Contemporary Evaluation and Management of Parathyroid Carcinoma

2020 ◽  
pp. JOP.19.00540
Author(s):  
Abbey L. Fingeret
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Recurrent Disease ◽  
Tumor Burden ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Female Predominance ◽  
Males And Females ◽  
Rare Malignancy ◽  
Disease Free

Parathyroid carcinoma is a rare malignancy, representing 0.005% of all cancers and 0.5%-1% of all parathyroid disorders. Parathyroid carcinoma occurs equally in males and females, as opposed to primary hyperparathyroidism, which has a female predominance. Patients with parathyroid carcinoma present with symptoms of hypercalcemia, similar to those with benign primary hyperparathyroidism. Parathyroid carcinoma should be suspected when calcium or parathyroid hormone levels are high. Because of the difficulty of discerning parathyroid carcinoma from adenoma preoperatively, the diagnosis of carcinoma is often made only after parathyroidectomy. The goals of surgery are resection with negative margins because surgery represents the only opportunity for cure. Adjuvant therapy with chemotherapy or external beam radiation has not been proven to affect disease-free or overall survival for these patients. Recurrence is common, with reoperation recommended for resectable recurrent disease. Palliation with calcimimetic pharmacotherapy can aid with management of symptomatic hypercalcemia in recurrent or persistent disease after parathyroidectomy. Ultimately, patients succumb to sequelae of hypercalcemia rather than tumor burden.

scholarly journals Primary Hyperparathyroidism Secondary to Simultaneous Bilateral Parathyroid Carcinoma

2002 ◽  
Vol 81 (6) ◽  
pp. 395-401 ◽  
Author(s):  
Jimmy J. Brown ◽  
Hezla Mohamed ◽  
Lorraine Williams-Smith ◽  
Ryan Osborne ◽  
Joan Coker ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Surgical Procedures ◽  
Parathyroid Carcinoma ◽  
Frozen Section ◽  
Rare Entity ◽  
Time Of Surgery ◽  
Frozen Section Diagnosis ◽  
Rare Malignancy ◽  
High Index Of Suspicion

Parathyroid carcinoma is a rare malignancy, and experience with its management is limited. It is generally accepted that surgery is the treatment of choice, and the initial operative intervention might represent the only chance for long-term success. At the time of surgery, a high index of suspicion for carcinoma is vital to performing the appropriate surgical procedures, because frozen-section diagnosis of parathyroid carcinoma is notoriously unreliable. In this article, we describe our experience with this rare entity.

Disease-specific survival outcomes in lymph node–positive patients with prostate cancer treated with radiotherapy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 182-182 ◽  
Author(s):  
G. Crehange ◽  
V. K. Weinberg ◽  
A. Izaguirre ◽  
C. C. Hsu ◽  
I. J. Hsu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Survival Outcomes ◽  
Primary Therapy ◽  
Newly Diagnosed ◽  
Beam Radiation ◽  
Androgen Ablation ◽  
Disease Free

182 Background: Involvement of regional lymph nodes (LN+) at the time of prostate cancer (PCa) diagnosis is widely regarded as an adverse prognostic factor associated with poor outcome. No commonly utilized treatment, composed of any combination of androgen ablation, surgery and radiation, has proven to be superior for survival. This study will evaluate the clinical survival outcomes of patients (pts) with newly diagnosed LN+ PCa at the University of California San Francisco (UCSF). Methods: All newly diagnosed LN+ PCa pts treated with External Beam Radiation Therapy (EBRT) as primary therapy or after surgery, each with and without androgen ablation between 1987 and 2009 were included. All pts had confirmed pathologic or radiologic LN+ whereas none had evidence of metastases on the work up. Cause Specific Survival (CSS), Disease Free survival (DFS) and biochemical control were measured from the start of treatment. PSA failure was determined by the Phoenix definition after EBRT and by a confirmed PSA >1 ng/mL following RP+EBRT. Results: A retrospective analysis identified 91 pts with LN+ at the time of diagnosis (75.8% high risk pts) with disease follow-up. Thirty-four (37%) were managed with exclusive EBRT alone (eRT), 18 pts (20%) with a combination of radical prostatectomy (RP) and adjuvant EBRT (RP+aRT) and 39 pts (43%) were treated with a combination of RP + salvage RT (RP+sRT). Overall 78% of patients also received hormone therapy (HT): 74.0% with eRT, 89% with RP+aRT and 79% with RP+sRT. The 10 years CSS estimates was 89% for eRT, 0% after RP+aRT and 88% after RP+sRT. The 10 years DFS estimates was 33% for eRT, 0% after RP+aRT and 75% after RP+sRT. Among pts remaining disease free the median follow-up is 38 mos for eRT, 26 mos for RP+aRT and 64 mos for RP+sRT. The last PSA for these patients was <0.1 for 85% of all patients which included 47% following eRT, 100% after RP+aRT and 97% after RP+sRT. There were 7 deaths due to PCa occurring between 5 and 73 mos from the start of EBRT. Conclusions: The results of the current analysis indicate that some pts with LN+ from PCa have prolonged disease free outcomes; and for these men, aggressive treatment may be appropriate. No significant financial relationships to disclose.

Prostate brachytherapy as salvage for local failure after external beam radiation.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 125-125 ◽  
Author(s):  
Brian Christopher Baumann ◽  
John Charles Baumann ◽  
John Paul Christodouleas ◽  
Edward M Soffen
Keyword(s):  
Salvage Therapy ◽  
Biochemical Failure ◽  
External Beam Radiation ◽  
Prostate Brachytherapy ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Psa Nadir ◽  
Grade 3 ◽  
Disease Free

125 Background: Local failure (LF) after external beam radiation (EBRT) for prostate cancer is a serious problem. Most patients receive non-curative androgen deprivation therapy (ADT), but there is a subset with LF who are still potentially curable. There is limited evidence to suggest that prostate brachytherapy (BT) is an effective, potentially curative salvage therapy with acceptable toxicity. We hypothesize that salvage BT following EBRT can achieve high rates of biochemical control with acceptable toxicity. Methods: We analyzed 39 consecutive patients treated from 1998-2013 with salvage BT at 2 centers. All patients had pathologically confirmed LF following previous EBRT without distant mets & a disease-free interval of ≥ 18-24 mo. Salvage BT to the whole prostate was delivered to 29 patients using low-dose rate I-125 or Pd-103 seed implants (median dose 100 Gy with Pd-103) while 10 received HDR BT (median 30 Gy in 6 fractions). Cases were planned as if de novo but to a lower dose. 33 (85%) received neoadjuvant and/or adjuvant ADT as part of their salvage therapy. Biochemical failure (BF) was defined using the Phoenix criteria. Risk factor analysis was conducted to identify characteristics that predict BF after salvage BT. Results: For the 39 patients, median PSA at diagnosis was 8.4, and 21 (54%) had high-risk disease. Median EBRT dose was 70 Gy with 11 patients (28%) receiving ADT. Median PSA nadir following EBRT was 0.8 (range 0 – 2.6). Median time to recurrence was 53 mo (range 18 – 150), and median pre-salvage PSA was 4.8. Median follow-up after salvage BT was 60.1 mo (range 7 – 150). Biochemical failure-free survival, DMFS and OS at 5 & 7 yrs were 76% & 67%; 91% & 85% and 92% & 84%, respectively. On univariate analysis, PSA nadir after EBRT & pre-salvage PSA were significant predictors of BF (p< 0.01 for both). On multivariate analysis, only pre-salvage PSA was a significant independent predictor of BF (p< 0.01). Freedom from late grade 3 GU toxicity at 3 yrs was 83%. There were no late Grade 3 GI toxicities. Conclusions: This is the largest series reporting on salvage prostate brachytherapy plus ADT for local-only failures after EBRT & suggests that salvage BT with ADT offers selected patients prolonged disease-free survival with acceptable toxicity.

Biochemical Disease-Free Survival in Men Younger Than 60 Years With Prostate Cancer Treated With External Beam Radiation

2002 ◽  
pp. 536-541 ◽  
Author(s):  
CHARLES J. ROSSER ◽  
RAMSAY CHICHAKLI ◽  
LAWRENCE B. LEVY ◽  
DEBORAH A. KUBAN ◽  
LEWIS G. SMITH ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Disease Free

Biochemical Disease-Free Survival in Men Younger Than 60 Years With Prostate Cancer Treated With External Beam Radiation

2002 ◽  
Vol 168 (2) ◽  
pp. 536-541 ◽  
Author(s):  
Charles J. Rosser ◽  
Ramsay Chichakli ◽  
Lawrence B. Levy ◽  
Deborah A. Kuban ◽  
Lewis G. Smith ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Disease Free

scholarly journals SUN-LB77 Incidental Anaplastic Thyroid Carcinoma: An Uncommon Entity

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Preethi Padmanaban ◽  
Eric Nylen
Keyword(s):  
Thyroid Cancer ◽  
Adjuvant Therapy ◽  
Median Survival ◽  
Anaplastic Thyroid Cancer ◽  
Anaplastic Carcinoma ◽  
External Beam Radiation ◽  
Whole Body ◽  
American Thyroid Association ◽  
Beam Radiation ◽  
Disease Free

Abstract Background: Anaplastic thyroid cancer is an aggressive thyroid malignancy with a median survival of 3 to 9 months. It is rare and represents 2-5% of all thyroid tumors. Even more uncommonly in about 2%–6% of all ATC cases, it is identified as a small, incidental finding after surgical resection of a predominantly non-anaplastic tumor. Clinical Case: We report a case of 67 year old Caucasian male who presented with history of hoarseness of voice for one month. Fine needle aspiration biopsy of right dominant thyroid nodule revealed papillary thyroid cancer. Pre-operative imaging was negative for involvement of surrounding structures or distant metastasis. He underwent total thyroidectomy and final pathology revealed Anaplastic carcinoma arising in papillary carcinoma measuring 3.6cm in greatest dimension. Undifferentiated (Anaplastic) Carcinoma comprised approximately 5% of the tumor. Areas from anaplastic and papillary tumor were dissected separately. DNA separated from these two specimens were analyzed by PCR amplification and both were positive for BRAF mutation. External beam radiation and radioactive iodine therapy were administered after surgery. Given absence of invasion or metastasis adjuvant therapy was not initiated. His positron emission tomography, computed tomography imaging and whole-body scan has been negative for residual/ recurrent or metastatic disease. He remains disease free at 18 months after diagnosis. Discussion: Anaplastic thyroid cancer is a rare but highly aggressive tumor. In most cases it develops from a pre-existing well differentiated thyroid cancer. ATC incidence typically peaks at the 6-7th decade of life, predominantly in women. The median survival is between 3 to 9 months with less than 10% of patients alive 3 years after the time of diagnosis. Because of its aggressive behavior, the American Joint Committee on Cancer Staging Manual classifies all Anaplastic thyroid cancer Stage IV tumors. Surgery, chemotherapy and radiotherapy are the conventional therapeutic strategies performed in the attempt to improve survival. However, incidental anaplastic thyroid cancer is rare variant with very few reported cases. American Thyroid Association (ATA) Guidelines for Management of Patients with ATC do not include specific recommendations for this form of ATC. There is no consensus to define best treatment approach as to whether intrathyroidal incidentally detected ATC is best treated with surgery alone, surgery followed by radiotherapy, or surgery followed by chemotherapy plus radiation therapy. Conclusion: Based on review of our case as well as outcomes of similar reported cases, prognosis is favorable for incidental anaplastic thyroid cancer. Hopefully, with more data from similar cases to demonstrate difference in disease free survival we should be able to define the role of chemotherapy and adjuvant therapy for incidental ATC better. The question remains open, as to whether incidental anaplastic thyroid cancer should be considered as a separate entity from aggressive form of ATC.

Multimodality salvage therapy for anal cancer failing standard chemoradiation

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15635-e15635
Author(s):  
Y. N. You ◽  
D. W. Larson ◽  
E. J. Dozois ◽  
H. Nelson ◽  
E. Antpack Filho ◽  
...  
Keyword(s):  
Overall Survival ◽  
Recurrent Disease ◽  
Perineal Wound ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Beam Radiation ◽  
Intraoperative Radiation ◽  
Multimodality Approach ◽  
Pelvic Resection

e15635 Background: Most squamous cell carcinomas of the anal canal (SCC) respond to chemoradiation, but effective therapy for locally-invasive(T4) or recurrent disease that fails standard chemoradiation and/or salvage abdominoperineal resection (APR) has not been clearly delineated. A multimodality approach including chemoradiation, extended pelvic resection and intraoperative radiation therapy (IORT) was assessed for survival impact and treatment morbidity.morbidities. Methods: A prospective registry including 26 patients with locally-invasive or recurrent disease treated between 1993 and 2007 was reviewed. Primary endpoint was overall survival (OS), obtained from prospectively collected patient questionnaires and medical record review, and analyzed by the Kaplan-Meier method. Short (60-day postoperative) and long-term (median followup: 1.6 years; 5.3 years among survivors) complications were assessed. Results: Patients (median age: 51 years) presented with (1) locally-invasive disease that persisted despite initial standard chemoradiation (n=10, 39%), (2) disease that recurred after initial standard chemoradiation (n=10, 39%; median 1.7 years to recurrence), or (3) re-recurrence after a salvage APR (n=6, 23%; median 1.3 years since APR). All patients received chemotherapy and external beam radiation preoperatively, and 19% received additional postoperative chemoradiation. Gross pelvic disease was completely resected in all (R0 in 73%; R1 in 27%). IORT (750–3250cGy) was delivered at single (92%) or two sites (8%). Median overall survival (OS) was 1.7 years. Five-year OS were: 50%, 10%, and 22% for patients with locally-invasive, recurrent, and re-recurrent disease respectively. Short-term complications predominantly related to the perineal wound. Fifteen patients reported long-term complications (>grade3): bowel obstruction in 8 (1 requiring operation), perineal wound fistula/non-healing in 9, leg paresthesia in 5, hydronephrosis in 3. Conclusions: For select patients with locally-persistent or recurrent SCC who fail standard primary treatment, a multimodality approach involving chemoradiation, extended pelvic resection and IORT offers a chance for improved survival. No significant financial relationships to disclose.

Is the number of TACE treatments in HCC patients associated with improved survival? A SEER-Medicare population analysis.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 210-210
Author(s):  
Fadia T. Shaya ◽  
Ian Michael Breunig ◽  
Nader Hanna ◽  
Naimish B. Pandya ◽  
Viktor Chirikov ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Proportional Hazards ◽  
Population Analysis ◽  
Tumor Burden ◽  
Cox Proportional Hazards ◽  
External Beam Radiation ◽  
Marginal Effect ◽  
Beam Radiation ◽  
Stage 4 ◽  
The Impact

210 Background: We examine treatment patterns and associated survival outcomes of TACE at all stages of Hepatocellular Carcinoma in SEER Medicare. Methods: Medicare enrollees, 65 and older, with a diagnosis of a primary HCC between 2000-07 who received treatment were followed through end of 2009 using the Surveillance, Epidemiology and End-Results Program (SEER) and linked Medicare databases, with claims from Medicare parts A and B. Using Cox proportional hazards models, we assessed the impact on mortality, of each additional TACE, systemic chemotherapy, SIRT, external beam radiation therapy, ablation and surgical resection, controlling for cancer stage, general health status, underlying liver disease (alcohol related, Hepatitis B and C, moderate/severe liver dysfunction), and demographics. We assessed overall and HCC-related mortality for all, then for TACE-only treated patients, and stratified outcomes by stage. Results: Out of 3322 treated non-transplant HCC patients, 1094 got TACE, 74% were Caucasian, 6% African American, 66% male, and 45% were at stage 1/2, 17% at stage 3 and 14% at stage 4. Most (56%) received 1, 23% 2, 11% 3 and 10% 4 or more TACEs. In the adjusted models, both overall and HCC mortality reduction were associated with treatment with up to 2 TACEs (HR=0.68, P=<0.001 and HR=0.73, P=<0.001, respectively). A third TACE, but not a fourth, provided a further decrease in overall mortality (0.46, <0.001) and HCC mortality (.45, <0.001). When stratified by stage, the second TACE had a significant marginal effect within Stage 3, and only the first TACE had benefit within Stage 4. No effects were found for TACE in early HCC. In the adjusted models, liver conditions were not associated with HCC mortality among TACE treated patients only. Conclusions: TACE provides a survival benefit for elderly HCC patients in clinical practice. However, the survival benefit may decrease beyond 3 TACE treatments and varies by stage. Additional TACE treatments may be confounded if 4+ TACE treatments are utilized mainly to treat biologically aggressive disease related to extensive tumor burden, advanced disease or recurrences. Treatment selection bias cannot be excluded and should be further explored.

Parathyroid carcinoma: a report of two cases and a concise review and update of the literature

2005 ◽  
Vol 119 (7) ◽  
pp. 577-580 ◽  
Author(s):  
Humera Babar-Craig ◽  
Alberto Quaglia ◽  
Michael Stearns
Keyword(s):  
Primary Hyperparathyroidism ◽  
Dialysis Patient ◽  
Parathyroid Carcinoma ◽  
Recurrent Disease ◽  
Treatment Options ◽  
Renal Dialysis ◽  
Neck Mass ◽  
Tertiary Hyperparathyroidism ◽  
Concise Review ◽  
Recent Trends

Parathyroid carcinoma is very rare and when diagnosed can be difficult to treat as more than 50 per cent have persistent or recurrent disease. Patients generally present with profound symptoms of hypercalcaemia and a palpable neck mass. We describe a case of parathyroid carcinoma in primary hyperparathyroidism and a case in tertiary hyperparathyroidism in a renal dialysis patient. Most studies in the literature are retrospective but recent trends in presentation, treatment options and complications have been reviewed and are summarized in this paper.

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