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Salivary gland protection by amifostine in high-dose radioiodine therapy of differentiated thyroid cancer

Spelcheldrüsenschutz durch Amifostin bei hochdosierter Radiojodtherapie des differenzierten Schilddrüsenkarzinoms

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Abstract

Background

Salivary gland impairment following high-dose radioiodine treatment is a well-recognized side effect, in general caused by free radicals. Therefore, it seemed promising to evaluate the radioprotective effect of the radical scavenger amifostine in patients receiving high-dose radioiodine therapy.

Patients and Method

Quantitative salivary gland scintigraphy using 100 to 120 MBq Tc-99m-pertechnetate was performed in 17 patients with differentiated thyroid cancer prior to and 3 months after radioiodine treatment with 6 GBq 1–131. Eight patients were treated with 500 mg/m2 amifostine prior to high-dose radioiodine treatment and compared retrospectiveley with 9 control patients. Xerostomia was graded according to WHO criteria.

Results

In 9 control patients high-dose radioiodine treatment significantly (p < 0.01) reduced Tc-99m-pertechnetate uptake by 35.4 ±22.0% and 31.7 ±21.1% in parotid and submandibular glands, respectively. Of these 9 patients, 3 exhibited xerostomia Grade I (WHO). In contrast, in 8 amifostine-treated patients, there was no significant (p = 0.878) decrease in parenchymal function following high-dose radioiodine treatment, and xerostomia did not occur in any of them.

Conclusion

Parenchymal damage in salivary glands induced by high-dose radioiodine treatment can be reduced significantly by amifostine. This may help to increase patients’ quality of life in differentiated thyroid cancer.

Zusammenfassung

Hintergrund

Eine SchÄdigung der Speicheldrüsen mit konsekutiver Xerostomie ist eine bekannte, durch freie Radikale verursachte Nebenwirkung der hochdosierten Radiojodtherapie bei Patienten mit differenziertem Schilddrüsenkarzinom. Daher wurde der Effekt des RadikalfÄngers Amifostin nach hochdosierter Radiojodtherapie geprüft.

Patienten und Methode

Im Rahmen eines Heilversuchs wurde eine limitierte Anzahl von Patienten untersucht. Vor und drei Monate nach Gabe von 6 GBq 1–131 wurde eine quantitative Speicheldrüsenszintigraphie mit 100 bis 120 MBq Tc-99m-Pertechnetat an 17 Patienten mit differenzierten Schilddrüsenkarzinomen durchgeführt. Acht Patienten erhielten vor Radiojodtherapie 500 mg/m2 Amifostin und wurden mit einer historischen Kontrollgruppe aus neun Patienten verglichen. Eine Xerostomie wurde nach WHO-Kriterien beurteilt.

Ergebnisse

Die Patienten der Kontrollgruppe wiesen sowohl für die Glandulae parotides als auch für die Glandulae submandibulares eine signifikante Verminderung der Tc-99m-Pertechnetat-Aufnahme um 35,4 ±22,0% bzw. 31,7 +21, 1% (Abbildungen 1 und 2, Tabellen 1 und 2) als Zeichen einer ParenchymschÄdigung auf. Bei drei dieser neun Patienten fand sich eine Xerostomie Grad I (WHO). Im Gegensatz dazu konnte bei den mit Amifostin behandelten Patienten keine signifikante Verminderung der Parenchymfunktion festgestellt werden (p = 0,878). Dementsprechend wies keiner dieser Patienten eine Xerostomie auf.

SchluΒfolgerung

Bei Patienten mit differenziertem Schilddrüsenkarzinom kann die durch hochdosierte Radiojodtherapie regelhaft verursachte ParenchymschÄdigung der Speicheldrüsen signifikant vermindert werden. Dies könnte die LebensqualitÄt dieser Patienten wesentlich verbessern.

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References

  1. Albrecht HH, Creutzig H. Funktionsszintigraphie der Speicheldrüsen nach hochdosierter Radiojodtherapie. Fortschi Röntgenstr 1976;125:546–51.

    Article  CAS  Google Scholar 

  2. Baum BJ. Principles of saliva secretion. Ann NY Acad Sei 1993;694: 17–23.

    Article  CAS  Google Scholar 

  3. Bohuslavizki KH, Brenner W, Lassmann S, et al. Die quantitative Sialo-szintigraphie —eine sinnvolle Untersuchung im Vorfeld und in der Nachsorge der Radiojodtherapie. Nuklearmedizin 1997;36:103–9.

    PubMed  CAS  Google Scholar 

  4. Bohuslavizki KH, Brenner W, Lassmann S, et al. Quantitative salivary gland scintigraphy in the diagnosis of parenchymal damage after treatment with radioiodine. Nucl Med Commun 1996;17:681–6.

    Article  PubMed  CAS  Google Scholar 

  5. Bohuslavizki KH, Brenner W, Tinnemeyer S, et al. Is quantitative salivary gland scintigraphy a mandatory examination prior to and after radioiodine therapy? Radiol Oncol 1997;31:5–12.

    Google Scholar 

  6. Bohuslavizki KH, Brenner W, Tinnemeyer S, et al. Quantitative salivary gland scintigraphy derived from 166 normals. Radiol Oncol 1995;29: 297–305.

    Google Scholar 

  7. Bohuslavizki KH, Brenner W, Wolf H, et al. Value of quantitative salivary gland scintigraphy in the early stage of Sjögren’s syndrome. Nucl Med Commun 1995;16:917–22.

    PubMed  CAS  Google Scholar 

  8. Helman J, Turne, RJ, Fox PC, et al. Tc-99m-pertechnetate uptake in parotid acinar cells by the Na+/K+/Cl--co-transport system. J Clin Invest 1987;79:1310–3.

    Article  PubMed  CAS  Google Scholar 

  9. McDonald S, Meyerowitz C, Smudzin T, et al. Preliminary results of a pilot study using WR-2721 before fractionated irradiation of the head and neck to reduce salivary gland dysfunction. Int J Radiat Oncol Biol Phys 1994;29:747–54.

    PubMed  CAS  Google Scholar 

  10. Menard TW, Izutsu KT, Ensign WY, et al. Radioprotection by WR-2721 of gamma-irradiated rat parotid gland:effect on gland weight and secretion at 8–10 days post irradiation. Int J Radiat Oncol Biol Phys 1984;10: 1555–9.

    PubMed  CAS  Google Scholar 

  11. Niibe H, Takahashi I, Mitsuhashi N, et al. An evaluation of the clinical usefulness of amifostine (YM-08310) radioprotective agent. A doubleblind placebo-controlled study. 1. Head and neck tumor. J Jap Soc Cancer Ther 1985;20:984–93.

    CAS  Google Scholar 

  12. Patt HM, Tyree EB, StrÄube RL, et al. Cystein protection against X irradiation. Science 1994;110:213–4.

    Article  Google Scholar 

  13. Phillips TL, Kane LJ, Utley JF. Radioprotection of tumor and normal tissues by thiophosphonate compounds. Cancer 1973;32:528–35.

    Article  PubMed  CAS  Google Scholar 

  14. Pratt NE, Sodicoff M, Liss J, et al. Radioprotection of the rat parotid gland by WR-2721 S-2-3 aminopropylaminoethyl phosphorothioate morphology at 60 days post irradiation. Int J Radiat Oncol Biol Phys 1980;6:431–6.

    PubMed  CAS  Google Scholar 

  15. Rasey JS, Grunbaum Z, Krohn KA, et al. Biodistribution of the radioprotective drug S-labeled 3-amino-2-hydroxypropyl phosphorothioate (WR-77913). Radiat Res 1986;102:130–7.

    Article  Google Scholar 

  16. Rasey JS, Krohn KA, Grunbaum Z, et al. Synthesis, biodistribution, and autoradiography of radiolabeled S-2-(3-methylaminopropylamino)-ethyl-phosphorothioic acid (WR-3689). Radiat Res 1986;106:366–79.

    Article  PubMed  CAS  Google Scholar 

  17. Rasey JS, Krohn KA, Menard TW, et al. Comparative biodistribution and radioprotection studies with three radioprotective drugs in mouse tumor. Int J Radiat Oncol Biol Phys 1986;12:1487–90.

    PubMed  CAS  Google Scholar 

  18. Rasey JS, Spence AM, Badger CC, et al. Specific protection of different normal tissues. Pharm Ther 1988;39:33–43.

    Article  CAS  Google Scholar 

  19. Reiners C, Eilles C, Eichner R, et al. Speicheldrüsen-Funktionsszintigraphie zur Verlaufskontrolle bei der Therapie des Schilddrüsen-Karzinoms mit Radiojod. Nuklearmediziner 1980;3:281–6.

    Google Scholar 

  20. Sachs L. Applied statistics —A handbook of techniques, 2nd edn. New York: Springer, 1984.

    Google Scholar 

  21. Sodicoff M, Conger AD, Pratt NE, et al. Radioprotection by WR-2721 against long-term chronic damage to the rat parotid gland. Radiat Res 1978;76:172–9.

    Article  PubMed  CAS  Google Scholar 

  22. Sodicoff M, Conger AD, Trepper P, et al. Short-term radioprotective effects of WR-2721 on the rat parotid glands. Radiat Res 1978;76:317–26.

    Article  Google Scholar 

  23. Spiegel W, Reiners C, Börner W. EinschrÄnkung der Speicheldrüsenfunktion nach hochdosierter Radiojodtherapie. Nuklearmediziner 1986;9: 159–66.

    Google Scholar 

  24. Takahashi I, Nagai T, Miyaishi K, et al. Clinical study of the radioprotective effects of amifostine (YM-08310, WR-2721) on chronic radiation injury. Int J Radiat Oncol Biol Phys 1986;12:935–8.

    PubMed  CAS  Google Scholar 

  25. Utley JF, Marlowe C, Waddell WJ. Distribution of 35 S-labeled WR-2721 in normal and malignant tissues of the mouse. Radiat Res 1976;68:284–91.

    Article  PubMed  CAS  Google Scholar 

  26. Utley JF, Phillips TL, Kane LJ. Protection of normal tissues by WR-2721 during fractionated irradiation. Int J Radiat Oncol Biol Phys 1976;1: 699–703.

    PubMed  CAS  Google Scholar 

  27. Utley JF, Quinn CA, White FC, et al. Protection of normal tissue against late radiation injury by WR-2721. Radiat Res 1981;85:408–15.

    Article  PubMed  CAS  Google Scholar 

  28. Washburn LC, Carlton JE, Hayes RL, et al. Distribution of WR-2721 in normal and malignant tissues of mice and rats bearing solid tumors: dependence on tumor type, drug dose and species. Radiat Res 1974;59:475–83.

    Article  PubMed  CAS  Google Scholar 

  29. Yuhas JM, Spellman JM, Culo F. The role of WR-2721 in radiotherapy and/or chemotherapy. Cancer Clin Trials 1980;3:211–16.

    PubMed  CAS  Google Scholar 

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Author notes

  1. Karl H. Bohuslavizki

    Present address: Department of Nuclear Medicine, University Hospital Eppendorf, Martinistra\e 52, D-20246, Hamburg

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Eppendorf, Martinistra\e 52, D-20246, Hamburg

    Susanne Klutmann, Christian Bleckmann, János Mester & Malte Clausen

  2. Clinic of Nuclear Medicine, Christian Albrechts University of Kiel, Germany

    Winfried Brenner, Stefan Lassmann & Eberhard Henze

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  1. Karl H. Bohuslavizki
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Bohuslavizki, K.H., Klutmann, S., Bleckmann, C. et al. Salivary gland protection by amifostine in high-dose radioiodine therapy of differentiated thyroid cancer. Strahlenther Onkol 175, 57–61 (1999). https://doi.org/10.1007/BF02753843

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  • DOI: https://doi.org/10.1007/BF02753843

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