In Response to Letter to the Editor Entitled, "The Role of Radiation in Tympanojugular Paragangliomas Needs to be Re-evaluated".
In Response to Letter to the Editor Entitled, "The Role of Radiation in Tympanojugular Paragangliomas Needs to be Re-evaluated".
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回应题为“放射治疗在鼓室颈静脉副神经节瘤中的作用需要重新评估”的致编辑的信。
DOI：
10.1097/mao.0000000000001472
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
StClair,William
中科院分区：
文献类型：
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作者：
Bush,MatthewL;Dobberpuhl,MitchellR;Maxwell,Stevie;Feddock,Jonathan;StClair,William
回复：我们要感谢作者就我们的研究给编辑写了这封信。这封信的杰出作者帮助建立了颅底外科领域关于这些肿瘤的管理的手术标准，我们非常重视他们的意见。作者提出了对使用“glomus”一词的担忧。尽管这些标签的使用存在地区差异，并且最近发表的另外两份报告使用了该术语（1，2），但我们同意术语一致性的价值。组织学上，这些肿瘤被准确地描述为副神经节瘤。此外，作者提出了对预处理生长特征的担忧。这是我们研究的一个局限性，也是颅底放射治疗的一个重要考虑因素。最近的一项研究表明，86%的肿瘤生长控制已经证明了预处理生长（1）;然而，这一领域需要进一步的研究。其次，作者对本研究的平均随访时间（27.6个月）表示担忧。我们同意这是本研究的局限性，我们在讨论部分承认了这一点。这些肿瘤的治疗在过去主要是手术治疗，直到最近才对单一模式治疗感兴趣，因此长期随访是有限的。近期还有其他类似的报道，随访时间更长，分别为39.1个月（1）和51.5个月（2），肿瘤生长控制率相似。第三，作者建议将手术治疗作为这些肿瘤的主要治疗方法。我们同意手术治疗仍然是一个很好的选择。然而，内科合并症可能使手术候选人复杂化，放射治疗可以被视为替代方案。我们的手稿并没有减少手术治疗的作用，但提出了与单一模式放射治疗的结果。有证据表明，与综合治疗相比，单独放疗可改善这些肿瘤患者的生活质量（3）。最后，作者正确地提出了对辐射诱发恶性转化可能性的关切。这一点必须考虑在内，并被视为考虑放疗的患者的标准治疗讨论点。与其他良性颅底肿瘤相比，这些肿瘤具有更高的自发性恶性变性率（4）。这些作者提出的不幸案例说明了这一关切。需要进行持续的研究，以充分告知我们的患者有关循证治疗方案，这将改善结果和生活质量。
In Reply: We would like to thank the authors for this letter to the editor regarding our study. The eminent authors of this letter have helped to establish the surgical standards within the skull base surgery field regarding the management of these tumors and we greatly value their comments. The authors raised the concern regarding the use of the term ‘‘glomus.’’In spite of regional differences with use of these labels and the presence of two other recently published reports using this terminology (1, 2), we agree that there is value in consistency with terminology. Histopathologically, these tumors are accurately described as paragangliomas. Additionally, the authors raised concern regarding the pretreatment growth characteristics. This is a limitation of our study and is an important consideration in skull base radiotherapy. A recent study demonstrated an 86% growth control in tumors that had demonstrated pretreatment growth (1); however, this area needs further research. 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.