title: The influence of saliva flow stimulation on the absorbed radiation dose to the salivary glands during radioiodine therapy of thyroid cancer using 124I PET(/CT) imaging.
abstract: OBJECTIVE
  A serious side effect of high-activity radioiodine therapy in the treatment of differentiated thyroid cancer is radiogenic salivary gland damage. This damage may be diminished by lemon-juice-induced saliva flow immediately after 131I administration. The aim of this study was to assess the effect of chewing lemon slices on the absorbed (radiation) doses to the salivary glands.
  
  
  METHODS
  Ten patients received (pretherapy) 124I PET(/CT) dosimetry before their first radioiodine therapy. The patients underwent a series of six PET scans at 0.5, 1, 2, 4, 48 and ≥96 h and one PET/CT scan at 24 h after administration of 27 MBq 124I. Blood samples were also collected at about 2, 4, 24, 48, and 96 h. Contrary to the standard radioiodine therapy protocol, the patients were not stimulated with lemon juice. Specifically, the patients chewed no lemon slices during the pretherapy procedure and neither ate food nor drank fluids until after completion of the last PET scan on the first day. Organ absorbed doses per administered 131I activity (ODpAs) as well as gland and blood uptake curves were determined and compared with published data from a control patient group, i.e. stimulated per the standard radioiodine therapy protocol. The calculations for both groups used the same methodology.
  
  
  RESULTS
  A within-group comparison showed that the mean ODpA for the submandibular glands was not significantly different from that for the parotid glands. An intergroup comparison showed that the mean ODpA in the nonstimulation group averaged over both gland types was reduced by 28% compared to the mean ODpA in the stimulation group (p=0.01). Within each gland type, the mean ODpA reductions in the nonstimulation group were statistically significant for the parotid glands (p=0.03) but not for the submandibular glands (p=0.23). The observed ODpAs were higher in the stimulation group because of increased initial gland uptake rather than group differences in blood kinetics.
  
  
  CONCLUSIONS
  The 124I PET(/CT) salivary gland dosimetry indicated that lemon juice stimulation shortly after 131I administration in radioiodine therapy increases the absorbed doses to the salivary glands.
authors.affiliation: Klinik für Nuklearmedizin, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany. walter.jentzen@uni-duisburg-essen.de
authors.forename: Walter
authors.initials: W
authors.lastname: Jentzen
authors.forename: Dorothee
authors.initials: D
authors.lastname: Balschuweit
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitz
authors.forename: Lutz
authors.initials: L
authors.lastname: Freudenberg
authors.forename: Ernst
authors.initials: E
authors.lastname: Eising
authors.forename: Thomas
authors.initials: T
authors.lastname: Hilbel
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.forename: Alexander
authors.initials: A
authors.lastname: Stahl
mesh_terms: D000328:Adult; D000368:Aged; D002957:Citrus / Q000737:chemistry*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010936:Plant Extracts / Q000494:pharmacology*; D049268:Positron-Emission Tomography / Q000379:methods; D011829:Radiation Dosage; D012463:Saliva / Q000378:metabolism; D012469:Salivary Glands / Q000000981:diagnostic imaging / Q000378:metabolism*; D012472:Salivation / Q000187:drug effects*; D012796:Sialography; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D007457:Iodine Radioisotopes; D010936:Plant Extracts