Quality of life with well-differentiated thyroid cancer: treatment toxicities and their reduction.
BACKGROUND
Patients with well-differentiated thyroid cancer have a good prognosis but a significant chance for local recurrence. In the past, limited surgery with postoperative 131I only for extremely high-risk cases or recurrence was not uncommon. As more aggressive surgical and postoperative treatments appear to gain wider acceptance, toxicity and long-term morbidity become more important issues. Our goal is to present the experience of a single institution with emphasis on oral side effects related to 131I as well as acute and chronic symptoms related to this diagnosis and their impact on quality of life.


METHODS
Fifty-seven patients were followed for a median time of 19.3 months. All patients received therapeutic 131I (mean dose, 154.7 mCi) between January 1, 1996 and August 30, 2002.


RESULTS
Fifty-four patients (94.7%) were alive at the time of analysis. Sixteen (28.1%) required a second treatment: any sign of persistence resulted in retreatment. Complaints with 131I treatment included altered taste, 26.3%; acute xerostomia, 21.1%; and acute sialoadenitis, 15.8%. Chronic xerostomia occurred in 6 (35.3%) of all patients who received multiple treatments. The incidence of chronic xerostomia was reduced to 1 of 11 (9.1%) with amifostine pretreatment. Other chronic side effects associated with this disease included fatigue 54.4%, weight gain of more than 6 months duration 24.6%, with 12 (27.9%) of those under 60 experiencing an average gain of 2.3 kg from initial diagnosis.


CONCLUSIONS
Review of treatment-related symptoms prompted policies to reduce toxicity including amifostine pretreatment for 131I therapy and thyrotropin (synthetic TSH) use in place of iatrogenic hypothyroidism for thyroglobulin testing and scanning.
Mendoza
April
A
Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Shaffer
Brian
B
Karakla
Daniel
D
Mason
M Elizabeth
ME
Elkins
David
D
Goffman
Thomas E
TE
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004999:Amifostine / Q000627:therapeutic use; D002908:Chronic Disease; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011832:Radiation Injuries / Q000150:complications; D011837:Radiation-Protective Agents / Q000627:therapeutic use; D019233:Retreatment; D012793:Sialadenitis / Q000209:etiology; D013649:Taste / Q000528:radiation effects; D013964:Thyroid Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000532:radiotherapy*; D013972:Thyrotropin / Q000627:therapeutic use; D016896:Treatment Outcome; D015430:Weight Gain; D014987:Xerostomia / Q000209:etiology / Q000517:prevention & control
D007457:Iodine Radioisotopes; D011837:Radiation-Protective Agents; D013972:Thyrotropin; D004999:Amifostine