Current practice of radioiodine treatment in the management of differentiated thyroid cancer in Germany

Hoelzer, Simon; Steiner, Dagmar; Bauer, Richard; Reiners, Christoph; Farahati, Jamshid; Hundahl, Scott A.; Dudeck, Joachim

doi:10.1007/s002590000333

Cited by 24 publications

(20 citation statements)

References 12 publications

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“…None of these series included patients prepared with rhTSH stimulation. Similar to our study, a dose-response relationship was seen in 2 of the studies (11,23), demonstrating an increased risk of SSEs at administered activities greater than 11,100 MBq (300 mCi). The slightly higher incidence of side effects in our series is likely related to improved documentation associated with the standardized data collection forms completed by a trained thyroid cancer nurse or clinicians with an interest in potential RRA side effects.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Salivary Gland Side Effects Commonly Develop Several Weeks After Initial Radioactive Iodine Ablation

Grewal¹,

Larson²,

Pentlow³

et al. 2009

J Nucl Med

121

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Salivary gland side effects (SSEs) can be a source of significant morbidity in thyroid cancer patients receiving radioactive iodine (RAI) for remnant ablation or therapy. However, the incidence, time course, and ultimate resolution of SSEs that develop in the first few months after a single administered activity of RAI for remnant ablation has not be adequately defined. Methods: We retrospectively reviewed the clinical records of patients after RAI remnant ablation (RRA) to determine the incidence of salivary gland-related side effects reported within the first year of RRA, the dose-response relationship between administered activity and specific SSEs, and the incidence of specific SSEs based on the method of preparation for remnant ablation (recombinant human thyroid-stimulating hormone [rhTSH] vs. traditional thyroid hormone withdrawal [THW]). Results: SSEs were reported within the first year of RAI ablation in 39% of a cohort of 262 patients (66% women, 93% papillary thyroid cancer; median dose, 5,217 MBq [141 mCi]). Persistent side effects were noted after a median of 7 y in 5% or less of the entire cohort. However, when side effects developed in patients during the first year, the incidence of persistence of the symptom at last follow-up ranged from 5% to 13%. A statistically significant dose response was seen between administered activity of RAI and development of salivary gland swelling (P 5 0.001, logistic dose-response curve) but not with dry mouth (P 5 0.63), altered taste (P 5 0.27), or salivary gland pain (P 5 0.152). SSEs developed in 14% of patients receiving administered activities of 1,110 MBq (30 mCi); administered activities of 2,775 MBq (75 mCi) or more were associated with symptoms in 40% of patients (P 5 0.046). Despite receiving a statistically higher administered activity (5,661 6 2,997 MBq [153 6 81 mCi] for THW vs. 4,958 6 2,294 MBq [134 6 62 mCi] for rhTSH), THW was associated with a lower rate of salivary gland swelling than the rhTSH preparation (20% vs. 10%; P 5 0.017), without differences in the development of dry mouth, altered taste, or salivary gland pain. Conclusion: Although SSEs occurred in 39% of patients after routine RRA, they were usually transient, so that the overall incidence of persistent side effects at a median follow-up of 7 y was only 5%. Even though the risk for persistent side effects is rather small, these data do emphasize the need to select patients carefully for RRA who are thought to be at moderate to high risk for recurrence and to use the minimally effective dose of RAI activity, in an attempt to maximize the potential benefit while minimizing the risk for adverse events for an individual patient.

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Section: Discussionsupporting

confidence: 89%

“…Only 4 studies (Table 3) (11,12,22,23) that would be comparable to our series have examined long-term SSEs with single-dose RAI. These studies have reported salivary gland toxicity rates in the range of 6.7%233% in patients prepared with traditional THW.…”

Section: Discussionmentioning

confidence: 98%

Salivary Gland Side Effects Commonly Develop Several Weeks After Initial Radioactive Iodine Ablation

Grewal¹,

Larson²,

Pentlow³

et al. 2009

J Nucl Med

121

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“…Several previous studies reported a higher number of cumulative treatments were associated with increased risk of salivary gland side effects from 131 I therapy [8,19,24,25,31]. In single-dose radioiodine therapy, the risk of persistent salivary gland side effects is increased at administered doses of more than 11,100 MBq (300 mCi) [32,33]. .…”

Section: Early and Late Sialadenitismentioning

confidence: 99%

“…Normal technetium-99m pertechnetate uptake is shown in both parotid and submandibular glands and normal clearance of accumulated technetium-99m pertechnetate Persistent salivary gland side effects developed in a few patients with ablation doses of radioiodine. Acute salivary gland side effects developed in 6.9-33% of patients with single dose 131 I ablation [32][33][34][35]. They demonstrated a dose-response relationship between administered amount of radioiodine and salivary gland side effects.…”

Section: Early and Late Sialadenitismentioning

confidence: 99%

RETRACTED ARTICLE: Radiation Sialadenitis Induced by High-dose Radioactive Iodine Therapy

Jeong

Lee

2010

Nucl Med Mol Imaging

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Radioactive iodine ((131)I) is accumulated in the thyroid tissue and plays an important role in the treatment of differentiated papillary and follicular cancers after thyroidectomy. Simultaneously, (131)I is concentrated in the salivary glands and secreted into the saliva. Dose-related damage to the salivary parenchyma results from the (131)I irradiation. Salivary gland swelling and pain, usually involving the parotid, can be seen. The symptoms may develop immediately after a therapeutic dose of (131)I and/or months later and progress in intensity with time. In conjunction with the radiation sialadenitis, secondary complications reported include xerostomia, taste alterations, infection, increases in caries, facial nerve involvement, candidiasis, and neoplasia. Prevention of (131)I sialadenitis may involve the use of sialogogic agents to hasten the transit time of the radioactive iodine through the salivary glands. However, studies are not available to delineate the efficacy of this approach. Treatment of the varied complications that may develop encompass numerous approaches and include gland massage, sialogogic agents, duct probing, antibiotics, mouthwashes, good oral hygiene, and adequate hydration. Recently interventional sialoendoscopy has been introduced an effective tool for the management of patients with (131)I-induced sialadenitis that is unresponsive to medical treatment.

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“…In European countries, 2.6% of patients in a Greek center (Tzavara et al 1999) employed EXT. In a German study of 2376 patients with differentiated thyroid cancer (DTC), 12% (19/162) of patients with advanced stage PTC (T1-3N1M0, American Joint Committee on Cancer (AJCC) 5th edition) received EXT (Hoelzer et al 2000).…”

Section: Introductionmentioning

confidence: 99%

Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition

Chow

Yau²,

Kwan

et al. 2006

Endocr Relat Cancer

130

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To identify indications for external radiotherapy (EXT) and radioactive iodine (RAI) in papillary thyroid carcinoma (PTC), we conducted a retrospective study of local and regional control in 1297 patients diagnosed with PTC in a tertiary referral center. Managed by surgery alone, patients with bilateral thyroidectomy had a lower rate of local relapse compared with lobectomy (PZ0.02). EXT improved locoregional (LR) failure-free survival (FFS) (P!0.001) and survival (PZ0.01) in patients with gross postoperative LR residual disease. EXT also improved local FFS in patients with pathologically confirmed positive resection margins (P!0.001) and reduced local failures in patients with T4 disease (PZ0.002). In patients with lymph nodes (LN) metastasis, more extensive surgery by functional or radical neck dissection resulted in less LN relapse compared with excision alone (P!0.001). EXT improved 10-year LN FFS in patients with N1b disease (PZ0.005) and patients with LN metastasis of size O2 cm (PZ0.02). RAI was effective in improving local control in patients with T2 to T4 diseases and LN control in patients with N0, N1a, and N1b categories. Local or LN relapses were associated with worse survival (P!0.001 and P!0.0001). The survival of patients with PTC could be improved by reducing local or LN relapses. RAI is indicated in patients with T2 to T4 disease. EXT is indicated in patients with gross postoperative disease, positive resection margins or T4 disease, N1b, or a LN size of O2 cm. LN relapse can be reduced by RAI in N0, N1a, and N1b disease.

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Current practice of radioiodine treatment in the management of differentiated thyroid cancer in Germany

Cited by 24 publications

References 12 publications

Salivary Gland Side Effects Commonly Develop Several Weeks After Initial Radioactive Iodine Ablation

Salivary Gland Side Effects Commonly Develop Several Weeks After Initial Radioactive Iodine Ablation

RETRACTED ARTICLE: Radiation Sialadenitis Induced by High-dose Radioactive Iodine Therapy

Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition

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