Bohuslavizki K H, Klutmann S, Jenicke L, Kröger S, Buchert R, Mester J, Clausen M
Department of Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany.
Cancer Biother Radiopharm. 1999 Oct;14(5):337-47. doi: 10.1089/cbr.1999.14.337.
Since differentiated thyroid cancer has an excellent prognosis, reduction of long-term side effects of high-dose radioiodine treatment (HD-RIT), i.e. salivary gland impairment is important. Thus, radioprotective effects of amifostine were studied. Salivary gland function was quantified by scintigraphy both in rabbits and patients. Fifteen rabbits were studied prior to and up to 6 months after HD-RIT applying 2 GBq 131I. Ten animals received 200 mg/kg amifostine prior to HD-RIT, and five served as controls. Animals were examined histopathologically. Fifty patients with differentiated thyroid cancer were evaluated prospectively prior to and 3 months after HD-RIT with either 3 or 6 GBq 131I in a double-blind, placebo-controlled study. Twenty-five patients were treated with 500 mg/m2 amifostine intravenously prior to HD-RIT, and 25 patients receiving physiological saline solution served as controls. Complete ablation of the thyroid was achieved in all rabbits four weeks after HD-RIT. In control rabbits 6 months after HD-RIT parenchymal function was reduced significantly (p < 0.0001) by 75.3 +/- 5.3% and 53.6 +/- 17.4% in parotid and submandibular glands, respectively. In contrast, in amifostine-treated rabbits parenchymal function was not significantly reduced. Histopathologically, marked lipomatosis was observed in control animals but was negligible in amifostine-treated animals. In control patients, salivary gland function was significantly (p < 0.001) reduced by 40.2 +/- 14.1% and 39.9 +/- 15.3% in parotid and submandibular glands, respectively, three months after HD-RIT, and 11 patients developed xerostomia. In 25 amifostine-treated patients, salivary gland function was not significantly reduced (p = 0.691), and xerostomia did not occur. Thus, parenchymal damage in salivary glands induced by high-dose radioiodine therapy can be reduced significantly by amifostine. This may improve quality of life of patients with differentiated thyroid cancer.
由于分化型甲状腺癌预后良好，减少高剂量放射性碘治疗（HD-RIT）的长期副作用，即唾液腺损伤至关重要。因此，对氨磷汀的辐射防护作用进行了研究。通过闪烁扫描法对兔和患者的唾液腺功能进行了量化。对15只兔在给予2GBq 131I进行HD-RIT之前及之后长达6个月进行了研究。10只动物在HD-RIT之前接受200mg/kg氨磷汀，5只作为对照。对动物进行了组织病理学检查。在一项双盲、安慰剂对照研究中，对50例分化型甲状腺癌患者在给予3或6GBq 131I进行HD-RIT之前及之后3个月进行了前瞻性评估。25例患者在HD-RIT之前静脉注射500mg/m2氨磷汀，25例接受生理盐水溶液的患者作为对照。HD-RIT四周后所有兔的甲状腺均实现完全消融。HD-RIT后6个月，对照兔腮腺和颌下腺的实质功能分别显著降低（p<0.0001）75.3±5.3%和53.6±17.4%。相比之下，氨磷汀治疗的兔实质功能未显著降低。组织病理学上，对照动物中观察到明显的脂肪化生，但在氨磷汀治疗的动物中可忽略不计。在对照患者中，HD-RIT后3个月腮腺和颌下腺的唾液腺功能分别显著降低（p<0.001）40.2±14.1%和39.9±15.3%，11例患者出现口干。在25例氨磷汀治疗的患者中，唾液腺功能未显著降低（p=0.691），且未出现口干。因此，氨磷汀可显著减少高剂量放射性碘治疗诱导的唾液腺实质损伤。这可能改善分化型甲状腺癌患者的生活质量。
