不摄取131I的甲状腺癌治疗
Treatment of non-uptaking 131I thyroid cancer
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摘要: 甲状腺癌通常预后较好,但约30%发生肿瘤去分化,最终发展成高度恶性的未分化癌,平均生存率少于8个月。由于有关去分化的甲状腺特异性功能的丧失,这些肿瘤不能接受标准的治疗方法,例如131I治疗和甲状腺激素调节的促甲状腺激素抑制。甲状腺髓样癌也是高侵犯性肿瘤,治疗局限于外科手术,若患者对标准治疗方法不反应则无其他选择。最近,几个新的方法已试用于甲状腺癌的治疗,其中大多数采用基因治疗方法:①肿瘤抑制体p53基因的再引进;②自杀基因治疗;③白细胞介素-2基因表达的抗肿瘤免疫应答;④抗肿瘤标志物降钙素的DNA接种以诱导免疫应答;⑤甲状腺钠碘转运体的转导使不摄碘组织可以接受131I治疗;⑥通过抗敏低聚核苷酸阻断肿瘤基因c-myc的表达;⑦放射性标记抗体的放射免疫靶向治疗;⑧维甲酸再分化治疗;⑨生长激素释放抑制激素。Abstract: Normally, thyroid cancer is a disease with a good prognosis, but about 30% of the tumors dedifferentiate and may finally develop into highly malignant thyroid carcinoma with a mean survival time of less than 8 months. Due to the loss of thyroid-specific functions associated with dedifferentiation. These tumors are inaccessible to standard therapeutic procedures such as radioiodine therapy and thyroxine-mediated thyrotropin suppression. Medullary thyroid carcinomas are also highly aggressive. Here, therapy is limited to surgery, and no alternative is left if patients do not respond to this standard procedures. Several novel approaches are currently being tested for the treatment of thyroid cancer. Many of them utilize methods of gene therapy:① reintroduction of the tumor suppressor p53; ② suicide gene therapy; ③ anti-tumor immune response by expression of an adenovirus-delivered interleukin-2(IL-2)gene; ④ immune response by DNA vaccination against the tumor marker calcitonin; ⑤ transduction of the thyroid sodium/iodine transporter gene to make tissues that do not accumulate iodide treatable by radioiodide therapy; ⑥ blocking of the expression of the oncogene c-myc by antisense oligonuleotides; ⑦ radioimmunotherapy by a radiolabelled antibody; ⑧ retinoic acid is used for a redifferentiation therapy, and ⑨ somatostatin.