Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: Benefits and limits of radioiodine therapy
Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: Benefits and limits of radioiodine therapy
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DOI：
10.1210/jc.2005-2838
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发表时间：
2006-08-01
影响因子：
5.8
通讯作者：
Schlumberger, M.
中科院分区：
文献类型：
--
作者：
Durante, C.;Haddy, N.;Schlumberger, M.
目的：本研究的目的是评估I-131对甲状腺癌远处转移患者的累积活性。方法：从1953年至1994年，共有444例甲状腺乳头状癌和滤泡状癌远处转移患者接受了治疗：仅肺转移223例，仅骨转移115例，肺骨转移82例，其他部位转移24例。治疗包括在停止甲状腺激素治疗后给予3.7 GBq（100 mCi）I-131，在前2年中每3-9个月一次，然后每年一次，直到任何转移性摄取消失。甲状腺素治疗给予抑制剂量之间的I-131治疗courses.Results：阴性成像研究（负全身I-131扫描和常规X线照片）达到43%的295例I-131摄取;更常见于那些年轻，分化良好的肿瘤，并有一个有限的疾病程度。大多数阴性研究（96%）是在给予3.7-22 GBq（100-600 mCi）后获得的。几乎一半的阴性研究是在转移瘤治疗开始后5年以上获得的。在获得阴性研究的患者中，只有7%的患者随后出现肿瘤复发。在10年后开始的I-131治疗的总生存率为92%的患者谁取得了阴性研究和19%的那些谁没有。结论：I-131治疗是非常有效的年轻患者与I-131摄取和小转移。他们应该接受治疗，直到任何摄取消失或直到22 GBq的累积活性已经管理。在其他患者中，当记录到肿瘤进展时，应使用其他治疗方式。
Aim: The goal of this study was to estimate the cumulative activity of I-131 to be administered to patients with distant metastases from thyroid carcinoma.Methods: A total of 444 patients were treated from 1953-1994 for distant metastases from papillary and follicular thyroid carcinoma: 223 had lung metastases only, 115 had bone metastases only, 82 had both lung and bone metastases, and 24 had metastases at other sites. Treatment consisted of the administration of 3.7 GBq (100 mCi) I-131 after withdrawal of thyroid hormone treatment, every 3-9 months during the first 2 yr and then once a year until the disappearance of any metastatic uptake. Thyroxine treatment was given at suppressive doses between I-131 treatment courses.Results: Negative imaging studies ( negative total body I-131 scans and conventional radiographs) were attained in 43% of the 295 patients with I-131 uptake; more frequently in those who were younger, had well-differentiated tumors, and had a limited extent of disease. Most negative studies (96%) were obtained after the administration of 3.7-22 GBq (100-600 mCi). Almost half of negative studies were obtained more than 5 yr after the initiation of the treatment of metastases. Among patients who achieved a negative study, only 7% experienced a subsequent tumor recurrence. Overall survival at 10 yr after initiation of I-131 treatment was 92% in patients who achieved a negative study and 19% in those who did not.Conclusion: I-131 treatment is highly effective in younger patients with I-131 uptake and with small metastases. They should be treated until the disappearance of any uptake or until a cumulative activity of 22 GBq has been administered. In the other patients, other treatment modalities should be used when tumor progression has been documented.