大剂量^(131)I治疗36例分化型甲状腺癌转移灶的临床分析

Clinical Results of Treatment of Metastatic Foci From Differentiated Thyroid Carcinoma with High Doses of ^(131)I

目的 :评价分化型甲状腺癌 (以下简称甲癌 )并远处转移患者接受多次大剂量1 3 1 I治疗的临床效果及其副作用。方法 :根据甲癌转移部位给予患者每次口服1 3 1 I (5 5 5～ 9 2 5 )GBq ,两次治疗间隔 6个月。根据1 3 1 I显像 ,血甲状腺球蛋白 (Tg)水平判断治疗效果 ;观察治疗对血像、甲状旁腺功能等的影响。结果 :①疗效 :36例甲癌转移患者治愈 5 5 5 % (2 0例 ) ,有效 38 9% (1 4例 ) ,无效 5 6 % (2例 )。②副作用 :仅 1例患者在治疗后 2周出现甲状旁腺素 (PTH)一过性下降。结论 :采用1 3 1 I多次大剂量治疗甲癌转移灶疗效佳 ,副作用小 。

Objective To assess the treatment effect of metastatic foci from differentiated thyroid carcinoma with multiple larger than the conventional 1.85～3.70GBq doses of 131 I. Methods Thirty-six patients with metastatic foci from differentiated thyroid carcinoma were treated with 131 I. Dose of 131 I varied according to site of metastasis (5.55GBq for neck and mediastinum, nodes, 7.40 GBq for lungs and 9.25GBq for bone lesions). Blood picture was monitored weekly for 4 times; blood PTH, Ca, P levels were determined every two weeks for 2 times. Treatment efficacy was assessed 6 months later with 131 I scanning and blood thyroglobulinlevelsdetermination .Repeateddosesof1 3 1 Iwereadminsterediffurthertherapywasindicated .Results ①Treatmentefficacy :cured (no residualmetastaticfociwithnormalTglevel)n =2 0 ,5 5 .5 % ;improved (lessand/orsmallerfociwithlowerTglevelthanbefore)n =1 4 , 38.9% ;failure (stationaryorlargerand/ormorenumerousfociwithhighTg)n =2 ,5 .6 % .②Adverseside -effect:verylittle ,onlyone caseoftransientloweringofbloodPTHlevel.Conclusion Treatmentwithmultiplehighdosesof1 3 1 Iissafeandeffectivewithlittleadverse side -effect.