Salivary gland protection by amifostine in high-dose radioiodine treatment: results of a double-blind placebo-controlled study.
OBJECTIVE
Salivary gland impairment is a well-recognized side effect following high-dose radioiodine treatment (HD-RIT). Since differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. Therefore, the effect of amifostine was studied in HD-RIT.


METHODS
Parenchymal function was assessed by quantitative salivary gland scintigraphy performed prospectively in 50 patients with differentiated thyroid cancer before and 3 months after HD-RIT with either 3 GBq iodine ((131)I) (n=21) or 6 GBq (131)I (n=29) in a double-blind, placebo-controlled study. Twenty-five patients were treated with 500 mg/m2 amifostine intravenously before HD-RIT and 25 patients served as controls, who received physiologic saline solution. Xerostomia was graded according to World Health Organization (WHO) criteria.


RESULTS
Before HD-RIT in 25 control patients, uptake of technetium-99m (99mTc)-pertechnetate was 0.45%+/-0.16% and 0.42%+/-0.16% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function was significantly (P < .001) reduced by 40.2%+/-14.1% and 39.9%+/-15.3% in parotid and submandibular glands, respectively. Nine control patients developed grade I and two grade II xerostomia. In 25 amifostine-treated patients, uptake of 99mTc-pertechnetate was 0.46%+/-0.16% and 0.43%+/-0.17% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function of salivary glands was not significantly altered (P=.691) and xerostomia did not occur in any of these patients.


CONCLUSIONS
Parenchymal damage in salivary glands caused by HD-RIT can significantly be reduced by amifostine, which may improve the quality of life of patients with differentiated thyroid cancer.
Bohuslavizki
K H
KH
Department of Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany. bohu@medsph2.uke.uni-hamburg.de
Klutmann
S
S
Brenner
W
W
Mester
J
J
Henze
E
E
Clausen
M
M
D018263:Adenocarcinoma, Follicular / Q000532:radiotherapy; D000328:Adult; D004999:Amifostine / Q000627:therapeutic use*; D002291:Carcinoma, Papillary / Q000532:radiotherapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects*; D008297:Male; D010919:Placebos; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D012469:Salivary Glands / Q000000981:diagnostic imaging / Q000528:radiation effects*; D013670:Sodium Pertechnetate Tc 99m / Q000378:metabolism; D013964:Thyroid Neoplasms / Q000532:radiotherapy
D007457:Iodine Radioisotopes; D010919:Placebos; D011837:Radiation-Protective Agents; D013670:Sodium Pertechnetate Tc 99m; D004999:Amifostine