Tubiana M, Haddad E, Schlumberger M, Hill C, Rougier P, Sarrazin D
Cancer. 1985 May 1;55(9 Suppl):2062-71. doi: 10.1002/1097-0142(19850501)55:9+<2062::aid-cncr2820551406>3.0.co;2-o.
Surgery is the most effective treatment for thyroid cancer; however, in some subsets of patients, the role of radiotherapy (RT) is important. The main indication for external-beam RT is incomplete surgery. When neoplastic tissue is left behind at operation, RT must be considered, but only if an experienced surgeon feels that everything that can be done has been done. Generally, in those patients, the neoplastic tissue involves the larynx, trachea, esophagus, blood vessels or mediastinum. Of 539 patients with differentiated thyroid cancer treated at Villejuif, France, until 1976, 97 were treated by external radiotherapy after an incomplete surgical excision. Fifteen years after irradiation, the survival rate is 57% and is approximately 40% at 25 years. The relapse-free survival is lower (39% at 15 years). In patients irradiated with an adequate dose (greater than or equal to 50 Gy) to residual neoplastic tissue after incomplete surgery, the incidence of local recurrence is low (actuarial probability of local recurrence 11% at 15 years versus 23% for patients treated by surgery alone, although the irradiated patients had larger and more extensive tumors). This demonstrates the efficacy of external-beam radiotherapy. The effects of radiotherapy on a residual tumor can be monitored by a serum thyroglobulin assay. With regard to local control of tumors, the effectiveness of radioiodine administration is clearly lower. However, since radioiodine facilitates early detection of distant metastases, a combination of external RT and radioiodine is indicated and is well-tolerated. For inoperable patients, the results of RT are limited: although complete remissions are sometimes obtained, the incidence of local recurrence is high. External RT is effective in medullary carcinoma despite the slow shrinkage of the tumor after irradiation. Assay of the calcitonin level helps to monitor the effects of the treatment during follow-up and has demonstrated in some patients the efficacy of cervical RT. In undifferentiated cancers, the results of RT are poor. Combination of RT and chemotherapy are being explored despite the disappointing preliminary results of this combination.
手术是甲状腺癌最有效的治疗方法；然而，在某些亚组患者中，放射治疗（RT）的作用也很重要。外照射放疗的主要适应证是手术不彻底。如果手术时遗留了肿瘤组织，就必须考虑放疗，但前提是经验丰富的外科医生认为已尽一切所能。一般来说，这些患者的肿瘤组织累及喉、气管、食管、血管或纵隔。在法国维勒瑞夫治疗的539例分化型甲状腺癌患者中，截至1976年，97例在手术切除不彻底后接受了外照射放疗。放疗15年后，生存率为57%，25年后约为40%。无复发生存率较低（15年时为39%）。在手术不彻底后对残留肿瘤组织给予足够剂量（大于或等于50 Gy）照射的患者中，局部复发率较低（15年时局部复发的精算概率为11%，而单纯手术治疗的患者为23%，尽管接受放疗的患者肿瘤更大、范围更广）。这证明了外照射放疗的有效性。放疗对残留肿瘤的效果可通过血清甲状腺球蛋白检测来监测。关于肿瘤的局部控制，放射性碘治疗的效果明显较低。然而，由于放射性碘有助于早期发现远处转移，因此建议联合外照射放疗和放射性碘，且耐受性良好。对于无法手术的患者，放疗的效果有限：尽管有时能实现完全缓解，但局部复发率较高。尽管放疗后肿瘤缩小缓慢，但外照射放疗对髓样癌有效。降钙素水平检测有助于在随访期间监测治疗效果，并且在一些患者中已证明颈部放疗的有效性。在未分化癌中，放疗效果不佳。尽管这种联合治疗的初步结果令人失望，但仍在探索放疗与化疗的联合应用。
