儿童和青少年分化型甲状腺癌^131I治疗分析

目的回顾性分析放射性碘（^131I）治疗儿童和青少年分化型甲状腺癌（DTC）的特点及其疗效。方法回顾性分析20例首次接受^131I治疗时年龄≤21岁（5～21岁）DTC患者的临床及随访资料。20例患者中，乳头状癌18例，滤泡状癌2例；单纯淋巴结转移7例，肺转移8例。所有患者均接受^131I清除剩余甲状腺治疗；根据患者年龄、病情、转移灶位置以及病灶摄取^131I的程度等调整转移灶的^131I治疗剂量。以^131I全身显像、^18F-FDG肿瘤显像及血清甲状腺球蛋白及其抗体水平评价疗效，同时观察不良反应发生情况。结果中位随访时间为48．50个月（6～110月），患者生存率为100％。20例患者中，病灶消除13例，好转或稳定5例，无效或进展2例。7例单纯淋巴结转移患者消除4例，8例肺转移患者消除4例。随访期间未发生肺纤维化、继发肿瘤及生长发育异常等不良事件。结论对于儿童和青少年DTC患者（尤其是已发生转移的患者），^131I是一种安全且有效的治疗方法。

Analysis of ^131I treatment for children and adolescents with differentiated thyroid carcinoma

Objective To investigate the characteristics and outcomes of radioactive iodine （ ^131 I） therapy in children and adolescents with differentiated thyroid carcinoma （ DTC）. Methods The clinical and follow-up data of 20 patients with DTC who received initial 13~I treatment at the age ≤21 years old （5 to 21 years old） were retrospectively analysed. There were 18 patients with papillary thyroid carcinoma and 2 with follicular thyroid carcinoma. Seven patients experienced simple lymph node metastases, and 8 had lung metastases. All patients received ^131I ablation of residual thyroid tissues, ^131 I therapeutic doses of metastatic loci were adjusted according to age, illness status, location of metastasis and uptake of ^131 I of lesions. Therapeutic effects were evaluated by ^131I whole body imaging, ^18F-FDG tumor imaging and levels of serum thyroglobulin and its receptor, and adverse effects were also observed. Results The median time of follow up was 48.50 months （6 to 110 months）, and all the patients survived. The lesions of 13 patients eliminated, 5 improved or controlled, and 2 progressed. Four of the 7 patients with simple lymph node metastases and 4 of the 8 patients with lung metastases experienced lesion elimination. No pulmonary fibrosis, secondary malignancies and abnormity of growth and development were found during follow-up. Conclusion ^131I therapy is an effective and safe method for young patients with DTC, especially for those with metastatic lesions.