48例甲状腺癌术后放疗的临床分析

Clinical analysis of postoperative radiotherapy in 48 patients with thyroid carcinoma

目的 评价甲状腺癌术后放疗疗效。方法 对 1991年 3月～ 1996年 9月间 ,接受术后放疗的48例甲状腺癌进行总结分析。照射范围 :对分化型者 (乳头状癌、滤泡状癌、髓样癌 )包括瘤床及双颈 ;对未分化型者 (未分化癌 )包括瘤床、双颈及上纵隔 ;采用60 Coγ线加深部 180kvX线或电子流照射 ,照射剂量DT45～ 6 5Gy/ 5 - 7周 ,常规分割照射。结果 全组总的 5年生存率为 81.3% ,其中分化型为 90 .5 % ,未分化型为 16 .7% ,两者比较有显著性差异 (P <0 .0 1)。死亡 9例 ,1例缘于局部复发 ,8例因为远处转移。结论 分化型甲状腺癌首选手术治疗 ,术后T4 N1者需补充放疗 ,未分化型者需采用放化疗综合治疗措施。

Objective To evaluate the efficacy of the postoperative radiation for thyroid carcinoma .Methods From Mar 1991 to Sep 1996,48 patients with thyroid carcinoma were treated by conventional fractions with r-rays from cobalt 60 and election from linear acceleraters or 180kv X-rays to field that include the thyroid bed and all lymph nodes in both sides of the neck for differentiated thyroid carcinoma and addeitionally including the superior mediastinum for non-differectiated thyroid carcinoma to a total dose of 45Gy～65Gy in 5～7weeks .Results The overall 5-year survival rate was 81.3%,and 90.5% for differentiated thyroid carcinoma and 16.7% for non-differentiated thyroid carcinoma.There was a significant difference between differentiated and non-differentiated thyroid carcinoma in the overall survival rate.The causes of death were distant metastases in eight patients and recurrence in one case.Conclusion The operation is the first choice for differentiated thyroid carcinoma and the postopertive radiotherapy is needed for T 4N 1.The combined therapy of radiotherpay and chemotherapy need be adopted for non-differentiated tyroid carcinoma.