Abstract
Since 1989, the incidence of thyroid cancer in children from areas afflicted by the Chernobyl NPP reactor accident increased considerably. Here the results of a treatment project that has been jointly started in April 1993 by partners from Belarus and Germany are presented. Up to now, 242 children (144 girls and 89 boys, mean-age 12.7 +/- 2.5 years) with differentiated thyroid cancer (240 papillary and 2 follicular) had been treated. In 152 cases (63%) tumor stage pT4 had to be diagnosed; 235 (97%) presented with lymph node metastases (pN1) and in 104 cases (43%) distant spread to the lungs was revealed by I-131 wholebody-scintigraphy. After surgery, which had been performed in Minsk, the children were treated in Germany with totally 935 courses of radioiodine therapy. The intervals between treatment courses amounted to 4-6 months. In 180 (86%) out of 210 children, who at least had received 2 courses of radioiodine therapy, complete remissions (CR) or stable partial remissions (SPR) were achieved (CR: wholebody scan negative, thyroglobulin not measurable; SPR: wholebody scan negative, thyroglobulin in hypothyroidism measurable, but below 10ng/ml). In the subgroup of children with pulmonary metastases, the rates of CR and SPR amounted to 68%. In 7 children clinical signs of pulmonary fibrosis were diagnosed: in two cases after radioiodine treatment only, in five cases after radioiodine- and pre-treatment with bleomycin. No single case of tumor progression has been seen up to now; in one case a recurrence was diagnosed after 10 years and follow-up. Radioiodine treatment of radiation induced thyroid carcinoma can induce complete or stable partial remissions even in cases with advanced tumor stages.
