Wei Lan, Bai Lin, Zhao Lina, Yu Tianyu, Ma Qingjie, Ji Bin
Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, Jilin Province, China.
Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, Jilin Province, China.
World J Surg. 2019 May;43(5):1256-1263. doi: 10.1007/s00268-019-04924-0.
One of the presumed advantages of prophylactic central neck dissection (pCND) is offering staging basis for more aggressive radioactive iodine (RAI) therapy, which postulates the necessity of high dose for treatment efficacy. The present study aims to compare the effectiveness between low-dose and high-dose RAI in a select cohort of cN0 papillary thyroid cancer (PTC) patients with pathological N1a (pN1a) disease revealed by pCND in terms of ablation rate and response to therapy. The frequency of short-term adverse effects between the two groups was also compared.
From January 2014 to April 2016, cN0 PTC patients with pN1a disease revealed by pCND in our hospital were retrospectively reviewed. Patients with other indications for high-dose RAI, such as the presence of extrathyroidal extension, vascular invasion or suspicions of distant metastasis, were excluded. For the included patients, high dose (3700 MBq) was administered between January 2014 and August 2015 and low dose (1110 MBq) between August 2015 and April 2016. Ablation assessment was performed 6 months after RAI therapy. Response evaluation after RAI therapy was performed after 46.3 ± 9.5 months for high-dose group and 29.1 ± 2.6 months for low-dose group. All patients were also evaluated for short-term adverse effects 24 and 72 hours after RAI administration.
A total of 84 patients were enrolled. Among them, 42 were in the high-dose group and the other 42 in the low-dose group. There was no significant difference in ablation rate (P = 0.7707) and response to RAI therapy (P = 0.6454) between the two groups. Twenty-four hours after RAI administration, neck pain and swelling (33.3% VS. 11.9%; P = 0.0372) and gastrointestinal discomfort (45.2% vs. 21.4%; P = 0.0373) were significantly more frequent in the high-dose group.
High-dose RAI therapy, with higher frequency of short-term adverse effects, appears to be not superior to low-dose RAI therapy for cN0 PTC patients with pN1a disease revealed by pCND to achieve better response to therapy. Further randomized studies with larger series of patients and longer follow-up duration, especially with the low-dose group, are needed to validate our results.
预防性中央区颈清扫术（pCND）的一个假定优势是为更积极的放射性碘（RAI）治疗提供分期依据，这假定了高剂量对于治疗效果的必要性。本研究旨在比较低剂量和高剂量RAI在一组经pCND显示为病理N1a（pN1a）疾病的cN0乳头状甲状腺癌（PTC）患者中的有效性，包括消融率和对治疗的反应。还比较了两组之间短期不良反应的发生率。
回顾性分析2014年1月至2016年4月在我院经pCND显示为pN1a疾病的cN0 PTC患者。排除有其他高剂量RAI指征的患者，如存在甲状腺外侵犯、血管侵犯或怀疑远处转移。对于纳入的患者，2014年1月至2015年8月给予高剂量（3700 MBq），2015年8月至2016年4月给予低剂量（1110 MBq）。RAI治疗后六个月进行消融评估。高剂量组在RAI治疗后46.3±9.5个月进行反应评估，低剂量组在29.1±2.6个月进行评估。所有患者在RAI给药后24小时和72小时也进行短期不良反应评估。
共纳入84例患者。其中，高剂量组42例，低剂量组42例。两组之间的消融率（P = 0.7707）和对RAI治疗的反应（P = 0.6454）无显著差异。RAI给药后24小时，高剂量组颈部疼痛和肿胀（33.3%对11.9%；P = 0.0372）以及胃肠道不适（45.2%对21.4%；P = 0.0373）的发生率明显更高。
对于经pCND显示为pN1a疾病的cN0 PTC患者，高剂量RAI治疗虽然短期不良反应发生率更高，但在实现更好的治疗反应方面似乎并不优于低剂量RAI治疗。需要进一步开展更大样本量、更长随访时间的随机研究，尤其是针对低剂量组，以验证我们的结果。
