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Published on: September 18, 2013
Thyroid cancer in children of Ukraine after the Chernobyl accident
S J Rybakov1, I V Komissarenko, N D Tronko
1Department of Surgery, Institute of Endocrinology, 69 Vyshgorodskaya Strasse, 254114 Kiev, Ukraineraine.
Insights
The Chernobyl accident led to a significant increase in thyroid cancer among children and adolescents, often aggressive and metastatic. Long-term monitoring of this high-risk population is crucial for effective management.
Area of Science:
- Endocrinology
- Oncology
- Public Health
Background:
- The 1986 Chernobyl nuclear disaster resulted in significant radioactive iodine exposure.
- Thyroid cancer incidence in children and adolescents increased dramatically following the accident.
- Many affected individuals were young children at the time of exposure and lived in highly contaminated areas.
Purpose of the Study:
- To analyze the treatment outcomes of pediatric and adolescent thyroid cancer patients operated on after the Chernobyl accident.
- To evaluate the clinical characteristics, treatment modalities, and complications in this specific patient cohort.
- To project future trends and emphasize the need for long-term surveillance.
Main Methods:
- Retrospective analysis of 330 children and adolescents treated for thyroid cancer.
- Review of patient demographics, time of accident, exposure levels, and clinical presentation.
- Surgical interventions included total thyroidectomy and modified neck dissection, followed by radioiodine and TSH suppressive therapy.
Main Results:
- A sharp rise in thyroid cancer cases was observed post-1986, particularly in those under 8 years old and from high-exposure zones.
- Thyroid cancers presented with short latency, aggressive behavior, and high rates of metastasis (regional 57.3%, distant 14.5%).
- Solid papillary carcinoma was the predominant type (93.1%), with frequent coexisting thyroid conditions. Complications included nerve palsy (12.3%) and hypoparathyroidism (6%).
Conclusions:
- The Chernobyl accident significantly increased the incidence of aggressive pediatric thyroid cancer.
- Effective surgical management combined with radioiodine therapy and TSH suppression is essential.
- Continued long-term monitoring of this high-risk population is imperative due to anticipated future cases.
Abstract:
The results of treatment of 330 children (< 14 years) and adolescents (15-18 years) with thyroid cancer who were operated on at the Institute of Endocrinology after the Chernobyl accident in 1986 were analyzed. The number of young patients increased after 1986 (1981-1985, 9 cases; 1986-1990, 37 cases; 1991-1995, 177 cases; 1996-1998, 116 cases). Most of these children and adolescents were younger than 8 years at the time of the accident (84.2%). More than half of the children (58.1%) lived in areas receiving the highest radiation exposure. These thyroid cancers developed after a short latent period, were more aggressive at presentation, and expressed regional (57.3%) or distant (14.5%) metastasis. Solid papillary cancers were present in 93.1%. Coexisting thyroid conditions were common (thyroid hyperplasia, 25.1%; nodular goiter, 18.8%; chronic thyroiditis, 10.2%). Most patients were treated by total thyroidectomy with intraoperative visualization of recurrent laryngeal nerves and parathyroid glands. When lymph node metastases were identified, a modified neck dissection was performed. Such operations were done in 277 (84.1%) patients. Postoperatively, the patients were treated with radioiodine and thyroid-stimulating hormone suppressive therapy. Postoperative complications included recurrent nerve palsy in 12.3% and permanent hypoparathyroidism in 6%. Operations for local recurrence of cancer were performed in 2.8% cases and for regional metastasis in 4%. The general mortality was 1. 8%. We anticipate that there will be more patients with thyroid cancer during the next few years. Therefore this high risk population for thyroid cancer must be carefully monitored and evaluated during the next several decades.
