Shokoohi Aria, Berthelet Eric, Gill Sabrina, Prisman Eitan, Sexsmith George, Tran Eric, White Adam, Wiseman Sam M, Wu Jonn, Ho Cheryl
Medical Oncology, BC Cancer, Vancouver, CAN.
Radiation Oncology, BC Cancer, Vancouver Cancer Centre, Vancouver, CAN.
Cureus. 2020 Feb 27;12(2):e7122. doi: 10.7759/cureus.7122.
Management of recurrent differentiated thyroid cancer (DTC) may include surgery, radioactive iodine (RAI), and external beam radiotherapy (EBRT). Systemic therapy may also be offered for RAI-refractory DTC. The study objective was to review patterns of practice in British Columbia (BC) for treatment of recurrent DTC, assess rates of RAI-refractory disease, and evaluate outcomes.
BC Cancer provides cancer care to a population of 4.6 million. A retrospective review of all patients with DTC stage I-IVB disease referred to BC Cancer from 2009 to 2013 was conducted. Patient and DTC characteristics, locoregional and distant recurrence, surgical management, RAI, EBRT, and systemic therapy details were retrospectively collected. Relapse-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) were calculated using the Kaplan-Meier method.
RESULTS/DISCUSSION: Some 1062 DTC patients were identified. Median follow-up was 4.1 years. Baseline characteristics: female 74%, median age 50, papillary/follicular/Hurthle cell 92%/6%/2%. Stage at presentation: I 60%, II 8%, III 22%, IVA/IVB 10%. Locoregional and/or distant recurrence occurred in 136 patients (13%). Locoregional recurrence (n=118) was treated with surgery +/- RAI or EBRT 48%, RAI +/- EBRT 40%, EBRT alone 1%, 11% were observed without treatment. Some 27 patients had a second cancer recurrence. Some 37 patients (3%) developed distant metastatic disease and common sites of distant metastases were: lung 76%, bone 30%, and liver 8%. Some 27 cases (2%) were deemed RAI-refractory. Some six patients (0.6%) received systemic therapy with a vascular endothelial growth factor tyrosine kinase inhibitor (VEGF TKI). Five-year RFS was calculated to be 82%, OS 95%, and DSS 98% for the study population.
In our population-based study cohort, 87% of patients were rendered disease-free by primary disease management. Multi-modality treatment of locoregional recurrence facilitated disease-free status in the majority of patients (67%). RAI-refractory disease developed in 2% of patients and despite a significant number of metastatic recurrences, only a small number of patients received systemic therapy.
复发性分化型甲状腺癌（DTC）的治疗可能包括手术、放射性碘（RAI）和外照射放疗（EBRT）。对于放射性碘难治性DTC，也可提供全身治疗。本研究的目的是回顾不列颠哥伦比亚省（BC）复发性DTC的治疗模式，评估放射性碘难治性疾病的发生率，并评估治疗结果。
BC癌症机构为460万人口提供癌症护理。对2009年至2013年转诊至BC癌症机构的所有I-IVB期DTC患者进行了回顾性研究。回顾性收集患者和DTC的特征、局部区域和远处复发情况、手术治疗、放射性碘治疗、外照射放疗和全身治疗的详细信息。采用Kaplan-Meier方法计算无复发生存期（RFS）、总生存期（OS）和疾病特异性生存期（DSS）。
结果/讨论：共确定了1062例DTC患者。中位随访时间为4.1年。基线特征：女性占74%，中位年龄50岁，乳头状/滤泡状/许特氏细胞癌分别占92%/6%/2%。初诊时分期：I期占60%，II期占8%，III期占22%，IVA/IVB期占10%。136例患者（13%）发生了局部区域和/或远处复发。局部区域复发（n=118）的治疗方式为：手术±放射性碘或外照射放疗占48%，放射性碘±外照射放疗占40%，单纯外照射放疗占1%，11%未接受治疗。27例患者出现第二次癌症复发。37例患者（3%）发生远处转移，常见远处转移部位为：肺占76%，骨占30%，肝占8%。27例患者（2%）被认为是放射性碘难治性的。6例患者（0.6%）接受了血管内皮生长因子酪氨酸激酶抑制剂（VEGF TKI）的全身治疗。研究人群的5年无复发生存率为82%，总生存率为95%，疾病特异性生存率为98%。
在我们基于人群的研究队列中，87%的患者通过原发性疾病管理实现了无病状态。局部区域复发的多模式治疗使大多数患者（67%）获得了无病状态。2%的患者发生了放射性碘难治性疾病，尽管有大量转移性复发，但只有少数患者接受了全身治疗。
