131I在甲状腺癌术后复发诊治中应用

分化型甲状腺癌(DTC)总体预后良好,死亡风险低,其管理重点在于防治肿瘤复发及对复发疾病的妥善处理.131I作为DTC诊治的重要辅助手段,在复发疾病中仍然发挥着独特的诊治作用,主要包括复发灶的定位、摄碘性判断以及针对不可手术切除的摄碘性复发疾病的治疗.准确把握131I在DTC术后复发中的应用指征,将有助于提高综合治疗效...     

失分化型甲状腺癌再分化研究进展

甲状腺碘代谢相关基因是甲状腺癌分化的重要标志。分化型甲状腺癌由于失去或下调一系列碘代谢相关基因的表达而发生失分化,导致癌细胞丧失对放射性碘（^131I）的摄取能力。因此,再分化的研究对甲状腺癌^131I治疗具有重要意义。研究证实,BRAF基因突变与甲状腺乳头状癌的失分化现象密切相关。文章就通过上调甲状腺碘代谢相关基因表达和抑制BRAF基因突变而使失分化型甲状腺癌再分化的研究进展作一综述。     

分化型甲状腺癌术后或替代药物撤除后患者血清相关激素水平的变化研究

目的观察和分析分化型甲状腺癌（DTC）患者术后或替代治疗药物（左旋甲状腺素）撤除后相关激素水平的变化。方法 102例DTC患者根据术后131I清甲治疗和替代治疗使用情况分为首次治疗未清甲组（n=33）和多次治疗清甲组（n=69）。两组患者分别于术后或停药后第2、3、4周测定血清促甲状腺素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）水平。比较两组相应时间点的激素水平;以血清TSH〉30 m IU/L为限值,观察两组患者达标率。分析多次治疗清甲组患者血清TSH与FT3、FT4的相关性,比较性别、年龄、肿瘤组织学类型及临床分期不同患者的血清TSH水平及达标率。结果血清TSH水平及达标率比较,首次治疗未清甲组在各相应时间点均低于多次治疗清甲组,其中第3、4周时间点比较差异有统计学意义（P〈0.05）。多次治疗清甲组患者血清FT3、FT4与TSH水平呈显著负相关（r=-0.285,r=-0.345,P〈0.05）。血清TSH水平及达标率,女性患者显著低于男性患者（P〈0.05）,年龄〉45岁者显著低于年龄≤45岁者（P〈0.05）;而不同组织学类型和临床分期DTC患者的血清TSH水平及其达标率比较,差异均无统计学意义（P〉0.05）。结论 DTC术后患者血清TSH水平及达标率均低于已接受131I清甲治疗的患者。随着停药的延长,已接受131I清甲治疗患者血清TSH水平逐渐上升,而FT3、FT4水平逐渐下降;其血清TSH水平及达标率与患者的年龄和性别有关。     

131I治疗甲状腺Ⅲ度肿大伴甲状腺功能亢进一例报道

报道一例经多次131碘（131I）治疗的甲状腺Ⅲ度肿大伴甲状腺功能亢进（甲亢）的治愈病例。对于甲状腺Ⅲ度肿大伴甲亢的病例,多次碘131治疗是必须的,而抗甲状腺药物的配合使用和个性化的131I剂量可以使131I治疗既安全又有效。     

腺叶切除不完全分化型甲状腺癌^131I疗效观察

目的研究腺叶切除不完全的分化型甲状腺癌（DTC）患者实施放射性碘（^131I）清除甲状腺组织（清甲）治疗的效果。方法回顾性分析DTC术后接受^131I清甲治疗的103例患者的临床资料。根据甲状腺平面显像结果分为腺叶切除不完全组（n=33）和腺叶切除完全组（n=70）。首次^131I清甲剂量为1．11～3．7GBq（30—100mCi）。3～6个月后复查并评估清甲效果：若诊断剂量^131I全身显像显示颈部无放射性摄取即认为清甲完全;若有放射性摄取,即认为清甲不完全,需再次行^131I清甲治疗,定期随访复查清甲效果。结果实施3次清甲治疗的成功率,腺叶切除完全组分别为61．43％、88．89％和100％,腺叶切除不完全组分别为21．21％、46．15％和78．57％。统计学分析表明,腺叶切除完全组的第1、2次清甲疗效与腺叶切除不完全组的第2、3次清甲疗效比较,差异均无统计学意义（P〉0．05）。结论对于甲状腺腺叶切除不完全的DTC患者,实施^131I治疗的一次清甲成功率较低,但经2—3次治疗后同样可达到较高的清甲疗效。尤其适用于再次手术可能会导致严重的手术并发症或拒绝再次手术的患者。     

131I治疗分化型甲状腺癌患者唾液腺损伤的影响

目的:了解分化型甲状腺癌(differentiated thyroid carcinoma,DTC)的患者经大剂量131I治疗后,慢性唾液腺损伤的发病情况?方法:143例分化型甲状腺癌的患者经手术切除后行大剂量的131I治疗,在131I治疗前和治疗后的6~39个月随访中分别行唾液腺功能显像?结果:143例DTC患者中有31例(21.7%)出现慢性唾液腺损伤,131I治疗2次以上(累积剂量7.4~37.0 GBq)发生慢性唾液腺损伤的发病率明显高于131I治疗1次者(累积剂量<3.7 GBq)(P < 0.005)?结论:反复的?大剂量131I治疗引起的慢性唾液腺损伤更多见?     

131I治疗Graves病的预后评估及对A-TPO、TRAb和IL-17水平的影响

目的：回顾分析222例行131 I治疗的Graves病患者,评估各临床指标对预后的影响及131 I治疗对抗甲状腺过氧化物酶抗体（A‐TPO）、促甲状腺激素受体抗体（TRAb）、白细胞介素‐17（IL‐17）的影响。方法比较222例患者131 I治疗后半年的临床效果,根据治疗后甲状腺功能评估,将患者分为治疗后甲亢组、正常组、甲减组;Logistic回归分析患者性别、病程、发病年龄、甲状腺重量、摄碘率、治疗前 TRAb水平与疗效之间的关系;分析131 I治疗对 A‐TPO、TRAb、IL‐17水平的影响。结果治疗前甲状腺重量、TRAb水平为影响疗效的独立危险因素（OR值分别为1.108、8.917,P值分别为0.0094、0.0411）;A‐TPO值在治疗后转归为甲减组较治疗前明显升高（P＜0.05）,而甲亢组和正常组患者较治疗前均无明显变化（P＞0.05）;TRAb值在治疗后转归为甲亢组和甲减组患者较治疗前明显升高（P＜0.05）,而正常组较治疗前无明显变化（ P＞0.05）;IL‐17值在131 I治疗前后各组均无明显变化（ P＞0.05）。结论甲状腺重量越大、治疗前TRAb的水平越高,131 I治疗失败的可能性越大;治疗后半年A‐TPO升高明显者更容易发生甲减;治疗后 TRAb、IL‐17水平与预后的关系不明确。     

Clinical outcome of radioiodine treatment of hyperthyroidism: a follow-up study

Objectives. To study the clinical outcome of treatment of hyperthyroid patients with radioiodine.
Design. Records of patients treated for hyperthyroidism with radioiodine from 1989 to 1992 were examined in 1994, and a questionnaire was sent to patients 70 years with Graves' disease (GD) and toxic nodular goitre (TNG) to obtain information regarding thyroxine substitution, smoking habits and present state of health.
Setting. Outpatients in a thyroid unit; follow-up by primary care.
Subjects. Seven hundred and fifty-four patients with hyperthyroidism treated with radioiodine, 327 receiving the questionnaire, 72% response rate.
Intervention. Radioiodine treatment using a delivered absorbed dose method, aiming at an absorbed dose to the thyroid of 100–120 Gy.
Main outcome measures. Statistical analysis of clinical records and results from questionnaire.
Results. Only 10% of the patients needed more than one treatment. At the time of follow-up, thyroxine supplementation was given to 178 (93%) of the GD and to 21 (47%) of the TNG patients. Smoking was more common in GD patients than in the general population (44% vs. 26%; P <0.001). Smoking GD patients experienced eye discomfort more often than smoking TNG patients (53% vs. 7%; P <0.001). Weight gain after therapy was a problem in 79% of the hyperthyroid individuals.
Conclusions. Few patients needed retreatment and most of the GD patients had thyroxine after 1–5 years after therapy. Smoking patients, especially those with GD, had more eye symptoms. At follow-up, the euthyroid patients still consider themselves having a poorer health than individuals in the general population.     

125I-寡核苷酸-长循环脂质体的制备

目的　制备1 2 5I-寡核苷酸(ON) -长循环脂质体(L CL) ,并测定其包封率。方法　设计合成ON,包括针对bcl- 2 m RNA蛋白编码区的反义寡核苷酸(ASON)、正义寡核苷酸(SON)和无义寡核苷酸(NON)。以三氯化铊(Tl Cl3)为氧化剂进行ON的1 2 5I标记,分离纯化后,测定其标记率、放射化学纯度(放化纯)和放射性比活度。37℃条件下,测定不同时间1 2 5I- ON在0 .0 1m ol/L HEPES洗脱液(p H=7.4 )和人血清中的放化纯,观察其稳定性。采用改进的逆相蒸发法制备1 2 5I- ON-长循环脂质体(1 2 5I- ON- L CL ) ,并对其质量进行评价。结果　1ASON、NON和SON的1 2 5I标记率、放化纯和比活度分别为(72 .80±0 .6 8) %、(98.33±0 .39) %和(0 .6 3±0 .11) MBq/μg;(72 .77±0 .81) %、(98.4 2±0 .4 0 ) %和(0 .6 2±0 .11) MBq/μg;(72 .2 1±0 .6 0 ) %、(98.2 8±0 .36 ) %和(0 .6 3±0 .14 ) MBq/μg。2 37℃条件下,1 2 5I- ASON在0 .0 1mol/L HEPES洗脱液(p H=7.4 )中1h、2 h、4 h时的放化纯均大于93% ,在人血清中均大于80 %。31 2 5I- ASON、1 2 5I- NON和1 2 5I- SON的L CL 包封率分别为(6 6 .2 1±0 .2 1) % ,(70 .93±0 .0 3) % ,(6 7.6 7±0 .10 ) % ,平均粒径115 nm,聚分散指数(PDI) =0 .10 3,Zeta电位为- 2 9.2 3m V。     

Lenvatinib for the Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer: Treatment Optimization for Maximum Clinical Benefit

BackgroundLenvatinib is a multitargeted tyrosine kinase inhibitor approved for treating patients with locally recurrent or metastatic progressive radioiodine-refractory differentiated thyroid cancer (RR-DTC). In this review, we discuss recent developments in the optimization of RR-DTC treatment with lenvatinib.SummaryInitiation of lenvatinib treatment before a worsening of Eastern Cooperative Oncology Group performance status and elevated neutrophil-to-lymphocyte ratio could benefit patients with progressive RR-DTC. The median duration of response with lenvatinib was inversely correlated with a smaller tumor burden, and prognosis was significantly worse in patients with a high tumor burden. An 18 mg/day starting dose of lenvatinib was not noninferior to 24 mg/day and had a comparable safety profile. Timely management of adverse events is crucial, as patients with shorter dose interruptions benefitted more from lenvatinib treatment. Caution should be exercised when initiating lenvatinib in patients who have tumor infiltration into the trachea or other organs, or certain histological subtypes of DTC, as these are risk factors for fistula formation or organ perforation. The Study of (E7080) LEnvatinib in Differentiated Cancer of the Thyroid (SELECT) eligibility criteria should be considered prior to initiating lenvatinib treatment.ConclusionsCurrent evidence indicates that patients benefit most from lenvatinib treatment that is initiated earlier in advanced disease when the disease burden is low. A starting dose of lenvatinib 24 mg/day, with dose modifications as required, yields better outcomes as compared to 18 mg/day. Appropriate supportive care, including timely identification of adverse events, is essential to manage toxicities associated with lenvatinib, avoid longer dose interruptions, and maximize efficacy.