Head and Neck Paragangliomas: Evidence-Based Management and What Genetics Can Tell Us

Monday, October 2, 2023

1:45 PM - 2:45 PM East Coast USA Time

Location: 201AB

Moderator(s)

Kevin J. Contrera, MD, MPH

Assistant Professor
University of Pittsburgh Medical Center
Houston, TX, United States

Panelist(s)

Kevin J. Contrera, MD, MPH

Assistant Professor
University of Pittsburgh Medical Center
Houston, TX, United States
Kyle M. Hatten, MD

Associate Professor
University of Maryland School of Medicine
Baltimore, MD, United States
Adam J. Luginbuhl, MD

Professor
Department of Otolaryngology, Thomas Jefferson University
Philadelphia, PA, United States
James l. Netterville, MD

Professor of Head and Neck Oncology, Director of Head and Neck Oncologic Services
Vanderbilt University Medical Center
Nashville, TN, USA

Disclosure(s):

Kevin J. Contrera, MD, MPH: No relevant relationships to disclose.

Kyle M. Hatten, MD: No relevant relationships to disclose.

Adam J. Luginbuhl, MD: No relevant relationships to disclose.

PROGRAM DESCRIPTION: Head and neck paragangliomas can be a clinical challenge to providers identifying these rare neural crest-derived tumors. They present with unique clinical exam findings, radiologic characteristics, and histopathologic features. Therefore, providers should approach management, including surgery, radiation, and observation, with up-to-date knowledge of the literature, particularly as it pertains to hereditary paragangliomas. Recent studies have changed the way we should manage patients. There is a greater emphasis on watchful waiting and new data on when, where, and how patients should be serially imaged. This information is critical to providing an evidence-based survivorship program, including monitoring for recurrence, progression, or second primary paragangliomas.

This panel will begin with a brief review of head and neck paragangliomas as well as an updated overview of diagnosis, hereditary disease, and a cost-effective model for genetic testing. Next, recent literature will be applied to provide evidence-based guidelines on clinical management, including personalized longitudinal surveillance and survivorship. Lastly, Dr. Netterville will provide practical lessons from his several decades of experience. Each of these topics will be followed by case presentations to apply these concepts to the management of actual patients. This session will be conducted using audience polling software to facilitate engagement and discussion among the panelists while highlighting fundamental principles and guidelines.

OUTCOME OBJECTIVE 1: Compose a comprehensive initial workup for a patient presenting with a newly diagnosed head and neck paraganglioma.

OUTCOME OBJECTIVE 2: Describe the treatment options based on up-to-date literature and endocrine society guidelines with knowledge of the gaps in modern knowledge.

OUTCOME OBJECTIVE 3: Provide evidence-based, individualized recommendations for patient surveillance.

BACKGROUND STATEMENT: The hereditary and benign nature of paragangliomas is in stark contrast with traditional malignancies of the head and neck—the management should be as well. Further, there are numerous updates on the impact of genetics on treatment and surveillance that are not familiar to most surgeons.