Drozd, Valentina M.1,5; Fridman, Mikhail V. 2; Saenko, Vladimir A.3; Leonova, Tatiana2; Shaverda, Elena1; Shimanskaya, Irina1; Demidchik, Yuri E.4; Branovan, Igor 5; Shiglik, Nikolay5; Rogounovitch, Tatiana I.3; Yamashita, Shunichi3; Biko, Johannes6; Reiners, Christoph6
1 The International fund “Help for patients with radiation-induced thyroid cancer “Arnica”, Belarus
2 Republican Centre for Thyroid Tumors, Minsk Municipal Clinical Oncological Dispensary, Minsk, Belarus
3 Atomic Bomb Disease Institute, Nagasaki University, Japan
4 Department of Oncology, Belarusian Medical Academy for Postgraduate Education, Minsk, Belarus
5 Project Chernobyl, New-York, USA
6 Clinic and Polyclinic of Nuclear Medicine, University of Wuerzburg, Germany
Background: An abnormal increase in the incidence of papillary thyroid cancer (PTC) in children of Belarus began 4 years after the Chernobyl accident reaching a peak of 12.6 per 100,000 in the most contaminated Gomel region in 1996. Radiation dose was significantly associated with thyroid cancer risk. Additional environmental factors such as nitrates in drinking water in the places of residence of patients might have also played a role, modifying the effect of radiation.
Methods: We investigated the results of a median 15.4 years follow-up of 1078 children and adolescents (61.9% female, 38.1% male) with PTC surgically treated from 1990 to 2005 in Belarus. Mean age (±SD) of patients at surgery was 13 (±3.5) years, mean tumor size – 14.4 mm, neck lymph node involvement frequency – 73.7%, distant metastases – 11.1%, extrathyroidal extension – 41.3%,
Results: Total thyroidectomy (TT) (68.6%) and radioiodine therapy (RIT) (62.7%) were the most frequent modalities. Hypoparathyroidism was registered in 5%, but in high-risk patients after TT with repeated surgery and RIT it was observed in 36.3%. Young female patients were at risk of reproductive dysfunctions when the cumulative activity of 131I exceeded 12 GBq, while young males at more than 5 GBq. The prevalence of second primary malignancies was 1.4%. Overall survival was 96.9%, complete clinical remission – 90.4%, relapses – 7.1%, 1.9% patients died. The most frequent causes of death were suicide, trauma and second malignancy.
Discussion & Conclusion: The long-term outcome of PTC is generally favorable, but there is an urgent need in the improvement of rehabilitation programs.