Kim J H, Leeper R D
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Cancer. 1987 Nov 15;60(10):2372-5. doi: 10.1002/1097-0142(19871115)60:10<2372::aid-cncr2820601004>3.0.co;2-1.
Since 1979, 41 patients with locally advanced thyroid cancers have been prospectively treated in our institution according to a combination regimen of low-dose Adriamycin (doxorubicin) and external-beam radiation therapy. Two types of treatment regimen were used depending on tumor histologic type. Group 1 patients with well-differentiated papillary, follicular, or mixed type tumor (n = 22) received the combined regimen consisting of once weekly administration of Adriamycin (10 mg/m2) before radiation therapy (RT). Radiation therapy was carried out with a daily dose of 200 cGy for 5 days per week to a total tumor dose of 5600 cGy. Group 2 patients with anaplastic giant and spindle cell carcinoma of the thyroid (n = 19) received the combined regimen, consisting of once weekly administration of Adriamycin (10 mg/m2) before hyperfractionated RT. Radiation therapy was carried out with a fractional dose of 160 cGy per treatment twice a day for 3 days per week to a total dose of 5760 cGy in 40 days. Initial complete tumor response rates in the group 1 and 2 were 91% and 84%, respectively. Local tumor control rates at 2 years after combined therapy were 77% and 68%, respectively. The median survival time was 4 years for group 1 and 1 year for group 2. There was no disproportionately enhanced normal tissue morbidity seen with this combined approach. Patients in group 1 have a good quality of life, once the local disease is under control due to the indolent course of the disease. On the contrary, most patients in group 2 promptly developed distant metastases and died from the disease.
自1979年以来，我院对41例局部晚期甲状腺癌患者采用小剂量阿霉素（多柔比星）联合外照射放疗的联合方案进行前瞻性治疗。根据肿瘤组织学类型采用两种治疗方案。第1组为高分化乳头状、滤泡状或混合型肿瘤患者（n = 22），接受放疗（RT）前每周一次给予阿霉素（10 mg/m²）的联合方案。放疗采用每周5天、每天200 cGy的剂量，总肿瘤剂量达5600 cGy。第2组为甲状腺间变性巨细胞和梭形细胞癌患者（n = 19），接受超分割放疗前每周一次给予阿霉素（10 mg/m²）的联合方案。放疗采用每次160 cGy、每天两次、每周3天的分割剂量，40天内总剂量达5760 cGy。第1组和第2组的初始肿瘤完全缓解率分别为91%和84%。联合治疗后2年的局部肿瘤控制率分别为77%和68%。第1组的中位生存时间为4年，第2组为1年。这种联合治疗方法未出现不成比例的正常组织并发症增加。由于疾病进展缓慢，一旦局部疾病得到控制，第1组患者的生活质量良好。相反，第2组的大多数患者迅速发生远处转移并死于该疾病。
