What features or presentations would prompt you to offer radiotherapy for paraganglioma vs. continued surveillance?

I think aside from symptomatic disease, other criteria I would consider for treating vs surveillance for paraganglioma include size/location where tumor growth in a particular location may lead to progressive/permanent neuropathies and therefore prophylactic RT may be warranted. I am also more likely to offer radiation to asymptomatic lesions that are >2cm.

Many reasonable RT options out there including fractionated RT ~45-50 Gy in 1.8-2 Gy/day or SRS 12-16 Gy or hypofx RT 25 in 5 fx. For tumors >3cm I'd probably go fractionated (hypo or conventional RT). Control rates are generally >80%.