摘要
背景与目的:甲状腺低分化癌(poorly differentiated thyroid carcinoma,PDTC)是一种罕见恶性肿瘤,易发生侵袭及转移,目前尚缺乏有效的治疗方法。本研究旨在分析调强放疗对局部晚期及复发PDTC的疗效及安全性。方法:纳入2011年2月—2014年9月在复旦大学附属肿瘤医院接受调强放疗的8例局部晚期及复发PDTC患者(均经病理及影像学确诊为T4a-b期PDTC)。1例术后无残留病灶但包膜侵犯的患者接受处方剂量60 Gy/30次的单纯放疗,其余患者甲状腺原发灶及淋巴结转移灶的处方剂量为66 Gy/33次,并接受顺铂为基础的联合化疗。结果:患者在放疗±化疗后,2例局部区域病灶完全缓解(complete response,CR),1例部分缓解(partial response,PR),5例保持疾病稳定(stable disease,SD)。截止末次随访或患者死亡时,局部区域控制率为87.5%(5例CR+1例PR+1例SD)。随访期间共有4例(50%)患者死亡,死亡原因分别为原发病灶进展(12.5%)和肺转移(37.5%)。大部分治疗相关不良反应为1~2级。结论:对于局部晚期及复发PDTC,调强放疗为基础的综合治疗能控制局部区域病灶,延长生存时间,不良反应可控,是一种有效且安全的治疗手段。
Background and purpose： Poorly differentiated thyroid carcinoma（PDTC） is a rare malignant tumor with high rates of invasion and distant metastasis, and there is no effective treatment. This study aimed to investigate the efficacy and adverse effects of intensity-modulated radiotherapy（IMRT） for locoregionally advanced and recurrent PDTC. Methods： From February 2011 to September 2014, eight patients with biopsy-proven T4 a-b PDTC who underwent IMRT at our center were enrolled. The prescribed dose was 60 Gy/30 F to high-risk areas for one patient with extracapsular invasion after radical surgery, and 66 Gy/33 F to primary lesion and positive lymph nodes for the rest patients who also received cisplatin-based chemotherapy. Results： After completion of treatment, 2 patients had complete response（CR） to the locoregional disease, 1 patient had partial response（PR） and 5 patients had stable disease（SD）. By the last follow-up, the overall locoregional control rate was 87.5%（5 CR＋1 PR＋1 SD）. Four patients（50%） finally died of locoregional disease progress（12.5%） and lung metastasis（37.5%）. Most of the treatment-related toxicities were grade 1-2. Conclusion： IMRT-based therapy was effective and safe for locoregionally advanced and recurrent PDTC, with improved locoregional control and overall survival, as well as acceptable toxicities.
作者
薛芬
李端树
胡超苏
王卓颖
吴毅
何霞云
XUE Fen;LI Duanshu;HU Chaosu;WANG Zhuoying;WU Yi;HE Xiayun(Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China;Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2018年第3期216-221,共6页
China Oncology
关键词
调强放疗
甲状腺低分化癌
局部区域控制
Intensity-modulated radiotherapy
Poorly differentiated thyroid carcinoma
Locoregional control
