Ford D, Giridharan S, McConkey C, Hartley A, Brammer C, Watkinson J C, Glaholm J
Cancer Centre, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Clin Oncol (R Coll Radiol). 2003 Sep;15(6):337-41. doi: 10.1016/s0936-6555(03)00162-6.
No randomised trials have addressed the use of external beam radiotherapy (EBRT) in the treatment of differentiated thyroid cancer. The indications for EBRT, the technique and recommended dose all remain controversial.
We included patients treated with EBRT with curative intent from two cancer centres between 1988 and 2001. Data were collected from hospital notes, radiotherapy prescriptions and local cancer registry.
The indications for treatment in the 41 identified patients were macroscopic residual disease 23 (56%), microscopic residual disease 10 (25%), Hurthle cell variants 3 (7%), multiple lymph-node involvement 3 (7%) and other 2 (5%). Delivered doses ranged from 37.5-66 Gy over 3-6.5 weeks. Rate of local recurrence and overall survival at 5 years were as follows: papillary 26% and 67%; follicular 43% and 48%; well differentiated 21% and 67%; focus of poor differentiation/Hurthle cell variants 69% and 32%; complete excision 25% and 61%; residual disease 37% and 59%; EBRT total dose < 50 Gy 63% and 42%; 50-54 Gy 15% and 72%; > 54 Gy 18%, and 68%.
The results in this study are consistent with previous retrospective studies of EBRT. The wide range of indications and doses used with radical intent highlights the lack of clinical and radiobiological data on the response of differentiated thyroid cancer to EBRT. Despite the small study size, the 5-year local recurrence results indicate a possible dose response within the dose range used.
尚无随机试验探讨外照射放疗（EBRT）在分化型甲状腺癌治疗中的应用。EBRT的适应证、技术及推荐剂量仍存在争议。
我们纳入了1988年至2001年间来自两个癌症中心接受EBRT且有治愈意图的患者。数据收集自医院病历、放疗处方和当地癌症登记处。
41例确诊患者的治疗适应证为肉眼可见残留病灶23例（56%）、显微镜下残留病灶10例（25%）、许特莱细胞变异型3例（7%）、多组淋巴结受累3例（7%）以及其他2例（5%）。放疗剂量在3至6.5周内为37.5 - 66 Gy。5年局部复发率和总生存率如下：乳头状癌分别为26%和67%；滤泡状癌分别为43%和48%；高分化癌分别为21%和67%；低分化灶/许特莱细胞变异型分别为69%和32%；完整切除分别为25%和61%；残留病灶分别为37%和59%；EBRT总剂量<50 Gy分别为63%和42%；50 - 54 Gy分别为15%和72%；>54 Gy分别为18%和68%。
本研究结果与先前关于EBRT的回顾性研究一致。用于根治性目的的适应证和剂量范围广泛，凸显了分化型甲状腺癌对EBRT反应的临床和放射生物学数据的缺乏。尽管研究规模较小，但5年局部复发结果表明在所使用的剂量范围内可能存在剂量反应。
