Treatment of a Non-syndromic Carotid Body Paraganglioma Using Fast Neutron Radiotherapy: A Case Report and Review of Literature

Abstract

Non-syndromic carotid body paragangliomas (CBPs) are the most common head and neck CBPs. Malignant transformation or symptomatic presentation is rare, but patients may occasionally endorse tinnitus, cranial nerve (CN) deficits, and ear pulsations. Historically, treatment of CBP was primarily through surgical intervention, which predisposed patients to CN deficits and significant blood loss due to the neurovascular structures in close proximity to these tumors. More recently, the utilization of pre-treatment embolization and radiotherapy has allowed for the reduction in treatment morbidity. Stereotactic radiosurgery (SRS) and external beam radiotherapy (EBRT) have been investigated as alternatives to traditional surgical intervention, with a documented reduction in the incidence of postoperative morbidity. While several retrospective studies and meta-analyses compare outcomes following surgical and traditional radiotherapeutic interventions, currently no literature exists regarding the potential utility of fast neutron therapy in treating this disease. In this case report, we highlight a patient with a non-syndromic CBP treated with pre-treatment embolization and fast neutron therapy, review the post-treatment course, and present a review of the extant literature on the subject.

Keywords: carotid body paraganglioma; glomus tumor; neutron therapy; pre-treatment embolization; radiation therapy.

Figure 1. T2-weighted MRI of prior radiation bed (arrow) in December 2021 demonstrating no increase in size from the previous scan

Figure 2. T2-weighted MRI (left) and MRI STIR sequence (right) on December 2021 demonstrating a new mediastinal mass (arrows)

Figure 3. PET/CT completed in February 2022 demonstrating an increased FDG uptake in mediastinal mass (arrow)