有关远处转移性分化型甲状腺癌放射性碘治疗的意义  

Iodine-131 therapy for distant metastases of differentiated thyroid carcinoma

作　　者：林岩松 李若尘 LIN Yan-song;LI Ruo-chen(De-partment of Nuclear Medicine,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospi-tal,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院核医学科,疑难重症及罕见病国家重点实验室,核医学分子靶向诊疗北京市重点实验室,北京100730

出　　处：《中国实用外科杂志》2024年第6期619-624,共6页Chinese Journal of Practical Surgery

基　　金：北京协和医院中央高水平医院临床科研专项基金项目(No.2022-PUMCH-B072)。

摘　　要：分化型甲状腺癌(DTC)是一种常见的甲状腺癌类型,包括甲状腺乳头状癌(PTC)、甲状腺滤泡癌(FTC)和甲状腺嗜酸细胞癌(OTC)。尽管大多数DTC病人通过手术、放射性碘治疗(RAIT)和促甲状腺激素(TSH)抑制治疗后预后较好,但仍有部分病人发展为远处转移性分化型甲状腺癌(DM-DTC),其中肺和骨是最常见的转移部位。RAIT是DM-DTC术后的一线治疗手段,能有效降低复发及死亡风险。针对DM-DTC,RAIT的治疗方案需基于病人的病灶摄碘特征进行个体化制定。研究结果显示,RAIT在肺微转移灶的完全缓解率较高,而对于骨转移病人,虽然治愈率低但能显著改善预后。此外,RAIT前的准备工作如升高TSH水平和低碘饮食也对治疗效果有重要影响。病灶摄碘能力的预评估[如诊断性全身显像(Dx-WBS)]和分子特征(如BRAFV600E和TERT启动子突变)的检测有助于预测RAIT疗效和放射性碘治疗抵抗(RAIR)-DTC的风险。对于不摄碘或疗效不佳的病人,可考虑其他局部治疗或新型分子靶向药物,以提高生存率和生活质量。总体而言,RAIT在DM-DTC的治疗中发挥了关键作用,但需要根据个体情况进行综合决策和动态调整。Differentiated thyroid carcinoma(DTC)is a common type of thyroid cancer,including papillary thyroid carcinoma(PTC),follicular thyroid carcinoma(FTC),and oncocytic thyroid carcinoma(OTC).Although most patients with DTC have a favorable prognosis following surgery,radioactive iodine therapy(RAIT),and TSH suppression therapy,a subset of patients develop distant metastatic differentiated thyroid carcinoma(DM-DTC),with the lungs and bones being the most common sites of metastasis.RAIT is the first-line postoperative treatment for DM-DTC and can effectively reduce recurrence and mortality risks.The RAIT treatment plan for DM-DTC should be individualized based on the iodine uptake characteristics of the lesions.Research indicates that RAIT has a high complete remission rate for lung micro-metastases,while for bone metastases,although the cure rate is low,it significantly improves prognosis.Additionally,preparatory work before RAIT,such as elevated TSH levels and a low-iodine diet,significantly impacts treatment outcomes.The pre-assessment of iodine uptake capability(e.g.,Dx-WBS)and the detection of molecular characteristics(e.g.,BRAFV600E and TERT promoter mutations)help predict RAIT efficacy and the risk of RAIR-DTC.For patients who do not uptake iodine or have poor treatment responses,other local treatments or novel molecular-targeted drugs should be considered to improve survival rates and quality of life.Overall,RAIT plays a crucial role in of treating DM-DTC,but comprehensive decision-making and dynamic adjustments based on individual conditions are necessary.

关 键 词：分化型甲状腺癌 远处转移 放射性碘治疗 

分 类 号：R6[医药卫生—外科学]