分化型甲状腺癌术后大剂量131I治疗的必要性

 目的　分析分化型甲状腺癌（DTC）甲状腺切除术后大剂量131I清除剩余甲状腺组织（清甲）的必要性。方法　对257例DTC患者资料进行回顾性分析。根据手术方式及术后是否用131I清甲治疗,将257例DTC患者分为3组,A组：甲状腺全部切除+甲状腺素片抑制治疗患者72例,B组：甲状腺全部切除+ 131I清甲+甲状腺素片抑制治疗患者98例,C组：甲状腺部分切除+131I清甲+甲状腺素片抑制治疗患者87例,平均随访时间为7.4年,比较各组患者在随访期间的复发率。结果　A组、B组、C组的复发率分别为15.2 %（11／72）、5.1 %（5／98）、5.7 %（5／87）,A组与B、C组相比差异均有统计学意义（χ2值分别为4.36、3.95,P值均＜0.05）,B组与C组相比差异无统计学意义（P＞0.05）。B组首次131I清甲的成功率为85.7 %（84／98）,清甲的次数1～3次,累积剂量为3.7～11.1 GBq（100～300 mCi）,C组首次清甲的成功率为64.4 %（56／87）,清甲的次数为1～5次,累积剂量为3.7～22.2 GBq（100～600 mCi）,C组清甲次数及累及剂量高于B组。结论　DTC后131I清甲治疗是非常有必要的,对于手术全部切除困难或错过全切时机的患者,甲状腺部分切除+131I清甲治疗应作为DTC的一种可选择的治疗方案。     

大剂量131I对分化型甲状腺癌患者术后剩余甲状腺组织的去除治疗

[目的]探讨131I对分化型甲状腺癌患者术后剩余甲状腺组织的去除治疗剂量及去除治疗效果.[方法]分化型甲状腺癌患者55例,根据131I全身显像及99mTcO4-甲状腺扫描的情况,具有一叶或一叶以上的残留甲状腺组织,给予3.7GBq～4.44GBq;具有一叶以下的残留甲状腺组织,给予2.96GBq～3.7GBq;伴有甲状腺外转移(如肺、骨、颈部淋巴结等)则常规给予3.7GBq后3个月,再行大剂量131I治疗转移灶.[结果]大部分患者1次大剂量131I就可以达到去除治疗的效果.对于一叶或一叶以上的剩余甲状腺较多的或者伴有甲状腺外转移的患者,则1次131I去除治疗的效果稍差,需接受第2次去除治疗.采用131I 2.96GBq～3.7GBq平均剂量为3.7GBq作为去除剂量,完全去除率为85.5%.[结论]剩余甲状腺量、有无甲状腺外的转移、剩余甲状腺吸131I率是影响去除治疗效果的重要因素.131I去除治疗后定期监测血HTG变化是判断DTC患者有无复发或转移及评价131I治疗效果的重要指标.     

大剂量^131Ⅰ对分化型甲状腺癌患者术后剩余甲状腺组织的去除治疗

[目的]探讨^131Ⅰ对分化型甲状腺癌患者术后剩余甲状腺组织的去除治疗剂量及去除治疗效果。[方法]分化型甲状腺癌患者55例，根据^131Ⅰ全身显像及^99mTcO4甲状腺扫描的情况，具有一叶或一叶以上的残留甲状腺组织．给予3．7GBq～4．44GBq；具有一叶以下的残留甲状腺组织，给予2．96GBq～3.7GBq;伴有甲状腺外转移（如肺、骨、颈部淋巴结等）则常规给予3．7GBq后3个月，再行大剂量^131Ⅰ治疗转移灶。[结果]大部分患者1次大剂量^131Ⅰ就可以达到去除治疗的效果。对于一叶或一叶以上的剩余甲状腺较多的或者伴有甲状腺外转移的患者，则1次^131Ⅰ去除治疗的效果稍差，需接受第2次去除治疗。采用^131Ⅰ2．96GBq～3．7GBq平均剂量为3．7GBq作为去除剂量，完全去除率为85．5％。[结论]剩余甲状腺量、有无甲状腺外的转移、剩余甲状腺吸^131Ⅰ率是影响去除治疗效果的重要因素。^131Ⅰ去除治疗后定期监测血HTG变化是判断DTC患者有无复发或转移及评价^131Ⅰ治疗效果的重要指标。     

甲状腺癌131I治疗及SPECT扫描动态观察的临床意义

目的 :评价ECT扫描在动态观察甲状腺癌13 1I治疗中临床价值。方法 :5 1例经手术后确诊为分化型甲状腺癌患者 ,经几个疗程的13 1I治疗同时加用ECT扫描动态观察。结果 :以各病人前后相应的ECT片对照 ,5例患者第一次ECT扫描显示 :甲状腺显影同时肺显影 ( ) ,直至两者影都消失。有 35例病人第一次ECT扫描显示 ,肺不显影 ,甲状腺显影清楚 ,直至两者影都消失。结论 :ECT扫描在动态观察甲状腺癌13 1I治疗中 ,对发现甲状腺癌残余 ,转移情况及治疗后的效果有重要临床意义     

~(131)I加替代治疗对甲状腺癌转移灶的疗效观察

目的 :观察131I加替代治疗对甲状腺癌转移灶的疗效。方法 :对分化好的甲状腺癌行手术治疗后且其转移灶有摄131I功能的15例患者 ,服131I治疗 ,并加用甲状腺素替代治疗。结果 :15例患者转移灶摄131I功能完全消除者7例 ,占46.7 % ;部分消除者4例 ,占26.7 % ;治疗后好转又复发者2例 ,占13.3 % ;无效或加重者2例 ,占13.3 %。总有效率86.6% ,且副作用较轻。结论 :131I及替代治疗对甲状腺癌转移灶有较好的近期疗效。     

~(131)碘全身显像、甲状腺球蛋白测定及颈部超声检查在分化型甲状腺癌~(131)碘治疗随访中的意义

目的:探讨131I-全身显像(131I-WBS)、甲状腺球蛋白(Tg)测定及颈部B超检查在分化型甲状腺癌术后131I治疗随访中的意义.方法:31例分化型甲状腺癌术后131I治疗患者,治疗前后及随访中行甲状腺吸131I率、颈部B超、131I显像及甲状腺球蛋白测定.结果:治疗剂量131I-WBS较诊断剂量131I-WBS多发现3例转移灶;64人次Tg与131I-WBS检查结果:Tg与131I-WBS均阳性者19/64,均阴性者35/64,Tg阳性而131I-WBS阴性者5/64,Tg阴性而131I-WBS阳性者5/64;B超发现颈部淋巴结增大者为80.6%.结论:131I治疗分化型甲状腺癌转移灶效果突出,131I-WBS、Tg测定与颈部B超在其随访中联合应用可以相互补充,具有重要意义.     

分化型甲状腺癌（131）~I全身扫描中消化系统（131）~I摄取分析

[目的]探讨分化型甲状腺癌（DTC）131I全身扫描中消化系统131I摄取的病理生理机制及其临床意义。[方法]分化型甲状腺癌术后患者1002例,其中乳头状癌743例,滤泡状癌253例,混合型106例。按卫生部核医学临床诊疗指南进行131I治疗前后处理,根据临床症状和体征,结合血清Tg水平和影像学检查（胸部X线片、CT、MRI、超声等）,对131I全身扫描结果进行判读和分析。[结果]甲状腺肿瘤转移灶摄取131I16例（2.0%）;病理性（非肿瘤转移）摄取2例（0.2%）;生理性代谢显像鼻—口腔—唾液腺887例（88.52%）,食管—胃—肠道771例（76.95%）,弥漫性肝摄取689例（68.76%）。[结论]分化型甲状腺癌131I全身扫描其消化系统显像图的准确读片可避免误诊和不恰当的131I治疗。     

分化型甲状腺癌术后99Tcm-MIBI显像与131I显像比较及其意义

目的:探讨分化型甲状腺癌( DTC)术后99Tcm-MIBI显像结果的意义.方法:300例DTC术后患者中随机选取69例行99Tcm-MIBI显像.2名有经验核医学医师盲法阅片.将99Tcm-MIBI显像结果与治疗后131 I显像结果比较.另对经高分辨CT或治疗后131I显像诊断肺转移和无肺转移患者行半定量分析,比较靶本底比值(T/B).结果:排除1例死于血管肉瘤者,余按照手术方式及131I治疗情况分为3组(A组:44例甲状腺癌术后拟131I治疗组;B组:22例有再次131I治疗指征组;C组:2例甲状腺大部切除组).A组99Tcm-MIBI显示残余甲状腺34.1％ (15/44),转移灶30.0％(6/20).B组99Tcm-MIBI显示复发及转移灶63.6％(7/11).C组99Tcm-MIBI显示残余甲状腺100.0％(2/2),并为唯一一种发现颈部转移显像方法.5例患者同时存在多种性质转移灶:MIBI+I-,MIBI-I+及MIBI+I+.肺转移与无肺转移患者T/B比值差异无统计学意义.结论:99Tcm-MIBI可发现分化好及失分化病灶,联合131I显像为DTC术后患者选择治疗方式提供重要信息,有临床应用价值.     

HTg测定和 131I全身显像检查对甲状腺癌131I治疗后随访的临床意义

目的 :评价血清HTg和 13 1I全身显像联合检查对分化型甲状腺癌 (differentiat edthyvoidcarcinoma ,DTC)患者 13 1I治疗后随访的临床意义。方法 :85例DTC患者停服甲状腺激素 4～ 6周并忌碘饮食 3 0d后 ,双抗体法测定血清HTg ,同时口服 13 1I 185～3 70MBq 2 4h后 ,和 (或 )口服治疗剂量 13 1I 4～ 7d后做全身显像。结果 :61例经临床证实有复发或转移的DTC患者中 ,3 8例(62 3 0 % )HTg高于正常 ,有肺或 (和 )骨转移者 ,血清HTg升高更加明显 ,极端甚至 >2 0 0 μg/L。2 2例肺转移及肺 (骨 )转移患者 ,其血清HTg水平随 13 1I治疗剂量的增加而呈降低趋势。 5 3例 (86 88% ) 13 1I全身显像结果和 (或 )血清HTg有阳性表现 ,只有49 18% (3 0 /61)的患者同时出现 13 1I全身显像有异常浓聚和血清HTg异常升高。 结论 :DTC术后及 13 1I治疗后 ,常规进行血清HTg测定和 13 1I全身显像检查 ,对早期发现复发或有无转移灶、13 1I治疗方案的选择以及评估 13 1I疗效具有重要的临床价值。     

Outcomes Measurement in Patients with Head and Neck Cancer

Outcomes research is defined as clinical and population-based research that investigates the results of healthcare practices or interventions through the filter of the benefit to the patient and other stakeholders. Outcomes research is an increasingly important field or research, because of the pressing need for evidence-based information that can be used to make better informed health and healthcare decisions, and define desired health care practices in the current era of healthcare reform. This article will review the head and neck cancer (HNCA) outcomes literature published in the past year, with a focus on studies evaluating treatment and survival, short-term and long-term complications, and quality of life (QOL).     

分化型甲状腺癌术后患者131I治疗的辐射防护初探

摘 要：［目的］ 通过测定碘-131(131I)治疗分化型甲状腺癌(DTC)患者体外辐射水平和有关人员受照剂量,探讨131I治疗过程中的辐射防护方法,使得在临床治疗过程中将辐射危害降到合理的最低水平。［方法］ 选择DTC术后行131I治疗的患者10例及其陪同人员作为研究对象。患者服药后,用451P-DE-S1-YGG型电离室巡测仪测量即时、24h、72h、5d及7d不同时间点距患者5cm、50cm、100cm及200cm处的剂量当量率水平,用个人剂量测量30d内的个人剂量,采用谱仪测量服药室内空气中131I的活度水平。［结果］ 服药即刻患者周围辐射剂量值非常高,可达2000μSv/h,5d后200cm处的辐射剂量率均小于5μSv/h;甲癌患者的个人剂量水平为26.78~61.96(46.25±11.58)mSv,陪同人员的个人剂量水平中位数为0.35(0.29~0.43)mSv;服药室空气中131I的活度水平为42.6Bq/m3,工作人员每年因吸入131I所致的有效剂量为0.019mSv。［结论］ 甲状腺癌患者在行131I治疗的过程中其周围具有较高的辐射剂量水平,应提高工作人员、患者和陪同人员的辐射防护意识,减少不必要的照射。     

Multiple Primary Malignancies in Patients with Head and Neck Cancer

During the 15 years from 1967 to 1981, 3, 162 patients withcarcinoma of the head and neck were treated with radiation therapy.Among them, 262 patients (8.3%) developed two or more independentmalignancies. There were 80 patients with prior cancer. Theoverall incidence of second malignancies in patients who hadradiation therapy was 5.8%. The incidences were 8.9, 7.7, 5.2and 1.7% of index cancer in the larynx, pharynx, oral cavityand paranasal sinus, respectively. Second primaries were observedin the head and neck (36%), digestive tract (35%), lung (19%)and the remaining 10% in other bodily sites. Of the 1, 486 patientswho survived for five years or more after radiation therapy,only 10 (0.7%) developed second malignancies within the previousradiation field.     

Second Primary Tumors in Patients with Head and Neck Cancer

This is a review on second primary tumors in patients with head and neck cancer. These patients have a high risk of developing other cancers simultaneously or subsequently. The incidence of multiple primary tumors in this population can be as high as 27%. Recurrences are the most common cause of treatment failure within the first 2 years of follow-up. After the third year the diagnosis of a second primary tumor becomes the most important cause of morbimortality in head and neck cancer patients, especially in those treated for cancers early diagnosed. Most second primary tumors occur in the upper aerodigestive tract (40%–59%), lung (31%–37.5%), and esophagus (9%–44%). Patients who develop second primary tumor have a significant reduction of survival expectancy.     

Informational Needs of Head and Neck Cancer Patients

The patient journey with head and neck cancer (HNC) is particularly challenging given the physical and functional impact of the cancer and treatment. The ability to perform activities of daily living can be severely compromised and have a profound impact on psychosocial well-being. These complex and long-lasting effects can affect patient quality of life for months to years and the literature shows that information for HNC patients is often insufficient. This observational cross-sectional study utilized survey methodology to investigate the informational needs of HNC patients and the preferred modalities for delivery. This was done to inform the development of resources for HNC patients. Four hundred fifty surveys were analyzed. The median age was 61 years and 58% of the cohort was born in Canada. Most were Caucasian (72%), Chinese being the next largest ethnicity (12%). A third had less than high school education and most had cancer of the oral cavity (28%) and were in long-term follow-up (41%). Comparison of the percentage of items to which a patient responded “very important” across the six domains shows variation of importance by domain (overall mixed effects regression model p < 0.0001). Additionally, each domain was compared to the medical domain and all had significantly lower mean scores (all p < 0.0001) with the medical domain scoring highest (mean score 64.6). The top preferred education modalities were teaching with a healthcare professional and pamphlets. This study highlights the type of information that HNC patients want and the format they wish to receive it in. The design provides a comprehensive way to consult with patients toward building education that responds to their specific needs.     

Life Style Management in Head and Neck Cancer Patients

Head and neck (HN) cancers involve highly visible body parts, structurally complex, and crucial to survival. A diagnosis of HN cancer, like any cancer diagnosis, is often accompanied by much fear and uncertainty. In addition, patients treated for HN cancer face difficulties in eating, chewing, drinking, breathing, speaking, as well as changes in appearance. Simultaneously, the burden of HN cancer is often manifested in psychosocial dysfunction, which can have a negative impact on quality of life (QL). Psychosocial interventions such as education along with cognitive-behavioral therapy generally provide an overall positive effect. With the growing impetus to investigate factors associated with these dysfunctions and disfigurement caused by the treatment, and considerable advancement in the development and validation of many global and disease-specific measures, there is an opportunity for further research to develop an appropriate clinical intervention program for such patients so that these patients can live a near normal life. Life style changes including dietary habits make gross changes in QL.     

调强放疗对头颈部肿瘤患者甲状腺功能的影响

目的 探讨调强放疗对头颈部肿瘤患者甲状腺功能的影响.方法 40例头颈部恶性肿瘤(不包括甲状腺来源的恶性肿瘤),接受调强适形放射治疗,采用放射免疫法检测放疗前及放疗后3、6、12、18及24个月的T3、T4以及TSH水平.结果 40例头颈部非甲状腺癌的恶性肿瘤患者中,放疗后3、6、12、18及24个月T3、T4下降及TSH升高分别有1例(2.5％)、3例(7.5％)、5例(12.5％)、7例(17.5％)和10例(25％),其中2例(5％)伴有轻度的表情淡漠等临床症状,给予补充甲状腺素治疗后好转.结论 调强放射治疗可导致甲状腺功能不同程度的改变,且随着随访时间的延长,甲状腺功能损伤发生率呈增高趋势,应引起临床关注.     

Thyroid Dysfunction Following Therapeutic External Radiation to Head and Neck Cancer

Aim: The aim of the present study was to evaluate changes in thyroid function in patients with head andneck cancer treated with external beam radiotherapy (EBRT). Materials and Methods: This prospective studywas conducted on ninety patients with non-thyroid head and neck cancer who were referred to the departmentof radiotherapy. Thyroid function tests were conducted before, midway during and after EBRT, with followup at monthly intervals up to 6 months after the completion of therapy. Results: Serum T3 and T4 levels weredecreased at completion of EBRT and remained so after 6 months follow up. However, serum TSH levels didnot significantly vary. Conclusion: EBRT to the neck region for treatment of head and neck cancer induceshypothyroidism and therefore utmost care must be taken to exclude the thyroid from radiation beams withoutsparing the tumor as far as possible. The clinical protocol in such cases should include monitoring of T3, T4 andTSH levels during and after the EBRT.