全反式维甲酸诱导再分化治疗甲状腺癌的临床研究

目的评价利用全反式维甲酸(ATRA)诱导再分化甲状腺癌、提高摄碘功能的作用。方法32例经病理证实的甲状腺癌病例(24例分化型,8例失分化型)。全反式维甲酸剂量(1.0~1.5)mg/(kg·d),治疗时间6周。131I口服72小时后进行全身显像。使用美国pho/gammaHP型γ照相机,通过ROI半定量方法测定转移灶每像素的放射性计数,比较ATRA诱导前后转移灶摄取放射性变化;采用超声、X线或CT判定转移灶大小;放射免疫法测定血清TG。结果131I治疗后不同部位转移灶平均可测摄碘计数较治疗前明显降低;32例经ATRA诱导后,14例(43.8%)病灶131I摄取增高,7例(20.8%)无明显变化;6例(25%)131I摄取降低。8/27例诱导后转移灶缩小,12例无变化,7例增大。病灶摄131I的变化与病理类型无关。诱导后血清TG测定降低12例(40%),增高11例(36.7%),无变化7例(23.3%)。血清TG水平与摄碘能力改变无关。具有两项指标(病灶摄碘增高、病灶缩小和血清TG降低)及以上改变12例,占37.5%。结论初步表明ATRA治疗能够在诱导分化型甲状腺癌细胞再分化以及失分化甲状腺癌细胞的转化中产生作...

Clinical Study of All-trans-retinoic Acid in Redifferentiation Therapy for Thyroid Cancer

Objective To evaluate the effectiveness of retinoid therapy for improving 131I uptake in metastasized thyroid cancer with lower or lost radioiodine uptake ability. Methods A total of 32 thyroid cancer patients with insufficient or no radioiodine uptake (24 differentiated thyroid cancer, 8 non-differentiated thyroid cancer) were treated with all-trans-retinoic acid (ATRA) 1.0 to 1.5 mg/kg/day for 6 weeks before further radioiodine therapy. Three parameters for assessment of ATRA effects were established: (a) increment of the post-therapeutic dose radioiodine uptake; (b) tumor size regression after therapy; (c) reduction of serum thyroglobulin levels. Results Fourteen out of 32 patients showed an increase in radioiodine uptake, thirteen patients unchanged or decreased. Tumor regression was observed in eight of 27 patients. TG levels decreased in 12 (40%), increased in 11( 36.7%) patients, and did not change in 7 ( 23.3%) patients. In total, 12 patients ( 37.5%) showed satisfactory response (2 or more of the 3 criteria were reached). Response to retinoid therapy did not always correlate with increased radioiodine uptake. TG levels did not parallel a response in iodine uptake. Conclusion All-trans-retinoic acids do have an effect on differentiation status, reinducing iodine uptake in some patients with thyroid carcinoma tumor sites. The encouraging results of the study and the low rate of side-effects with good tolerability of retinoids warrant further studies. All-trans-retinoic acid might be an option for de-differentiated thyroid cancer.