外照射放疗在分化型甲状腺癌管理中的应用：单机构回顾性队列研究
External Beam Radiotherapy in the Management of Differentiated Thyroid Cancer: A Single Institution Retrospective Cohort Review.
文献信息
| PMID | 42785473 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Dana Bartolucci |
| 作者单位 | University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. |
| 期刊 | Practical radiation oncology |
| SCI 分区 | Q1 |
| IF | 3.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 外照射放疗（EBRT）在分化型甲状腺癌（DTC）中的作用仍存争议，主要依据回顾性数据，其中许多数据早于现代放疗技术。在本回顾性队列研究中，我们评估了在现代放疗时代接受治疗的晚期DTC患者的结局。
材料与方法： 对2004年至2020年间在单一机构接受治疗的232例DTC患者进行了回顾性队列审查。纳入临床或病理T4期疾病、甲状腺切除术后大体残留病灶、不可切除疾病、放射性碘难以控制的多次颈部复发的患者。放疗队列（n=133）接受IMRT/VMAT的EBRT。接受姑息性剂量的患者被排除。对照队列（n=99）未接受EBRT。数据收集包括患者人口统计学、疾病特征、疾病管理和患者结局/毒性。采用Kaplan-Meier方法和Cox回归分析进行统计分析。
结果： EBRT组呈现更多不良因素（年龄较大、男性占优势）。EBRT组的局部区域无复发生存期（lrRFS）显著改善（HR 0.41，p=0.0028），首次局部区域复发或死亡的时间显著延长（中位6.6年对3.2年，p<0.001）。多变量分析证实EBRT与lrRFS改善相关。总生存期无显著差异。从食管和喉部毒性角度看，EBRT耐受良好。
结论： 采用现代放疗技术（如IMRT和VMAT）的辅助颈部EBRT似乎可改善DTC患者的局部区域RFS。对颈部EBRT后失败模式的回顾未显示显著的边缘失败，表明适形计划的有效性。这些发现支持在局部区域复发高风险患者中考虑EBRT。未来研究有必要完善患者选择标准，并探讨颈部VMAT/IMRT对DTC疾病控制和患者报告结局的长期影响。
英文摘要
PURPOSE: The role of external beam radiotherapy (EBRT) in differentiated thyroid cancer (DTC) remains debated and is largely guided by retrospective data, much of which predates modern radiotherapy techniques. In this retrospective cohort study, we evaluate outcomes of patients with advanced DTC treated in the modern radiotherapy era.
MATERIALS AND METHODS: A retrospective cohort review was conducted of 232 DTC patients treated at a single institution between 2004 and 2020. Patients with clinical or pathological T4 disease, gross residual disease after thyroidectomy, unresectable disease, multiple neck recurrences poorly controlled with radioactive iodine, were included. The radiotherapy cohort (n=133) received EBRT with IMRT/VMAT. Patients treated with palliative doses were excluded. The comparator cohort (n=99) did not receive EBRT. Data collection included patient demographics, disease characteristics, disease management, and patient outcomes/ toxicity. Kaplan-Meier methods and Cox regression analyses were used for statistical analysis.
RESULTS: The EBRT group presented with more adverse factors (older age, male predominance). Locoregional relapse free survival (lrRFS) was significantly improved in the EBRT group (HR 0.41, p=0.0028), with a significantly longer time to first locoregional recurrence or death (median 6.6 years versus 3.2 years, p<0.001). Multivariable analysis confirmed EBRT was associated with improved lrRFS. Overall survival was not significantly different. EBRT was well-tolerated from an esophageal and laryngeal toxicity perspective.
CONCLUSIONS: Adjuvant neck EBRT with modern radiation techniques, such as IMRT and VMAT, appears to improve locoregional RFS in DTC patients. Review of our failure patterns following neck EBRT does not demonstrate significant marginal failures, indicating the efficacy of conformal planning. These findings support consideration of EBRT in patients at high-risk of locoregional recurrence. Future research is warranted to refine patient selection criteria and to investigate the long-term impact of neck VMAT/IMRT on disease control and patient recorded outcomes in DTC.