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Kim JM, Choi ME, Kim SK, Kim JW, Kim YM, Choi JS. Keratinocyte Growth Factor-1 Protects Radioiodine-Induced Salivary Gland Dysfunction in Mice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6322. [PMID: 32878050 PMCID: PMC7503708 DOI: 10.3390/ijerph17176322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most patients with thyroid cancer suffer from salivary gland (SG) dysfunctions after radioiodine (RI) therapy. We investigated the effects of keratinocyte growth factor (KGF)-1 on RI-induced SG dysfunction in an animal model. METHODS Six C57BL/6 mice were assigned to each of the following groups: treatment naïve control group, RI group, and RI+KGF-1 group. Body and SG weights, salivary flow rates, salivary lag times and changes in 99mTc pertechnetate uptake and excretion were measured, and histologic changes were noted. Amylase activities and epidermal growth factor (EGF) concentrations in saliva were also measured. In addition, TUNEL assays were performed and apoptosis-related protein expressions were assessed. RESULTS RI-induced reductions in salivary flow rates and increases in salivary lag times observed in the RI group were not observed in RI+KGF-1 group. Mice in RI group had higher HIF1a levels than controls, but HIF1a levels in RI+KGF-1 group were similar to those in control group. Furthermore, mice in RI+KGF-1 group had more mucin stained acini and decreased periductal fibrosis than mice in RI group, and tissue remodeling of many salivary epithelial cells (AQP5) and endothelial cells (CD31) were observed in RI+KGF-1 group. Amylase activity and expression in saliva were greater in RI+KGF-1 group than in RI group, and fewer apoptotic cells were observed in RI+KGF-1 group. Furthermore, BCLxl (anti-apoptotic) expression was higher, and Bax (pro-apoptotic) expression was lower in RI+KGF-1 group than in RI group. CONCLUSIONS Local delivery of KGF-1 might prevent RI-induced SG damage by reducing apoptosis.
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Affiliation(s)
- Jeong Mi Kim
- Translational Research Center, Inha University, Incheon 22332, Korea; (J.M.K.); (M.E.C.); (J.W.K.); (Y.-M.K.)
- Inha Research Institute for Medical Sciences, Inha University College of Medicine, Incheon 22332, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon 22332, Korea
| | - Mi Eun Choi
- Translational Research Center, Inha University, Incheon 22332, Korea; (J.M.K.); (M.E.C.); (J.W.K.); (Y.-M.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon 22332, Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang 10408, Korea;
| | - Ji Won Kim
- Translational Research Center, Inha University, Incheon 22332, Korea; (J.M.K.); (M.E.C.); (J.W.K.); (Y.-M.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon 22332, Korea
| | - Young-Mo Kim
- Translational Research Center, Inha University, Incheon 22332, Korea; (J.M.K.); (M.E.C.); (J.W.K.); (Y.-M.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon 22332, Korea
| | - Jeong-Seok Choi
- Translational Research Center, Inha University, Incheon 22332, Korea; (J.M.K.); (M.E.C.); (J.W.K.); (Y.-M.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon 22332, Korea
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Haraj NE, El Aziz S, Chadli A. [Anxiety and depression in patients treated for differentiated thyroid microcarcinoma]. Pan Afr Med J 2020; 35:133. [PMID: 32655747 PMCID: PMC7335252 DOI: 10.11604/pamj.2020.35.133.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 02/14/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Le microcarcinome de la thyroïde est un cancer de bon pronostic mais qui peut avoir un retentissement sur la qualité de vie des patients. L'objectif de l'étude est d'évaluer la dépression et l'anxiété chez les patients suivis pour microcarcinome différencié de la thyroïde et de les comparer aux autres stades du cancer. Méthodes Étude transversale observationnelle menée entre octobre 2013 et février 2015. L'étude a inclus les patients adultes suivis pour carcinome différencié de la thyroïde. La dépression et l'anxiété ont été évaluées en utilisant deux échelles de qualité de vie, dont la traduction a été validée en arabe: le Hamilton anxiété et Hamilton dépression. Les patients ont été répartis en deux groupes, un groupe microcarcinome de la thyroïde et un groupe non microcarcinome. L'analyse des données faite par le logiciel SPSS. 16. Résultats L'étude a concerné 37 patients suivis pour un microcarcinome différencié de la thyroïde, et un groupe de comparaison de 87 patients suivis pour autres stades de cancer différencié de la thyroïde. La qualité de vie des patients dans le groupe avec microcarcinome de la thyroïde était meilleure par rapport aux autres stades de carcinome différencié de la thyroïde. La présence de microcarcinome de la thyroïde était associée significativement à une absence d'anxiété (p = 0,042), une tendance positive a été notée sur le Hamilton dépression (mais p non significatif). Conclusion La qualité de vie des patients dans le groupe avec microcarcinome de la thyroïde était meilleure par rapport aux autres stades de carcinome différencié de la thyroïde. Ceci pouvant être expliqué par la non agressivité du traitement (absence de traitement par l'iode, et objectif de TSH plus souple).
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Affiliation(s)
- Nassim Essabah Haraj
- Service d'Endocrinologie et de Maladies Métaboliques, CHU Ibn Rochd, Casablanca, Maroc.,Laboratoire de Neuroscience, Faculté de Médecine et de Pharmacie de Casablanca, Université Hassan II, Casablanca, Maroc
| | - Siham El Aziz
- Service d'Endocrinologie et de Maladies Métaboliques, CHU Ibn Rochd, Casablanca, Maroc.,Laboratoire de Neuroscience, Faculté de Médecine et de Pharmacie de Casablanca, Université Hassan II, Casablanca, Maroc
| | - Asma Chadli
- Service d'Endocrinologie et de Maladies Métaboliques, CHU Ibn Rochd, Casablanca, Maroc.,Laboratoire de Neuroscience, Faculté de Médecine et de Pharmacie de Casablanca, Université Hassan II, Casablanca, Maroc
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Kim JW, Kim JM, Choi ME, Kim SK, Kim YM, Choi JS. Adipose-derived mesenchymal stem cells regenerate radioiodine-induced salivary gland damage in a murine model. Sci Rep 2019; 9:15752. [PMID: 31673085 PMCID: PMC6823479 DOI: 10.1038/s41598-019-51775-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 10/08/2019] [Indexed: 02/08/2023] Open
Abstract
After radioiodine (RI) therapy, patients with thyroid cancer frequently suffer from painful salivary gland (SG) swelling, xerostomia, taste alterations, and oral infections. This study was aimed to determine whether adipose-derived mesenchymal stem cells (AdMSCs) might restore RI-induced SG dysfunction in a murine model. Forty -five mice were divided into three groups; a PBS sham group, a RI+ PBS sham group (0.01 mCi/g mouse, orally), and an RI+AdMSCs (1 × 105 cells/150 uL, intraglandular injection on experimental day 28) treated group. At 16 weeks after RI treatment, body weights, SG weight, salivary flow rates (SFRs), and salivary lag times were measured. Morphologic and histologic examinations and immunohistochemistry (IHC) were performed and the activities of amylase and EGF in saliva were also measured. Changes in salivary 99mTc pertechnetate excretion were followed by SPECT and TUNEL assays were performed. The body and SG weights were similar in the AdMSCs and sham groups. Hematoxylin and eosin staining revealed the AdMSCs group had more mucin-containing acini than the RI group. Furthermore, AdMSCs treatment resulted in tissue remodeling and elevated expressions of epithelial (AQP5) and endothelial (CD31) markers, and increased SFRs. The activities of amylase and EGF were higher in the AdMSCs group than in the RI treated group. 99mTc pertechnetate excretions were similar in the AdMSCs and sham group. Also, TUNEL positive apoptotic cell numbers were less in the AdMSCs group than in the RI group. Local delivery of AdMSCs might regenerate SG damage induced by RI.
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Affiliation(s)
- Ji Won Kim
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Jeong Mi Kim
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Mi Eun Choi
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Young-Mo Kim
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Jeong-Seok Choi
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea.
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Newkirk KA, Ringel MD, Wartofsky L, Burman KD. The Role of Radioactive Iodine in Salivary Gland Dysfunction. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130007900612] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kenneth A. Newkirk
- Department of Otolaryngology, Georgetown University Medical Center and Washington Hospital Center, Washington, D.C
| | - Matthew D. Ringel
- Section of Endocrinology, Department of Medicine, Medlantic Research Institute, Washington Hospital Center, Washington, D.C
| | - Leonard Wartofsky
- Section of Endocrinology, Department of Medicine, Medlantic Research Institute, Washington Hospital Center, Washington, D.C
| | - Kenneth D. Burman
- Department of Otolaryngology, Georgetown University Medical Center and Washington Hospital Center, Washington, D.C
- Section of Endocrinology, Department of Medicine, Medlantic Research Institute, Washington Hospital Center, Washington, D.C
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Zeng Q, Mandel L. Radioactive Iodine-Induced Hyposalivation: Case Report. J Oral Maxillofac Surg 2019; 77:1837-1840. [PMID: 31028734 DOI: 10.1016/j.joms.2019.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/19/2023]
Abstract
Radioactive iodine (131I) is used in the treatment of differentiated thyroid cancers. Collateral damage to the salivary glands (SGs) can be anticipated. Standard therapeutic doses of 131I often cause SG obstructive symptomatology and hyposalivation can develop with the higher 131I doses used for aggressive thyroid malignancies with or without metastases.
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Affiliation(s)
- Qingcong Zeng
- Research Assistant, Salivary Gland Center; Third-Year Student, Columbia University College of Dental Medicine, Salivary Gland Center, Columbia University College of Dental Medicine, New York, NY
| | - Louis Mandel
- Director, Salivary Gland Center; Associate Dean; Clinical Professor, Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, Salivary Gland Center, Columbia University College of Dental Medicine, New York, NY.
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Haraj NE, Bouri H, El Aziz S, Nani S, Habti N, Chadli A. Evaluation of the quality of life in patients followed for differentiated cancer of the thyroid. ANNALES D'ENDOCRINOLOGIE 2019; 80:26-31. [DOI: 10.1016/j.ando.2018.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/30/2017] [Accepted: 01/12/2018] [Indexed: 11/16/2022]
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Selvakumar T, Nies M, Klein Hesselink MS, Brouwers AH, van der Horst-Schrivers ANA, Klein Hesselink EN, Tissing WJE, Vissink A, Links TP, Bocca G, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Smit JWA, Plukker JTM, Ronckers CM, van Santen HM. Long-term effects of radioiodine treatment on salivary gland function in adult survivors of pediatric differentiated thyroid carcinoma. J Nucl Med 2018; 60:jnumed.118.212449. [PMID: 30504138 DOI: 10.2967/jnumed.118.212449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/18/2018] [Indexed: 01/17/2023] Open
Abstract
Pediatric differentiated thyroid cancer (DTC) is a rare disease. Initial treatment of DTC consists of a (near) total thyroidectomy and radioactive iodine (131I) therapy. Previous studies in adults showed that 131I treatment may result in a reduced salivary gland function. Studies regarding salivary gland function in children treated for DTC are sparse. Our aim was to assess long-term effects of 131I treatment on salivary gland function in survivors of pediatric DTC. Methods: In a nationwide cross-sectional study, salivary gland function of patients treated for pediatric DTC between 1970 and 2013 (>5 years after diagnosis, ≥18 years old at time of evaluation) was studied. Salivary gland function was assessed by sialometry, sialochemistry and a xerostomia inventory. Salivary gland dysfunction was defined as unstimulated whole saliva flow ≤0.2mL/min and/or a stimulated whole saliva flow ≤0.7 mL/min. Results: Sixty-five patients (median age at evaluation 33 [IQR, 25-40] years, 86.2% female, median follow-up period 11 [IQR, 6-22] years) underwent 131I treatment. Median cumulative 131I activity was 5.88 [IQR, 2.92-12.95] GBq, 47.7% underwent multiple 131I administrations. Salivary gland dysfunction was present in 30 (47.6%) patients. Levels of amylase and total protein in saliva were reduced. Moderate to severe xerostomia was present in 22 (35.5%) patients. Stimulated salivary secretion was lower and severity of xerostomia complaints higher in patients treated with higher cumulative 131I activity. Conclusion: In survivors of pediatric DTC, clinically significant salivary gland dysfunction was found in 35.5% and was related to the cumulative 131I activity of the treatment.
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Affiliation(s)
- Tharsana Selvakumar
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Marloes Nies
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | | | - Adrienne H Brouwers
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Netherlands
| | | | - Esther N Klein Hesselink
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Wim J E Tissing
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Arjan Vissink
- Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
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Saluja K, Butler RT, Pytynia KB, Zhao B, Karni RJ, Weber RS, El-Naggar AK. Mucoepidermoid carcinoma post−radioactive iodine treatment of papillary thyroid carcinoma: unique presentation and putative etiologic association. Hum Pathol 2017; 68:189-192. [DOI: 10.1016/j.humpath.2017.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/18/2017] [Accepted: 04/29/2017] [Indexed: 11/25/2022]
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Clinical Studies of Nonpharmacological Methods to Minimize Salivary Gland Damage after Radioiodine Therapy of Differentiated Thyroid Carcinoma: Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:6795076. [PMID: 27446226 PMCID: PMC4944032 DOI: 10.1155/2016/6795076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/23/2016] [Accepted: 06/05/2016] [Indexed: 11/24/2022]
Abstract
Purpose. To systematically review clinical studies examining the effectiveness of nonpharmacological methods to prevent/minimize salivary gland damage due to radioiodine treatment of differentiated thyroid carcinoma (DTC). Methods. Reports on relevant trials were identified by searching the PubMed, CINHAL, Cochrane, and Scopus electronic databases covering the period 01/2000–10/2015. Inclusion/exclusion criteria were prespecified. Search yielded eight studies that were reviewed by four of the present authors. Results. Nonpharmacological methods used in trials may reduce salivary gland damage induced by radioiodine. Sialogogues such as lemon candy, vitamin E, lemon juice, and lemon slice reduced such damage significantly (p < 0.0001, p < 0.05, p < 0.10, and p < 0.05, resp.). Parotid gland massage also reduced the salivary damage significantly (p < 0.001). Additionally, vitamin C had some limited effect (p = 0.37), whereas no effect was present in the case of chewing gum (p = 0.99). Conclusion. The review showed that, among nonpharmacological interventions, sialogogues and parotid gland massage had the greatest impact on reducing salivary damage induced by radioiodine therapy of DTC. However, the studies retrieved were limited in number, sample size, strength of evidence, and generalizability. More randomized controlled trials of these methods with multicenter scope and larger sample sizes will provide more systematic and reliable results allowing more definitive conclusions.
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Klein Hesselink EN, Brouwers AH, de Jong JR, van der Horst-Schrivers AN, Coppes RP, Lefrandt JD, Jager PL, Vissink A, Links TP. Effects of Radioiodine Treatment on Salivary Gland Function in Patients with Differentiated Thyroid Carcinoma: A Prospective Study. J Nucl Med 2016; 57:1685-1691. [DOI: 10.2967/jnumed.115.169888] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/17/2016] [Indexed: 01/04/2023] Open
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Noaparast Z, Hosseinimehr SJ. Radioprotective agents for the prevention of side effects induced by radioiodine-131 therapy. Future Oncol 2013; 9:1145-59. [DOI: 10.2217/fon.13.79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Radioiodine 131 (131I) has been used worldwide for the ablation of remnant thyroidal tissue after surgery or as the first-line treatment for Graves’ disease. Although the use of 131I is becoming increasingly prevalent, there is evidence suggesting that this treatment is associated with side effects such as salivary gland dysfunction and an increased risk of leukemia. This article aims to review the potential use of radioprotective agents and the side effects induced by 131I therapy. Several synthetic and natural compounds have been investigated in preclinical and clinical studies. The protective agents reduced the toxicity of 131I, mainly in the salivary glands, and mitigated the genetic damage through different mechanisms. There are limited clinical studies evaluating the use of radioprotective agents in patients undergoing radioiodine therapy. However, lemon candies, lemon juice and sugarless chewing gum have been proposed to be beneficial for minimizing the side effects of radioiodine within the salivary glands.
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Affiliation(s)
- Zohreh Noaparast
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Bonnema SJ, Hegedüs L. Radioiodine therapy in benign thyroid diseases: effects, side effects, and factors affecting therapeutic outcome. Endocr Rev 2012; 33:920-80. [PMID: 22961916 DOI: 10.1210/er.2012-1030] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Radioiodine ((131)I) therapy of benign thyroid diseases was introduced 70 yr ago, and the patients treated since then are probably numbered in the millions. Fifty to 90% of hyperthyroid patients are cured within 1 yr after (131)I therapy. With longer follow-up, permanent hypothyroidism seems inevitable in Graves' disease, whereas this risk is much lower when treating toxic nodular goiter. The side effect causing most concern is the potential induction of ophthalmopathy in predisposed individuals. The response to (131)I therapy is to some extent related to the radiation dose. However, calculation of an exact thyroid dose is error-prone due to imprecise measurement of the (131)I biokinetics, and the importance of internal dosimetric factors, such as the thyroid follicle size, is probably underestimated. Besides these obstacles, several potential confounders interfere with the efficacy of (131)I therapy, and they may even interact mutually and counteract each other. Numerous studies have evaluated the effect of (131)I therapy, but results have been conflicting due to differences in design, sample size, patient selection, and dose calculation. It seems clear that no single factor reliably predicts the outcome from (131)I therapy. The individual radiosensitivity, still poorly defined and impossible to quantify, may be a major determinant of the outcome from (131)I therapy. Above all, the impact of (131)I therapy relies on the iodine-concentrating ability of the thyroid gland. The thyroid (131)I uptake (or retention) can be stimulated in several ways, including dietary iodine restriction and use of lithium. In particular, recombinant human thyrotropin has gained interest because this compound significantly amplifies the effect of (131)I therapy in patients with nontoxic nodular goiter.
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Affiliation(s)
- Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark.
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Ma C, Xie J, Chen Q, Wang G, Zuo S. Amifostine for salivary glands in high-dose radioactive iodine treated differentiated thyroid cancer. Cochrane Database Syst Rev 2009; 2009:CD007956. [PMID: 19821441 PMCID: PMC6465044 DOI: 10.1002/14651858.cd007956.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Radioactive iodine treatment for differentiated thyroid cancer possibly results in xerostomia. Amifostine has been used to prevent the effects of irradiation to salivary glands. To date, the effects of amifostine on salivary glands in radioactive iodine treated differentiated thyroid cancer remain uncertain. OBJECTIVES To assess the effects of amifostine on salivary glands in high-dose radioactive iodine treated differentiated thyroid cancer. SEARCH STRATEGY Studies were obtained from computerized searches of MEDLINE, EMBASE, The Cochrane Library and paper collections of conferences held in Chinese. SELECTION CRITERIA Randomised controlled clinical trials and quasi-randomised controlled clinical trials comparing the effects of amifostine on salivary glands after radioactive iodine treatment for differentiated thyroid cancer with placebo and a duration of follow up of at least three months. DATA COLLECTION AND ANALYSIS Two authors independently assessed risk of bias and extracted data. MAIN RESULTS Two trials with 130 patients (67 and 63 patients randomised to intervention versus control) were included. Both studies had a low risk of bias. Amifostine versus placebo showed no statistically significant differences in the incidence of xerostomia (130 patients, two studies), the decrease of scintigraphically measured uptake of technetium-99m by salivary or submandibular glands at twelve months (80 patients, one study), and the reduction of blood pressure (130 patients, two studies). Two patients in one study collapsed after initiation of amifostine therapy and had to be treated by withdrawing the infusion and volume substitution. Both patients recovered without sequelae. Meta-analysis was not performed on the function of salivary glands measured by technetium-99m scintigraphy at three months after high dose radioactive iodine treatment due to the highly inconsistent findings across studies (I(2) statistic 99%). None of the included trials investigated death from any cause, morbidity, health-related quality of life or costs. AUTHORS' CONCLUSIONS Results from two randomised controlled clinical trials suggest that the amifostine has no significant radioprotective effects on salivary glands in high-dose radioactive iodine treated differentiated thyroid cancer patients. Moreover, no health-related quality of life and other patient-oriented outcomes were evaluated in the two included trials. Randomised controlled clinical trials with low risk of bias investigating patient-oriented outcomes are needed to guide treatment choice.
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Affiliation(s)
- Chao Ma
- Affiliated Hospital of Medical College Qingdao UniversityDepartment of Nuclear MedicineJiangsu Road 16QingdaoShandong ProvinceChina266003
| | - Jiawei Xie
- Affiliated HospitalStomatologyJiangsu Road 16QingdaoShandongChina266003
| | - Qingfeng Chen
- Affiliated HospitalSurgeryJiangsu Road 16QingdaoShandongChina266003
| | - Guoming Wang
- Affiliated HospitalNuclear MedicineJiangsu Road 16QingdaoShandongChina266003
| | - Shuyao Zuo
- Affiliated HospitalNuclear MedicineJiangsu Road 16QingdaoShandongChina266003
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Ma C, Xie J, Chen Q, Wang G, Zuo S. Amifostine for salivary glands in high-dose radioactive iodine treated differentiated thyroid cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007956] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Marchetti F, Coleman MA, Jones IM, Wyrobek AJ. Candidate protein biodosimeters of human exposure to ionizing radiation. Int J Radiat Biol 2009; 82:605-39. [PMID: 17050475 DOI: 10.1080/09553000600930103] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To conduct a literature review of candidate protein biomarkers for individual radiation biodosimetry of exposure to ionizing radiation. MATERIALS AND METHODS Reviewed approximately 300 publications (1973 - April 2006) that reported protein effects in mammalian systems after either in vivo or in vitro radiation exposure. RESULTS We found 261 radiation-responsive proteins including 173 human proteins. Most of the studies used high doses of ionizing radiation (>4 Gy) and had no information on dose- or time-responses. The majority of the proteins showed increased amounts or changes in phosphorylation states within 24 h after exposure (range: 1.5- to 10-fold). Of the 47 proteins that are responsive at doses of 1 Gy and below, 6 showed phosphorylation changes at doses below 10 cGy. Proteins were assigned to 9 groups based on consistency of response across species, dose- and time-response information and known role in the radiation damage response. CONCLUSIONS ATM (Ataxia telengiectasia mutated), H2AX (histone 2AX), CDKN1A (Cyclin-dependent kinase inhibitor 1A), and TP53 (tumor protein 53) are top candidate radiation protein biomarkers. Furthermore, we recommend a panel of protein biomarkers, each with different dose and time optima, to improve individual radiation biodosimetry for discriminating between low-, moderate-, and high-dose exposures. Our findings have applications for early triage and follow-up medical assessments.
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Affiliation(s)
- Francesco Marchetti
- Biosciences Directorate, Lawrence Livermore National Laboratory, Livermore, California, USA
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Abstract
Radioactive iodine ((131)I) targets the thyroid gland and has been proven to play an effective role in the treatment of differentiated papillary and follicular cancers. Simultaneously, this radioisotope hones in on the salivary glands where it is concentrated 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, stomatitis, candidiasis, and neoplasia. Prevention of the (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. Recently, amifostine has been advocated to prevent the effects of irradiation. 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.
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Affiliation(s)
- Susan J Mandel
- Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Medical School, Philadelphia, Pennsylvania 19104, USA.
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18
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Abstract
Radiation sialadenitis is a complication of I-131 therapy for thyroid cancer. They authors report a case of intense uptake by parotid glands in a diagnostic I-131 scan (2 mCi) in whom sialadenitis had developed previously after a 100-mCi dose of I-131. Similar examples of images could not be found in the literature.
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Affiliation(s)
- M R Carlisle
- Division of Nuclear Medicine, Stanford Health Services, California 94305-5281, USA
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