Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ, Brasil.
Braz J Med Biol Res. 2011 Jan;44(1):73-7. doi: 10.1590/s0100-879x2010007500120. Epub 2010 Nov 12.
During thyroid tumor progression, cellular de-differentiation may occur and it is commonly accompanied by metastatic spread and loss of iodine uptake. Retinoic acid (RA) administration might increase iodine uptake in about 40% of patients, suggesting that RA could be a promising therapeutic option for radioiodine non-responsive thyroid carcinoma, although a prospective study with a long-term follow-up has not been reported. This was a clinical prospective study assessing the value of 13-cis-RA in patients with advanced thyroid carcinoma and its impact on major outcomes such as tumor regression and cancer-related death with a long-term follow-up of patients submitted to radioiodine (¹³¹I) therapy after RA administration. Sixteen patients with inoperable disease and no significant radioiodine uptake on post-therapy scan were selected. Patients were treated orally with 13-cis-RA at a dose of 1.0 to 1.5 mg·kg⁻¹·day⁻¹ for 5 weeks and then submitted to radioiodine therapy (150 mCi) after thyroxine withdrawal. A whole body scan was obtained 5 to 7 days after the radioactive iodine therapy. RECIST criteria were used to evaluate the response. An objective partial response rate was observed in 18.8%, a stable disease rate in 25% and a progression disease rate in 56.2%. Five patients died (62.5%) in the group classified as progression of disease. Progression-free survival rate (PFS) ranged from 72 to 12 months, with a median PFS of 26.5 months. RA may be an option for advanced de-differentiated thyroid cancer, due to the low rate of side effects.
在甲状腺肿瘤进展过程中，细胞去分化可能发生，通常伴随着转移扩散和碘摄取的丧失。维甲酸（RA）的给药可能会增加约 40%患者的碘摄取，这表明 RA 可能是一种有前途的放射性碘治疗无反应性甲状腺癌的治疗选择，尽管尚未报道具有长期随访的前瞻性研究。这是一项临床前瞻性研究，评估了 13-顺式 RA 在晚期甲状腺癌患者中的价值及其对主要结局的影响，如肿瘤消退和癌症相关死亡，对接受 RA 给药后接受放射性碘（¹³¹I）治疗的患者进行了长期随访。选择了 16 名无法手术且治疗后扫描无明显碘摄取的疾病患者。患者口服 13-顺式 RA，剂量为 1.0 至 1.5mg·kg⁻¹·day⁻¹，连续 5 周，然后在甲状腺素停药后接受放射性碘治疗（150mCi）。放射性碘治疗后 5 至 7 天进行全身扫描。采用 RECIST 标准评估反应。观察到客观部分缓解率为 18.8%，稳定疾病率为 25%，进展疾病率为 56.2%。在疾病进展组中有 5 名患者死亡（62.5%）。无进展生存期（PFS）范围为 72 至 12 个月，中位 PFS 为 26.5 个月。由于副作用发生率低，RA 可能是晚期去分化甲状腺癌的一种选择。
