- 期刊
分化型甲狀腺癌的術後風險分期與放射性碘治療
Post-Operative Risk Stratification and Radioiodine Therapy of Differentiated Thyroid Cancer
摘要
美國甲狀腺學會根據2009年之後所發表的相關研究成果，於2015年更新了甲狀腺結節與分化型甲狀腺癌診療的指引，對於甲狀腺癌的治療也因為新的實證研究結果而有些改變。過去以來，甲狀腺癌術後的放射性碘治療幾乎是常規執行，然而，近期研究顯示對於一些極低復發風險的病患，術後的放射性碘治療並未帶來更多的好處。基因重組促甲狀腺激素(recombinant human thyroid-stimulating hormone, rhTSH)的使用，除了高風險的病患外，可作為刺激促甲狀腺激素第一線的建議。在放射性碘(I-131)劑量上的考量，對於甲狀腺組織的清除，30 mCi與更高劑量相比，有相當的清除效率(ablation rate)，然而，長期的預後尚未有定論。分化型甲狀腺癌的追蹤，病程發展會隨時間及對治療反應而改變，且沒有單一的因子可做完美的長期預測，因此2015美國甲狀腺學會指引發展出了「動態風險評估(dynamic risk stratification)」的方法。分化型甲狀腺癌的診療，以風險調整(risk-adapted)的角度切入，有了更趨「個人化醫療」的思維與進展。我們必須持續透過新的實證資訊來給予病患最適切的診療。
並列摘要
In 2015, the American Thyroid Association (ATA) renewed the guidelines regarding the management of differentiated thyroid carcinoma (DTC) based on the results of studies published since 2009. According to the new evidences, the treatment of DTC has continued to modify and evolve. Post-surgical radioactive iodine (RAI) ablation is almost routinely performed, however, recent studies showed that ablation is not beneficial for survival in low-risk patients. Recombinant human thyroid-stimulating hormone (rhTSH) has been recommended as the first line mode of TSH stimulation except for high risk patients or those with recurrent/metastatic disease. Although low-dose (30 mCi) ablation showed similar ablation rate to high-dose ablation, long-term outcome has not yet been established. According to the follow-up of DTC patients, no single factor is capable of completely predicting the long-term outcomes. The concepts of ＂dynamic risk assessment＂ have important implications on DTC management during follow-up. Recently, policy for treating DTCs has changed in many aspects and tends to be more ＂personalized.＂ We have to continue to capture the new information with time to present the best treatments for DTC patients.
延伸閱讀
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