| 131I治疗分化型甲状腺癌颈部摄碘组织的吸收剂量与疗效分析 |
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| 引用本文： | 张廷杰,李建芳,秦露平,谢良骏,程木华.131I治疗分化型甲状腺癌颈部摄碘组织的吸收剂量与疗效分析[J].国际放射医学核医学杂志,2019,43(5):405-410. |
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| 作者姓名： | 张廷杰 李建芳 秦露平 谢良骏 程木华 |
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| 作者单位： | 中山大学附属第三医院核医学科,广州510630;中国医学科学院肿瘤医院深圳医院核医学科,深圳518116;中山大学附属第三医院核医学科,广州,510630 |
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| 摘 要： | 目的 评估分化型甲状腺癌（DTC）术后行131I治疗后，甲状腺残余灶、DTC转移灶内照射的吸收剂量与治疗反应的关系。 方法 收集2017年2月至9月中山大学附属第三医院核医学科22例DTC术后行131I治疗的患者，其中男性10例、女性12例，年龄21~59岁，中位年龄39.5岁。在患者服药后多个时间点行131I全身平面显像及局部SPECT/CT显像，测算甲状腺残余灶、DTC转移灶的吸收剂量及患者的平均吸收剂量。按照《2015美国甲状腺协会成人甲状腺结节与分化型甲状腺癌指南》评估患者的治疗后反应。使用Mann-Whitney U检验评估残余灶与转移灶在不同疗效及分组之间的吸收剂量差异，受试者工作特征（ROC）曲线评估吸收剂量预测治疗效果的性能。 结果 100%（28/28）的甲状腺残余灶及34.8%（8/23）的DTC转移灶为完全反应。完全反应的DTC转移灶吸收剂量（M=79.3 Gy）高于未完全反应（M=29.8 Gy）的转移灶（Z=?2.195，P=0.028）。ROC曲线分析提示，DTC转移灶的吸收剂量可用于预测病灶行131I治疗后的疗效反应，曲线下面积达0.783（Z=?2.195，P=0.028），预测病灶达完全反应的截止值为70.6 Gy。患者平均吸收剂量可预测治疗后病情的缓解状况，曲线下面积达0.823（Z=?2.285，P=0.022）。 结论 DTC转移灶的吸收剂量需要达到足量才可达到治疗完全反应。摄碘组织的吸收剂量与患者平均吸收剂量均可作为碘治疗后治疗反应的预测指标。
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| 关 键 词： | 单光子发射计算机体层摄影术 分化型甲状腺癌 碘放射性同位素 吸收剂量 疗效评估 |
| 收稿时间： | 2019-08-23 |
Prognostic values of the cervical lesions absorbed dose in the radioactive iodine treatment of differentiated thyroid carcinoma |
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| Tingjie Zhang,Jianfang Li,Luping Qin,Liangjun Xie,Muhua Cheng.Prognostic values of the cervical lesions absorbed dose in the radioactive iodine treatment of differentiated thyroid carcinoma[J].International Journal of Radiation Medicine and Nuclear Medicine,2019,43(5):405-410. |
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| Authors: | Tingjie Zhang Jianfang Li Luping Qin Liangjun Xie Muhua Cheng |
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| Affiliation: | 1.Department of Nuclear Medicine, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China |
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| Abstract: | Objective To evaluate the dose–response relationship of thyroid remnants and differentiated thyroid carcinoma (DTC) cervical metastases in the radioiodine treatment of DTC. Methods Post-therapeutic iodine-131 whole-body scintigraphy and SPECT/CT imaging were performed in 22 patients with DTC, including 10 males and 12 females, of the Nuclear Department of Third Affiliated Hospital of Sun Yat-Sen University. The ages of the patients were between 21 and 59 years, with a median of 39.5 years. Images were acquired from iodine-131 whole-body scintigraphy and SPECT/CT at multiple time points after treatment. The absorbed doses (ADs) of thyroid remnants and DTC metastases and the mean individual ADs were calculated using these images. Lesion response was determined using the 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The differences in lesion AD of each observed group were analyzed using the Mann–Whitney U test. Moreover, the receiver operating characteristic (ROC) curves were used to test the performance of the estimated AD for prognostic assessment. Results All (28/28) thyroid remnants and 34.8% (8/23) of DTC metastases responded completely. The lesion ADs of the completely responded DTC metastases (M=79.3 Gy) were significantly higher than that of the incompletely responded lesions (M=29.8 Gy) (Z=?2.195, P=0.028). The ROC curve analysis indicated that the estimation of lesion AD, which had an area under the curve of 0.783 (Z=?2.195, P=0.028) for DTC metastases, may be a prognostic factor for the prediction of lesion-based iodine-131 therapy response. The corresponding lesion AD threshold value for correctly predicting the complete response of metastatic lesions was 70.6 Gy. The mean individual ADs of clinically relieved patients, which had an area under the curve of 0.823 (Z=?2.285, P=0.022), were also significantly higher than that of the clinically nonrelieved patients. Conclusion Completely responded metastases demonstrated higher AD than the incompletely responded ones. The AD of iodine uptake tissue and the average AD of patients are possibly valuable to predict the response to iodine therapy. |
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