University Hospital Bonn, Bonn, Germany.
Semin Nucl Med. 2011 Mar;41(2):139-48. doi: 10.1053/j.semnuclmed.2010.10.005.
The prognosis of patients with surgically unresectable differentiated thyroid tumors deteriorates significantly if radioiodine therapy is or becomes ineffective, considering the limited role of conventional chemotherapies in these patients. Several alternative approaches have been investigated for the treatment of patients with advanced thyroid malignancies in recent years. Among targeted therapies, tyrosine kinase inhibitors have resulted in the most encouraging responses and could soon be, along with redifferentiation therapy, the possible palliative strategies. Radiopeptide therapy, especially with beta emitter-labeled DOTANOC, which shows a great affinity to the somatostatin receptors expressed by thyroid tumor cells, might also be an attractive approach considering its comparatively low rate of side effects. However, the indication should be evaluated on individual basis. Medullary thyroid carcinoma shows a worse overall prognosis compared with the other differentiated thyroid tumors especially because of its natural resistance to radioiodine therapy. However, among possible palliative strategies, (131)I-meta-iodobenzylguanidine therapy is a noteworthy therapeutic approach in patients experiencing metastasized medullary thyroid carcinoma. In summary, recent developments in the treatment of patients with advanced thyroid malignancies have shown promising results, raising the hope for better outcomes in these patients in future.
对于手术无法切除的分化型甲状腺肿瘤患者，如果放射性碘治疗无效或失效，其预后会显著恶化，因为这些患者的常规化疗作用有限。近年来，人们已经研究了多种替代方法来治疗晚期甲状腺恶性肿瘤患者。在靶向治疗中，酪氨酸激酶抑制剂的效果最为令人鼓舞，并且可能很快与再分化治疗一起成为可能的姑息治疗策略。放射性肽治疗，特别是用β发射体标记的 DOTANOC，由于其对甲状腺肿瘤细胞表达的生长抑素受体具有很高的亲和力，因此也可能是一种有吸引力的方法，因为其副作用相对较低。然而，应该根据个体情况评估适应证。与其他分化型甲状腺肿瘤相比，甲状腺髓样癌的总体预后更差，尤其是因为其对放射性碘治疗天然耐药。然而，在可能的姑息治疗策略中，(131)I-间碘苄胍治疗是转移性甲状腺髓样癌患者值得关注的治疗方法。总之，晚期甲状腺恶性肿瘤患者治疗的最新进展显示出了有希望的结果，为这些患者未来的更好疗效带来了希望。
