Leukaemias and cancers following iodine-131 administration for thyroid cancer

Abstract

We studied 1771 patients treated for a thyroid cancer in two institutions. None of these patients had been treated with external radiotherapy and 1497 had received 131I. The average 131I cumulative activity administered was 7.2 GBq, and the estimated average dose was 0.34 Sv to the bone marrow and 0.80. Sv to the whole body. After a mean follow-up of 10 years, no case of leukaemia was observed, compared with 2.5 expected according to the coefficients derived from Japanese atomic bomb survivors (P = 0.1). A total of 80 patients developed a solid second malignant neoplasm (SMN), among whom 13 developed a colorectal cancer. The risk of colorectal cancer was found to be related to the total activity of 131I administered 5 years or more before its diagnosis (excess relative risk = 0.5 per GBq, P= 0,02). These findings were probably caused by the accumulation of 131I in the colon lumen. Hence, in the absence of laxative treatment, the dose to the colon as a result of 131I administered for the treatment of thyroid cancer could be higher than expected from calculation of the international Commission on Radiological Protection (ICRP). When digestive tract cancers were excluded, the overall excess relative risk of second cancer per estimated effective sievert received to the whole body was -0.2 (P = 0.6).