局部晚期分化型甲状腺癌多学科临床讨论

  目的  探讨局部晚期分化型甲状腺癌（locally advanced differentiated thyroid cancer）多学科协作体系（multidisciplinary treat?ment，MDT）的诊治流程。  方法  分析2018年4月重庆大学附属肿瘤医院收治的1例局部晚期分化型甲状腺癌患者的MDT诊疗过程。经过MDT讨论后采用全喉切除+颈部淋巴结清扫+胸大肌皮瓣修复手术治疗，后续131I内照射治疗，辅以分子靶向治疗，并监测甲状腺球蛋白（thyroglobulin，Tg）的变化及不良反应。  结果  患者进行手术治疗恢复良好，随访Tg缓慢下降。  结论  个体化精准治疗是局部晚期分化型甲状腺癌未来的发展趋势，平衡疗效和不良反应是临床医生应重点考虑的问题。采取MDT有利于制定规范化、个体化的治疗方案，针对局部晚期分化型甲状腺癌患者探索更有效的治疗方法可让更多患者获益。 

Multidisciplinary discussion for the treatment of a patient with locally advanced differentiated thyroid cancer

  Objective  To investigate the process of diagnosis and treatment of locally advanced differentiated thyroid cancer with a multidisciplinary team (MDT).  Methods  We analyzed the MDT diagnosis and treatment process of a patient with locally advanced differentiated thyroid cancer admitted to Chongqing University Cancer Hospital in April 2018. After the MDT discussion, total laryngectomy+ cervical lymph node dissection+pectoralis major musculocutaneous flap repair was adopted for treatment. After administering the follow-up 131-iodine irradiation treatment supplemented by molecular targeted therapy, the change in thyroglobulin level and adverse reactions were monitored.  Result  The patient recovered well after surgical treatment, and a slow decrease in thyroglobulin level was observed during follow-up.  Conclusions  Individualized and accurate treatment is the trend for locally advanced differentiated thyroid cancer, and the balance between efficacy and adverse reactions is the key issue for clinicians to consider. MDT management is conducive to the formulation of a standardized and individualized treatment plan, and more effective treatment methods for locally advanced differentiated thyroid cancer patients can benefit more patients.