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131I treatment for thyroid cancer and the risk of developing salivary and lacrimal gland dysfunction and a second primary malignancy: a nationwide population-based cohort study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to determine the prevalence of salivary and lacrimal gland dysfunction and a second primary malignancy in patients from Taiwan with thyroid cancer after radioiodine therapy.

Methods

This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database from 2000 to 2011. A total of 1,834 thyroid cancer patients treated with 131I therapy and 1,834 controls (thyroid cancer without 131I therapy) selected by 1:1 matching on a propensity score were enrolled. The cumulative 131I dose in each patient was calculated. A Cox proportional hazards model was applied to estimate the effect of radiation from the 131I therapy on the risk of salivary and lacrimal gland impairment as well as second primary malignancies in terms of hazard ratios (HRs) and 95 % confidence intervals (CIs).

Results

In patients treated with 131I therapy and in controls, the incidence rates of salivary gland dysfunction were 6.76 and 1.01 per 10,000 person-years, respectively (HR 6.81, 95 % CI 0.74 – 55.3), the incidence rates of keratoconjunctivitis sicca (KCS) were 13.6 and 16.3 per 10,000 person-years, respectively (HR 0.84, 95 % CI 0.41 – 1.73), and the incidence rates of second primary malignancy were 76.7 and 62.4 per 10,000 person-years, respectively (HR 1.23, 95 % CI 0.88 – 1.72). The risk of salivary secretion impairment significantly increased with increasing administered doses (HR 14.3, 95 % CI 1.73 – 119.0). However, there was no increase in the incidence of KCS or secondary cancer in patients treated with higher doses.

Conclusion

131I therapy insignificantly increased the risk of salivary gland dysfunction and second primary malignancy. In patients with higher cumulative doses, an increase in the incidence of salivary gland dysfunction was observed. By contrast, we did not find an association between 131I treatment and KCS development.

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Acknowledgments

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW104-TDU-B-212-113002); China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM104010092); NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039 -006); Tseng-Lien Lin Foundation, Taichung, Taiwan; Taiwan Brain Disease Foundation, Taipei, Taiwan; Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and Health, and welfare surcharge of tobacco products, China Medical University Hospital Cancer Research Center of Excellence (MOHW104-TDU-B-212-124-002, Taiwan). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study.

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    Authors and Affiliations

    1. Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan

      Kuan-Yin Ko

    2. Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

      Chia-Hung Kao

    3. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

      Chia-Hung Kao

    4. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

      Cheng-Li Lin

    5. College of Medicine, China Medical University, Taichung, Taiwan

      Cheng-Li Lin

    6. Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan

      Wen-Sheng Huang

    7. Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan

      Ruoh-Fang Yen

    8. Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan

      Ruoh-Fang Yen

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    1. Kuan-Yin Ko
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    2. Chia-Hung Kao
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    Correspondence to Ruoh-Fang Yen.

    Additional information

    Kuan-Yin Ko and Chia-Hung Kao contributed equally to this work.

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    Ko, KY., Kao, CH., Lin, CL. et al. 131I treatment for thyroid cancer and the risk of developing salivary and lacrimal gland dysfunction and a second primary malignancy: a nationwide population-based cohort study. Eur J Nucl Med Mol Imaging 42, 1172–1178 (2015). https://doi.org/10.1007/s00259-015-3055-0

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    • DOI: https://doi.org/10.1007/s00259-015-3055-0

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