1. Characterization of Salivary Gland Side Effects Up to 7 Days After 131I Therapy:
Updated Report of the Thyroid Cancer Survivors’ Association, Inc. (ThyCa) National Survey
Hall JP1, Kharazi P1, Van Nostrand D1, Khorjekar G1, Brennan M2, McIver B 3, Mete M4,, Bloom G5
1
Washington Hospital Center, Division of Nuclear Medicine, 2Carolinas Med Center, 3Mayo Clinic,
4
MedStar Health Research Institute, 5ThyCa: Thyroid Cancer Survivors’ Association, Inc.
Abstract Introduction Graph 2:
Table 3
Duration of Salivary Pain
Day of Onset of Salivary Pain Table 4
Severity of Salivary Pain
Objectives: Sialoadenitis (SA) is an important side Sialoadenitis is an important side effect of 131I therapy for 50%
45%
362/789 Less than 30 min
30 min to <1 hr
25/770
25/770
3.2%
3.2%
effect of 131I therapy (tx) for differentiated thyroid differentiated thyroid cancer; however, its reported
1 to < 2 hrs 28/770 3.6%
Percentage of
40% Grades Grades Grades Grades Grades
35% 2 to < 3 hrs 17/770 2.2%
1-2 3-4 5-6 7-8 9-10
Patients
cancer (DTC); however, its reported frequency, frequency, severity, and time of onset are quite variable in 30%
25% 178/789
3 to < 4 hrs
4 to < 5 hrs
19/770
9/770
2.5%
1.2%
Frequency 83/904
(9.2%)
256/904
(28.2%)
332/904
(36.7%)
190/904
(21.0%)
43/904
(4.8%)
severity, and time of onset are quite variable in the the literature. The objective of this study was to create and 20%
15%
112/789
5 to < 6 hrs
6 to <12 hrs
9/770
20/770
1.2%
2.6%
literature. In this study, a nationwide survey was implement a nationwide survey to better characterize the 10%
5%
65/789
26/789 19/789
7/789 20/789
12 to < 18 hrs
18 to < 24 hrs
14/770
32/770
1.8%
4.2%
implemented to better characterize the above above parameters for sialoadenitis in patients with 0%
Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
24 to < 48 hrs
48 to < 72 hrs
123/770
109/770
16.0%
14.2%
Grade 0 Grade 2 Grade 4 Grade 6 Grade 8 Grade 10
parameters for SA in pts with DTC from the day of 131I differentiated thyroid cancer from the day of 131I therapy Day of Onset
Greater than 72 hrs 340/770 44.2%
tx until 7 d after 131I tx. until 7 days after 131I therapy.
Methods: A survey regarding the side effects of 131I tx
was e-mailed to ~15,000 associates of ThyCa and
Materials and Methods Graph 3:
Table 5
Duration of Salivary Swelling Table 6
Severity of Salivary Swelling
Day of Onset of Salivary Swelling
made available on its website. Responses of pts who A survey regarding the side effects of 131I therapy was e- 50% 323/689
Less than 30 min
30 min to <1 hr
4/677
13/677
0.6%
1.9%
had their most recent tx in US with DTC and at least mailed to the members and associates of the Thyroid
45%
40%
1 to < 2 hrs
2 to < 3 hrs
12/677
7/677
1.8%
1.0%
Grades
1-2
Grades
3-4
Grades
5-6
Grades
7-8
Grades
9-10
Percentage of
35% Frequency 56/769 176/769 268/769 189/769 80/769
one 131I tx were tabulated. The frequency, severity, Cancer Survivors’ Association, Inc. (ThyCa) and made 30% 3 to < 4 hrs 13/677 1.9% (7.3%) (22.9%) (34.9%) (24.6%) (10.4%)
Patients
25% 154/689 4 to < 5 hrs 3/677 0.4%
time of onset, and duration of SA in regards to publically available on its website. Responses of patients 20%
15% 92/689
5 to < 6 hrs
6 to <12 hrs
8/677
19/677
1.2%
2.8%
salivary gland pain, swelling, and xerostomia after the who had DTC, at least one outpatient 131I therapy, and their 10%
5%
56/689
15/689 19/689
6/689
24/689 12 to < 18 hrs 10/677 1.5%
18 to < 24 hrs 33/677 4.9%
patients’ most recent 131I tx are reported. most recent therapy in the United States or its territories
0%
Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 24 to < 48 hrs 117/677 17.3%
Grade 0 Grade 2 Grade 4 Grade 6 Grade 8 Grade 10
48 to < 72 hrs 122/677 18.0%
were tabulated. Only responses by the patients regarding Day of Onset Greater than 72 hrs 316/677 46.7%
Results: Of the 2811 total respondents, 2573 met the their most recent 131I therapy were included. The frequency,
above criteria. Pain (P) was reported in severity, time of onset, and duration of sialoadenitis in
938/2141(43.8%) of pts. 904 Pts categorized their P regards to salivary gland pain, swelling, and xerostomia are Table 7 Table 8
Duration of Xerostomia Severity of Xerostomia
as Grade 1-2 (83, 9%), 3-4 (256,28%), 5-6 reported.
Less than 30 min 10/792 1.3%
(332,36%), 7-8 (190,21%), and 9-10 (43,5%). For 789 Table 2 30 min to <1 hr 11/792 1.4% Grades Grades Grades Grades Grades
Table 1 Frequency of Side Effects 1 to < 2 hrs 12/792 1.5% 1-2 3-4 5-6 7-8 9-10
pts, the time of onset of P during the first seven days Demographics
2 to < 3 hrs 6/792 0.8% Frequency 71/1022 250/1022 380/1022 213/1022 108/1022
3 to < 4 hrs 12/792 1.5% (6.9%) (24.5%) (37.2%) (20.8%) (10.6%)
was: 112 (14%) on Day (D) 0, 362 (46%) on D1, 178 Male 245/2573 9.5%
Salivary Pain
In Males 58/208 27.9% 4 to < 5 hrs 2/792 0.3%
Female 2328/2573 90.5% In Females 880/1933 45.5% 5 to < 6 hrs 3/792 0.4%
(23%) on D2, 65 (8%) on D3, 26 (3%) on D4, 19 (2%) Mean Age
Range
46.5
8 – 86
Total 938/2141 43.8%
6 to <12 hrs 13/792 1.6%
Standard Deviation 12.1 Salivary Swelling 12 to < 18 hrs 11/792 1.4%
on D5, 7 (1%) on D6 and 20 (3%) on D7. For 770 Level of Education
In Males
In Females
49/187
734/1791
26.2%
41.0% 18 to < 24 hrs 18/792 2.3% Grade 0 Grade 2 Grade 4 Grade 6 Grade 8 Grade 10
24 to < 48 hrs 51/792 6.4%
respondents, the duration was less than 30 mins in
Elementary 8/2573 0.3% Total 783/1978 39.6%
Middle School 13/2573 0.5%
High School 504/2573 19.6% Xerostomia
48 to < 72 hrs 76/792 9.6%
Greater than 72 hrs 567/792 71.6%
25 (3%), 30mins-<1 hour (h) in 25 (3%), 1-<2h in 28 College –AA
College-BA-BS
Graduate School
602/2573
775/2573
671/2573
23.4%
30.1%
26.1%
In Males
In Females
Total
84/186
950/1770
1034/1956
45.2%
53.7%
52.9%
(4%), 2- <3h in 17 (2%), 3-<4h in 19 (3%), 4-<5h in 9
(1%), 5-<6h in 9 (1%), 6-<12h in 20 (3%), 12-<18h in
14 (2%), 18-<24h in 32 (4%), 24-<48h in 123 (16%), Results Discussion Conclusion
48- <72h in 109 (14%), and ≥72h in 340 (44%). The
complete data for the short term effects of both Graph 1:
salivary swelling and xerostomia are also reported. 100%
Statistics for Salivary Pain, Swelling, and Xerostomia
88%
Following 131I therapy, the side effects of sialodenitis This is the largest report to date that characterizes the
90% 82%
appear to be highly prevalent. The peak onset of side signs and symptoms of sialodenitis. While this study
Percentage of Patients
74%
80% 70% 69%
70% 63%
Summary: This is the largest report in the literature 60%
50% 44%
40%
53%
46% 47%
38% effects (i.e., salivary pain, swelling, and xerostomia) documents the frequency, onset, duration, and severity of
further characterizing the signs and symptoms of
40%
the side effects for up to 7 days after 131I therapy, further
30%
20% occurred one day after 131I therapy and appeared to last
studies are warranted to more thoroughly characterize
sialoadenitis occurring up to 7 days after 131I tx.
10%
0%
Fr eq
uenc
y
Day
of Onse
Dura
ti on >
for more than 24 hours in the majority of differentiated the nature of these side effects.
t on 24 h
thyroid cancer patient respondents.
Day rs
1
Pain Swelling Xerostomia