In Response to Letter to the Editor Entitled, “The Role of Radiation in Tympanojugular Paragangliomas Needs to be Re-evaluated”
Secondly, the authors raised concern regarding the average length of the follow-up in this study, which was 27.6 months. We agree that this is a limitation of this study and we acknowledged this in the discussion section. The management of these tumors has primarily been surgical in the past and only recently has there been interest in single modality management thus long-term follow-up is limited. There are other similar recent reports with longer follow-up, 39.1 months (1) and 51.5 months (2), with similar tumor growth control rates.
Thirdly, the authors have suggested that surgical management be used as the primary treatment of these tumors. We agree that surgical management continues to be an excellent option. However, medical comorbidities may complicate surgical candidacy and radiation therapy can be considered as an alternative. Our manuscript does not diminish the role of surgical management but presents outcomes related to single modality radiotherapy. There is evidence of improved quality of life in patients with these tumors treated with radiotherapy alone compared with multimodality treatment (3).
Finally, the authors rightly raise concern regarding the possibility of radiation-induced malignant transformation. This must be taken into consideration and is considered a standard of care discussion point with patients considering radiotherapy. It is established that these tumors have higher spontaneous malignant degeneration rate compared with other benign skull base tumors (4). The unfortunate case presented by these authors illustrates this concern. Ongoing research is needed to fully inform our patients regarding evidenced-based treatment options that will improve outcomes and quality of life.