Long Shadow of Chernobyl (2): German and Belarusian Researchers Say 64% of 229 Belarusian Children with High-Risk Thyroid Cancer in Complete Remission, 30% in Near-Complete Remission

For what it's worth, on the anniversary day of the accident.

From Science Daily (4/24/2013; emphasis is mine):

Chernobyl Follow-Up Study Finds High Survival Rate Among Young Thyroid Cancer Patients

Apr. 24, 2013 — More than a quarter of a century after the Chernobyl nuclear disaster, many children and teenagers who developed thyroid cancer due to radiation are in complete or near remission, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

Following the April 26, 1986 explosion and fire at the Chernobyl nuclear plant in the former Soviet Union, the number of children and teenagers diagnosed with differentiated thyroid cancer spiked in Ukraine, Belarus and western areas of Russia. Most of the patients developed the papillary subtype of differentiated thyroid cancer. Although this cancer tends to be more aggressive in children than adults, nearly all of the patients tracked in the study responded favorably to treatment.

"Even though some patients did not receive optimal treatment initially, the vast majority went into remission after receiving state-of-the-art radiodine treatment and follow-up care," said study lead author Christoph Reiners, MD, of the University of Würzburg, Germany. "Many patients recovered from advanced cancers. Of this group, 97 percent had cancer spread to the lymph nodes, and 43 percent had cancer metastasize in the lungs."

The observational study followed the treatment and outcomes of 229 Belarusian children and adolescents who underwent surgery in Belarus and radioiodine therapy in Germany. The study participants were among the highest-risk young patients exposed to radiation from the accident.

Despite the risk, 64 percent of the patients are in complete remission and 30 percent nearly complete remission of their cancer. One patient died of lung fibrosis, a side effect of cancer treatment. Only two had cancer recurrences.

The findings suggest victims of more recent nuclear accidents like the 2011 Fukushima accident in Japan face lower risk of developing advanced-stage thyroid cancer, Reiners said.

(Full article at the link)

From Journal of Clinical Endocrinology and Metabolism (JCEM) (4/24/2013; emphasis is mine):

Twenty-Five Years after Chernobyl: Outcome of Radioiodine Treatment in Children and Adolescents with Very-High-Risk Radiation-Induced Differentiated Thyroid Carcinoma

Christoph Reiners, MD1,
Johannes Biko, MD1,
Heribert Haenscheid, PhD1,
Helge Hebestreit, MD2,
Stalina Kirinjuk, MD3,
Oleg Baranowski, MD3,
Robert J. Marlowe, BA4,
Ewgeni Demidchik, MD5,†,
Valentina Drozd, MD6 and
Yuri Demidchik, MD7

- Author Affiliations

1Department of Nuclear Medicine, University of Würzburg, Germany;
2Department of Pediatrics, University of Würzburg, Germany;
3Hospital for Oncology, Thyroid Cancer Center, Minsk, Belarus;
4Spencer-Fountayne Corporation, Jersey City, NJ, USA;
5National Academy of Sciences, Minsk, Belarus;
6International Fund Help for Patients with Radiation Induced Thyroid Cancer “Arnica”, Minsk, Belarus;
7Belarusian Medical Academy of Post-Graduate Education, Minsk, Belarus

Address all correspondence and requests for reprints to: Prof.Dr.Dr.med.h.c. Christoph Reiners, Department of Nuclear Medicine, University of Würzburg, Oberdürrbacherstr. 6, D-97080 Würzburg, Germany, Tel. +49 931 201 55001, Fax. +49 931 201 655001, E-mail: reinersc@klinik.uni-wuerzburg.de.


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 post-surgical radioiodine therapy (RIT) in Germany.

Interventions: Cumulatively 100 (134) children with (without) 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 Tg <1 μ g /L), 69 (30.1%) showed nearly complete remission (complete response, except stimulated Tg 1–10 μ g/L), and 11 (4.8%) had partial remission (Tg >10 μ g/L, decrease from baseline in radioiodine uptake intensity in ≥ 1 focus, in tumour volume, or in Tg). Except two recurrences (0.9%) after partial remission, no recurrences, progression, or disease-specific mortality were noted. One patient died of lung fibrosis 16 years post-therapy, two of apparently thyroid cancer-unrelated causes. The only RIT side effect observed was pulmonary fibrosis in 5/69 patients (7.2%) with disseminated lung metastases undergoing intensive pulmonary surveillance.

Conclusions: Experience of a large, very-high-risk paediatric 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 favourable.

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