大剂量^(131)I治疗312例分化型甲状腺癌转移灶的临床分析

The clinical summary of 312 cases of differentiated thyroid cancer metastases with 131I treatment

目的 评价甲状腺癌 (简称甲癌 )转移灶患者多次大剂量1 31 I治疗疗效及其副作用。方法 ①治疗方法 :肺、骨转移者每次口服1 31 I7.4GBq ,淋巴结转移者每次口服1 31 I 5 .5 5GBq ,2次治疗间隔 4个月。②疗效判断 :分治愈 :为1 31 I显像阴性 ,血甲状腺球蛋白 (Tg)降至正常水平 ;有效 :血Tg转阴 ,1 31 I显像仅见病灶缩小或减少或病灶吸1 31 I率下降 ;无效 :血Tg高水平 ,1 31 I显像有新病灶出现或患者死亡。③副作用观察为对甲状旁腺功能及染色体畸变的影响。结果 ①疗效 :312例甲癌转移灶患者治愈 35 .9% (112例 ) ,有效 6 0 .2 % (188例 ) ,无效 3.8% (12例 )。②副作用 :8.6 %的患者有甲状旁腺素 (PTH)一过性下降 ,但无 1例甲状旁腺减退症发生。治疗后外周淋巴细胞染色体出现多种畸变 ,部分患者的辐射耐受增强。结论 采用1 31 I多次大剂量治疗甲癌转移灶疗效佳 ,副作用小 ,不会发生甲状旁腺功能减退症等并发症。1 31 I治疗的适应证应扩大至手术病理检查发现淋巴结转移者。

ObjectiveThree hundred and twelve thyroid carcinoma patients with metastasis treated by the multiple 'high dose' program were followed up for 10 years. The results of 131I adverse effects were assessed. Methods1.Treatment protocol: In case of lung and bone metastasis, 7.4 GBq 131I was administered each time. For patients with lymphotic metastasis, 5.55 GBq 131I was given each time. The interval between 2 doses was 4 months. 2. Assessment of therapeutic results: negative 131I scanning was marked as cured, lesion size decrease, reduction of the number of foci or reduction of iodine uptake by the lesion, normal blood thyroglobulin (Tg) indicated effective treatment; higher blood Tg, appearance of new lesions with ensuing death were considered as treatment failure. 3. Adverse events: ①bone marrow inhibition; ② pulmonary function affected; ③parathyroid function affected; ④salivary glands affected; ⑤chromosome aberration. Results of the 312 patients: 112 (35.9%) were cured, effective treatment was shown in 118 patients (60.2%) and treatment failure in 12 cases (3.8%). ResultsTwo adverse events: ①Bone marrow inhibition. Cumulation of 131I could produce temporary reversible inhibition of bone marrow, no aplastic anemia was evident. ②Reversible changes were seen upon salivary glands. Submaxilla glandular function was slightly affected.③Effect on parathyroid function: PTH showed temporary change, without a single case of hypoparathyroidism. ④Effect on pulmonary function: no pulmonary function change or a single case of pulmonary fibrosis was seen. ⑤ Effect on the chromosome: After treatment, lymphocytes in peripheral blood showed aberration, in part of the patients, radioaction tolerability increased. Conclusions TBMultiple high dose therapy in treatment of metastatic thyroid carcinoma is an effective method. Indication can be extended to patients showing lymphatic metastases on operation. Adverse events seen in the study were almost neglegible. Good results were obtained and no aplastic anemia, hypoparathyroidism, decrease of pulmonary function, Sjgren's syndrome were seen.