Vosberg H
Nuklearmedizinische Klinik, Medizinische Einrichtungen der Heinrich-Heine-Universität, Düsseldorf.
Praxis (Bern 1994). 1998 Mar 11;87(11):376-82.
The long-term prognosis of differentiated thyroid carcinoma depends on early diagnosis and treatment of metastases and local recurrences and is modulated by several factors, age and histology being the most relevant. This article summarizes current trends in the use of radioactive iodine (131J) and gives explicit advice on its use in the treatment of these cancers. Complications of therapy are discussed in detail. We currently recommend that all patients undergoing a subtotal or total thyroidectomy are followed up by 131J thyroid scanning approximately 4 weeks after surgery. The combined use of three diagnostic modalities (measurement of serum thyroglobulin, neck ultrasonography with ultrasound-guided biopsy for detecting recurrences of carcinoma in the neck region and 131J whole-body scintigraphy) appears to give the best results in the follow up of patients with differentiated thyroid carcinoma. If any residual uptake is detected in the neck or if the tumor extends beyond the thyroid, we recommend routine thyroid ablation with 1,5-3 GBq of radioactive 131J. External radiotherapy is always indicated in papillary and folliculary carcinoma in the pT4 stage of pTNM classification but not in those in pT1-3 pN0 stage. In the presence of lymph-node metastases and distant metastases, an individual treatment concept is recommended regarding all risk factors, especially the age and sex of the patient, the histology and grading of the tumor and the completeness of tumor resection. Finally, radiotherapy is usually not indicated in medullary carcinoma, whereas it is always indicated in anaplastic carcinoma.
分化型甲状腺癌的长期预后取决于转移灶和局部复发的早期诊断与治疗，并受多种因素调节，其中年龄和组织学最为关键。本文总结了放射性碘（¹³¹I）的当前应用趋势，并就其在这些癌症治疗中的使用给出明确建议。详细讨论了治疗的并发症。我们目前建议，所有接受甲状腺次全切除术或全切除术的患者在术后约4周进行¹³¹I甲状腺扫描随访。联合使用三种诊断方法（血清甲状腺球蛋白测定、颈部超声检查及超声引导下活检以检测颈部区域癌的复发以及¹³¹I全身闪烁显像）在分化型甲状腺癌患者的随访中似乎能取得最佳效果。如果在颈部检测到任何残留摄取或肿瘤超出甲状腺范围，我们建议用1.5 - 3GBq的放射性¹³¹I进行常规甲状腺消融。对于pTNM分类中pT4期的乳头状癌和滤泡状癌，总是需要进行外照射放疗，但pT1 - 3 pN0期的则不需要。存在淋巴结转移和远处转移时，建议根据所有风险因素制定个体化治疗方案，尤其是患者的年龄和性别、肿瘤的组织学和分级以及肿瘤切除的完整性。最后，髓样癌通常不需要放疗，而未分化癌则总是需要放疗。
