131I治疗儿童及青少年分化型甲状腺癌的疗效分析

Efficacy analysis of 131I in the treatment of differentiated thyroid cancer in children and adolescents

关键词:  分化型甲状腺癌  儿童  青少年  放射疗法  碘放射性同位素

Key words:  differentiated thyroid cancer  child  adolescence  radiotherapy  iodine radioisotopes

摘要:

目的 探讨儿童及青少年分化型甲状腺癌（DTC）的临床病理特征并评价¹³¹I治疗的疗效。方法 回顾性分析30例接受甲状腺全切或次全切手术和¹³¹I治疗的儿童及青少年DTC患者的临床资料，按照年龄14岁为切点值将患者分为儿童组（<14岁）（17例）和青少年组（14~18岁）（13例）。对30例患者的临床病理特征及¹³¹I治疗次数和剂量进行分析，并进行疗效和短期副作用评价及随访。结果 30例患者淋巴结转移的发生率为86.7%，肺转移的发生率为36.67%。患者平均接受¹³¹I治疗2.43次，平均累积剂量为8.71 GBq。其中儿童组患者平均治疗2.29次，平均累积剂量5.89 GBq，青少年组患者分别为2.61次和12.41 GBq。无肺转移组患者平均治疗1.73次，平均累积剂量为5.85 GBq，肺转移组患者分别为3.63次和14.30 GBq。30例患者肿瘤完全缓解率（CR）为56.7%，部分缓解率（PR）为23.3%，稳定率（SD）为20.0%。无肺转移组的CR率为73.7%，PR率为10.5%，SD率为15.8%；肺转移组的CR率为27.3%，PR率为45.5%，SD率为27.3%。¹³¹I治疗后3天内颈部肿胀疼痛发生率为16.7%，胃肠道反应发生率为33.3%。结论 儿童及青少年DTC患者的淋巴结转移和肺转移发生率较高，¹³¹I治疗儿童及青少年DTC是一种有效的治疗方法。

Abstract:

Objective To investigate the clinical pathological characteristics of differentiated thyroid cancer (DTC) in children and adolescents and evaluate the efficacy and safety of radioiodine treatment. Methods Clinical data of 30 children and adolescents with DTC were retrospectively reviewed. The patients were divided into two groups:children group (<14 years) and adolescents group (14-18 years). All 30 patients received radioiodine treatment after surgery. The clinicopathological characteristics, number and dose of ¹³¹I treatment in the 30 patients were analyzed, and efficacy and short-term side effects were evaluated and followed up. Results The incidence of lymph node metastasis was 86.7% and pulmonary metastasis 36.67%. Patients received an average of radioiodine treatment 2.43 times, with an average cumulative dose of 8.71 GBq. The average treatment for the children group was 2.29, and the average cumulative dose was 5.89 GBq, and for the adolescent group 2.61 and 12.41 GBq. The average treatment for the non-lung metastasis group was 1.73, and the average cumulative dose was 5.85 GBq, and for the lung metastasis group 3.63 and 14.30 GBq. The 30 patients had a complete response rate 56.7%, partial response rate 23.3%, and stable disease 20.0%. The non-lung metastasis group had a complete response rate 73.7%,partial response rate 10.5%,and stable disease 15.8%. The lung metastasis group had a complete response rate 27.3%,partial response rate 45.5%,and stable disease 27.3%. The incidence of neck swelling and pain within 3 days after ¹³¹I treatment was 16.7%, and the incidence of gastrointestinal reactions was 33.3%. Conclusions The incidence of lymph node metastasis and lung metastasis is higher in children and adolescents with DTC. Radioiodine is an effective therapy for children and adolescent DTC.