Treatment of Recurrent Parathyroid Cancer

Approximately 40% to 60% of patients experience a postsurgical recurrence, typically between 2 to 5 years after the initial resection.[1,2] Because it is difficult to establish a histological diagnosis of parathyroid cancer at the time of initial surgery, the appearance of recurrent or metastatic tumor can be the first sign of malignancy.[3]

Because these tumors are slow-growing, repeated resection of local recurrences and/or distant metastases can result in significant palliation.[4-8] Pulmonary metastases and bone metastases should be resected, if possible, to decrease the magnitude of the hypercalcemia.[7,9] Occasionally, long-term salvage is achieved in this group of patients with aggressive surgical treatment.[10] The major morbidity of recurrent or metastatic parathyroid cancer results from severe hypercalcemia, which can be difficult to control. For patients not fit for surgery, treatment with bisphosphonates, plicamycin, calcitonin, and gallium pamidronate may control hypercalcemia.[11] Control of malignant hypercalcemia with these medical measures is often only temporary.

Treatment options for recurrent parathyroid cancer include the following:[4-10]