影像引导大分割放疗在转移性甲状腺癌中的应用

Hypofractionated image-guided external beam radiotherapy for metastatic thyroid cancer

目的:分析影像引导的大分割外照射放射治疗(external beam radiotherapy,EBRT)在转移性甲状腺癌患者中的临床疗效及不良反应。方法:回顾并分析2008年1月—2021年1月在北京协和医学院中国医学科学院北京协和医院接受大分割(2.5~8.0 Gy/f)EBRT的甲状腺癌患者。接受大分割EBRT,均采用影像引导的调强放射治疗(intensity-modulated radiation therapy,IMRT)技术。剂量(24~66)Gy/(6~25)次,2.5~8.0 Gy/次。应用数字分级评分法(numerical rating scale,NRS)评估临床症状缓解效果,按照实体瘤临床疗效评价标准(response evaluation criteria in solid tumor,RECIST)1.1版对可测量病灶进行评估,应用不良事件通用术语标准(common terminology criteria for adverse events,CTCAE)4.0版评估不良反应。Kaplan-Meier方法计算无局部复发生存(local recurrence-free survival,LPFS)、无疾病进展生存(progression-free survival,PFS)及总生存(overall survival,OS),Cox模型进行预后因素分析。结果:63例转移性甲状腺癌患者接受了EBRT治疗。中位随访时间49个月,2年、5年的LRFS分别为55.0%和42.5%,2年、5年的PFS分别为70.0%和37.5%。单因素及多因素分析显示病理学类型、转移灶数目是影响患者5年PFS的因素(P<0.05)。35例骨转移患者获得临床症状缓解:治疗后1个月有效率为75.0%(18/24),治疗后3~6个月有效率为91.67%(22/24)。28例可测量病灶:治疗后2~6个月,完全缓解(complete response,CR)7例,部分缓解(partial response,PR)7例,疾病稳定(stable disease,SD)者10例,疾病进展(progressive disease,PD)者4例,评估疾病控制率(disease control rate,DCR)为85.71%,客观缓解率(objective response rate,ORR)为50.0%。全组无3级及以上不良反应。结论:应用影像引导大分割EBRT,对于转移性甲状腺癌患者,有很好的临床症状缓解率,局部病灶控制率高,延长了患者的无进展生存期,预期有生存获益转化。

Objective:To analyze the clinical efficacy and side effects of hypofractionated image-guided external beam radiotherapy(EBRT)in patients with metastatic thyroid cancer.Methods:Patients with thyroid cancer who received moderate to large fractionation(2.5-8.0 Gy/f)EBRT in Pecking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College from January 2008 to January 2021 were analyzed retrospectively.The irradiation site and dose were counted,moderate large segment external irradiation radiotherapy,all of which were treated with hypofractionated image guided radiotherapy.(24-66)Gy/(6-25)f,2.5-8.0 Gy/f,the clinical symptom relief effect was evaluated by numerical rating scale(NRS),and the measurable lesions were evaluated according to the response evaluation criteria in solid tumor(RECIST),and common terminology criteria for adverse events(CTECAE)4.0 to evaluate toxic side effects.Kaplan-Meier method was used to calculate local recurrence-free survival(LPFS),progression-free survival(PFS),overall survival(OS),and Cox model for prognostic factor analysis.Results:A total of 63 patients with metastatic thyroid cancer received EBRT.The median follow-up time was 49 months.The LRFS of 2 and 5 years were 55.0%and 42.5%respectively,and the PFS of 2 and 5 years were 70.0%and 37.5%respectively.Univariate and multivariate analysis showed that pathological type and the number of metastases were the factors affecting 5-year PFS(P<0.05).Of 35 patients with bone metastasis,the effective rate was 75.0%(18/24)at one month,91.67%(22/24)at 3-6 months after treatment.For 28 measurable lesions,7 cases achieved complete response(CR),7 cases partial response(PR),10 cases stable disease(SD)and 4 cases progressive disease(PD)after 2-6 months of treatment.The evaluated disease control rate(DCR)was 85.71%and the objective remission rate(ORR)was 50.0%.No toxic and side effects of grade 3 or above.Conclusion:The application of hypofractionated image-guided radiotherapy has good clinical symptom remission rate,high local focus control rate,prolonged disease-free progression time and survival benefit for patients with metastatic thyroid cancer.