^(125)I粒子植入治疗放射性碘难治性分化型甲状腺癌的效果分析

Analysis of treatment effect of ^(125)I seed implantation in patients with radioactive iodine-refractory differentiated thyroid cancer

目的探讨125I粒子植入治疗放射性碘难治性分化型甲状腺癌(RAIR-DTC)的疗效及安全性。方法回顾性分析2017年7月至2021年3月华中科技大学同济医学院附属武汉中心医院14例经病理或影像学证实的RAIR-DTC患者[男8例、女6例, 年龄(62.0±10.7)岁]。患者均行CT引导下放射性125I粒子植入治疗, 并于术后1.5、3、6及12个月行超声、CT、125I SPECT/CT或MRI检查评价病灶体积变化, 同时监测患者血清甲状腺球蛋白(Tg)变化以及症状缓解情况。采用配对t检验进行治疗前后数据比较。结果 14例患者共行16次125I粒子植入术(25个病灶), 随访3~44个月[中位时间6.5(4.5, 11.5)个月], 病灶治疗总有效率为60.0%(15/25), 总局部控制率为96.0%(24/25);转移性淋巴结治疗有效率为10/17, 局部控制率为16/17;局部复发有效率为1/3, 局部控制率为3/3;骨转移的治疗有效率和局部控制率均为3/3;肺转移的相应指标均为1/1, 鼻窦转移则分别为0/1和1/1。8例有临床症状的患者中4例症状完全缓解, 3例部分缓解, 1例无缓解。患者术后Tg较前下降[(245.99±44.85) μg/L与(330.38±50.78) μg/L;t=2.92, P=0.010], 肿瘤长径较前减小[(2.71±0.34) cm与(3.78±0.27) cm;t=3.13, P=0.007]。结论 125I粒子植入治疗作为RAIR-DTC的补充疗法, 安全、有效, 对转移及局部复发病灶的控制效果良好。

Objective To investigate the efficacy and safety of ^(125)I seed implantation in the treatment of radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC).Methods Fourteen patients(8 males,6 females,age:(62.0±10.7)years)with RAIR-DTC confirmed by pathology or imaging examination in the Central Hospital of Wuhan,Tongji Medical College between July 2017 and March 2021,were retrospectively analyzed.The patients were treated with ^(125)I seed implantation guided by CT.Ultrasound,CT,^(125)I-SPECT/CT or MRI were performed at 1.5,3,6 and 12 months after the implantation to evaluate the changes of lesion volume,and serum thyroglobulin(Tg),as well as symptom relief were monitored and recorded.The paired t-test was used for data analysis.Results The ^(125)I seeds were successfully implanted(16 operations)in 14 patients with 25 lesions.Patients were followed up for 3-44 months(median:6.5(4.5,11.5)months).The total effective rate was 60.0%(15/25)and the total local control rate was 96.0%(24/25).The effective rate for metastatic lymph nodes was 10/17,and the local control rate was 16/17.The effective rate and the local control rate for local recurrence were 1/3 and 3/3 respectively,and those for bone metastasis were both 3/3,those for sinus metastasis were 0/1 and 1/1 respectively,and those for lung metastasis were both 1/1.In 8 patients with clinical symptoms,symtoms of 4 cases were completely relieved,those of 3 cases were partially relieved and 1 case had no remission.The Tg level and the tumor length were both decreased after operation((245.99±44.85)μg/L vs(330.38±50.78)μg/L,t=2.92,P=0.010;(2.71±0.34)cm vs(3.78±0.27)cm,t=3.13,P=0.007).Conclusions ^(125)I seed implantation,as a supplementary treatment for RAIR-DTC,is safe and effective.It has a good effect against metastatic and local recurrent lesions.