Updates on the Management of Advanced, Metastatic, and Radioiodine Refractory Differentiated Thyroid Cancer.
Updates on the Management of Advanced, Metastatic, and Radioiodine Refractory Differentiated Thyroid Cancer.
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DOI：
10.3389/fendo.2017.00312
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发表时间：
2017
影响因子：
5.2
通讯作者：
Newbold K
中科院分区：
文献类型：
--
作者：
Tumino D;Frasca F;Newbold K
分化型甲状腺癌(DTC)占所有甲状腺癌的95%，通常是一种惰性肿瘤，可通过手术、放射性碘和促甲状腺激素抑制疗法有效地治疗。然而，5-10%的患者患有晚期疾病，有呼吸道侵犯、远处转移或放射性碘难治性疾病，预后较差。本文就晚期DTC的治疗方法作一综述，包括甲状腺外肉芽肿大的处理、复发的局部或远处转移疾病、外照射治疗和全身治疗的作用。局部消融治疗方式，包括手术、放射治疗和热消融正在发展，并可用于选定的患者。近年来，具有分子靶点的新的治疗剂已经问世，两种多激酶抑制剂，索拉非尼和Lenvatinib，已经被批准用于碘难治性DTC，显示出在无进展生存方面的优势，尽管对总体生存的影响尚未得到证实。晚期甲状腺癌的治疗可能具有挑战性，但多学科方法可以显着改善这一患者群体的预后。
Differentiated thyroid cancer (DTC) accounts for 95% of all thyroid cancers and is generally an indolent tumor, treated effectively with surgery, radioactive iodine, and thyroid-stimulating hormone suppressive therapy. However, 5–10% of patients have advanced disease, with aerodigestive tract invasion, distant metastases, or radioiodine refractory disease, with poor prognosis. This review focuses on the approaches for treating advanced DTC, including management of gross extra-thyroidal extension, recurrent loco-regional or distant metastatic disease, the role of external beam radiation therapy and systemic treatment. Locally ablative treatment modalities, including surgery, radiation therapy, and thermal ablation are evolving and can be used in selected patients. In recent years, new therapeutic agents with molecular targets have become available and two multi-kinase inhibitors, Sorafenib and Lenvatinib, have been licensed for iodine refractory DTC showing an advantage in terms of progression-free survival, although an impact on overall survival has not been proven yet. Management of advanced thyroid cancer can be challenging but a multidisciplinary approach can significantly improve outcomes for this patient population.