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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    Clinical course of atypical parathyroid neoplasm with soft tissue extension
    (Wiley, 2024-08-19) Feldman, Hope; Busaidy, Naifa; Tame-Elorduy, Andres; Silva-Figueroa, Angélica; Halfteck, Gili; Merriman, Kelly; Waguespack, Steven; Graham, Paul; Williams, Michelle; Perrier, Nancy
    Background and Objectives: The American Joint Committee on Cancer (AJCC) TNM staging system defines atypical parathyroid neoplasia (APN) as tumor in situ (Tis) and reserves the definition of parathyroid carcinoma (PC) to parathyroid tumor with invasion into surrounding structures. Because the parathyroid gland has no true capsule, “extension” with APN versus microscopic “invasion” of surrounding soft tissue can be difficult and confusing for clinicians. We aimed to determine the clinical course of atypical parathyroid neoplasm with and without soft tissue extension and parathyroid carcinoma with only soft tissue invasion (pT1) and to report the outcomes. Methods: Following an IRB‐approved protocol, we identified all patients treated for parathyroid neoplasm or cancer at our single tertiary care cancer center from 1990 to 2021. We excluded all patients with evidence of clinical or pathologic gross invasion into surrounding structures (pT2 or higher), lymph node involvement, or metastatic disease. By definition, this excluded all cases where the distinction was clinically evident to the surgeon at the time of the operation based on finding a hard, firm, sticky, or discolored parathyroid gland. Only patients with pathologic T1 (pT1) parathyroid carcinoma or APN were included. All pathologic examinations were independently re‐reviewed by a single designated expert senior endocrine pathologist. The definition of APN strictly followed the WHO definition of a clinically worrisome lesion having features including fibrous bands or increased mitotic rate, necrosis, or trabecular growth that did not meet robust criteria for frank invasion. Pathologic T1 disease was defined as invasion limited to soft tissue. Analyses were performed using R version 4.0.2 and Jamovi. Results: Of all PC patients at our institution, only 71 met the strict inclusion criteria of APN or pT1. Forty‐four patients had pT1 disease and 27 had APN: 12 of the APN had soft tissue extension, and 15 had no soft tissue extension. The groups were similar with regard to age at diagnosis (p = 0.328). The average follow‐up duration was 84 months from initial surgical intervention. Of the 12 with APN, one patient (1/12; 8%) with soft tissue extension recurred, developed distant metastases, andsubsequently died during follow up. Of the 44 patients with pT1 PC, six developed distant metastases and 13 (13/44; 30%) died during the follow‐up period. One patient with APN and soft tissue extension recurred and died and no patient with APN and no soft tissue extension died. Conclusions: Patients with APN and extension into soft tissue have a clinical course similar to that of APN without soft tissue extension. APN with soft tissue extension is a different disease from pT1 disease with invasion of soft tissue. The pTis classification appears justified for APN with and without soft tissue extension.
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    Diagnosis and surgical management of parathyroid carcinoma
    (Springer Nature, 2022-01) Silva-Figueroa, Angélica; Perrier, Nancy
    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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    Impacto en el patrón de atención en cirugía de cabeza y cuello y las medidas sanitarias adoptadas durante los primeros 150 días de la era COVID-19
    (Sociedad de Cirujanos de Chile, 2021-12) Toledo-Villegas, Karina; Silva-Figueroa, Angélica; Castro S., Rodrigo; Aguilar C., Oscar; Inturias C., Rene; Gallego C., Alejandra; González-Prado, Miguel
    Introducción: La pandemia COVID-19 generó una reestructuración en la atención quirúrgica mundialmente debido a su alta transmisibilidad y la inherente limitación de los recursos humanos y materiales disponibles. Objetivo: Describir el impacto de la pandemia COVID-19 en el Equipo de Cirugía Cabeza y Cuello del Complejo Asistencial Barros Luco Trudeau (CABL) en su ejecución clínico-quirúrgica y la secuenciación organizada de las medidas sanitarias aplicadas a lo largo del tiempo durante los primeros 150 días de iniciada la pandemia en Chile. Materiales y Método: Realizamos una revisión retrospectiva de los pacientes sometidos a cirugía y/o evaluados ambulatoriamente durante el período COVID-19 comprendido entre el 3 de marzo y el 31 de julio de 2020, comparado con el mismo intervalo de tiempo de 2019. Características clínicas y medidas sanitarias empleadas durante este período fueron sintetizadas. Resultados: Detectamos un descenso del 64% en atención ambulatoria y un descenso del 58% en la carga quirúrgica, comparado con el año 2019. Durante el período COVID-19 de 2020, un total de 61 pacientes fueron sometidos a intervención quirúrgica. La principal indicación de cirugía fue cáncer en un 75,4% (46). No se reportaron pacientes contagiados por COVID-19 en los 14 días siguientes a la hospitalización. Se discuten las consideraciones perioperatorias empleadas y restricciones nacionales/institucionales sanitarias. Conclusión: La crisis sanitaria mundial secundaria al COVID-19 generó una reducción en las atenciones ambulatorias y cirugías realizadas por Equipo de Cabeza y Cuello CABL. A pesar de las restricciones sanitarias, organizamos estratificadamente la atención para preservar la resolución de casos críticos no diferibles en cabeza y cuello
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    Puesta al día: carcinoma paratiroideo
    (Sociedad Médica de Santiago; Sociedad Chilena de Medicina Interna , 2021) Silva-Figueroa, Angélica; Barberán, Marcela; Campusano, Claudia; Salman, Patricio; Trejo, Pamela; Rivera, Sandra; Florenzano, Pablo; Velasco, Soledad; Illanes, Francisca; Trincado, Patricio; Canessa, José; Solar, Antonieta; Marcela, Moreno; Eugenin, Daniela; Jiménez, Beatriz; Arroyo, Patricia
    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.