Albero Ana, Lopéz Juliana Ester, Torres Alberto, de la Cruz Luis, Martín Tomas
Endocr Relat Cancer. 2016 Feb;23(2):R71-84. doi: 10.1530/ERC-15-0194.
In differentiated thyroid carcinoma refractory to radioactive iodine (CDT-RTI), chemotherapy has been considered for decades to be the only systemic therapy with palliative purpose. Phase II studies assessing the efficacy of different chemotherapy outlines have been published. Nevertheless, phase III studies in these tumours have not been performed. Our objective is to evaluate the effectiveness of chemotherapy in patients with CDT-RTI by a systematic review of published studies. Systematic research of the literature in Medline and Embase databases (among others) was carried out. The full texts of selected references were analysed by two independent reviewers and then assessed for risk of bias in each study. We also extracted data using specifically designed questionnaires. Later, a qualitative synthesis of results was performed and pooled data were calculated. We found that 16 studies with 473 patients published in the last 40 years were included out of 509 identified references in databases. Thirteen studies (176 patients) included data on response to treatment and histology. Four studies included 70 patients only with well-differentiated non-medullary tumours. Response rate (RR) was 22.1% (0-57%) for 13 studies, 25% for the 176 patients and 27.1% for the 70 patients, with 2.5, 3.4 and 2.8% complete responses respectively. Survival times could not be assessed or pooled due to the lack of data and heterogeneity of the studies, and was determined to have a high risk of bias. Although it has not been possible to find solid evidence about the efficacy of chemotherapy, the results shown indicate that it may have some effectiveness, although this should be proven with well-designed studies using modern drugs.
在放射性碘难治性分化型甲状腺癌（CDT-RTI）中，数十年来化疗一直被视为唯一具有姑息治疗目的的全身治疗方法。评估不同化疗方案疗效的II期研究已经发表。然而，尚未对这些肿瘤进行III期研究。我们的目的是通过对已发表研究的系统评价来评估化疗对CDT-RTI患者的有效性。我们在Medline和Embase数据库（以及其他数据库）中进行了文献的系统检索。由两名独立的评审员分析所选参考文献的全文，然后评估每项研究的偏倚风险。我们还使用专门设计的问卷提取数据。随后，对结果进行定性综合并计算汇总数据。我们发现，在数据库中识别出的509篇参考文献中，纳入了过去40年发表的16项研究，共473例患者。13项研究（176例患者）纳入了治疗反应和组织学数据。4项研究仅纳入了70例高分化非髓样肿瘤患者。13项研究的缓解率（RR）为22.1%（0-57%），176例患者的缓解率为25%，70例患者的缓解率为27.1%，完全缓解率分别为2.5%、3.4%和2.8%。由于缺乏数据以及研究的异质性，无法评估或汇总生存时间，并且确定存在较高的偏倚风险。尽管尚未找到关于化疗疗效的确凿证据，但所示结果表明化疗可能具有一定疗效，不过这需要通过使用现代药物的精心设计研究来证实。
