(0636) Do Symptoms in Head and Neck Paraganglioma Patients Predict the Need for Surgery?

Introduction: Paragangliomas (PGL) are rare tumors of the autonomic system, 3% of which occur in the head and neck. Few head and neck paragangliomas (HNPGLs) are vasoactive; rather, they are space occupying tumors that can impact local structures. Diagnosis is typically made from symptoms secondary to mass effect, or incidentally on head and neck imaging. The goal of this study is to determine if the presence of symptoms upon diagnosis correlates to the need for surgical intervention in adult patients.

Methods: This was a single institution, prospective study. All patients over the age of 50 with HNPGL seen at an interdisciplinary PGL clinic for genetic testing between 1989 to 2023 were reviewed. Patient demographics, clinical history, and outcomes were analyzed.

Results: There were 110 patients included, with 154 HNPGLs in total. There were 87 (79%) female patients and 23 (21%) male patients. The median age at presentation was 66 (IQR: 58-71) years. Of the total, 25 (22.7%) patients had bilateral/multifocal tumors. There were 111 (72.1%) carotid body tumors, 24 (15.6%) jugular paraganglioma, 12 (7.8%) vagal paraganglioma, and 2 (1.3%) glomus tympanicum. There were 54 (35.1%) tumors found incidentally, 84 (54.5%) diagnosed due to symptoms, and 9 (5.8%) found on surveillance scans following positive genetic testing. Of the tumors, 80 (51.9%) were observed, 66 (42.9%) underwent surgery, and the remaining 3 (1.8%) had chemotherapy or combination therapy. Tumors diagnosed incidentally were significantly more likely to be observed (46/80, 58%), while patients with symptoms were significantly more likely to undergo surgery (50/66, 76%) (p < .001). Presence of bilateral/multifocal tumors was not significantly correlated to management of tumors treated only with surgery, radiation, or observation (p = 0.359). Surgery patients were typically younger (median: 60, IQR: 54-65 years) than those treated with observation (median: 68, IQR: 63-75 years) (p < 0.001).

Conclusions: Surgical management of HNPGLs in older adult patients was significantly correlated to the presence of tumor related symptoms.