Selective use of radioactive iodine in the postoperative management of patients with papillary and follicular thyroid carcinoma
Selective use of radioactive iodine in the postoperative management of patients with papillary and follicular thyroid carcinoma
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DOI：
10.1002/jso.20696
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发表时间：
2006-12-15
影响因子：
2.5
通讯作者：
Hay, Ian D.
中科院分区：
文献类型：
--
作者：
Hay, Ian D.
放射性碘残留消融术(RRA)是在20世纪60年代发展起来的，用于乳头状甲状腺癌和滤泡性甲状腺癌的初步治疗。到了20世纪90年代，人们声称RRA可以降低滤泡细胞源性癌症(FCDC)患者的复发率，并降低40岁以上患者初次手术时的原因特异性死亡率(CSM)。过去十年的国际趋势是在大多数FCDC患者中采用常规的RRA。许多协会已经制定了临床指南，促进了这种积极的立场。自1997年以来，许多文献报道了双侧肺叶切除后患者接受RRA治疗后，FCDC的结果有所改善。然而，在同一时期，人们已经认识到，大多数FCDC患者确实处于威胁生命的复发的“低风险”。因此，有人建议，合理的治疗选择应该导致积极的治疗限制在那些“高危”的FCDC患者，更容易患上CSM。到目前为止，还没有预期的对照试验。目前可用的结果数据是基于单一机构或多中心的回顾研究。本文总结了现有的相关报道数据，并得出结论，在FCDC患者的术后管理中选择性地使用RRA是合理的，实际上应该鼓励。
Radioiodine remnant ablation (RRA) was developed in the 1960s to "complete a thyroidectomy" in the initial management of papillary and follicular thyroid cancer. By the 1990s, it was claimed that RRA diminished recurrence rates in follicular cell-derived cancer (FCDC) patients and decreased the cause-specific mortality (CSM) in patients more than 40 years old at initial surgery. The international trend for the past decade has been towards routine RRA in most FCDC patients. Clinical guidelines have been produced by many societies, promoting such an aggressive stance. Since 1997, many papers have reported improved outcome in FCDC, when patients were subjected to RRA after bilateral lobar resection. However, during the same time-period, it has been recognized that most FCDC patients are truly at "low-risk" of developing life-threatening recurrences. Accordingly, it has been suggested that rational therapy selection should lead to restricting aggressive therapy to those "high-risk" FCDC patients, more predisposed to CSM. To date, no prospective controlled trials exist. Presently available outcome data is based on single institutional or multicenter retrospective studies. This article summarizes the available relevant reported data, and concludes that a selective use of RRA in the postoperative management of FCDC patients is rational, and should actually be encouraged.