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目的回顾性分析放射性碘(~(131)I)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~(131)I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~(131)I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~(131)I的程度等调整转移灶的~(131)I治疗剂量。以~(131)I全身显像、~(18)F-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),~(131)I是一种安全且有效的治疗方法。
Objective To retrospectively analyze the characteristics and therapeutic effects of radioactive iodine (~ (131) I) in the treatment of differentiated thyroid cancer (DTC) in children and adolescents. Methods The clinical and follow-up data of 20 patients with DTC younger than or equal to 21 years (range 5-21 years) who were treated with ~ (131) I for the first time were retrospectively analyzed. Of the 20 patients, 18 had papillary carcinoma and 2 had follicular carcinoma; 7 had simple lymph node metastasis and 8 had lung metastases. All patients received ~ (131) I removal of the remaining thyroid gland. The dose of ~ 131 I in the metastatic tumor was adjusted according to the patient’s age, condition, metastasis location and extent of 131I uptake. The effects of ~ (131) I whole body imaging, ~ (18) F-FDG tumor imaging and serum thyroglobulin and their antibody levels were evaluated, and the incidence of adverse reactions was also observed. Results The median follow-up time was 48.50 months (6 ~ 110 months), and the patient survival rate was 100%. Of the 20 patients, 13 were eliminated, 5 were improved or stabilized, 2 were ineffective or advanced. Four patients were eliminated in seven patients with simple lymph node metastases and four patients were eliminated in eight patients with lung metastases. During follow-up, no pulmonary fibrosis, secondary tumor and abnormal growth and development and other adverse events. Conclusions 131I is a safe and effective treatment for children and adolescents with DTC, especially those with metastases.