Kiess Ana P, Agrawal Nishant, Brierley James D, Duvvuri Umamaheswar, Ferris Robert L, Genden Eric, Wong Richard J, Tuttle R Michael, Lee Nancy Y, Randolph Gregory W
Department of Radiation Oncology, Johns Hopkins Medical Institute, Baltimore, Maryland.
Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland.
Head Neck. 2016 Apr;38(4):493-8. doi: 10.1002/hed.24357. Epub 2015 Dec 30.
The use of external-beam radiotherapy (EBRT) in differentiated thyroid cancer (DTC) is debated because of a lack of prospective clinical data, but recent retrospective studies have reported benefits in selected patients. The Endocrine Surgery Committee of the American Head and Neck Society provides 4 recommendations regarding EBRT for locoregional control in DTC, based on review of literature and expert opinion of the authors. (1) EBRT is recommended for patients with gross residual or unresectable locoregional disease, except for patients <45 years old with limited gross disease that is radioactive iodine (RAI)-avid. (2) EBRT should not be routinely used as adjuvant therapy after complete resection of gross disease. (3) After complete resection, EBRT may be considered in select patients >45 years old with high likelihood of microscopic residual disease and low likelihood of responding to RAI. (4) Cervical lymph node involvement alone should not be an indication for adjuvant EBRT.
由于缺乏前瞻性临床数据，分化型甲状腺癌（DTC）中外照射放疗（EBRT）的应用存在争议，但最近的回顾性研究报告了在特定患者中的获益。美国头颈学会内分泌外科委员会基于文献综述和作者的专家意见，就EBRT用于DTC的局部区域控制提出了4项建议。（1）对于有大体残留或不可切除的局部区域疾病的患者，推荐使用EBRT，但＜45岁、大体疾病局限且对放射性碘（RAI）摄取良好的患者除外。（2）在大体疾病完全切除后，不应常规将EBRT用作辅助治疗。（3）在完全切除后，对于＞45岁、有微小残留疾病高可能性且对RAI反应可能性低的特定患者，可考虑使用EBRT。（4）单独的颈部淋巴结受累不应作为辅助EBRT的指征。
