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Head and Neck Cancers • Radiation Oncology
How do you manage parathyroid carcinomas with positive microscopic margins?
It seems that postoperative RT is indicated to help improve local control (based on small series from MD Anderson and Mayo Clinic). What areas should be treated? Just the tumor bed? Or should the neck be included? If so, what lymph node levels should be treated? What would the optimal dose be? The patient was presumed to have a thyroid nodule and underwent hemithyroidectomy with 2 negative perithyroid nodes and was found to have parathyroid carcinoma on final pathology.
Answer from: Radiation Oncologist at Academic Institution
As parathyroid ca is rare and no reliable data about post-op RT exist, we have to extrapolate from common tumors about which we have data. If this was a sq.c.ca in the low neck, or thyroid ca, we would treat the primary site (positive margins) to 66-70 Gy and neck levels II-IV as well as VI and uppe...
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