Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surgery. 2010 Dec;148(6):1198-204; discussion 1204-6. doi: 10.1016/j.surg.2010.09.006.
The purpose of this study was to evaluate the outcome of patients with differentiated thyroid carcinoma whose posttherapy imaging demonstrated I-131 uptake in cervical lymph nodes.
In this prospective cohort study, 95 patients who underwent surgery for well-differentiated thyroid carcinoma had evidence of persistent cervical lymph node metastasis on posttherapy I-131 scintigraphy. These patients were evaluated by subsequent I-131 scintigraphy, and treated with additional I-131 therapy or surgical excision of cervical lymph nodes as clinically indicated. Patients were followed for a mean of 6.8 years.
Patients received a total of one to three I-131 administrations (median dosage, 235 mCi). Surveillance I-131 scintigraphy was performed to evaluate disease activity. I-131 uptake was eliminated from the thyroid bed in all patients. Persistent disease was detected in cervical lymph nodes in 9 (9%) of 95 patients, and these 9 patients underwent lymph node excision (1 patient later had recurrent disease and was treated with additional I-131 therapy). All patients subsequently had negative I-131 imaging and undetectable serum thyroglobulin. Of the 95 patients in the study, 9 (9%) developed recurrent disease in cervical lymph nodes. Of these 9 patients, 2 also had distant metastases; 6 of these patients underwent surgical excision of cervical adenopathy, and 3 received additional I-131 therapy. There were no grade >3 toxicities attributable to I-131. At last follow-up, 93 (98%) of the 95 patients were free of disease.
Most patients (82%) in the study with cervical lymph node metastases detected on initial posttherapy I-131 scintigraphy were rendered free of disease with I-131 therapy. Surgical reintervention was required in 15% of patients (15/95). The use and timing of additional I-131 therapy versus surgical intervention in this group of patients needs to be further evaluated.
本研究旨在评估经碘-131 治疗后影像学显示颈部淋巴结摄取碘-131 的分化型甲状腺癌患者的治疗结果。
在这项前瞻性队列研究中，95 例经手术治疗的分化型甲状腺癌患者在碘-131 治疗后扫描中发现有持续性颈部淋巴结转移。这些患者随后接受碘-131 扫描评估，并根据临床情况接受额外的碘-131 治疗或手术切除颈部淋巴结。患者平均随访 6.8 年。
患者共接受 1 至 3 次碘-131 治疗（中位剂量为 235mCi）。进行碘-131 扫描以评估疾病活动情况。所有患者的甲状腺床碘-131 摄取均被消除。95 例患者中有 9 例（9%）在颈部淋巴结中发现持续性疾病，这 9 例患者接受了淋巴结切除术（1 例患者后来复发，并接受了额外的碘-131 治疗）。所有患者随后的碘-131 影像学检查均为阴性，血清甲状腺球蛋白无法检测。在研究的 95 例患者中，9 例（9%）在颈部淋巴结中出现复发性疾病。其中 2 例患者还有远处转移；这些患者中有 6 例接受了颈部淋巴结切除术，3 例接受了额外的碘-131 治疗。没有因碘-131 引起的>3 级毒性。末次随访时，95 例患者中有 93 例（98%）无疾病。
在最初的碘-131 治疗后扫描中发现颈部淋巴结转移的研究患者中，大多数患者（82%）通过碘-131 治疗获得治愈。需要对 15%的患者（15/95）进行手术干预。需要进一步评估这组患者中额外的碘-131 治疗与手术干预的使用和时机。
