Mayson Sarah E, Yoo Don C, Gopalakrishnan Geetha
The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, R.I., USA.
Oncology. 2015;88(4):247-56. doi: 10.1159/000369496. Epub 2014 Dec 11.
The incidence of differentiated thyroid cancer has increased worldwide over the last three decades, but thyroid cancer-related mortality remains stable. Until recently, the standard treatment for most thyroid cancers has been near-total thyroidectomy followed by radioiodine remnant ablation. Observational data support lower recurrence rates and improved survival after radioiodine ablation in patients with high-risk cancers; however, a similar benefit has not been established for all patients with thyroid cancer. Risk stratification should be used to identify patients who are likely to benefit from radioiodine ablation and guide therapeutic decisions. For most patients who need radioiodine remnant ablation, preparation for therapy with recombinant human thyroid-stimulating hormone stimulation is as effective as thyroid hormone withdrawal. Lower therapeutic doses of radioiodine are recommended for the majority of thyroid remnant ablations. Higher doses are reserved for advanced disease at initial diagnosis, local recurrences that cannot be treated with surgery alone, and distant metastatic disease.
在过去三十年中，分化型甲状腺癌的发病率在全球范围内有所上升，但甲状腺癌相关死亡率保持稳定。直到最近，大多数甲状腺癌的标准治疗方法一直是近全甲状腺切除术，随后进行放射性碘残留消融。观察数据支持高危癌症患者在放射性碘消融后复发率较低且生存率提高；然而，并非所有甲状腺癌患者都能获得类似的益处。应使用风险分层来识别可能从放射性碘消融中获益的患者，并指导治疗决策。对于大多数需要放射性碘残留消融的患者，使用重组人促甲状腺激素刺激进行治疗准备与停用甲状腺激素一样有效。大多数甲状腺残留消融建议使用较低的治疗剂量放射性碘。较高剂量用于初始诊断时的晚期疾病、无法仅通过手术治疗的局部复发以及远处转移性疾病。
