文摘
Abstract.
After the Chernobyl reactor accident on April 26, 1986, the incidence of thyroid cancer in children and adolescents living in contaminated areas of the Ukraine and Belarus increased significantly. In total, 4600 cases of thyroid cancer have been observed between 1986 and 2002 among those aged 0–18 years at the time of the reactor accident. It is estimated that approximately 40 % of those cases are associated with radiation exposure and 60 % are spontaneous cases. Starting April 1, 1993, a joint Belarussian–German project on the combined treatment with surgery and radioiodine was launched. Thyroid surgery was performed in the Center for Thyroid Tumors in Minsk, Belarus, and radioiodine therapy followed in Germany at the Universities of Essen (until the end of 1994) and afterwards the University of Würzburg. Until March 31, 2006, 245 selected children and adolescents with advanced disease had received a total of 995 one-week courses of radioiodine therapy. The number of girls was 147 and the number of boys 98. The age at the time of radioiodine therapy ranged from 7 to 19 years with a mean age of 12.7 ± 2.5 years. Histologically, 243 of the cancers had been classified as papillary and only 2 as follicular cancers. 152 out of those 245 patients suffered from locally advanced tumor stage pT4 (62 % ). In nearly all of the children (238 out of 245 = 97 % ) neck lymph node metastases were detected during surgery or follow-up. 104 out of 245 children (42 % ) revealed distant metastases (nearly all of them to the lungs). Up to now, 234 patients received more than one course of radioiodine therapy so that the effectivity of the preceding treatment course could be checked by a consecutive radioiodine whole-body scan. In total, 131 children (56 % ) are in complete remission, 70 children (30 % ) in stable partial remission and 33 children (14 % ) in partial remission. With respect to the subgroup of children with distant metastases, the rate of complete remissions is 35 % , stable partial remissions 34 % and partial remissions 31 % . All of the children and adolescents treated with radioiodine responded to treatment and are alive. Concerning transient side effects, gastritis with nausea and vomiting is usual especially in small children immediately after application of radioiodine. In 20–30 % of the children, acute sialadenitis occurs because of high radioiodine uptake in the salivary glands. In 20 % of the children, reversible leuco- and or thrombopenia is observed. Concerning late side effects approximately 10 % of female and male adolescents show signs of impairment of gonadal function. In up to 30 % of the males oligo- or asthenozoospermia occurs. A permanent Sicca syndrome is to be seen in less than 10 % of the patients and in up to 5 % of patients with lung metastases radiological signs of pulmonary fibrosis. Fortunately, no single case of leukemia, a secondary solid malignancy, has been observed during the 13-year follow-up of our treatment program.
