乳头状及滤泡状甲状腺癌术后如何选择性应用放射性碘治疗.pdfVIP

Journal of Surgical Oncology 2006;94:692–700 Selective Use of Radioactive Iodine in the Postoperative Management of Patients With Papillary and Follicular Thyroid Carcinoma IAN D. HAY, MB, PhD, FACP, FRCP*{ Mayo Clinic College of Medicine, Endocrinology and Internal Medicine, Mayo Clinic, Rochester, Minnesota Radioiodine remnant ablation (RRA) was developed in the 1960s to ‘‘complete a thyroidectomy’’ in the initial management of papillary and follicular thyroid cancer. By the 1990s, it was claimed that RRA diminished recurrence rates in follicular cell- derived cancer (FCDC) patients and decreased the cause-specific mortality (CSM) in patients more than 40 years old at initial surgery. The international trend for the past decade has been towards routine RRA in most FCDC patients. Clinical guidelines have been produced by many societies, promoting such an aggressive stance. Since 1997, many papers have reported improved outcome in FCDC, when patients were subjected to RRA after bilateral lobar resection. However, during the same time- period, it has been recognized that most FCDC patients are truly at ‘‘low-risk’’ of developing life-threatening recurrences. Accordingly, it has been suggested that rational therapy selection should lead to restricting aggressive therapy to those ‘‘high- risk’’ FCDC patients, more predisposed to CSM. To date, no prospective controlled trials exist. Presently available outcome data