Keywords
Radiotherapy
Thyroid neoplasms
Sualadenitis
Xerostomia
How to Cite
Abstract
Aim: To carry out a retrospective analysis of the frequency and severity of clinical signs of radioiodine (131I)-induced damage to the salivary glands in the early and long-term post-radiation periods, and identify risk factors for their occurrence in patients with differentiated thyroid carcinomas. Methods: A total of 330 patients underwent thyroidectomy with dissection of lymphatic nodes. One month after surgery, all the patients received radioiodine therapy. The dose and number of courses varied depending on the stage and morphological type of the tumor. In the late post-radiation period, the patients were surveyed with the use of a standard questionnaire, which allowed retrospective assessment of the nature and severity of symptoms of radiationinduced damage, as well as the time of their onset/subsidence. Results: Radiation-induced sialoadenitis of the salivary glands was observed in 51.2% of patients treated with 131I. The main symptoms included pain and discomfort in the salivary glands (51.2% of patients), swelling (48.8%), transient or permanent dry mouth (38%), and distortion of taste (38%). There were statistically significant correlations between the presence and severity of the main clinical symptoms of salivary gland irradiation. A significant relationship (r = 0.91, p < 0.001) was found between swelling of the salivary glands and the feeling of pain or discomfort, which was indicative of inflammation and retention of saliva. Conclusion: The main factors influencing the formation of chronic radiation-induced sialoadenitis and the severity of the inflammatory process included the tumor stage, the total dose of radiopharmaceuticals, and the duration following radioiodine therapy.
References
Seib CD, Sosa JA. Evolving understanding of the epidemiology of thyroid cancer. Endocrinol Metab Clin North Am. 2019 Mar;48(1):23-35. doi: 10.1016/j.ecl.2018.10.002.
Paulson VA, Rudzinski ER, Hawkins DS. Thyroid cancer in the pediatric population. Genes (Basel). 2019 Sep;10(9):723. doi: 10.3390/genes10090723.
Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on fundamental mechanisms of thyroid cancer. Front Endocrinol (Lausanne). 2020 Mar;11:102. doi: 10.3389/fendo.2020.00102.
Bogdanova TI, Saenko VA, Hashimoto Y, Hirokawa M, Zurnadzhy LY, Hayashi T, et al. Papillary thyroid carcinoma in ukraine after chernobyl and in Japan after Fukushima: different histopathological scenarios. Thyroid. 2021 Sep;31(9):1322-34. doi: 10.1089/thy.2020.0308.
Links TP, van Tol KM, Jager PL, Plukker JT, Piers DA, Boezen HM, et al. Life expectancy in differentiated thyroid cancer: a novel approach to survival analysis. Endocr Relat Cancer. 2005 Jun;12(2):273-80. doi: 10.1677/erc.1.00892.
Song X, Meng Z, Jia Q, Zhang L, Xu K, Tan J, et al. Different radioiodine dose for remnant thyroid ablation in patients with differentiated thyroid cancer: a meta-analysis. Clin Nucl Med. 2015 Oct;40(10):774-9. doi: 10.1097/RLU.0000000000000914.
Simões Lima GA, López RVM, de Freitas RMC, Willegaignon J, Sapienza MT, Chammas MC, et al. Evaluation of parotid salivary gland echo texture by ultrasound examinations and correlation with whole-body scintigraphy after radioiodine therapy in patients with differentiated thyroid carcinoma. J Ultrasound Med. 2020 Sep;39(9):1811-8. doi: 10.1002/jum.15289.
Van Nostrand D. Sialoadenitis secondary to ¹³¹I therapy for well-differentiated thyroid cancer. Oral Dis. 2011 Mar;17(2):154-61. doi: 10.1111/j.1601-0825.2010.01726.x.
Jeong SY, Kim HW, Lee SW, Ahn BC, Lee J. Salivary gland function 5 years after radioactive iodine ablation in patients with differentiated thyroid cancer: direct comparison of pre- and postablation scintigraphies and their relation to xerostomia symptoms. Thyroid. 2013 May;23(5):609-16. doi: 10.1089/thy.2012.0106.
Clement SC, Peeters RP, Ronckers CM, Links TP, van den Heuvel-Eibrink MM, Nieveen van Dijkum EJ, et al. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma--a systematic review. Cancer Treat Rev. 2015 Dec;41(10):925-34. doi: 10.1016/j.ctrv.2015.09.001.
Hoelzer S, Steiner D, Bauer R, Reiners C, Farahati J, Hundahl SA, et al. Current practice of radioiodine treatment in the management of differentiated thyroid cancer in Germany. Eur J Nucl Med. 2000 Oct;27(10):1465-72. doi: 10.1007/s002590000333.
Hyer S, Kong A, Pratt B, Harmer C. Salivary gland toxicity after radioiodine therapy for thyroid cancer. Clin Oncol (R Coll Radiol). 2007 Feb;19(1):83-6. doi: 10.1016/j.clon.2006.11.005.
Allweiss P, Braunstein GD, Katz A, Waxman A. Sialadenitis following I-131 therapy for thyroid carcinoma: concise communication. J Nucl Med. 1984 Jul;25(7):755-8.
Alexander C, Bader JB, Schaefer A, Finke C, Kirsch CM. Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma. J Nucl Med. 1998 Sep;39(9):1551-4.
Grewal RK, Larson SM, Pentlow CE, Pentlow KS, Gonen M, Qualey R, et al. Salivary gland side effects commonly develop several weeks after initial radioactive iodine ablation. J Nucl Med. 2009 Oct;50(10):1605-10. doi: 10.2967/jnumed.108.061382.
Caglar M, Tuncel M, Alpar R. Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer after radioiodine treatment. Clin Nucl Med. 2002 Nov;27(11):767-71. doi: 10.1097/00003072-200211000-00003.
Ciarallo A, Rivera J. radioactive iodine therapy in differentiated thyroid cancer: 2020 update. AJR Am J Roentgenol. 2020 Aug;215(2):285-91. doi: 10.2214/AJR.19.22626.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013 Mar;48(3):452-8. doi: 10.1038/bmt.2012.244.
Hurianov VH, Liakh YE, Parii VD, Korotkyi OV, Chalyi OV, Chalyi KO, et al. [Handbook of biostatistics. Analysis of the results of medical research in the EZR package (R – statistics)]. Кyiv Vistka; 2018. 208 p. Ukrainian.
Cohen B, Logothetopoulos JH, Myant NB. Autoradiographic localization of iodine-131 in the salivary glands of the hamster. Nature. 1955 Dec;176(4496):1268-9. doi: 10.1038/1761268a0.
Klein Hesselink EN, Brouwers AH, de Jong JR, van der Horst-Schrivers AN, Coppes RP, Lefrandt JD, et al. Effects of radioiodine treatment on salivary gland function in patients with differentiated thyroid carcinoma: a prospective study. J Nucl Med. 2016 Nov;57(11):1685-91. doi: 10.2967/jnumed.115.169888.
Walter MA, Turtschi CP, Schindler C, Minnig P, Müller-Brand J, Müller B. The dental safety profile of high-dose radioiodine therapy for thyroid cancer: long-term results of a longitudinal cohort study. J Nucl Med. 2007 Oct;48(10):1620-5. doi: 10.2967/jnumed.107.042192.
Venencia CD, Germanier AG, Bustos SR, Giovannini AA, Wyse EP. Hospital discharge of patients with thyroid carcinoma treated with 131I. J Nucl Med. 2002 Jan;43(1):61-5.
Badam RK, Suram J, Babu DB, Waghray S, Marshal R, Bontha SC, et al. Assessment of salivary gland function using salivary scintigraphy in pre and post radioactive iodine therapy in diagnosed thyroid carcinoma patients. J Clin Diagn Res. 2016 Jan;10(1):ZC60-2. doi: 10.7860/JCDR/2016/16091.7121.
Maier H. [Sialadenitis and sialolithiasis]. HNO. 2010 Mar;58(3):198-9. German. doi:10.1007/s00106-009-2073-2.
Adramerinas M, Andreadis D, Vahtsevanos K, Poulopoulos A, Pazaitou-Panayiotou K. Sialadenitis as a complication of radioiodine therapy in patients with thyroid cancer: where do we stand? Hormones (Athens). 2021 Dec;20(4):669-78. doi: 10.1007/s42000-021-00304-3.
Solans R, Bosch JA, Galofré P, Porta F, Roselló J, Selva-O'Callagan A, et al. Salivary and lacrimal gland dysfunction (sicca syndrome) after radioiodine therapy. J Nucl Med. 2001 May;42(5):738-43.
Malpani BL, Samuel AM, Ray S. Quantification of salivary gland function in thyroid cancer patients treated with radioiodine. Int J Radiat Oncol Biol Phys. 1996 Jun;35(3):535-40. doi: 10.1016/s0360-3016(96)80016-2.
Edmonds CJ, Smith T. The long-term hazards of the treatment of thyroid cancer with radioiodine. Br J Radiol. 1986 Jan;59(697):45-51. doi: 10.1259/0007-1285-59-697-45.
Nakada K, Ishibashi T, Takei T, Hirata K, Shinohara K, Katoh S, et al. Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med. 2005 Feb;46(2):261-6.
Stephens LC, Schultheiss TE, Price RE, Ang KK, Peters LJ. Radiation apoptosis of serous acinar cells of salivary and lacrimal glands. Cancer. 1991 Mar;67(6):1539-43. doi: 10.1002/1097-0142(19910315)67:6<1539::aid-cncr2820670613>3.0.co;2-q.
Dietlein M, Drzezga A. [Taste dysfunction (dysgeusia) and radioiodine therapy of thyroid cancer - be aware of side effects by antidepressants and sedatives. Vorschädigung durch Antidepressiva und Sedativa beachten]. Nuklearmedizin. 2017 Aug;56(4):125-31. German. doi: 10.3413/Nukmed-0906-17-06.
Mandel SJ, Mandel L. Radioactive iodine and the salivary glands. Thyroid. 2003 Mar;13(3):265-71. doi: 10.1089/105072503321582060.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Viktoriia Makarenko, Tetiana Pavlychuk, Andrii Kopchak
Downloads
