The Use and Benefit of Adjuvant Radiotherapy in Parathyroid Carcinoma: A National Cancer Database Analysis

Abstract

Background. The routine use of external beam radiotherapy (EBRT) is not recommended for parathyroid carcinoma (PC). However, case series have demonstrated a potential benefit in preventing local recurrence with EBRT. We aimed to characterize the patient population treated with EBRT and identify any impact of EBRT on overall survival (OS) in parathyroid carcinoma. Methods. Patients who underwent surgery for PC from 2004 to 2016 were identified from the National Cancer Database. Clinicopathologic variables and OS were compared between patients based on treatment with EBRT. Multivariable logistic and Cox regression models were performed with propensity scores and inverse-probabilityweighting (IPW) adjustment to reduce treatment-selection bias in the OS analysis. Results. A total of 885 patients met the inclusion criteria, with 126 (14.2%) undergoing EBRT. Demographics were similar between the two cohorts (EBRT vs. no EBRT). However, patients treated with EBRT had a higher frequency of regionally extensive disease, nodal metastases, and residual microscopic disease (all p \ 0.05). On multivariable analysis, Black race, regional tumor extension, nodal metastasis, and treatment at an urban facility were independently associated with EBRT. The 5-year OS was 85.3% with a median follow-up of 60.8 months. EBRT was not associated with a difference in OS in crude, multivariable, or IPW models. More importantly, 10.5% of patients with completely resected localized disease (M0, N0 or Nx) underwent EBRT without a benefit in OS (p = 0.183). Conclusions. EBRT is not associated with any survival benefit in the treatment of PC. Therefore, it may be overutilized, particularly in patients with localized disease and complete surgical resection.

Genomics and Epigenomics in Parathyroid Neoplasia: from Bench to Surgical Pathology Practice

“…1 e, f) [ 8 ]. Chemotherapy and/or radiotherapy are largely ineffective, and the 10-year survival rate is around 50–70% [ 22 ], with death often due to hypercalcemia. Morbidity due to complications following repetitive neck surgery (hypoparathyroidism, recurrent nerve palsy) is also high [ 23 ].…”

Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature

“…According to our experience and recent studies, radical surgical approach is currently the goal standard of treatment for recurrences [ 3 , 39 , 40 , 42 , 45 – 47 ].…”

“…In fact, according to literature, only a few authors [ 48 – 54 ] attest the usefulness of radiotherapy and chemotherapy in improving rate of recurrence and survivor but the efficacy of adjuvant therapies has recently been disappointed in the management of recurrent parathyroid carcinoma, even if multicentric studies for improved long-term outcomes are still lacking [ 46 , 47 ].…”

Radiation Treatment for Inoperable Local Relapse of Parathyroid Carcinoma With Symptomatic Hypercalcemia: A Case Report

“…The authors reported no significant association between any demographic or pathologic feature and prognosis. A recent National Cancer Database Analysis on 885 patients reported a 5-year and 10-year OS of 85.4% (95% CI 82.4-87.9%) and 67.1% (95% CI 61.7-72.0%) ( 3 ).…”

“…The cornerstone of the treatment for PC is surgery. Complete surgical en bloc resection with ipsilateral hemithyroidectomy and prophylactic central lymphadenectomy (level VI) is generally recommended, and microscopic negative margins are considered the best chance for cure ( 2 , 3 , 20 , 23 – 26 ). Lymphadenectomy of regional lymph nodes other than level VI is not recommended as no therapeutic benefit has been established ( 22 , 27 ).…”