To Radiate or Not to Radiate? Adjuvant External Beam Radiation Therapy for Nonanaplastic Thyroid Cancer.
To Radiate or Not to Radiate? Adjuvant External Beam Radiation Therapy for Nonanaplastic Thyroid Cancer.
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DOI：
10.1016/j.eprac.2022.03.373
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发表时间：
2022-07
影响因子：
4.2
通讯作者：
Papaleontiou, Maria
中科院分区：
文献类型：
--
作者：
Arida, Abdul Karim;Papaleontiou, Maria
非间变性甲状腺癌，包括分化甲状腺癌和髓样甲状腺癌，占甲状腺癌病例的95%以上，如果早期诊断，大多数通常是可以治愈的。非间变性甲状腺癌患者手术后使用辅助外束放射治疗（EBRT）并不常见，因为其治疗相关的发病率和缺乏前瞻性临床试验对其疗效的证据。其使用适应症仍有争议。目前的指南建议，术后有明显残留疾病的患者、有空气消化系统侵犯证据的患者和/或因局部晚期疾病而进行多次和频繁手术的患者应考虑EBRT。2,3鉴于EBRT在非间变性甲状腺癌中的使用和预后的现有数据仅来自单一机构的回顾性研究，这些研究存在选择偏倚，4,5,6,7,8 Hu等人的研究为非间变性甲状腺癌患者基于人群的使用趋势和治疗（而非姑息）目的的辅助EBRT的相关结果提供了重要见解。该研究包括57607名从加州癌症登记处确定的非间变性甲状腺癌患者，他们在2003年至2017年期间接受了手术后的EBRT，中位随访时间为3.1年。总体而言，EBRT的使用率较低（0.6%），甲状腺髓样癌患者的使用率最高，为7.7%，其次是滤泡性甲状腺癌和乳头状甲状腺癌，分别为1.1%和0.4%。在所有接受EBRT治疗的患者中，28.8%的患者死于甲状腺癌，而未接受EBRT治疗的患者死亡人数为1.3%。与非EBRT组相比，EBRT组患者中年龄较大、男性、患有甲状腺髓样癌、肿瘤大小较大、病情更晚期的比例更高。EBRT后所有甲状腺癌患者的10年病因特异性生存率（CSS）为61.5%。正如预期的那样，5年和10年的CSS在颈部病变患者中更好（分别为84.6%和80.3%），而在远处病变患者中，10年的CSS下降到34.4%。患者特征（如年龄较大）和肿瘤特征（如肿瘤大小较大、甲状腺外扩张、滤泡组织学和分期）与较低的10年CSS相关。
Nonanaplastic thyroid cancers, which include differentiated and medullary thyroid cancers, account for more than 95% of thyroid cancer cases, and the majority are often curable if diagnosed at an early stage. 1 The use of adjuvant external beam radiation therapy (EBRT) following surgery in patients with nonanaplastic thyroid cancers is uncommon because of its treatment-related morbidity and a paucity of evidence from prospective clinical trials on its efficacy. The indications for its use are still controversial. The current guidelines recommend that EBRT should be considered in patients with gross residual disease postoperatively, those with evidence of aerodigestive invasion, and/or those undergoing multiple and frequent operations because of locally advanced disease. 2, 3In view of the available data on EBRT use and outcomes in nonanaplastic thyroid cancer arising solely from single-institution retrospective studies that are subject to selection bias, 4, 5, 6, 7, 8 Hu et al’s 9 study provides important insight on population-based utilization trends and associated outcomes of adjuvant EBRT with curative (not palliative) intent in patients with nonanaplastic thyroid cancer. The study included 57 607 patients with nonanaplastic thyroid cancer identified from the California Cancer Registry who underwent EBRT following surgery between 2003 and 2017, with a median follow-up of 3.1 years. Overall, the utilization of EBRT was low (0.6%), with the highest utilization rate reaching 7.7% in medullary thyroid cancer patients, followed by 1.1% and 0.4% in patients with follicular and papillary thyroid cancers, respectively. Of all the patients treated with EBRT, 28.8% died of their thyroid cancer, compared with 1.3% of those who did not receive EBRT. Compared with the non-EBRT group, a higher proportion of patients in the EBRT group were older, male, had medullary thyroid cancer, a larger tumor size, and more advanced disease. The 10-year cause-specific survival (CSS) for all thyroid cancer patients following EBRT was 61.5%. As expected, 5-and 10-year CSS were better for patients with disease localized in the neck (84.6% and 80.3%, respectively), while the 10-year CSS dropped to 34.4% in patients with distant disease. Patient characteristics, such as older age, and tumor characteristics, such as larger tumor size, extrathyroidal extension, follicular histology, and stage, were associated with a lower 10-year CSS.
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DOI：
10.1016/j.ijrobp.2008.05.012
发表时间：
2009-03-01
影响因子：
7
作者：
Terezakis, Stephanie A.;Lee, Kyungiviouk S.;Lee, Nancy Y.
通讯作者：
Lee, Nancy Y.
影响因子：
6.6
作者：
Haugen, Bryan R.;Alexander, Erik K.;Wartofsky, Leonard
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Wartofsky, Leonard
DOI：
10.1016/j.ijrobp.2008.09.023
发表时间：
2009-07-15
影响因子：
7
作者：
Schwartz, David L.;Lobo, Mark J.;Garden, Adam S.
通讯作者：
Garden, Adam S.
影响因子：
2
作者：
Jin, Michael C.;Qian, Z. Jason;Megwalu, Uchechukwu C.
通讯作者：
Megwalu, Uchechukwu C.
DOI：
10.6004/jnccn.2014.0169
发表时间：
2014-12-01
影响因子：
13.4
作者：
Tuttle, R. Michael;Haddad, Robert I.;Hughes, Miranda
通讯作者：
Hughes, Miranda