Examinando por Autor "Silva-Figueroa, Angélica"

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    A nomogram for relapse/death and contemplating adjuvant therapy for parathyroid carcinoma
    (Elsevier, 2023-08) Silva-Figueroa, Angélica
    The staging systems proposed to date for PC have not been adequately validated. Recent multivariate have been carried out in large national and international databases to search for prognostic factors for survival and relapse in PC. Advanced age, male gender, high PTH and calcium levels at diagnosis, tumor size >30 mm, angioinvasion, presence of distant metastases, and specific tumor microenvironmental factors, such as parafibromin staining and tumor-infiltrating lymphocytes, have been strongly correlated with decreased OS and CSS, and with increased risk of local and distant recurrence. Because of their prognostic significance, these host and tumor factors should be included in any PC staging system. However, there is a need to promote collaborative PC registry plans to collate data on the above prognostic factors as well as new ways in a standardized global registry. Such a resource could be used to stratify patients with PC and identify those at high risk for relapse and death who may benefit from strict surveillance or adjuvant therapeutic care. PC is an indolent cancer with a high recurrence rate of 3 to 5 years after the first surgical intervention. Progression can remain dormant for decades until patients present with distant metastases. Such heterogeneity and neoplastic latency make OS an ambitious endpoint to achieve, and pursuing OS contradicts the actual needs of patients with this endocrine neoplasm. More relevant endpoints focus on achieving normal blood biochemistry to improve quality of life and intervening to lengthen recurrence/metastasis event-related-free survival. Surgery remains the standard treatment because traditional therapies, such as EBRT and chemotherapy, do not benefit patients with advanced unresectable or metastatic PC, new options are emerging for patients with PC. Genomic and phenotypic profiling can continue to inform personalized therapeutic strategies to expand the clinical options available to patients with PC.
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    Diagnosis and surgical management of parathyroid carcinoma
    (Springer Nature, 2022-01) Silva-Figueroa, Angélica
    This chapter describes the clinical presentation of parathyroid carcinoma (PC) and its variants. The current recommendations for diagnosis and management of patients with PC are described following the most current evidence-based literature. This chapter discusses the clinical factors of preoperative and intraoperative suspicion and the criteria for the unequivocal diagnosis of PC. It also comprehensively describes PC surgical management and the therapeutic goals of resection. A detailed description of the prognostic factors and recommendations for long-term clinical follow-up of patients with PC after their first surgical intervention are included as well. The chapter concludes with a case study along with a series of multiple-choice questions to enhance learning.
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    Puesta al día: carcinoma paratiroideo
    (Sociedad Médica de Santiago; Sociedad Chilena de Medicina Interna , 2021) Silva-Figueroa, Angélica
    Parathyroid carcinoma is a rare malignant disease that presents as a sporadic or familial primary hyperparathyroidism (PHP). The latter is associated with some genetic syndromes. It occurs with equal frequency in both sexes, unlike PHP caused by parathyroid adenoma that is more common in women. It hould be suspected in cases of severe hypercalcemia, with high parathyroid hormone levels and a palpable cervical mass. Given the difficulty in distinguishing between parathyroid carcinoma and adenoma prior to the surgery, the diagnosis is often made after parathyroidectomy. The only curative treatment is complete surgical resection with oncologic block resection of the primary tumor to ensure free margins. Adjuvant therapies with chemotherapy or radiation therapy do not modify overall or disease-free survival. Recurrences are common and re-operation of resectable recurrent disease is recommended. The palliative treatment of symptomatic hypercalcemia is crucial in persistent or recurrent disease after surgery since morbidity and mortality are more associated with hypercalcemia than with tumor burden.