分化型甲状腺癌^(131)I治疗简述与展望

A brief review and update on radioactive iodine-131 treatment for differentiated thyroid cancer

放射性碘-131(radioiodine-131,^(131)I)治疗是分化型甲状腺癌(differentiated thyroid carcinoma,DTC)术后经典的靶向治疗手段。基于DTC肿瘤细胞在一定程度上保留了甲状腺滤泡上皮细胞表达钠碘同向转运体(sodium iodide symporter,NIS)的功能,^(131)I引入人体后可被DTC细胞特异性摄取,其发射的γ射线有助于核医学显像在体内探测残余甲状腺组织及DTC病灶,而其发射的β射线将会对上述探测靶区实施精准打击。通过^(131)I这种诊疗一体化(theranostic)手段,可有效改善具有摄碘功能残留/复发/转移性病灶DTC患者的无进展生存、疾病特异性生存及总生存,并有助于降低高危患者的复发风险。然而,与^(131)I“精准化”治疗理念相比,临床实践过程中,^(131)I治疗前评估、治疗剂量制定、治疗后疗效评价等环节仍欠精细化,未能真正展现出^(131)I诊疗一体化的优势。近年来,随着循证医学证据的增加,^(131)I治疗在诊疗理念、治疗前风险分层、治疗后动态评估、患者全程管理等方面不断更新与细化,以发挥^(131)I精准诊疗的优势,笔者就上述内容及其更新作一简述。

The administration of radioactive iodine-131(^(131)I)is one of the representative traditional targeted therapy for post-surgical differentiated thyroid carcinoma(DTC).As DTC tumor cells largely preserve the capability of thyroid follicular epithelial cells,including the expression of the sodium iodide symporter(NIS),^(131)I can be selectively internalized by these cells once introduced into the body.The simultaneous emitting of bothγ-ray andβ-ray from ^(131)I featured its unique theranostic value in managing DTC,throughγ-ray to detect the residual thyroid tissue and DTC lesions via nuclear medical imaging,while throughβ-ray to yield the precise tumoricidal effect as well as remnant thyroid ablation.This theranostic potential of ^(131)I significantly enhances progression-free survival,disease-specific survival,and overall survival in DTC patients with residual/recurrent/metastatic lesions as long as they are capable of iodine uptake.Nevertheless,the clinical application of ^(131)I,despite its“precise”treatment philosophy,remains far from precision medicine while clinical practice,which urges further refinement in pre-treatment assessment,dosage tailoring,and posttreatment efficacy evaluation to fully capitalize on its theranostic benefits.Recently,with the accumulation of evidencebased medical data,^(131)I treatment has evolved with respect to treatment principles,pre-treatment risk stratification,posttreatment dynamic assessment,and comprehensive patient management,with an aim to optimize the diagnostic and therapeutic precision of ^(131)I.Here we briefly review and update the recent advance on ^(131)I management on DTC.