Ionizing radiation in diagnosis and treatment of thyroid cancer

The section devoted to topical issue - the diagnosis and treatment of thyroid cancer. Under the supervision were 385 patients aged from 10 to 75 years. Papillary cancer was observed significantly more often than other pathologic entities. Sometimes observed a combination of different pathological structures. A decisive role in the forecast played disease stage, and the degree of radical surgery in combination with timely and often by long-term application of ionizing radiation, primarily rentgenoterapii and J131
None of the patients who were in the I and II stages of thyroid cancer should not perish. The majority of patients were in stage III, live for many years. Many of them continue to work and normal activities. Of the few number of patients in stage IV, 18 years later one patient alive. Almost 70% of the scanning revealed some amount of thyroid tissue, nakaplivaya J131, although the surgery was considered radical. Obvious need for postoperative use of ionizing radiation (in particular, J131) for devitalisation of unremoved residual thyroid gland and impact on the disease. Protection of irradiated skin are provided the use of lead lattice, the construction of which was proposed by us. For effective treatment does not require a very large single or cumulative dose of J131 (single dose of 2-5 MK, total dose to the end of the year - 30-50 MK, for several years - 100-300 MK).
In the absence of metastases in the bones of a skeleton corresponding to the patients had fewer signs of aging than in healthy people of the same age.
Section designed for radiologists, radiologists and surgeons, illustrated 97 figures; bibliography - 218 names.

Table of contents
Chapter I. the Size and weight of a normal thyroid gland
Chapter II. Sex and age of the examined patients
Chapter III. Postmortem data and their clinical significance
Chapter IV. Some General data about patients with thyroid gland cancer
Chapter V. the Role of scanning in the diagnosis of thyroid cancer
Chapter VI. Stages of cancer of the thyroid gland, tumor localization and its features
Chapter VII. On the results of surgery for cancer of the thyroid gland and on the important role of other therapeutic measures
Chapter VIII. Metastasis of cancer of the thyroid gland
Chapter IX. Technical conditions applied by us exposures of patients with thyroid gland cancer
Chapter X. Palliative roentgen - and radiotherapy
Chapter XI. Combined treatment with the help of surgery, radiotherapy and J131
Chapter XII. The duration of observations and outcomes taking into account the stage of the disease
Chapter XIII. About metastatic thyroid cancer in the bones
Chapter XIV. About the state of the skeleton, not metastases in patients with thyroid gland cancer
Conclusion
Literature


Thyroid cancer usually occurs unnoticed by the patient, and quite a long time does not cause feelings of anxiety. Women get significantly more often than men. These ratios are retained even in those relatively rare cases when thyroid cancer is found in adolescents and children. Distinct symptoms and life-threatening aggressiveness of tumors are often found only several years after the initial symptoms of the disease. However, this tumor without being promptly detected and cured not only grows in the adjacent tissue, but often affects remote areas and vital organs, causing depletion, severe suffering and death.
This disease is rarely found in children and adolescents. It rarely occurs in old age. The main group of our patients at the time of detection of the disease was in the age of from 30 to 70 years.
Patients (especially with pronounced changes) are deprived of the opportunity to work normally. Several years later, and often before they die, if they are not provided timely qualified aid.
Thus, in the presence of thyroid cancer humanity often loses people with life experience, valuable skills and knowledge.
Within three quarters of a century since the discovery of x-rays and radioactivity, medicine, using different types of ionizing
radiation, provided unthinkable before the diagnostic accuracy of a huge number of diseases. However, has been quite important new therapeutic opportunities in many diseases. This particularly applies to thyroid cancer.
In 1948 one of the largest of our oncologists N. N. Petrov, organizer and leader of the first in our country oncological Institute, wrote that already has all the conditions for timely and accurate diagnosis of thyroid cancer on the basis of the clinical, radiological and is generally used histopathological data. He also pointed out that already exist conditions for the implementation of effective remedial measures, what were the surgical treatment and radiotherapy. They could, however, to ensure a favorable outcome only in the early stages of this disease. Yet the detection accuracy of I and II stages of thyroid cancer at this time was not yet at the required level. She currently is not always easy.
Great importance was later acquired application J131 to recognize not only close, but remote clinically silent metastases, if they have built up an isotope of iodine. In these cases, electoral accumulation J131 he was also becoming a therapeutic agent, the effect of which can to some extent beneficial impact in places of its accumulation.
For several decades, surgery, and often radiotherapy and, especially, the use of both remedial measures, could provide with a rather high frequency of the desired positive results in the I and II stages of the disease. Often, however, the disease stage III mistakenly considered as referring to stage II, and sometimes even to the stage I and allegedly not required the use of radical medical event. Meanwhile, at present and in the early stages sufficient radicalism in the treatment of such patients. In III and especially in the fourth stages of thyroid cancer used therapeutic measures until recently, the vast majority of cases had only short-term effect, often lasting 1-2-3 years, only occasionally more.
As surgery and radiotherapy could only be applied to detected cancer centers and other affected areas remained without devitalizing impact, of course, that after a certain period of time, they showed their dangerous for health activity.
Until recently (before 1948-1949) were unaware that even partial preservation of the thyroid gland prevents the accumulation J131 in metastases, particularly remote. These metastases remained silent for investigating and posed a threat to the life of the patient. Only the complete removal of the thyroid gland, and in particular its normal tissue allows even in the III and IV stages with a specific and rather long-lasting impact on metastases, including those who previously did not show itself. These metastases cannot compete against accumulation J131 - preserved part of the thyroid gland. Therefore, it is necessary fully to remove or devitalizate.
The presence or absence of metastatic thyroid cancer in the lungs for a number of years was determined rentgenograficheskie or rentgenograficheskie. This was revealed only a fairly large metastases in the lungs. Meanwhile, it is necessary and at present, we can detect even point metastases.
Distant metastases present, as is known, threatening complication. They must previously possible to identify. If they accumulate J131, they clearly play stenogramma. Relevant studies can objectively evaluate the condition of the patient and to judge about the further dynamics of pathological changes under the influence of the applied treatment measures.
A patient suffering from thyroid cancer in the presence of widespread metastases, once, namely to use J131, were often subjected to x-ray therapy. However, when a large extent the defeat of the use of radiotherapy in doses suppress the activity of tumor masses, is not only risky, but even dangerous interference.
This use of radiotherapy is unacceptable in the extensive damage even one and the more both multiple lung metastases. However, if these metastases absorb J131, appropriate treatment is not only shown, but is the only surviving opportunities to some extent, and often helps the patient. If saved at least a small part of the thyroid gland, it will accumulate entered J131 and many metastases will remain without its effect.
In these cases, as with other more frequent manifestations of thyroid cancer in the III and IV stages, modern medicine has not yet healing means. This, however, does not detract from those relatively favourable results that can be achieved now.
The achievements of treatment thyroid cancer in III and especially in the fourth stage is evidenced by the existence of a considerable number of such patients with no formidable harbingers of death, not only in the next 1-2 3 years. We present evidence suggests that the majority of unresectable patients death can be postponed for many years.
However, we have to treat not only adults, old people suffering from thyroid cancer. A lot meets young people suffering from the disease, rarely they are teenagers and children. In these cases, the criteria of the effectiveness of therapeutic measures in the III and IV stages of the disease cannot serve 5 to 10 and even 15-year follow that we currently have. Continuing to observe and treat children and adolescents, we are still very reserved for future forecast.
It should be emphasized that surgical intervention is performed by qualified specialists in cancer of the thyroid gland in clinically stage II, the success of which was further confirmed by the state after 3 or even 5 years, and occasionally longer, yet not always the final conclusion. Some patients, after a certain time, had metastases. Sometimes such a sad outcomes were discovered in cases of clinically recognized stage I, confirmed histopathological in the study of the remote share, supposedly the only one affected. Therefore, currently in contact with us surgeons often after surgery for cancer of the thyroid gland in all stages, particularly in the second and even first, send to us the appropriate patients not only to confirm the success achieved. The operated patients are sent to us for a test diagnostic studies and to apply, if necessary, additional radiographically and radiologically feasible treatment.
Posing in the present monograph the results of our many years of activity on rendering of roentgen radiology services to the patients suffering from thyroid cancer in I, II, III and IV stages, we thought it necessary to present fairly in detail the relevant data obtained by well-known domestic and foreign specialists.
Within a quarter of a century we are in close friendly mutually enriching contact with the surgeons faculty of the Department of surgery at the first Leningrad medical Institute, in particular the provision of medical care in cancer sitemodel cancer. The longest this contact with the merit. activities. science Professor C. I. Kolesov, a great experience, extensive knowledge and high surgical skills which we need to emphasize. We appreciate also the long-standing relations with other highly skilled surgeons, head of Department and chair in a number of cities of our Union and we hope for further fruitful contacts.
With proper attention, we will treat the statements and instructions read this work, and we are grateful for the valuable guidance.

Ionising Radiation in the Diagnosis and Treatment of Thyroid Cancer. Rokhlin D. G. and V. P. Zadvornova, 1972
The book deals with an important question - diagnosis and treatment of the thyroid cancer 385 patients of the age from 10 to 75 years were under investigation. Papillary cancer was more common as compared to other pathological forms, a combination of different pathological structures being occasionally observed. The stage of the disease and the extent of surgical treatment with timely or long-term administration of ionising radiation, mainly with J131 played the decisive role in prognosis.
None of the patients in the 1st or 2d stage of the thyroid cancer have died. Most of the patients in the 3d stage of the disease live for many years, many of do their work and live a normal live. From a small number of the patients in the 4th stage of the only patient is alive after 18 years. Scanning revealed some thyroid tissue accumulating J131 in 70% of cases, although surgical treatment was considered to be complete. Post-operative ionising therapy (in particular with J131) for the devitalization of unremoved parts of the thyroid gland and for the treatment of metastases was quite evident. The radiated area of the skin was protected with a specially deviced lead lattice. The effective treatment does not require large single and total doses of J131 (a single dose - 2-5 µC, a total dose by the end of the year-30-50 µC, during several years - 100-300 µC).
When the are no metastases to the bones, the skeleton of such patients revealed less signs of aging, as compared to healthy persons of the same age.
The book may be of interest fo roentgenologists, radiologists, and surgeons. It has 97 illustrations, its bibliography contains 218 works.
THE BOOK HAS BEEN APPROVED AND RECOMMENDED FOR PUBLICATION BY THE EDITORIAL BOARD OF THE PRESIDIUM, USSR, ACADEMY OF MEDICAL SCIENCES