分化型甲状腺癌131I治疗的争议与探索

Controversy and exploration of 131I therapy for differentiated thyroid cancer

  • 摘要: 分化型甲状腺癌(DTC)患者在规范的手术、选择性131I治疗、TSH抑制治疗下多数预后良好。131I治疗目标分为清甲治疗、辅助治疗及清灶治疗,其可完善疾病分期、便于随诊、降低疾病复发及死亡风险,但临床实践中仍在存诸多待明确的问题,如术后131I治疗前评估中,亚临床病灶判断困难,且无用以指导治疗的Tg临界值,增加了辅助治疗的决策难度;治疗后随诊中,尚无评价结构性病灶131I治疗疗效的标准;TgAb的存在会影响病情判断;131I累积剂量相关并发症亦需监测管理。本期重点号刊登了数篇DTC患者131I治疗相关的文章,多方位讨论了当下131I治疗中的难点和我国学者的探索。

     

    Abstract: Differentiated thyroid cancer (DTC) patients always holds a good prognosis under standard surgery, selective 131I therapy and TSH suppression therapy. The goals of 131I therapy are characterized as remnant ablation, adjuvant treatment, and treatment of known disease, which are supposed to refine initial staging, facilitate follow-up, decrease recurrence, and improve disease-specific survival. However, there are still many issues to be clarified in clinical practice. For example, in the assessment of postoperative disease status before 131I therapy, it is difficult to estimate subclinical lesions, and there is no Tg threshold to guide 131I therapy, which makes the decision of adjuvant treatment even harder. In the follow-up, there is no uniform response criterion for 131I therapy in structural disease, the presence of TgAb will interfere with the judgement of disease status; 131I cumulative dose-related complications also need to be monitored and managed. This issue contains several articles related to the 131I treatment of DTC patients, discusses the difficulties in current 131I treatment and the explorations of Chinese scholars in several aspects.

     

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