重组人促甲状腺激素在分化型甲状腺癌远处转移患者治疗中的潜在应用。
Potential use of recombinant human thyrotropin in the treatment of distant metastases in patients with differentiated thyroid cancer.
机构信息
Division of Endocrinology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA.
出版信息
Endocr Pract. 2013 Jan-Feb;19(1):139-48. doi: 10.4158/EP12244.RA.
OBJECTIVE
In order to effectively treat differentiated thyroid cancer (DTC) with radioiodine (RAI) it is necessary to raise serum TSH levels either endogenously by thyroid hormone withdrawal (THW) or exogenously by administration of recombinant human TSH (rhTSH). The goal of this review is to present current data on the relative efficacy and side effects profile of rhTSH-aided versus THW-aided RAI therapy for the treatment of patients with distant metastases of DTC.
METHODS
We have searched the PubMed database for articles including the keywords "rhTSH", "thyroid cancer", and "distant metastases" published between January 1, 1996 and January 7, 2012. As references, we used clinical case series, case reports, review articles, and practical guidelines.
RESULTS
Exogenous stimulation of TSH is associated with better quality of life because it obviates signs and symptoms of hypothyroidism resulting from endogenous TSH stimulation. The rate of neurological complications after rhTSH and THW-aided RAI therapy for brain and spine metastases is similar. The rate of leukopenia, thrombocytopenia, xerostomia, and pulmonary fibrosis is similar after preparation for RAI treatment with rhTSH and THW. There is currently a controversy regarding RAI uptake in metastatic lesions after preparation with rhTSH versus THW, with some studies suggesting equal and some superior uptake after preparation with THW. Analysis of available retrospective studies comparing survival rates, progression free survival, and biochemical and structural response to a dosimetrically-determined dose of RAI shows similar efficacy after preparation for therapy with rhTSH and THW.
CONCLUSION
The rhTSH stimulation is not presently approved by the FDA as a method of preparation for adjunctive therapy with RAI in patients with metastatic DTC. Data on rhTSH compassionate use suggest that rhTSH stimulation is as equally effective as THW as a method of preparation for dosimetry-based RAI treatment in patients with RAI-avid metastatic DTC.
目的
为了有效地用放射性碘（RAI）治疗分化型甲状腺癌（DTC），有必要通过甲状腺激素抑制（THW）或重组人促甲状腺激素（rhTSH）的外源性给药来提高血清 TSH 水平。本综述的目的是介绍 rhTSH 辅助与 THW 辅助 RAI 治疗 DTC 远处转移患者的相对疗效和副作用概况的最新数据。
方法
我们在 PubMed 数据库中搜索了包括“rhTSH”、“甲状腺癌”和“远处转移”等关键词的文章，检索时间范围为 1996 年 1 月 1 日至 2012 年 1 月 7 日。作为参考文献，我们使用了临床病例系列、病例报告、综述文章和实用指南。
结果
外源性 TSH 刺激与更好的生活质量相关，因为它避免了内源性 TSH 刺激导致的甲状腺功能减退症状。rhTSH 和 THW 辅助 RAI 治疗脑和脊柱转移后的神经并发症发生率相似。rhTSH 和 THW 准备治疗后的白细胞减少、血小板减少、口干和肺纤维化发生率相似。目前，rhTSH 准备与 THW 准备后转移性病变摄取 RAI 的情况存在争议，一些研究表明 THW 准备后的摄取相等，而一些研究表明 THW 准备后的摄取更好。对比较 rhTSH 和 THW 准备后生存率、无进展生存期以及生化和结构对放射性碘剂量测定剂量反应的回顾性研究进行分析，结果表明 rhTSH 和 THW 准备后的疗效相似。
结论
美国食品和药物管理局（FDA）目前尚未批准 rhTSH 作为辅助治疗转移性 DTC 患者的 RAI 准备方法。rhTSH 同情使用的数据表明，rhTSH 刺激与 THW 一样，作为基于剂量测定的 RAI 治疗的准备方法，对 RAI 敏化的转移性 DTC 患者同样有效。
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