对当前131I辅助疗法在中等和高风险差异化甲状腺癌的指示进行反射分析
Yuqing Sun1,2, Yihan Zhao1,2, Di Sun1,2
1Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, China.
概括
对差异化甲状腺癌 (DTC) 的放射性辅助疗法 (RAT) 显示出可变的反应. 具有良好反应的中等风险患者可能会避免RAT,而生化反应不完全的患者可能会从更高的活动中受益.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 核医学是一种核医学.
背景情况:
- 放射性辅助疗法 (RAT) 是对差异化甲状腺癌 (DTC) 的标准治疗方法.
- 然而,它的指示和益处,特别是对亚临床疾病的益处,仍然存在争议.
- 经常考虑当前的指导方针.
- 一个适合所有人的尺寸.
- 它可能不适合所有患者,也可能不适合所有患者.
研究的目的:
- 以后期评估中期和高风险DTC患者对RAT的实际目标和治疗反应.
- 通过确定可能受益最多或最少的患者子组,完善RAT的当前指南.
- 分析治疗反应和从不完整反应转化为完整反应的预测因素.
主要方法:
- 一项多中心的回顾性研究,涉及599名中等和高风险的DTC患者.
- 术后疾病状态的评估,即时目的验证和12个月后的反应,使用甲状腺蛋白水平,成像和治疗后全身扫描 (Rx-WBS).
- 统计分析以确定治疗反应的预测因素.
主要成果:
- 近50%的患者在术后实现了良好的反应 (ER) 或不确定的反应 (IDR).
- 大约37.5%的人有生化不完全反应 (BIR),12.7%的人有结构不完全反应 (SIR).
- 在12个月内,59.4%的人实现了ER,13.5%的IDR,16.6%的BIR和10.6%的SIR. 术后ER/IDR在很大程度上预测了12个月的ER/IDR (95.6%),而45.8%的术后BIR转换为ER/IDR.
结论:
- 术后ER或IDR的中级风险DTC患者可能不需要积极的RAT.
- 术后BIR患者可能是较高RAT活动 (>3.7GBq) 的候选人,特别是那些具有较少攻击性特征的患者.
- 这些发现表明,在DTC管理中对RAT采取更个性化的方法.
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