Twenty-five years after Chernobyl: outcome of radioiodine treatment in children and adolescents with very high-risk radiation-induced differentiated thyroid carcinoma.

Abstract

CONTEXT:

After severe reactor emergencies with release of radioactive iodine, elevated thyroid cancer risk in children and adolescents is considered the main health consequence for the population exposed.

DESIGN:

We studied thyroid cancer outcome after 11.3 years' median follow-up in a selected, very high-risk cohort, 234 Chernobyl-exposed Belarusian children and adolescents undergoing postsurgical radioiodine therapy (RIT) in Germany.

INTERVENTIONS:

Cumulatively 100 children with or (without; n = 134) distant metastasis received a median 4 (2) RITs and 16.9 (6.6) GBq, corresponding to 368 (141) MBq/kg iodine-131.

MAIN OUTCOME MEASURES:

Outcomes were response to therapy and disease status, mortality, and treatment toxicity.

RESULTS:

Of 229 patients evaluable for outcome, 147 (64.2%) attained complete remission [negative iodine-131 whole-body scan and TSH-stimulated serum thyroglobulin (Tg) < 1 μg /L], 69 (30.1%) showed nearly complete remission (complete response, except stimulated Tg 1-10 μg/L), and 11 (4.8%) had partial remission (Tg > 10 μg/L, decrease from baseline in radioiodine uptake intensity in ≥ 1 focus, in tumor volume or in Tg). Except for 2 recurrences (0.9%) after partial remission, no recurrences, progression, or disease-specific mortality were noted. One patient died of lung fibrosis 17.5 years after therapy, 2 of apparently thyroid cancer-unrelated causes. The only RIT side effect observed was pulmonary fibrosis in 5 of 69 patients (7.2%) with disseminated lung metastases undergoing intensive pulmonary surveillance.

CONCLUSIONS:

Experience of a large, very high-risk pediatric cohort with radiation-induced differentiated thyroid carcinoma suggests that even when such disease is advanced and initially suboptimally treated, response to subsequent RIT and final outcomes are mostly favorable.

• Authors: Christoph Reiners, Johannes Biko, Heribert Haenscheid, Helge Hebestreit, Stalina Kirinjuk, Oleg Baranowski, Robert J Marlowe, Ewgeni Demidchik, Valentina Drozd, Yuri Demidchik
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 98 Issue 7 Pg. 3039-48 (Jul 2013) ISSN: 1945-7197 [Electronic] United States
• PMID: 23616148 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Iodine Radioisotopes
• Radiopharmaceuticals

Topics

• Adolescent
• Carcinoma (epidemiology, radiotherapy, surgery)
• Chernobyl Nuclear Accident
• Child
• Child, Preschool
• Cohort Studies
• Combined Modality Therapy (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Infant
• Infant, Newborn
• Iodine Radioisotopes (adverse effects, therapeutic use)
• Male
• Neoplasms, Radiation-Induced (epidemiology, radiotherapy, surgery)
• Radiopharmaceuticals (adverse effects, therapeutic use)
• Remission Induction
• Republic of Belarus (epidemiology)
• Risk
• Thyroid Gland (radiation effects, surgery)
• Thyroid Neoplasms (epidemiology, radiotherapy, surgery)