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Pulmonary fibrosis in youth treated with radioiodine for juvenile thyroid cancer and lung metastases after Chernobyl

  • Helge HebestreitEmail author
  • Johannes Biko
  • Valentina Drozd
  • Yuri Demidchik
  • Antje Burkhardt
  • Andreas Trusen
  • Meinrad Beer
  • Christoph Reiners
Original Article

Abstract

Purpose

The objective of this project was to systematically determine the prevalence and consequences of pulmonary fibrosis in youth with thyroid carcinoma and lung metastases from Belarus who were treated with radioiodine (131I).

Methods

A total of 69 patients treated for juvenile thyroid carcinoma and lung metastasis with 131I were assessed. A group of 29 patients without lung metastases and prior 131I treatment served as controls. The assessments included a CT scan of the lungs, extensive pulmonary function testing and an incremental cycle test to volitional fatigue with measurements of oxygen uptake (\( {\mathop {\text{V}}\limits^ \cdot } \)O2), oxygen saturation and alveolar-arterial difference in oxygen partial pressure (ΔaaO2).

Results

Five patients with lung metastases showed advanced pulmonary fibrosis on CT scans and also had poorer lung functions compared with the 62 patients with none or minor signs of fibrosis and the 29 controls. Furthermore, these five patients showed lower peak \( {\mathop {\text{V}}\limits^ \cdot } \)O2, lower oxygen saturation at peak exercise and higher exercise ΔaaO2. They were younger at the time of cancer diagnosis and had received chemotherapy more frequently than youth with pulmonary metastases who did not develop fibrosis. One of the five patients subsequently died from pulmonary fibrosis.

Conclusion

Following the Chernobyl catastrophe, about 7% of children treated with radioiodine for thyroid carcinoma and lung metastases displayed pulmonary fibrosis which was associated with functional impairments. Based on the characteristics of affected individuals, the number of radioiodine courses may have to be limited, especially in young children, and chemotherapy should be avoided.

Keywords

Radioactive fallout Exercise test Oncology Respiratory Radionuclide therapy 

Notes

Acknowledgements

We thank Georg Schultz for his valuable input in the development of the CT-based staging system for pulmonary fibrosis in patients with juvenile thyroid cancer and for his help with the scoring of the CT images.

Funding

This study was funded in part by Deutsche Krebshilfe (German Cancer Foundation; grant number 50-2625-He 1). Radioiodine treatment in Germany and the travel costs for patients were covered by grants of the research project “Scientists Help Chernobyl Children”, the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety and the German-Belarusian Foundation “ARNICA”.

Contributors

HH, JB and CR conceived and designed the study, HH, JB, AB, AT, and MB undertook the trial and collected data. HH and AB were responsible for data analysis. HH, JB, VD, YD, MB and CR interpreted the data. HH drafted the manuscript with input and editing from all authors.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Helge Hebestreit
    • 1
    Email author
  • Johannes Biko
    • 2
  • Valentina Drozd
    • 3
  • Yuri Demidchik
    • 4
  • Antje Burkhardt
    • 1
  • Andreas Trusen
    • 5
  • Meinrad Beer
    • 6
  • Christoph Reiners
    • 2
  1. 1.University Children’s HospitalWürzburgGermany
  2. 2.Department of Nuclear MedicineUniversity HospitalWürzburgGermany
  3. 3.International Belarussian-German Foundation ‘Help for radiation-induced thyroid cancer patients: ARNICA‘MinskBelarus
  4. 4.Thyroid Cancer CentreMinskBelarus
  5. 5.Klinik für Radiologie, Johanniter-Krankenhaus, Genthin-Stendal gGmbHStendalGermany
  6. 6.Department of RadiologyUniversity HospitalWürzburgGermany

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