Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Thyroid. 2010 Mar;20(3):257-63. doi: 10.1089/thy.2009.0401.
In December 2007, the USFDA approved recombinant human thyroid stimulating hormone (rhTSH) for radioiodine remnant ablation after total thyroidectomy in patients with well-differentiated thyroid cancer without evidence of metastatic disease. Because previously undetected radioactive iodine (RAI)-avid metastatic lesions can be identified during remnant ablation, we sought to determine if rhTSH-stimulated uptake of RAI into these incidentally discovered metastases is associated with a significant therapeutic (tumoricidal) effect.
This retrospective review describes the clinical outcome of 84 well-differentiated thyroid cancer patients in whom RAI-avid lesions outside the thyroid bed were first identified at the time of RAI remnant ablation (64 rhTSH stimulated, 20 thyroid hormone withdrawal [THW]) on either the diagnostic (63/84, 75%) or posttherapy (21/84, 25%) whole body scan (76 with locoregional metastasis only and 8 with pulmonary uptake). Following ablation, patients were classified as having either no evidence of disease or persistent disease on the basis of subsequent diagnostic whole body RAI scans, stimulated thyroglobulin, and cross-sectional imaging studies.
Despite having RAI-avid metastatic disease identified outside the thyroid bed at the time of initial ablation, 70% (45/64) of rhTSH-assisted patients and 55% (11/20) of the THW group had no evidence of disease at a median of 2.7 years following the initial RAI ablation (p = 0.159). THW and rhTSH-stimulated RAI ablation had similar efficacy in eliminating RAI-avid locoregional metastases (42/60, 70% of rhTSH and 10/16, 63% of THW, p = 0.65) and pulmonary metastases (3/4, 75% of rhTSH and 1/4, 25% of THW, p = 0.41).
Preparation with either rhTSH or THW in this retrospective study appears to have similar therapeutic (tumoricidal) effects on small volume RAI-avid metastatic disease incidentally discovered at the time of ablation in both locoregional lymph nodes and pulmonary parenchyma.
2007 年 12 月，美国食品和药物管理局（FDA）批准重组人促甲状腺激素（rhTSH）用于分化型甲状腺癌患者甲状腺全切除术后的放射性碘（RAI）残留消融，这些患者无转移性疾病的证据。由于在残留消融期间可以发现先前未检测到的放射性碘（RAI）摄取的转移性病变，我们试图确定 rhTSH 刺激这些偶然发现的转移灶摄取 RAI 是否与显著的治疗（杀肿瘤）效果相关。
本回顾性研究描述了 84 例分化型甲状腺癌患者的临床结果，这些患者在 RAI 残留消融时首次在甲状腺床外发现 RAI 摄取的病变（64 例 rhTSH 刺激，20 例甲状腺激素停药[THW]），这些病变出现在诊断性（63/84，75%）或治疗后（21/84，25%）全身扫描上（76 例仅为局部区域转移，8 例有肺摄取）。消融后，根据随后的诊断性全身 RAI 扫描、刺激甲状腺球蛋白和影像学研究，将患者分为无疾病证据或持续性疾病。
尽管在初始消融时在甲状腺床外发现了 RAI 摄取的转移性疾病，但在初始 RAI 消融后 2.7 年中位数时，70%（45/64）的 rhTSH 辅助患者和 55%（11/20）的 THW 组无疾病证据（p=0.159）。THW 和 rhTSH 刺激的 RAI 消融在消除 RAI 摄取的局部区域转移方面具有相似的疗效（60 例中的 42 例，rhTSH 为 70%，16 例中的 10 例，THW 为 63%，p=0.65）和肺转移（4 例中的 3 例，rhTSH 为 75%，4 例中的 1 例，THW 为 25%，p=0.41）。
在这项回顾性研究中，用 rhTSH 或 THW 进行准备似乎对局部区域淋巴结和肺实质中消融时偶然发现的小体积 RAI 摄取的转移性疾病具有相似的治疗（杀肿瘤）效果。
