Carrillo José F, Flores Jesús Manuel, Espinoza Gilberto, Vázquez-Romo Rafael, Ramírez-Ortega Margarita C, Carrillo Liliana C, Cortés-García Beatriz Y, Ochoa-Carrillo Francisco J, Oñate-Ocaña Luis F
Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
Departamento de Radioterapia, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
Front Oncol. 2021 Jan 19;10:572958. doi: 10.3389/fonc.2020.572958. eCollection 2020.
In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC.
This is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis.
Thirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05-0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03-1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9-50) and EBRT dose (HR 1.05, 95% CI 1.01-1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01-0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1-28.6) and EBRT dose (HR 1.05, 95% CI 1.01-1.09) were independently associated to worse OS.
EBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.
在不可切除的分化型甲状腺癌（DTC）患者中，外照射放疗（EBRT）的应用主要是为了缓解症状。我们的目的是确定初始EBRT（无论是否随后进行挽救性手术）对DTC患者无进展生存期（PFS）或总生存期（OS）的作用。
这是一项对接受EBRT的初始不可切除DTC患者的队列研究。A组接受EBRT后进行挽救性手术，B组仅接受EBRT。采用Kaplan-Meier法和Cox模型进行生存分析。
纳入33例患者；女性占69.6%，男性占30.3%。平均年龄为60.6岁，平均肿瘤直径为10.4 cm；A组和B组分别纳入17例和16例患者。属于A组（风险比[HR] 0.177，95%可信区间0.05 - 0.7）和使用调强放疗（HR 0.177，95%可信区间0.03 - 1.08）与更好的PFS相关，而高危组织病理学（HR 6.6，95%可信区间0.9 - 50）和EBRT剂量（HR 1.05，95%可信区间1.01 - 1.08）与较低的PFS独立相关。A组患者（HR 0.061，95%可信区间0.01 - 0.3）的OS有所改善，而高危组织病理学（HR 5.7，95%可信区间1.1 - 28.6）和EBRT剂量（HR 1.05，95%可信区间1.01 - 1.09）与较差的OS独立相关。
EBRT以及在可行时进行的挽救性手术，应成为初始不可切除DTC治疗策略的一个组成部分。
