甲状腺乳头状癌术后放疗的作用  

Analysis of the effectiveness of radiotherapy in postoperative residual tumors in patients with thyroid papillary carcinoma

作　　者：吴跃煌[1] 易俊林[2] 罗德红[3] 杨红鹰[4] 李德志[1] 梁青壮 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院头颈外科,100021 [2]中国医学科学院北京协和医学院放疗科,100021 [3]中国医学科学院北京协和医学院诊断科,100021 [4]中国医学科学院北京协和医学院病理科,100021

出　　处：《中华肿瘤杂志》2015年第10期776-779,共4页Chinese Journal of Oncology

摘　　要：目的：探讨放疗在术后残存或复发甲状腺乳头状癌中的作用。方法选择2011年1月至2014年1月间接受过手术和放疗、但仍有肿瘤残留的甲状腺乳头状癌患者34例，其中Ⅰ期22例，Ⅲ期5例，Ⅳa期7例。34例患者放疗前平均接受过1．5次手术。术后接受的放疗剂量为50～70 Gy，平均56 Gy。入院后再行手术治疗，分析放疗后患者临床病理特征的变化，放疗前后甲状腺肿瘤及颈部转移灶的影像学特征，并测量病灶大小的变化情况。采用实体瘤的疗效评价标准评价肿瘤残留病灶的客观疗效。结果再行手术切除的甲状腺或颈部淋巴结均经病理证实为甲状腺乳头状癌或颈淋巴结乳头状癌转移。病理学检查显示，轻或中度细胞变性22例，肿瘤细胞无明显退变12例。放疗客观效果评估无完全缓解病例。放疗前后肿瘤平均最长径分别为27．18 mm和27．76 mm，差异无统计学意义（ P＞0．05）。再手术仅3例局部少许残留外，其余均完全手术切除；除1例喉返神经损伤外，无其他严重并发症。结论放疗对甲状腺局部及颈部残留或复发的乳头状癌作用无明显效果，应仅限于因侵及重要器官组织而确切不能彻底手术切除者，或其他原因不能手术的患者给予辅助治疗。Objective The aim of this study was to assess the impact of radiotherapy on patients with postoperative residual or recurrent papillary thyroid cancer （ PTC）. Methods We retrospectively reviewed the medical records of 34 patients with PTC, who underwent surgery and radiotherapy in other hospitals, and treated at the Department of Head and Neck Surgery at Cancer Institute ＆amp; Hospital CAMS from January 2011 to January 2014. Among the 34 cases, 22 were in stageⅠ, 5 in stageⅡ and 7 in stageⅣa. The 34 patients received 1. 5 times of surgery before radiotherapy in average. All the cases received radiotherapy （mean, 56 Gy; range, 50-70 Gy）. The patients were re-operated in our hospital, and the specimens were examined by pathology. The pre-and post-radiotherapy images （ CT and B-ultrasound） were compared, and the changes of tumor volume were examined. The objective effect of treatment on the tumor residual focus was evaluated using RECIST, and analyzed by t-test （SPSS 17.0）. Results All the re-resected lesions after radiotherapy were proved by pathology to be papillary thyroid cancer （ PTC ） or metastatic PTC in cervical lymph nodes. Among the 34 patients, 22 cases showed mild or moderate cell degeneration and the other 12 cases showed no obvious degeneration. The largest tumor diameter was 27.18 mm before radiotherapy and 27. 76 mm after radiotherapy, with a non-significant difference between them （ t=-1.618, P〉0.05） . Among the 34 patients, only 3 patients received reoperation, all other 31 cases had complete resection, and no severe complications were observed except recurrent laryngeal nerve injury in one case. Conclusions Radiotherapy has few therapeutic benefit to PTC patients after surgery with residual tumor or local recurrence. It should be used in the PTC patients, in which the tumor invasion involves important organ tissues and is difficult for a single operation to achieve safe resection margin, or in patients who can′t bear a surgery because of severe coronary heart di

关 键 词：甲状腺肿瘤 乳头状瘤 放射治疗 再手术 

分 类 号：R736.1[医药卫生—肿瘤]