中国实用外科杂志

中国实用外科杂志

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有关远处转移性分化型甲状腺癌放射性碘治疗的意义

林岩松，李若尘   

  1. 中国医学科学院北京协和医学院北京协和医院核医学科  疑难重症及罕见病国家重点实验室  核医学分子靶向诊疗北京市重点实验室，北京 100730
  • 出版日期:2024-06-01

  • Online:2024-06-01

摘要： 分化型甲状腺癌（DTC）是一种常见的甲状腺癌类型，包括甲状腺乳头状癌（PTC）、甲状腺滤泡癌（FTC）和甲状腺嗜酸细胞癌（OTC）。尽管大多数DTC病人通过手术、放射性碘治疗（RAIT）和促甲状腺激素（TSH）抑制治疗后预后较好，但仍有部分病人发展为远处转移性分化型甲状腺癌（DM-DTC），其中肺和骨是最常见的转移部位。RAIT是DM-DTC术后的一线治疗手段，能有效降低复发及死亡风险。针对DM-DTC，RAIT的治疗方案需基于病人的病灶摄碘特征进行个体化制定。研究结果显示，RAIT在肺微转移灶的完全缓解率较高，而对于骨转移病人，虽然治愈率低但能显著改善预后。此外，RAIT前的准备工作如升高TSH水平和低碘饮食也对治疗效果有重要影响。病灶摄碘能力的预评估［如诊断性全身显像（Dx-WBS）］和分子特征（如BRAFV600E和TERT启动子突变）的检测有助于预测RAIT疗效和放射性碘治疗抵抗（RAIR）-DTC的风险。对于不摄碘或疗效不佳的病人，可考虑其他局部治疗或新型分子靶向药物，以提高生存率和生活质量。总体而言，RAIT在DM-DTC的治疗中发挥了关键作用，但需要根据个体情况进行综合决策和动态调整。

关键词: 分化型甲状腺癌, 远处转移, 放射性碘治疗

Abstract: Iodine-131 therapy for distant metastases of differentiated thyroid carcinoma        LIN Yan-song, LI Ruo-chen. Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing Key Laboratory of  Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
Corresponding author: LIN Yan-song, E-mail:linys@pumch.cn
Abstract    Differentiated thyroid carcinoma（DTC）is a common type of thyroid cancer, including papillary thyroid carcinoma（PTC）, follicular thyroid carcinoma（FTC）, and oncocytic thyroid carcinoma（OTC）.  Although most patients with DTC have a favorable prognosis following surgery, radioactive iodine therapy（RAIT）, and TSH suppression therapy, a subset of patients develop distant metastatic differentiated thyroid carcinoma（DM-DTC）, with the lungs and bones being the most common sites of metastasis. RAIT is the first-line postoperative treatment for DM-DTC and can effectively reduce recurrence and mortality risks.  The RAIT treatment plan for DM-DTC should be individualized based on the iodine uptake characteristics of the lesions. Research indicates that RAIT has a high complete remission rate for lung micro-metastases, while for bone metastases, although the cure rate is low, it significantly improves prognosis.  Additionally, preparatory work before RAIT, such as elevated TSH levels and a low-iodine diet, significantly impacts treatment outcomes.  The pre-assessment of iodine uptake capability（e.g., Dx-WBS）and the detection of molecular characteristics（e.g., BRAFV600E and TERT promoter mutations）help predict RAIT efficacy and the risk of RAIR-DTC. For patients who do not uptake iodine or have poor treatment responses, other local treatments or novel molecular-targeted drugs should be considered to improve survival rates and quality of life. Overall, RAIT plays a crucial role in of treating DM-DTC, but comprehensive decision-making and dynamic adjustments based on individual conditions are necessary.

Key words: differentiated thyroid carcinoma, distant metastatic, radioactive iodine-131 therapy