Results of a systematic literature review of treatment modalities for jugulotympanic paraganglioma, stratified per Fisch class.

Objective: Key for successful jugulotympanic paraganglioma management is a personalised approach aiming for the best practice for each individual patient. To this end, a systematic review is performed, evaluating the local control and complication rates for the different treatment modalities stratified by the broadly accepted Fisch classification. Design: A systematic literature review according to the PRISMA statement was performed. A detailed overview of individual treatment outcomes per Fisch class is provided. Main outcome measures: Local control, cranial nerve damage, complications, function recovery. Results: Eighteen studies were selected, resembling 83 patients treated with radiotherapy and 299 with surgery. Excellent local control was found post‐surgery for class A and B tumours, and risk of cranial nerve damage was <1%. For class C1‐4 tumours, local control was 80%‐95% post‐surgery (84% post‐radiotherapy), and cranial nerve damage was found in 71%‐76% (none post‐radiotherapy; <italic>P </italic><<italic> </italic>.05). There was no difference in treatment outcomes between tumours of different C class. For class C1‐4De/Di tumours, local control was 38%‐86% (98% post‐radiotherapy; <italic>P </italic><<italic> </italic>.05) and cranial nerve damage/complication rates were 67%‐100% (3% post‐radiotherapy; <italic>P </italic><<italic> </italic>.05). C1‐4DeDi tumours showed lesser local control and cranial nerve damage rates when compared to C1‐4De tumours. Conclusions: An individual risk is constituted for surgery and radiotherapy, stratified per Fisch class. For class A and B tumours, surgery is a suitable treatment option. For class C and D tumours, radiotherapy results in lower complication rates and similar or better local control rates when compared to the surgical group. [ABSTRACT FROM AUTHOR]