Outcome after radioiodine therapy in 107 patients with differentiated thyroid carcinoma and initial bone metastases: side-effects and influence of age
Outcome after radioiodine therapy in 107 patients with differentiated thyroid carcinoma and initial bone metastases: side-effects and influence of age
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DOI：
10.1007/s002590000420
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发表时间：
2001-02-01
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影响因子：
--
通讯作者：
Knapp, WH
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作者：
Petrich, T;Widjaja, A;Knapp, WH
分化型甲状腺癌患者的初始骨转移是罕见的，尤其是年轻的ER患者。长期的治疗和高放射性碘常常是导致转移性疾病缓解所必需的。放射性碘疗法的治疗潜力，特别是在年轻患者中的治疗潜力尚未确定。在这项回顾性研究中，我们评估了107例初发骨转移患者的治疗结果、总放射性碘活度和相关的副作用。107例患者中有8例年龄小于45岁(37.5+/-7.3岁)，属于第1组(WHO分级，II期，“低风险”)。其余99例患者年龄>45岁(64.1+/-9.5岁)，形成2组(IV期，WHO分级，“高危”)。1组完全缓解或部分缓解的发生率高于2组(62.5%对49.5%)。第1组活动量较低(18.89+/-15.08 GBQ vs 31.97+/-31.25 GBQ)，血细胞计数变化不明显。在第一组中，血细胞变化仅达到I级或II级(WHO分级)，而第二组中有III级和IV级变化以及急性白血病。在第一组中，骨转移小于或等于3的4例患者中，有3例经放射性碘治疗(11.1GBQ)后完全缓解。额外的肺转移(107例患者中有44例存在)不影响预后。我们的结论是，分化型甲状腺癌的初始骨转移可以通过放射性碘治疗达到治疗目的，而且这种方法在年轻患者和转移数量较少的患者中具有特别现实的成功机会。
Initial bone metastases in patients with differentiated thyroid carcinoma are rare, especially in young er patients. Long duration of therapy and high activities of radioiodine are often necessary to induce remission of metastatic disease. The curative potential of radioiodine therapy, in particular in younger patients, has not yet been determined. In this retrospective study we evaluated the therapeutic outcome, total radioiodine activities and associated side-effects in 107 patients with initial bone metastases. Eight of the 107 patients were younger than 45 (37.5+/-7.3) years, and were classified as group 1 (stage II, "low risk", WHO classification). The remaining 99 patients were older than 45 (64.1+/-9.5) years, and formed,group 2 (stage IV, "high risk", WHO classification). Total or partial remission was more frequently achieved in group 1 than in group 2 (62.5% vs 49.5%). Lower activities were needed in group 1 (18.89+/- 15.08 GBq vs 31.97+/-31.25 GBq), and there were less marked alterations in the blood count in this group. In group 1, blood count alterations reached only grade I or II (WHO classification), whereas grade III and grade IV alterations as well as acute leukaemia were observed in group 2. In group 1, complete remission was achieved with radioiodine therapy (11.1 GBq) in three out of four patients with less than or equal to3 bone metastases. Additional pulmonary metastases (present in 44 out of 107 patients) did not influence prognosis. We conclude that initial bone metastases in differentiated thyroid carcinoma can be treated with curative intent by means of radioiodine therapy, and that this approach has a particularly realistic chance of success in younger patients and those with a small number of metastases.