^(131)I治疗分化型甲状腺癌的应用价值与风险

Benefits and risks of I-131 therapy in patients with differentiated thyroid cancer

131I治疗分化型甲状腺癌已有50余年的历史,尽管此疗法利弊一直存在争议,但专家学者一直致力于对131I治疗的研究。我们分析131I清甲、清灶治疗以及对局部复发和(或)转移性分化型甲状腺癌的治疗等方法和结果,对131I治疗并发症的风险性做出尽可能中肯的评价。131I清甲治疗的优点包括:①提高血清TG测定的特异性水平;②提高全身碘扫描诊断复发和(或)转移性疾病的灵敏度;③使治疗效果最大化;④131I清甲治疗后的全身碘扫描能够辅助诊断全身其他部位转移的、在清甲治疗前无法实施碘扫描或者清甲治疗前碘扫描无法诊断的病灶。131I清灶治疗的潜在优点包括降低复发率以及降低因未知的微小病灶局部复发和(或)远处转移病灶造成的患者死亡率。131I治疗复发和(或)远处转移病灶的潜在优点是降低复发率和降低特异性疾病的死亡率和(或)疼痛。131I清灶治疗的不良反应和风险与恶性肿瘤一样,最常累及的器官及系统如眼/鼻、唾液、肺、胃肠、造血系统以及生殖系统。虽然人们对131I治疗分化型甲状腺癌效果的争议从未停止,但是它的疗效和风险也越来越被人们所熟知,这对医生和患者在选择是否进行131I治疗时提供了帮助。

The benefits of 131I remnant ablation include ： （1） facilitating the interpretation of subsequent serum thyroglob- ulin levels ; （2） increasing the sensitivity of detection of locoregional and/or metastatic disease on subsequent follow-up radioactive iodine whole-body scans; （3） maximizing the therapeutic effect of subsequent treatments, and （4） allowing a postablation scan to help identify additional sites of disease that were not identified on the preablation scan or when a preablation scan was not performed. The potential benefits of 131I adjuvant treatment include decreasing recurrence and disease-specific mortality for unknown microscopic, locoregional, and/or distant metastatic disease. The potential bene- fits of 131I treatment of known locoregional and/or distant metastases are （1） decreasing recurrence, and （2） decreasing disease-specific mortality and/or palliation. The more significant risks and side effects involve organ systems including eye/nasolacrimal, salivary, pulmonary, gastrointestinal, hematopoietic, and gonads as well as secondary primary ma- lignancies. Although there are never-ending controversies regarding 131I therapy in differentiated thyroid cancer, the ben- efits and risks are becoming better understood. This in turn helps the treating physician and patient in making decisions regarding therapy.