基础医学与临床 ›› 2019, Vol. 39 ›› Issue (8): 1188-1192.

• 临床研究 • 上一篇    下一篇

应用外照射放射治疗64例复发/转移性甲状腺癌的临床疗效分析

沈晶1,侯晓荣1,甄宏楠1,马佳彬1,何蕾1,张福泉2   

  1. 1. 北京协和医院
    2. 北京协和医院放疗科
  • 收稿日期:2019-06-03 修回日期:2019-06-25 出版日期:2019-08-05 发布日期:2019-07-16
  • 通讯作者: 张福泉 E-mail:zhangfuquan3@126.com

External beam radiation therapy for relapse/metastases thyroid carcinoma: feasibility and clinical results

  • Received:2019-06-03 Revised:2019-06-25 Online:2019-08-05 Published:2019-07-16
  • Contact: FU QUANZHANG E-mail:zhangfuquan3@126.com

摘要: 目的 分析外照射在复发/转移性甲状腺癌患者中的近期临床疗效及毒副反应。方法 回顾分析2008年1月至2018年1月,北京协和医院放射治疗科收治的复发/转移性甲状腺癌患者共64例。均经手术病例确诊为甲状腺癌,其中女性45例,男性19例,中位年龄61岁,病理类型包括甲状腺乳头状癌34例,滤泡型乳头状癌4例,滤泡状癌 13例,髓样癌7例,未分化癌6例。外照射均采用6MV-X线,三维适形(3DCRT)或调强(IMRT)放疗技术,根据不同的部位分割方案如下:1)复发性甲状腺癌:50.4-60Gy/25-28次,1.8-2Gy/次,调强放疗。2)转移性甲状腺癌:骨转移灶:24-50Gy/6-25次, 2-4Gy/次;脑、肺、肝转移灶:48-64Gy/7-8次,6-8Gy/次。疗效评估方法:1) 对于有可测量病灶的40例复发及转移性病灶,按照实体瘤治疗疗效评价标准(RECIST 1.1)分析评估治疗后1月的疗效。2) 应用数字疼痛评分法(NRS)评估甲状腺癌骨转移患者的近期止痛效果。结果 1) 40例可测量病灶的复发及转移性甲状腺癌患者,应用外照射放射治疗后,疾病控制率(DCR)为90.62%。2)24例骨转移患者,疗前NRS疼痛评分为(7.65±0.67)分, 治疗结束后1个月为(4.36±1.09)分, 有效率为75%(18/24)。治疗结束后3个月为(2.15±1.28)分, 有效率为91.67%(22/24),p<0.05。外照射放射治疗的止疼效果有延迟。3) 外照射后,分化型甲状腺癌患者体内甲状腺球蛋白(Tg)的中位下降率为56%(0%?99%),提示治疗有效。全组患者均未出现不良事件报告(CTC)-3级及以上毒副反应。结论 对于复发及转移性甲状腺癌患者,外照射治疗有明显改善生活质量,控制局部病灶的作用,且无严重毒副作用,可为相关临床治疗提供一定的参考。

关键词: 甲状腺癌, 复发, 转移, 外照射放射治疗, 疗效

Abstract: Objective To evaluate the clinical results and adverse of external beam radiation therapy (EBRT) on relapse/metastases thyroid carcinoma. Methods A prospective cohort of 64 patients was treated between January 2008 and January 2018 with EBRT. All patients were diagnosis with surgery, 45 females and 19 males, median age was 61 years old. Pathology characters included:34 papillary thyroid carcinoma, 13 follicular thyroid carcinoma, 7 medullary carcinoma and 6 undif-ferentiated thyroid cancer. EBRT use 6MV-X, three-dimensional conformal or intensity modulated radiotherapy, relapse lesions were treated with the total dose and per-friction dose with 50.4Gy-60Gy, 1.8-2Gy/f, metastases lesions were treated according to clinical decision(bone lesions 24-50Gy/6-25f, 2-4Gy/f, brain, lung or liver lesions 48-64Gy/7-8f, 6-8Gy/f(under image-guided radiotherapy). The RECIST 1.1 standard was used to assess the EBRT on 40 evaluable lesions efficiency, the NRS(numerical rating scale) was used to assess pain, response rates to radiotherapy were calculated following the criteria of NRS, accounting for the use of concomitant analgesics. Meanwhile the TG change rate and clinical adverse were also reported. Results 1)40 evaluable lesions of relapse or metastases showed disease control at 1 month(DCR 90.62%), 2)the mean NRS score before treatment was 7.65±0.67, and pain score were reduced to 4.36±1.09 after one month and 2.15±1.28 after three months. NRS-based response categories ranged from 75% to 91.67% respectively, p<0.05. 3)The medium downgrade level of TG-Ab for differential thyroid cancer patients was 56%(0%-99%), all patients showed no serious adverse judging by CTC-3. Conclusion EBRT is a valid option for relapse/metastases thyroid patients with endurable side effects, could be an effective treatment option for clinical trail.

Key words: Thyroid carcinoma, relapse cancer, metastases cancer, EBRT, clinical effect.