Mendoza April, Shaffer Brian, Karakla Daniel, Mason M Elizabeth, Elkins David, Goffman Thomas E
Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Thyroid. 2004 Feb;14(2):133-40. doi: 10.1089/105072504322880373.
Patients with well-differentiated thyroid cancer have a good prognosis but a significant chance for local recurrence. In the past, limited surgery with postoperative 131I only for extremely high-risk cases or recurrence was not uncommon. As more aggressive surgical and postoperative treatments appear to gain wider acceptance, toxicity and long-term morbidity become more important issues. Our goal is to present the experience of a single institution with emphasis on oral side effects related to 131I as well as acute and chronic symptoms related to this diagnosis and their impact on quality of life.
Fifty-seven patients were followed for a median time of 19.3 months. All patients received therapeutic 131I (mean dose, 154.7 mCi) between January 1, 1996 and August 30, 2002.
Fifty-four patients (94.7%) were alive at the time of analysis. Sixteen (28.1%) required a second treatment: any sign of persistence resulted in retreatment. Complaints with 131I treatment included altered taste, 26.3%; acute xerostomia, 21.1%; and acute sialoadenitis, 15.8%. Chronic xerostomia occurred in 6 (35.3%) of all patients who received multiple treatments. The incidence of chronic xerostomia was reduced to 1 of 11 (9.1%) with amifostine pretreatment. Other chronic side effects associated with this disease included fatigue 54.4%, weight gain of more than 6 months duration 24.6%, with 12 (27.9%) of those under 60 experiencing an average gain of 2.3 kg from initial diagnosis.
Review of treatment-related symptoms prompted policies to reduce toxicity including amifostine pretreatment for 131I therapy and thyrotropin (synthetic TSH) use in place of iatrogenic hypothyroidism for thyroglobulin testing and scanning.
高分化甲状腺癌患者预后良好，但局部复发风险较高。过去，仅对极高风险病例或复发患者采用有限手术加术后 131I 治疗的情况并不少见。随着更积极的手术和术后治疗方法得到更广泛认可，毒性和长期发病率成为更重要的问题。我们的目标是介绍单一机构的经验，重点关注与 131I 相关的口腔副作用以及与该诊断相关的急性和慢性症状及其对生活质量的影响。
对 57 例患者进行了中位时间为 19.3 个月的随访。所有患者在 1996 年 1 月 1 日至 2002 年 8 月 30 日期间接受了治疗性 131I（平均剂量，154.7 毫居里）。
分析时 54 例患者（94.7%）存活。16 例（28.1%）需要二次治疗：任何持续迹象均导致再次治疗。131I 治疗的不良反应包括味觉改变，占 26.3%；急性口干，占 21.1%；急性涎腺炎，占 15.8%。接受多次治疗的所有患者中有 6 例（35.3%）出现慢性口干。使用氨磷汀预处理后，慢性口干的发生率降至 11 例中的 1 例（9.1%）。与该疾病相关的其他慢性副作用包括疲劳，占 54.4%；持续超过 6 个月的体重增加，占 24.6%，其中 60 岁以下的患者中有 12 例（27.9%）自初次诊断后平均体重增加 2.3 千克。
对治疗相关症状的回顾促使制定了降低毒性的政策，包括对 131I 治疗采用氨磷汀预处理以及使用促甲状腺素（合成 TSH）代替医源性甲状腺功能减退进行甲状腺球蛋白检测和扫描。
