Radioprotection of salivary glands by amifostine in high-dose radioiodine treatment. Results of a double-blinded, placebo-controlled study in patients with differentiated thyroid cancer.
OBJECTIVE
Parenchymal impairment of salivary glands following high-dose radioiodine treatment is a well-known side effect in general caused by free radicals. Therefore, the radioprotective effect of the radical scavenger amifostine was evaluated prospectively in patients receiving high-dose radioiodine treatment.


METHODS
Parenchymal function was assessed by quantitative salivary gland scintigraphy performed in 50 patients with differentiated thyroid cancer prior to and 3 months after high-dose radioiodine treatment with either 3 GBq 131I (n = 21) or 6 GBq 131I (n = 29) in a double-blinded, placebo-controlled study. Twenty-five patients treated with 500 mg/m2 amifostine intravenously prior to high-dose radioiodine treatment were compared to 25 control patients receiving physiological saline solution. Xerostomia was graded according to WHO-criteria.


RESULTS
In 25 control patients high-dose radioiodine treatment significantly (p < 0.001) reduced parenchymal function of parotid and submandibular glands by 40.2 +/- 14.1% and 39.9 +/- 15.3%, respectively. Nine out of these 25 patients developed Grade I and 2 Grade II xerostomia. In contrast, in 25 amifostine-treated patients there was no significant (p = 0.691) decrease in parenchymal function following high-dose radioiodine treatment, and xerostomia did not occur in any of them.


CONCLUSIONS
Parenchymal damage of salivary glands induced by high-dose radioiodine treatment can be significantly reduced by amifostine which may improve quality of life of patients with differentiated thyroid cancer.
Bohuslavizki
K H
KH
Department of Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany. bohu@uke.uni-hamburg.de
Klutmann
S
S
Brenner
W
W
Kröger
S
S
Buchert
R
R
Bleckmann
C
C
Mester
J
J
Henze
E
E
Clausen
M
M
D018263:Adenocarcinoma, Follicular / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004999:Amifostine / Q000494:pharmacology*; D002291:Carcinoma, Papillary / Q000532:radiotherapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000187:drug effects / Q000528:radiation effects; D010919:Placebos; D011446:Prospective Studies; D011837:Radiation-Protective Agents / Q000494:pharmacology*; D011877:Radionuclide Imaging; D011879:Radiotherapy Dosage; D012469:Salivary Glands / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000528:radiation effects*; D013363:Submandibular Gland / Q000187:drug effects / Q000528:radiation effects; D013964:Thyroid Neoplasms / Q000532:radiotherapy*; D013997:Time Factors; D014987:Xerostomia / Q000209:etiology / Q000517:prevention & control
D007457:Iodine Radioisotopes; D010919:Placebos; D011837:Radiation-Protective Agents; D004999:Amifostine