Samuel A M, Rajashekharrao B, Shah D H
Radiation Medicine Centre and Radiation Safety Systems Division, Parel, Mumbai, India.
J Nucl Med. 1998 Sep;39(9):1531-6.
In this study, 27 patients less than 18 yr old with pulmonary metastases from well-differentiated thyroid carcinoma were evaluated to determine their response to (131)I therapy.
Of 121 children and adolescents treated with (131)I between 1963 and 1996, 27 patients had pulmonary metastases associated with nodal disease. Treatment response from (131)I was measured by three parameters: chest radiograph, scintigraphic images and serum thyroglobulin levels. Total activity of (131)I administered ranged from 4.6 GBq (125 mCi) to 38.7 GBq (1.05 Ci). Four patients were given one treatment, 8 were given two treatments, 4 were given three treatments and 11 were given more than three treatments. Radiation doses to the lungs were estimated in 14 patients using the MIRD methodology. The minimum duration of follow-up was 6 mo.
At the time of initial presentation, diagnostic (131)I studies revealed bilateral radioiodine uptake in the lungs in 19 (70.4%) patients, whereas 12 (44.4%) patients had abnormal chest radiographs. One patient was lost to follow-up and was excluded from the study. Of the 26 patients studied, complete ablation of pulmonary metastases was observed in 8 (30.8%), partial ablation in 17 (65.4%) and there was no response to treatment in 1 (3.8%). Dosimetric parameters such as radioiodine uptake as a percentage of therapeutic activity, effective half-life and radiation dose delivered to the lungs were evaluated with each therapy. There was a progressive decline in each of these parameters with successive therapies. No correlation was observed between the radiation dose delivered and the response of pulmonary metastases to therapy. The number of therapies and amount of radioiodine administered had no influence on the ablation response. Of the 26 patients, 13 had a follow-up duration of less than 5 yr, 7 had 5-10 yr and 6 had more than 10 yr. One patient developed new metastases after 7 yr of diagnosis and treatment. One patient died of the disease after 4 yr. All surviving patients were asymptomatic and leading normal lives.
Complete response of pulmonary metastases after (131)I therapy is difficult to achieve. A partial response with reduction of metastatic disease is possible and, in general, the patients had a good quality of life with no further disease progression and a low mortality rate.
在本研究中，对27例年龄小于18岁的分化型甲状腺癌肺转移患者进行评估，以确定他们对碘-131治疗的反应。
在1963年至1996年间接受碘-131治疗的121名儿童和青少年中，27例患者有与淋巴结疾病相关的肺转移。碘-131的治疗反应通过三个参数来衡量：胸部X光片、闪烁显像图像和血清甲状腺球蛋白水平。给予的碘-131总活度范围为4.6GBq（125mCi）至38.7GBq（1.05Ci）。4例患者接受一次治疗，8例接受两次治疗，4例接受三次治疗，11例接受三次以上治疗。使用MIRD方法对14例患者的肺部辐射剂量进行了估计。最短随访时间为6个月。
在初次就诊时，诊断性碘-131检查显示19例（70.4%）患者肺部有双侧放射性碘摄取，而12例（44.4%）患者胸部X光片异常。1例患者失访，被排除在研究之外。在研究的26例患者中，观察到8例（30.8%）肺转移完全消融，17例（65.4%）部分消融，1例（3.8%）对治疗无反应。对每次治疗评估剂量学参数，如放射性碘摄取占治疗活度的百分比、有效半衰期和肺部接受的辐射剂量。随着连续治疗，这些参数中的每一个都逐渐下降。未观察到肺部接受的辐射剂量与肺转移治疗反应之间的相关性。治疗次数和给予的放射性碘量对消融反应没有影响。26例患者中，13例随访时间少于5年，7例为5至10年，6例超过10年。1例患者在诊断和治疗7年后出现新的转移。1例患者在4年后死于该疾病。所有存活患者均无症状，过着正常生活。
碘-131治疗后肺转移完全缓解难以实现。有可能出现转移病灶减少的部分缓解，总体而言，患者生活质量良好，无疾病进一步进展，死亡率低。
