Characterization of sialoadenitis after administration of continuous sialogogues during the day and night after 131I therapy.
1. Characterization of sialoadenitis after administration of continuous sialogogues
during the day and night after 131I therapy.
Orquiza M1, Khorjekar G1, Schneider M1, Kulkarni K1, Garcia C1, Acio E1, Burman K2, Wartofsky L3 Van Nostrand D1
MedStar Washington Hospital Center, Div of Nuclear Medicine1, Div of Endocrinology2, Dept of Medicine3
References
Objectives:
To characterize sialoadenitis (SA) with continuous
administration of sialogogues (SGs) during the day and night
after 131I therapy in patients who have differentiated thyroid
cancer (DTC) at MedStar Washington Hospital Center (MWHC).
Methods:
A survey was performed from September to December
2012 of all patients who received 131I therapy. The
frequency, severity, and duration of SA (i.e., salivary gland
pain[P], swelling[S], and xerostomia[X]) after the patient‟s most
recent 131I therapy were tabulated between 5-10 days after 131I
therapy.
Results:
Of the 18 patients evaluated, 9 patients started using SGs
within 2 h of 131I therapy and used SGs at least every hour
throughout the first day and night after 131I therapy. The
frequency, severity, and duration of P, S, and X were as follows:
P reported in 4(44%); severity of P = Grade(Gr)1-2 in 3 and Gr3-
4 in 1; duration of P 18-<24h in 1, 24-<48h in 2, and ≥72h in 1. S
reported in 3(33%); severity of S was one each of Gr1-2, Gr3-
4, and Gr7-8; duration of S was one each of 18-<24h, 24-
<48h, and ≥72h. X was reported in 3(33%); severity of X was
Gr1-2 in 1 and Gr5-6 in 1, and Gr7-8 in 1, and the duration of X
was 24-<48h in 1 and ≥72h in 2. Comparison of this MWHC
study to the Thyroid Cancer Survivors Association, Inc. (ThyCa)
national survey (J Nuc Med. 2012;53(Suppl 5):94P) in which the
use of SGs was not controlled is noted.
Conclusions:
Salivary gland swelling and xerostomia were less
frequently noted when SGs were administered hourly within the
first day and night after 131I therapy as compared to patients who
did not receive a standard protocol of SG administration. These
results are encouraging, and further study is necessary with a
significantly greater number of patients and appropriate control
group to determine if SA is reduced.
SA is an important side effect of 131I therapy for
differentiated thyroid cancer (DTC); however, its reported
frequency, severity, and time of onset are quite variable in the
literature.
In this study, we aim to characterize SA with continuous
Discussion
Of the 18 patients evaluated, 9 patients started using SGs
within 2 hours of 131I therapy and used SGs at least every hour
throughout the first day and night after 131I therapy.
The frequency, severity, and duration of salivary gland
pain, salivary gland swelling, and xerostomia were as follows:
salivary gland pain was reported in 4(44%); severity of salivary
gland pain was Grade 1-2 in 3 patients and Grade 3-4 in 1
patient; duration of salivary gland pain was 18-<24 hours in 1
patient, 24-<48 hours in 2 patients, and ≥72 hours in 1 patient.
Salivary gland swelling was reported in 3(33%); severity of
salivary gland swelling was Grade 1-2 in 1 patient, Grade 3-4 in
1 patient and Grade 7-8 in 1 patient; duration of salivary gland
swelling was 18-<24 hours in 1 patient, 24-<48 hours in 1
patient, and ≥72 hours in 1 patient.
Xerostomia was reported in 3(33%); severity of
Xerostomia was Grade 1-2 in 1 patient, Grade 5-6 in 1 patient,
and Grade 7-8 in 1 patient; duration of Xerostomia was 24-<48
hours in 1 patient and ≥72 hours in 2 patients.
Comparison of the MWHC study to the ThyCa national
survey up to 7 days report [1] in which sialogogue use was not
controlled is shown in Table 1.
Salivary gland swelling and xerostomia were less frequently noted when
SGs were administered hourly within the first day and night after 131I therapy as
compared to patients who did not receive a standard protocol of SG
administration.
These results are encouraging, and further study is necessary with a
significantly greater number of patients as well as an appropriate control group
to ascertain whether SA is reduced.
Results
Methods
Abstract
Introduction
1. Hall J, Kharazi P, Van Nostrand D, et al. Characerization of
salivary gland side effects up to 7 days after 131I therapy:
updated report of the Thyroid Cancer Surviovrs„ Association, Inc.
(ThyCa) national survey. J Nuc Med. 2012;53(Suppl 5):94P.
2. Van Nostrand D. Sialoadenitis secondary to 131I therapy for well–
differentiated thyroid cancer. Oral Dis. 2011;17:154-161.
3. Van Nostrand, Freitas J. Side effects of 131I for ablation and
treatment of well-differentiated thyroid carcinoma. In: Wartofsky
L, Van Nostrand D, eds. Thyroid Cancer: A Comprehensive
Guide to Clinical Management. Totowa, NJ: Humana Press;
2006:459-484.
4. McDougall IR. Management of thyroid cancer and related
nodular disease. In: McDougall IR, ed. Management of Thyroid
Cancer and Related Nodular Disease. New York, NY: Springer;
2006:218.
5. Amdur RJ, Mazzaferri EL. Potential side effects and
complications of I-131 therapy. In: Amdur RJ, Mazzaferri
EL, eds. Essentials of Thyroid Cancer Management. New
York, NY: Springer; 2005;267-279.
6. DiRusso G, Kern KA. Comparative analysis of complications
from I-131 radioablation for well-differentiated thyroid cancer.
Surgery. 1994;116:1024-1030.
An IRB-approved survey was conducted from September
to December 2012 at MWHC of all patients who were >18 years
old who had DTC and received 131I therapy at MWHC and who
consented to participate in the study.
The survey included questions regarding the
frequency, severity, and duration of SA (i.e., salivary gland
pain, salivary gland swelling, and xerostomia) after the patient‟s
most recent 131I therapy at 5-10 days after 131I therapy.
Consequently, the MWHC data of patients on “continuous”
SGs was tabulated and then compared to the data from the
ThyCa national survey up to 7 days where no standard protocol
of sialogogues existed.
MWHC ThyCa p value
“Continuous”
sialogogues
No standard protocol
of sialogogues
Salivary gland pain (%) 4/9(44%) 938/1241(44%) 0.08
Salivary gland swelling (%) 3/9(33%) 783/1978(40%) 0.19
Xerostomia (%) 3/9(33%) 1034/1956(53%) 0.62
Table 1
Comparison of the MWHC study to the ThyCa national survey
Conclusion
Variability exists in the literature [1-6] regarding frequency, severity, and
time of onset of SA after 131I therapy. This study sought to characterize SA with
continuous administration of SGs during the day and night after 131I therapy in
DTC patients.
The limitations of this study are that the data presented is preliminary
and that the sample size is small. We expect to have a larger sample size to
better assess whether “continuous” SGs result in the reduction of SA.
However, currently the preliminary data does not show a statistical
difference between “continuous” use of SGs and no standard protocol of SGs
as the p values for the following suggest: salivary gland pain, p=0.08; salivary
gland swelling, p=0.19; xerostomia, p=0.62.
*Statistical analysis was performed using Chi-square with Yates correction
Introduction (cont’d)
administration of SGs during the day and night after 131I therapy in
patients who have DTC at MWHC.
![Characterization of sialoadenitis after administration of continuous sialogogues
during the day and night after 131I therapy.
Orquiza M1, Khorjekar G1, Schneider M1, Kulkarni K1, Garcia C1, Acio E1, Burman K2, Wartofsky L3 Van Nostrand D1
MedStar Washington Hospital Center, Div of Nuclear Medicine1, Div of Endocrinology2, Dept of Medicine3
References
Objectives:
To characterize sialoadenitis (SA) with continuous
administration of sialogogues (SGs) during the day and night
after 131I therapy in patients who have differentiated thyroid
cancer (DTC) at MedStar Washington Hospital Center (MWHC).
Methods:
A survey was performed from September to December
2012 of all patients who received 131I therapy. The
frequency, severity, and duration of SA (i.e., salivary gland
pain[P], swelling[S], and xerostomia[X]) after the patient‟s most
recent 131I therapy were tabulated between 5-10 days after 131I
therapy.
Results:
Of the 18 patients evaluated, 9 patients started using SGs
within 2 h of 131I therapy and used SGs at least every hour
throughout the first day and night after 131I therapy. The
frequency, severity, and duration of P, S, and X were as follows:
P reported in 4(44%); severity of P = Grade(Gr)1-2 in 3 and Gr3-
4 in 1; duration of P 18-<24h in 1, 24-<48h in 2, and ≥72h in 1. S
reported in 3(33%); severity of S was one each of Gr1-2, Gr3-
4, and Gr7-8; duration of S was one each of 18-<24h, 24-
<48h, and ≥72h. X was reported in 3(33%); severity of X was
Gr1-2 in 1 and Gr5-6 in 1, and Gr7-8 in 1, and the duration of X
was 24-<48h in 1 and ≥72h in 2. Comparison of this MWHC
study to the Thyroid Cancer Survivors Association, Inc. (ThyCa)
national survey (J Nuc Med. 2012;53(Suppl 5):94P) in which the
use of SGs was not controlled is noted.
Conclusions:
Salivary gland swelling and xerostomia were less
frequently noted when SGs were administered hourly within the
first day and night after 131I therapy as compared to patients who
did not receive a standard protocol of SG administration. These
results are encouraging, and further study is necessary with a
significantly greater number of patients and appropriate control
group to determine if SA is reduced.
SA is an important side effect of 131I therapy for
differentiated thyroid cancer (DTC); however, its reported
frequency, severity, and time of onset are quite variable in the
literature.
In this study, we aim to characterize SA with continuous
Discussion
Of the 18 patients evaluated, 9 patients started using SGs
within 2 hours of 131I therapy and used SGs at least every hour
throughout the first day and night after 131I therapy.
The frequency, severity, and duration of salivary gland
pain, salivary gland swelling, and xerostomia were as follows:
salivary gland pain was reported in 4(44%); severity of salivary
gland pain was Grade 1-2 in 3 patients and Grade 3-4 in 1
patient; duration of salivary gland pain was 18-<24 hours in 1
patient, 24-<48 hours in 2 patients, and ≥72 hours in 1 patient.
Salivary gland swelling was reported in 3(33%); severity of
salivary gland swelling was Grade 1-2 in 1 patient, Grade 3-4 in
1 patient and Grade 7-8 in 1 patient; duration of salivary gland
swelling was 18-<24 hours in 1 patient, 24-<48 hours in 1
patient, and ≥72 hours in 1 patient.
Xerostomia was reported in 3(33%); severity of
Xerostomia was Grade 1-2 in 1 patient, Grade 5-6 in 1 patient,
and Grade 7-8 in 1 patient; duration of Xerostomia was 24-<48
hours in 1 patient and ≥72 hours in 2 patients.
Comparison of the MWHC study to the ThyCa national
survey up to 7 days report [1] in which sialogogue use was not
controlled is shown in Table 1.
Salivary gland swelling and xerostomia were less frequently noted when
SGs were administered hourly within the first day and night after 131I therapy as
compared to patients who did not receive a standard protocol of SG
administration.
These results are encouraging, and further study is necessary with a
significantly greater number of patients as well as an appropriate control group
to ascertain whether SA is reduced.
Results
Methods
Abstract
Introduction
1. Hall J, Kharazi P, Van Nostrand D, et al. Characerization of
salivary gland side effects up to 7 days after 131I therapy:
updated report of the Thyroid Cancer Surviovrs„ Association, Inc.
(ThyCa) national survey. J Nuc Med. 2012;53(Suppl 5):94P.
2. Van Nostrand D. Sialoadenitis secondary to 131I therapy for well–
differentiated thyroid cancer. Oral Dis. 2011;17:154-161.
3. Van Nostrand, Freitas J. Side effects of 131I for ablation and
treatment of well-differentiated thyroid carcinoma. In: Wartofsky
L, Van Nostrand D, eds. Thyroid Cancer: A Comprehensive
Guide to Clinical Management. Totowa, NJ: Humana Press;
2006:459-484.
4. McDougall IR. Management of thyroid cancer and related
nodular disease. In: McDougall IR, ed. Management of Thyroid
Cancer and Related Nodular Disease. New York, NY: Springer;
2006:218.
5. Amdur RJ, Mazzaferri EL. Potential side effects and
complications of I-131 therapy. In: Amdur RJ, Mazzaferri
EL, eds. Essentials of Thyroid Cancer Management. New
York, NY: Springer; 2005;267-279.
6. DiRusso G, Kern KA. Comparative analysis of complications
from I-131 radioablation for well-differentiated thyroid cancer.
Surgery. 1994;116:1024-1030.
An IRB-approved survey was conducted from September
to December 2012 at MWHC of all patients who were >18 years
old who had DTC and received 131I therapy at MWHC and who
consented to participate in the study.
The survey included questions regarding the
frequency, severity, and duration of SA (i.e., salivary gland
pain, salivary gland swelling, and xerostomia) after the patient‟s
most recent 131I therapy at 5-10 days after 131I therapy.
Consequently, the MWHC data of patients on “continuous”
SGs was tabulated and then compared to the data from the
ThyCa national survey up to 7 days where no standard protocol
of sialogogues existed.
MWHC ThyCa p value
“Continuous”
sialogogues
No standard protocol
of sialogogues
Salivary gland pain (%) 4/9(44%) 938/1241(44%) 0.08
Salivary gland swelling (%) 3/9(33%) 783/1978(40%) 0.19
Xerostomia (%) 3/9(33%) 1034/1956(53%) 0.62
Table 1
Comparison of the MWHC study to the ThyCa national survey
Conclusion
Variability exists in the literature [1-6] regarding frequency, severity, and
time of onset of SA after 131I therapy. This study sought to characterize SA with
continuous administration of SGs during the day and night after 131I therapy in
DTC patients.
The limitations of this study are that the data presented is preliminary
and that the sample size is small. We expect to have a larger sample size to
better assess whether “continuous” SGs result in the reduction of SA.
However, currently the preliminary data does not show a statistical
difference between “continuous” use of SGs and no standard protocol of SGs
as the p values for the following suggest: salivary gland pain, p=0.08; salivary
gland swelling, p=0.19; xerostomia, p=0.62.
*Statistical analysis was performed using Chi-square with Yates correction
Introduction (cont’d)
administration of SGs during the day and night after 131I therapy in
patients who have DTC at MWHC.](https://image.slidesharecdn.com/whcsalivarymay312013-130603001634-phpapp02/85/characterization-of-sialoadenitis-after-administration-of-continuous-sialogogues-during-the-day-and-night-after-131i-therapy-1-320.jpg)
