Department of Nuclear Medicine, University of Würzburg, Oberdürrbacherstr.6, D-97082 Würzburg, Germany.
Genes (Basel). 2011 May 31;2(2):374-83. doi: 10.3390/genes2020374.
The risk of developing thyroid cancer increases considerably after exposure to external or internal radiation, especially in children below the age of 10. After the Chernobyl reactor accident, the yearly incidence of childhood thyroid cancer in Belarus increased to approximately 40 per 1.000.000 in girls and to roughly 20 per 1.000.000 in boys compared to approximately 0.5 cases per 1.000.000 prior to the accident. Typically, young children with thyroid cancer after radiation exposure present in ≈95% of the cases as papillary cancers, in ≈50% as invasive tumors growing outside the thyroid capsule, in ≈65% with lymph node metastases and in ≈15% with distant metastases. A joint Belarusian-German project starting in April 1993 that combined treatment with surgery and radioiodine was organized in 237 selected children from Belarus who were exposed to the Chernobyl fallout and had advanced stages of thyroid cancer. The study group included 141 girls and 96 boys. Their median age at the time of the accident was 1.7 years; whereas the median age at the time of diagnosis was 12.4 years. With the exception of two cases with follicular histology, the majority of the patients had been diagnosed with papillary thyroid cancers. In 63%, the tumor had grown outside the thyroid capsule and invaded the tissue of the neck (pT4). Nearly all of the selected cases (96%) showed-up with lymph node metastases (pN1) and 43% of the patients with distant metastases mainly to the lungs (pM1). In 58% of the children, complete remissions of thyroid cancer could be achieved until December 31st 2010 and in 34% of the children, stable partial remissions; in the remaining 8% of the patients, partial remissions were observed. The risk of radiation-induced thyroid cancer increased considerably in children and adolescents who were affected by the Chernobyl reactor accident. In spite of the fact, that thyroid cancers in young children seem to behave more aggressively than in older patients, the results of combined treatment with thyroidectomy, radioiodine therapy and thyroid hormone replacement are excellent.
在接触外部或内部辐射后，甲状腺癌的发病风险会显著增加，尤其是 10 岁以下的儿童。切尔诺贝利反应堆事故后，白俄罗斯儿童甲状腺癌的年发病率在女孩中约为每 100 万 40 例，在男孩中约为每 100 万 20 例，而事故前每 100 万约为 0.5 例。通常，在辐射暴露后患有甲状腺癌的幼儿，约 95%为乳头状癌，约 50%为侵犯甲状腺包膜外的侵袭性肿瘤，约 65%有淋巴结转移，约 15%有远处转移。1993 年 4 月，白俄罗斯和德国开展了一项联合项目，对接触切尔诺贝利沉降物且患有晚期甲状腺癌的 237 名白俄罗斯儿童进行手术和放射性碘联合治疗。研究组包括 141 名女孩和 96 名男孩。他们在事故中的中位年龄为 1.7 岁，而诊断时的中位年龄为 12.4 岁。除 2 例滤泡组织学外，大多数患者被诊断为甲状腺乳头状癌。在 63%的患者中，肿瘤已侵犯甲状腺包膜并侵袭颈部组织（pT4）。几乎所有被选病例（96%）均出现淋巴结转移（pN1），43%的患者出现远处转移，主要为肺部（pM1）。截至 2010 年 12 月 31 日，58%的儿童完全缓解甲状腺癌，34%的儿童稳定部分缓解，其余 8%的儿童部分缓解。受切尔诺贝利反应堆事故影响的儿童和青少年患辐射诱导甲状腺癌的风险显著增加。尽管如此，年幼儿童的甲状腺癌似乎比老年患者更具侵袭性，但甲状腺切除术、放射性碘治疗和甲状腺激素替代联合治疗的效果非常好。
