenal Paraganglion System (Including Chemoreceptors). Washington, DC: Armed Forces Institute of Pathology,1974. 2. Evenson LJ, Mendenhall WM, Parsons JT, Cassini NJ. Radiotherapy in the management of chemodectomas of the carotid body and glomus vagale. Head Neck 1998; 20: 609-- 613. 3. Hinerman RW, Mendenhall WM, Amdur RJ, Stringer SP, Antonelli PJ, Cassini NJ. Definitive radiotherapy in the management of chenodctomas arising in the temporal bone, carotid body and glomus vagale. Head Neck 2001; 23: 363--371.
Quality assessment (scale 1 = fair, 4 = excellent) Relevance 1 Validity 2 Applicability 2 Feasibility 3 Impact 1 Knowledge context 2 Dr Adolfo G. Hinojar Hospital Universitario de la Princesa, Madrid, Spain
140
Evidence-based Oncology (2002) 3,139^140
Level and Quality of Evidence: 4C