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目的评价放射性同位素90Y标记的奥曲肽(90Y-DOTATOC)及131I标记的间碘苄胍(131I-MIBG)在治疗转移性甲状腺髓样癌中的价值。方法12例经病理学检查证实的转移性甲状腺髓样癌患者均进行了131In-奥曲肽和131I-MIBG或123I-MIBG联合显像。根据显像结果,分别选择奥曲肽显像阳性或MIBG显像阳性的患者行90Y-DOTATOC或131I-MIBG内照射靶向治疗。内照射靶向治疗方案为:静脉滴注3．33 GBq90Y-DOTATOC,治疗间期为6周;或11．1 GBq131I-MIBG,治疗间期3个月以上。结果12例患者联合显像均为阳性,其中奥曲肽显像阳性8例,MIBG显像阳性6例。根据联合显像结果,筛选出4例采用90Y-DOTATOC治疗,5例采用131I-MIBG治疗。经过3～5个疗程的治疗,随访15-36个月,9例核素治疗的患者中,3例部分缓解,6例病情稳定,有效率为33．3％(3／9),反应率为100％(9／9),未见明显副作用。结论核素标记的奥曲肽及MIBG靶向治疗转移性甲状腺髓样癌安全有效,可作为改善患者预后的一种方法。
Objective To evaluate the value of 90Y-DOTATOC and 131I-labeled metronidazole (131I-MIBG) in the treatment of metastatic thyroid medullary carcinoma. Methods Thirteen 131In-octreotide and 131I-MIBG or 123I-MIBG imaging were performed in 12 patients with metastatic thyroid carcinoma confirmed by pathology. According to the results of imaging, patients who were selected for octreotide imaging positive or MIBG imaging positive respectively were treated with 90Y-DOTATOC or 131I-MIBG internal irradiation. Targeted internal radiation treatment programs: intravenous infusion of 3.33 GBq90Y-DOTATOC, the treatment interval of 6 weeks; or 11.1 GBq131I-MIBG, the treatment interval of 3 months or more. Results All the 12 cases were positive for imaging, of which 8 were positive for octreotide imaging and 6 were positive for MIBG imaging. According to the results of joint imaging, 4 patients were screened with 90Y-DOTATOC and 5 patients with 131I-MIBG. After 3 to 5 courses of treatment, follow-up 15-36 months, 9 cases of radionuclide therapy in patients, 3 cases partially relieved, 6 cases stable condition, the effective rate was 33.3% (3/9), the response rate 100% (9/9), no obvious side effects. Conclusions Nuclide-labeled octreotide and MIBG are safe and effective in the treatment of metastatic thyroid medullary carcinoma and may be used as a method to improve the prognosis of patients.