Bohuslavizki K H, Klutmann S, Brenner W, Mester J, Henze E, Clausen M
Department of Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany.
J Clin Oncol. 1998 Nov;16(11):3542-9. doi: 10.1200/JCO.1998.16.11.3542.
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.
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.
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.
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.
唾液腺损伤是大剂量放射性碘治疗（HD-RIT）后一种公认的副作用。由于分化型甲状腺癌预后良好，减少长期副作用很重要。因此，研究了氨磷汀在HD-RIT中的作用。
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HD-RIT前及HD-RIT后3个月进行前瞻性定量唾液腺闪烁显像，评估实质功能。21例患者接受3GBq碘（¹³¹I），29例患者接受6GBq¹³¹I。25例患者在HD-RIT前静脉注射500mg/m²氨磷汀，25例患者作为对照，接受生理盐水。口干症根据世界卫生组织（WHO）标准分级。
25例对照患者在HD-RIT前，腮腺和颌下腺中高锝酸盐⁹⁹ᵐTc摄取率分别为0.45%±0.16%和0.42%±0.16%。HD-RIT后3个月，腮腺和颌下腺的实质功能分别显著（P <.001）降低40.2%±14.1%和39.9%±15.3%。9例对照患者出现I级口干，2例出现II级口干。在25例接受氨磷汀治疗的患者中，腮腺和颌下腺中高锝酸盐⁹⁹ᵐTc摄取率分别为0.46%±0.16%和0.43%±0.17%。HD-RIT后3个月，唾液腺实质功能无显著改变（P = 0.691），且这些患者均未出现口干症。
氨磷汀可显著降低HD-RIT所致唾液腺实质损伤，这可能改善分化型甲状腺癌患者的生活质量。
