Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston.
Division of Internal Medicine, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston.
JAMA Otolaryngol Head Neck Surg. 2017 Dec 1;143(12):1244-1251. doi: 10.1001/jamaoto.2017.2077.
As incidence of differentiated thyroid cancer rises, treatment paradigms have become increasingly defined. Despite this, locally advanced disease continues to be challenging to manage. Postoperative therapy in the form of radioactive iodine (RAI) is generally recommended, but the role of external beam radiation therapy (EBRT) is less well defined.
To investigate the role of EBRT in locally advanced differentiated thyroid cancer.
DESIGN, SETTING, AND PARTICIPANTS: For this retrospective cohort study, patients treated surgically for T4a differentiated thyroid cancer at the University of Texas MD Anderson Cancer Center from January 2000 through December 2015 were recruited, and 88 patients were included for analysis.
Adjuvant treatment with RAI alone or both RAI and EBRT.
Disease-free survival (DFS), defined as the time from primary surgery to locoregional or distant recurrence or death due to any cause. Kaplan-Meier survival analysis was completed. Univariate and multivariate analysis was completed with Cox proportional hazards model to determine predictors of DFS.
A total of 88 patients (44 women [50%]; mean [SD] age, 58.2 [15.3] years) were included in the analysis. Median (range) follow-up was 117 (12-164) months. Forty-four patients (50%) underwent RAI alone and 44 patients (50%) underwent RAI with adjuvant EBRT. Patients undergoing RAI alone did not receive EBRT owing to invasion into the recurrent laryngeal nerve only (n = 14 [32%]) or invasion into the tracheal perichondrium and/or esophageal muscularis only (n = 18 [41%]). Five-year DFS was 43% in those undergoing RAI alone, compared with 57% in those undergoing RAI and EBRT (effect size = 14%; 95% CI, −7% to 33%). Patients undergoing RAI alone had an increased rate of locoregional failure (effect size = −32%; 95% CI, −47% to −16%), with those undergoing RAI treatment alone, for minimal tracheal perichondrium and/or esophageal muscularis invasion having worse locoregional control than those with recurrent laryngeal nerve invasion only (effect size = 49%; 95% CI, 20% to 71%). Age (adjusted hazard ratio [adjusted HR], 1.02/y; 95% CI, 1.00 to 1.05) and esophageal invasion (adjusted HR, 2.30; 95% CI, 1.16 to 4.60) were independent predictors of worse DFS.
The addition of EBRT to RAI results in good disease control in locally advanced differentiated thyroid cancer, particularly in patients with tracheal or esophageal invasion treated with aggressive surgical resection. Increased age and presence of esophageal invasion were independent predictors of poor disease control.
随着分化型甲状腺癌发病率的上升，治疗模式已逐渐明确。尽管如此，局部晚期疾病的治疗仍然具有挑战性。术后放射性碘（RAI）治疗通常是推荐的，但外照射放射治疗（EBRT）的作用则不太明确。
研究 EBRT 在局部晚期分化型甲状腺癌中的作用。
设计、地点和参与者：本回顾性队列研究招募了 2000 年 1 月至 2015 年 12 月期间在德克萨斯大学 MD 安德森癌症中心接受手术治疗 T4a 分化型甲状腺癌的患者，共纳入 88 例患者进行分析。
单独接受 RAI 辅助治疗或同时接受 RAI 和 EBRT 治疗。
无病生存（DFS），定义为从原发手术到局部或远处复发或任何原因导致的死亡的时间。进行 Kaplan-Meier 生存分析。采用 Cox 比例风险模型进行单因素和多因素分析，以确定 DFS 的预测因素。
共纳入 88 例患者（44 例女性[50%]；平均[SD]年龄为 58.2[15.3]岁）进行分析。中位（范围）随访时间为 117（12-164）个月。44 例（50%）患者仅接受 RAI 治疗，44 例（50%）患者接受 RAI 联合辅助 EBRT 治疗。仅因侵犯喉返神经（n=14[32%]）或侵犯气管软骨和/或食管肌层（n=18[41%]）而未接受 EBRT 的患者仅接受 RAI 治疗。单独接受 RAI 治疗的患者 5 年 DFS 为 43%，而同时接受 RAI 和 EBRT 治疗的患者为 57%（效果大小为 14%；95%CI，-7%至 33%）。单独接受 RAI 治疗的患者局部区域失败率较高（效果大小为-32%；95%CI，-47%至-16%），对于最小程度的气管软骨和/或食管肌层侵犯的患者，局部区域控制情况比仅侵犯喉返神经的患者更差（效果大小为 49%；95%CI，20%至 71%）。年龄（调整后的危险比[调整后 HR]，1.02/y；95%CI，1.00 至 1.05）和食管侵犯（调整后 HR，2.30；95%CI，1.16 至 4.60）是 DFS 较差的独立预测因素。
在局部晚期分化型甲状腺癌中，RAI 联合 EBRT 可获得良好的疾病控制，特别是在接受积极手术切除的气管或食管侵犯的患者中。年龄增加和存在食管侵犯是疾病控制不良的独立预测因素。
