Journal of Clinical Oncology, Vol 16, 3542-3549, Copyright © 1998 by American Society of Clinical Oncology
Salivary gland protection by amifostine in high-dose radioiodine treatment: results of a double-blind placebo-controlled study
KH Bohuslavizki, S Klutmann, W Brenner, J Mester, E Henze and M Clausen
Department of Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany. bohu@medsph2.uke.uni-hamburg.de
PURPOSE: 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.
PATIENTS AND 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.
CONCLUSION: 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.
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