RADT-78. DOTATATE-PET-GUIDED MULTIMODAL TREATMENT OF GLOMUS JUGULARE PARAGANGLIOMAS IMPROVES TINNITUS RESOLUTION AND SURGICAL OUTCOMES

Abstract BACKGROUND Glomus Jugulare paragangliomas represent challenging skull base neuroendocrine tumors with significant morbidity from cranial nerve compression and auditory symptoms. Current management paradigms emphasize tumor control over symptom resolution. We analyzed outcomes of DOTATATE-PET-guided multimodal therapy focusing on Tumor control, functional preservation, and symptom relief. METHODS Thirteen consecutive patients between 2021 – 2025 with histologically confirmed glomus jugulare paragangliomas underwent comprehensive evaluation, including DOTATATE-PET imaging for somatostatin receptor expression mapping. Treatment strategies included surgical debulking (n=11) followed by stereotactic radiotherapy (SBRT 25 Gy/5 fractions or Gamma Knife 14-16 Gy), or Radiosurgery alone (n=2). DOTATATE-PET demonstrated intense somatostatin receptor expression (SUV max 83-173) in all tumors, facilitating precise radiation therapy targeting after surgical resection. Clinical outcomes assessed included tinnitus resolution, hearing preservation, and cranial nerve function. RESULTS Median follow-up was 18 months. Among surgically treated patients, 8/11 (73%) achieved tinnitus improvement or resolution, compared to 0/2 (0%) with radiotherapy alone (p=0.04). Complete tinnitus resolution occurred in 4/11 (36%) surgical patients. Hearing outcomes varied: 5 patients maintained stable hearing, 4 developed conductive loss, and 2 experienced sensorineural deterioration. No patient developed new permanent cranial neuropathies. There were no recurrences. Imaging follow-up revealed stable disease in 11/13 patients, and partial response in 2 patients. CONCLUSIONS DOTATATE-PET imaging enables precise anatomical mapping of paragangliomas for stereotactic radiotherapy, even in a post-operative setting. Combined surgical debulking and radiotherapy achieves superior tinnitus control compared to radiotherapy alone, with acceptable hearing preservation rates. This functional outcome advantage supports multimodal therapy as the preferred approach for symptomatic glomus jugulare paragangliomas. Prospective studies are warranted to validate these findings and establish standardized treatment algorithms incorporating molecular imaging guidance.