放射性碘难治性分化型甲状腺癌的治疗新进展
Evolving approaches in managing radioactive iodine-refractory differentiated thyroid cancer.
作者信息
Sacks Wendy, Braunstein Glenn D
机构信息
Cedars-Sinai Medical Center, Los Angeles, California.
出版信息
Endocr Pract. 2014 Mar;20(3):263-75. doi: 10.4158/EP13305.RA.
OBJECTIVE
To discuss the approach to care of patients with advanced differentiated thyroid cancer (DTC), in particular those with radioactive iodine (RAI)-refractory disease, and the transition to systemic treatment.
METHODS
A PubMed search was conducted using the search terms "radioactive iodine-refractory, differentiated thyroid cancer and treatment" restricted to a 2000-2012 timeframe, English language, and humans. Relevant articles were identified from the bibliographies of selected references. Four patient cases are presented to illustrate the clinical course of RAI-refractory DTC.
RESULTS
The current standard of care for early stage DTC could include surgery, RAI in some cases, and thyroid hormone suppression. For advanced RAI-refractory DTC, clinical practice guidelines established by the National Comprehensive Cancer Network and the American Thyroid Association recommend, as one option, the use of systemic therapy, including kinase inhibitors. Numerous trials are underway to evaluate the clinical benefit of these targeted therapies.
CONCLUSION
Preliminary results are encouraging with respect to the clinical benefit of targeted systemic therapies. However, at present there is no consensus on the criteria that define RAI-refractory disease and the optimal timing for transition to systemic therapy. There remains a need to establish common criteria to enhance patient care and enable better comparison across clinical studies.
目的
探讨晚期分化型甲状腺癌（DTC）患者的治疗方法，尤其是那些对放射性碘（RAI）难治性疾病患者的治疗方法，以及向全身治疗的过渡。
方法
在PubMed上进行检索，检索词为“放射性碘难治性、分化型甲状腺癌及治疗”，检索时间范围限制在2000年至2012年，语言为英语，研究对象为人类。从选定参考文献的参考文献中识别相关文章。介绍4例患者病例以说明放射性碘难治性DTC的临床病程。
结果
早期DTC的当前治疗标准可能包括手术、某些情况下的放射性碘治疗以及甲状腺激素抑制。对于晚期放射性碘难治性DTC，美国国立综合癌症网络和美国甲状腺协会制定的临床实践指南推荐，作为一种选择，使用全身治疗，包括激酶抑制剂。正在进行多项试验以评估这些靶向治疗的临床益处。
结论
靶向全身治疗的临床益处的初步结果令人鼓舞。然而，目前对于定义放射性碘难治性疾病的标准以及向全身治疗过渡的最佳时机尚无共识。仍需要建立共同标准以加强患者护理并实现临床研究之间更好的比较。
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