^(131)I治疗分化型甲状腺癌脑转移

Treatment of brain metastases from differentiated thyroid cancer with ^(131)I

目的 探讨1 31 I治疗分化型甲状腺癌 (DTC)脑转移的临床价值。方法 随访 8例经1 31 I治疗的DTC脑转移患者 ,通过临床症状、影像学检查及生存率分析 ,观察DTC脑转移1 31 I治疗效果。结果 ①1 31 I治疗后生存期 2～ 3 5年 ,2 0 0 1年底随访时均存活。② 1例患者1 31 I治疗 5次 ( 2 0 .65GBq)后CT示右小脑占位灶缩小 ,6次 ( 2 3 .61GBq)后CT示占位灶消失。③甲状腺双侧切除者 ,术后剩余甲状腺平均1 31 I清除次数为 2次 ,平均总清除剂量 8.87GBq ;单侧切除者 ,平均清除次数 5 .7次 ,平均总清除剂量 2 9.98GBq ,后者的清除次数和剂量均明显高于前者 (P <0 .0 1)。④合并有肺和 (或 )骨转移者 6例。1 31 I治疗后 1例脑转移灶消失 ,但肺转移灶仍有1 31 I摄取 ;1例治疗后1 31 I肺显像阴性 ,但脑和骨转移灶仍见1 31 I摄取。结论 合并有肺和 (或 )骨转移的DTC脑转移者治疗难度增加 ,但术后1 31

Objective To study the clinical value of treatment of brain metastases from differentiated thyroid cancer(DTC) with 131I. Methods Eight cases of brain metastases from DTC were followed-up after 131I therapy (2 males, 6 females). The results of 131I therapy were evaluated with clinical presentation, imaging scan and survival analysis. Results ①All cases had been survival for 2～35 years within follow-up. ②A space-occupying lesion in right cerebellum was shrunk after taking 131I 20.65 GBq and disappeared after 23.61 GBq, demonstrated by CT. ③The times of treatment and total dose of 131I used for each case were clearly decreased with total thyroidectomy than with semithyroidectomy (P<0.01). ④The brain plus lung and/or bone metastases from DTC were 6. It was difficult to cure all the metastases with the same therapeutic program. Conclusion The treatment of brain metastases from DTC with 131I may improve clinical symptoms and life quality, reduce lesion size, and prolong survival.