Sun X S, Guevara N, Fakhry N, Sun S-R, Marcy P-Y, Santini J, Bosset J-F, Thariat J
Département de radiothérapie, centre hospitalier régional universitaire de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
Cancer Radiother. 2013 Jun;17(3):233-43; quiz 255-6, 258. doi: 10.1016/j.canrad.2012.12.003. Epub 2013 Feb 8.
Anaplastic thyroid cancers represent 1-2% of all thyroid tumours and are of very poor prognosis even with multimodality treatment including external beam radiation therapy. Conversely, differentiated thyroid carcinomas (at least 80% of thyroid cancers) hamper good prognosis with surgery with or without radioiodine and there is hardly any room for external beam radiation therapy. Insular and medullar carcinomas have intermediary prognosis and are rarely irradiated. We aimed to update recommendations for external beam irradiation in these different clinical situations and put in light the benefits of new irradiations techniques. A search of the French and English literature was performed using the following keywords: thyroid carcinoma, anaplastic, chemoradiation, radiation therapy, surgery, histology and prognostic. Non-mutilating surgery (often limited to debulking) followed by systematic external beam radiation therapy is the standard of care in anaplastic thyroid cancers (hyperfractionated-accelerated radiation therapy with low-dose weekly doxorubicin with or without cisplatin if possible). Given anaplastic thyroid cancers' median survival of 10 months or less, neoadjuvant and adjuvant chemotherapy may also be discussed. Ten-year survival rates for patients with papillary, follicular and Hürthle-cell carcinomas are 93%, 85%, and 76%, respectively. Massive primary incompletely resected iodine-negative disease indicates external beam radiation therapy. Older age (45 or 60-year-old), poor-prognosis histological variants (including tall cell cancers) and insular cancers are increasingly reported as criteria for external beam radiation therapy. Massive extracapsular incompletely resected nodal medullary disease suggests external beam radiation therapy. Radiation therapy morbidity has been an important limitation. However, intensity modulated radiation therapy (IMRT) offers clear dosimetric advantages on tumour coverage and organ sparing, reducing late toxicities to less than 5%. The role of radiation therapy is evolving for anaplastic thyroid cancers using multimodal strategies and new chemotherapy molecules, and for differentiated cancers using minor criteria, such as histological variants, with IMRT becoming a standard of care.
间变性甲状腺癌占所有甲状腺肿瘤的1%-2%，即便采用包括外照射放疗在内的多模式治疗，其预后仍很差。相反，分化型甲状腺癌（至少占甲状腺癌的80%）通过手术（无论有无放射性碘）预后良好，外照射放疗几乎没有用武之地。岛状癌和髓样癌预后中等，很少进行放疗。我们旨在更新这些不同临床情况下外照射放疗的建议，并阐明新放疗技术的益处。使用以下关键词检索了法语和英语文献：甲状腺癌、间变性、放化疗、放射治疗、手术、组织学和预后。对于间变性甲状腺癌，标准治疗方案是进行非致残性手术（通常限于减瘤手术），然后进行系统性外照射放疗（如果可能，采用超分割加速放疗，每周低剂量给予阿霉素，可联合或不联合顺铂）。鉴于间变性甲状腺癌的中位生存期为10个月或更短，也可讨论新辅助化疗和辅助化疗。乳头状癌、滤泡状癌和嗜酸性细胞癌患者的10年生存率分别为93%、85%和76%。大量原发灶未完全切除的碘阴性疾病提示需进行外照射放疗。年龄较大（45岁或60岁）、预后不良的组织学亚型（包括高细胞癌）和岛状癌越来越多地被报道为外照射放疗的标准。大量包膜外未完全切除的髓样癌转移灶提示需进行外照射放疗。放射治疗的不良反应一直是一个重要限制因素。然而，调强放射治疗（IMRT）在肿瘤覆盖和器官保护方面具有明显的剂量学优势，可将晚期毒性降低至5%以下。对于间变性甲状腺癌，采用多模式策略和新的化疗药物，放射治疗的作用正在不断演变；对于分化型甲状腺癌，采用诸如组织学亚型等次要标准，IMRT正成为一种标准治疗方法。
