Parathyroid carcinoma: Is there a role for adjuvant radiation therapy?

Abstract

BACKGROUNDThe authors proposed to determine risk factors associated with postoperative progression of parathyroid carcinoma within the neck (locoregional) and to assess the efficacy of postoperative adjuvant radiation therapy in preventing disease progression within the neck.METHODSA retrospective review of patients with pathologically confirmed parathyroid carcinoma who underwent surgical resection was performed. Risk factors identified on univariate analysis were applied in a proportional hazards analysis to identify significant independent predictors of locoregional disease progression and cause‐specific survival after surgical resection. Fifty‐seven patients were treated with surgery alone (no adjuvant radiation therapy [RT]) and were determined to have sufficient follow‐up and pathologically confirmed features to be included in the current analysis. Four patients were treated with surgery and adjuvant RT. Four patients received RT to the neck and mediastinum for unresectable locoregional disease progression. Patients were followed for a median of 75.6 months (range, 8.4–358 months).RESULTSTwenty‐five patients (44%) developed locoregional disease progression at a median of 27.1 months after surgery (range, 6.2–138.3 months). The univariate analysis revealed that surgical margin status and the institution at which the initial surgery was performed were predictive of locoregional progression‐free survival. The institution at which the initial surgery was performed was found to be an independent predictor of cause‐specific survival. Of the four patients treated with surgery and adjuvant RT, all were alive and without disease at the time of last follow‐up. All four patients who received RT for locoregional disease progression after initial surgery achieved locoregional disease control.CONCLUSIONSPatients with parathyroid carcinoma are reported to have a significant risk of locoregional disease progression after surgery alone. The results of the current study demonstrated that the risk of postoperative disease progression can be predicted by surgical margin status and the institution at which the initial surgery is performed. Patients treated with surgery and postoperative RT may have a lower risk of locoregional disease progression and improved cause‐specific survival. RT can be used to provide locoregional control of recurrent disease. Cancer 2003. © 2003 American Cancer Society.

Non-functional parathyroid carcinoma: a case report and review of the literature

“…65 Munson has used a radiation dosage as high as 70 Gy in studies. 66 No reports on the efficacy of chemotherapy in patients with non-functional parathyroid carcinoma have been published. It can be only found in the case reports which described the role of chemotherapy in the management of nonfunctional parathyroid carcinoma.…”

Hiperparatiroidismo primario y cáncer de paratiroides: Caso clínico

“…Su utilidad estaría dada en aquellos casos con márgenes positivos de resección o para disminuir la recurrencia local. Existen muy pocos antecedentes para considerarla como opción de tratamiento único 20 . En cuanto a la quimioterapia, se reporta en algunas publicaciones, su utilización para el manejo de hipercalcemias severas, ultilizando 5-Fluoracilo o Ciclofosfamida, en caso de enfermedad metastásica a distancia.…”

Parathyroid Carcinoma: A Rare Cause Of Hyperparathyroidism

“…Chemotherapy regimes such as adriamycin, cyclophosphamide, dacarbazine has limited effect on metastatic or recurrent disease. [2,13,16,[19][20][21] Metabolic manifestations of unresectable tumor leads the patients to the death and management of these conditions depend on medical treatment. The management of hypercalcaemia starts with administration of saline infusion and loop diuretics to increase calciuresis.…”

“…Previous reports of 5 years and 10 years survival rates are 85.5% and 49.1%, respectively for patients with parathyroid carcinoma. [2,13,15,19] Even though parathyroid surgery in benign diseases carries out pitfalls for experienced surgeons, carcinoma of this gland is a cul-de-sac for many physicians. The management of parathyroid carcinoma depends on a multidisciplinary approach consist of surgeon, pathologist, endocrinologist, radiologist, nuclear medicine doctor, and oncologist.…”