Parathyroid carcinoma: pointers to successful management.

Five patients with parathyroid carcinoma are reported. In the first case the clinical and histological features of malignancy at initial surgery were not recognised and recurrence of the tumour occurred within two years. Referring to previously published series this sequence appeared to be typical and underlined the likely reasons for the poor prognosis of this rare tumour. A review of the diagnostic criteria to improve early diagnosis was undertaken and a treatment protocol drawn up. It was based on a more radical surgical extirpation to include the tumour bed together with postoperative radiotherapy. Four further cases have subsequently been identified, treated according to the protocol and at 16 to 49 months' follow up, show no sign of recurrence and have a normal serum calcium.