Would you offer post-operative radiation for a glomus tumor of the spine following decompressive laminectomy and incomplete resection?

[⁶⁸Ga]-DOTATATE PET/CT has demonstrated excellent diagnostic value in the localization of SDHx-related and sporadic head and neck paragangliomas. Significantly more lesions were identified on [⁶⁸Ga]-DOTATATE PET/CT compared to all other functional and anatomical imaging modalities Janssen et al., PMID 26564322; thus, I would agree that functional imaging would likely help in the work up of this patient and in the delineation of the GTV. Furthermore, since therapeutic approaches for these patients may be still very limited, knowing the functionality of these tumors may open the door to treatment with so-called “cold” synthetic somatostatin analogs like octreotide.

As for the main question of post operative radiation for an incompletely resected glomus tumor, considering the location in the thoracic spine, I would favor post-operative upfront treatment rather than "salvage" treatment due to the risk of further growth and irreversible spinal cord myelitis. I would use a dose of 45-50 Gy with standard fractionation of 1.8-2 Gy/fraction, using no CTV (as these tumors are mostly benign in nature), and a tight PTV based on the imaging available in the department, such as CBCT or SGRT to ensure accurate targeting on the day-to-day set up. 

• Manzoor et al., PMID 32660391 

Interesting question. I’ve treated many paragangliomas over 40 plus years. I’ve never encountered this scenario. Short answer, yes. 45 Gy/25 fractions.