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I-131 effective in Chernobyl-exposed children
In 1986, the Chernobyl nuclear power plant reactor accident released large levels of cesium and iodine radioisotopes, leading to a higher prevalence for differentiated thyroid carcinoma among children and adolescents. In a recent study, researchers examined thyroid cancer outcomes in an 11.3-year follow-up and found that many patients responded favorably to radioactive iodine therapy.
“Even though some patients did not receive optimal treatment initially, the vast majority went into remission after receiving state-of-the-art radioiodine treatment and follow-up care,” Christoph Reiners, MD, of the University of Würzburg, Germany, said in a press release. “Many patients recovered from advanced cancers. Of this group, 97% had cancer spread to the lymph nodes, and 43% had cancer metastasize in the lungs.”
Reiners and colleagues included 234 Chernobyl-exposed children and adolescents (100 with, 134 without distant metastasis) from Belarus who were administered surgical radioactive iodine therapy (I-131).
According to data, 147 (64.2%) of the 229 evaluable patients demonstrated complete remission, 69 (30.1%) displayed nearly complete remission and 11 (4.8%) had partial remission.
Further results indicate two recurrences (0.9%) after partial remission. However, there were no recurrences, progression or disease-specific mortality, the researchers wrote. One patient died of lung fibrosis 16 years after therapy, and two patients died of apparent thyroid cancer-unrelated causes.
Adverse events included pulmonary fibrosis in five of 69 patients (7.2%) with disseminated lung metastases who underwent intensive pulmonary surveillance, they wrote.
These findings suggest that even if disease is in the advanced stage and initial treatment is suboptimal, outcomes tended to be favorable after I-131 therapy, they concluded.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Radiation exposure is one of the few known risk factors for thyroid cancer. In this study, Reiners C. et al evaluated outcome in 229 children and adolescents exposed to radiation from Chernobyl. Many of the children had aggressive disease including evidence of pulmonary metastases. The median follow-up was 11.3 years. The authors found that even with high-risk thyroid cancer secondary to radiation exposure, survival is excellent. The authors attribute survival to radioactive iodine treatment, with evidence of remission of pulmonary metastases post radioactive iodine in several patients. However, pulmonary fibrosis secondary to high dose radioactive iodine was seen in 7% of patients and longer follow-up may be needed to clarify whether or not there were additional adverse events secondary to radioactive iodine treatment. Overall, this was an interesting study documenting the outcome of children with thyroid cancer secondary to radiation exposure.