Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
Eur J Nucl Med Mol Imaging. 2011 Oct;38(10):1798-805. doi: 10.1007/s00259-011-1849-2. Epub 2011 Jun 23.
The aim of this study was to assess the clinical outcome of redifferentiation therapy using retinoic acid (RA) in combination with 131I therapy, and to identify biological parameters that predict therapeutic response in Korean patients with radioiodine-refractory papillary thyroid carcinoma (PTC).
A total of 47 patients (13 men, 34 women; age 54.2±13.6 years) with radioiodine-refractory PTC underwent therapy consisting of consecutive treatment with 131I and RA. Each 131I/RA treatment cycle involved the administration of oral isotretinoin for 6 weeks at 1-1.5 mg/kg daily followed by a single oral dose of 131I (range 5.5-16.7 GBq). Therapeutic responses were determined using serum thyroglobulin (Tg) levels and the change in tumour size 6 months after completing the 131I/RA therapy. Biological parameters and pathological parameters before and after combined therapy were compared.
After completing 131I/RA therapy, 1 patient showed a complete response, 9 partial response, 9 stable disease, and 28 progressive disease, representing an overall response rate of 21.3%. Univariate analysis revealed that an age of <45 years and a persistently high serum Tg level were related to a good response. No clinical response was achieved when metastases showing no iodine uptake were present. Multivariate regression analysis showed that an age of <45 years was significantly associated with a good response. Of the 24 patients with well-differentiated carcinoma, 5 (20.8%) responded to 131I/RA therapy, whereas all 6 patients with poorly differentiated carcinoma failed to respond.
131I/RA therapy was found to elicit a response rate of 21.3% among patients with radioiodine-refractory PTC, and an age of <45 years was found to be significantly associated with a good response.
本研究旨在评估全反式维甲酸（RA）联合 131I 治疗在韩国放射性碘难治性甲状腺乳头状癌（PTC）患者中的临床疗效，并确定预测治疗反应的生物学参数。
共 47 例放射性碘难治性 PTC 患者（男 13 例，女 34 例；年龄 54.2±13.6 岁）接受 131I 和 RA 连续治疗。每个 131I/RA 治疗周期包括口服异维 A 酸 6 周，剂量为 1-1.5mg/kg/天，随后单次口服 131I（范围 5.5-16.7GBq）。治疗反应通过血清甲状腺球蛋白（Tg）水平和 131I/RA 治疗结束后 6 个月肿瘤大小的变化来确定。比较联合治疗前后的生物学参数和病理参数。
完成 131I/RA 治疗后，1 例患者完全缓解，9 例部分缓解，9 例病情稳定，28 例疾病进展，总有效率为 21.3%。单因素分析显示，年龄<45 岁和持续高血清 Tg 水平与良好反应相关。无碘摄取转移灶者无临床反应。多因素回归分析显示，年龄<45 岁与良好反应显著相关。24 例分化良好的癌患者中，有 5 例（20.8%）对 131I/RA 治疗有反应，而 6 例低分化癌患者均无反应。
131I/RA 治疗放射性碘难治性 PTC 的有效率为 21.3%，年龄<45 岁与良好反应显著相关。
