用^(131)I治疗不能切除的分化型甲状腺癌转移性淋巴结

^(131)I therapy of inoperable lymph node metastases from differentiated thyroid cancer

目的 探讨1 31 I治疗不能手术切除的分化型甲状腺癌转移性淋巴结 (LMDTC)的治疗剂量和疗效。方法 对 2 4例分化型甲状腺癌术后不能手术切除的 84个LMDTC ,在 7 4～ 16 6 5GBq范围内选择不同剂量1 31 I治疗。分别于治疗后 1、3、6和 12个月随访观察LMDTC的状况。对≥ 2cm的LMDTC ,1 31 I治疗后视其变化确定再手术切除时间。结果 84个不能手术切除的分化型LMDTC ,1 31 I治疗后有 78个分别消除、缩小和再次手术切除 ,有效率为 92 9% (78 84个 )。对 37个≥ 2cm的LMDTC1 31 I治疗后结合再手术治疗 ,切除病灶 16个 ,再切除率占 4 3 2 % (16 37个 )。与单纯用1 31 I治疗 <2cm的LMDTC的结果比较 ,差异有极显著性 (P <0 0 1)。1 31 I剂量为 3 7～ 12 95GBq时 ,各剂量组对LMDTC的疗效差异无显著性 (P均 >0 0 5 )。结论 大剂量1 31 I治疗分化型LMDTC有较好的疗效。

Objective To determine the therapeutic dosage and effect of 131 I for inoperable lymph node metastases from differentiated thyroid cancer so as to acquire optimum chance of next operation. Methods Twenty-four patients with 84 inoperable lymph node metastases from differentiated thyroid cancer received 131 I at a dose ranging from 7.4 to 16.65 GBq. The therapeutic effect was observed after 1,3,6 and 12 months,respectively. If lymph node metastasis from differentiated thyroid cancer was ≥2 cm in diameter,the next operation was determined depending on its extent after 131 I therapy. Results Seventy-eight of 84 inoperable lymph node metastases from differentiated thyroid cancer were eliminated,minimized and operated. The effective rate was 92.9%(78/84). Sixteen of 37 lymph node metastases with ≥2 cm in diameter were operated. Reoperative rate was 43.2%(16/37) compared with patient with lymph node metastases from differentiated thyroid cancer of less than 2 cm in diameter treated only by 131 I,the difference was significant (P<0.01). With the 131 I dosage ranging from 3.7 to 12.95 GBq,there was no significant difference among all groups in therapeutic efficiency (P>0.05). Conclusions High dosage of 131 I therapy has rather powerful effects on lymph node metastases from differentiated thyroid cancer. It can reduce the number of inoperable metastatic lymph nodes and offer the opportunity for the next operation.