Zusammenfassung
Die Radioiodtherapie ist ein entscheidender Pfeiler in der Therapie des differenzierten
Schilddrüsenkarzinoms. Allerdings sind nicht nur die Schilddrüsenkarzinomzellen in
der Lage Radioiod zu konzentrieren, sondern auch andere Zellen, die den Natrium-Iodid-Symporter
exprimieren – insbesondere auch die großen Kopfspeicheldrüsen. So ist zu erklären,
dass die akute und chronische Sialadenitis mit Xerostomie eine der wesentlichen Komplikationen
der Radioiodtherapie ist, die die Lebensqualität der Patienten erheblich negativ beeinflussen
kann. Ziel dieser Arbeit ist es, die Bedeutung der Speicheldrüsenfunktion zu erläutern
und die aktuellen Aspekte der Speicheldrüsendosimetrie bei der Radioiodtherapie zusammenzufassen.
Schließlich werden die über Jahrzehnte angewandten Maßnahmen zur Protektion der radiogenen
Speicheldrüsenschäden kritisch diskutiert.
Abstract
Radioiodine therapy plays a key role in the management of patients with differentiated
thyroid cancer. However, radioiodine is concentrated not only in the target tissues
but also by other tissue expressing sodium/iodine symporters – in particular the submandibular
and parotid salivary glands. As a consequence, high-activity radioiodine therapy may
be associated with unwanted radiogenic salivary gland damages. As a consequence, the
most frequently observed adverse short- and long-term side effects of radioiodine
therapy include sialoadenitis and some degree of xerostomia, both with a potentially
negative impact on quality of life. In this review, we highlight the function and
importance of salivary glands and discuss the current results of dosimetry studies
of the salivary glands in patients, who undergo radioiodine therapy. Based on the
dosimetry findings, the commonly applied radioprotective procedure to diminish damage
to the salivary glands are discussed critically.
Schlüsselwörter
Speicheldrüsen - Radioiodtherapie - Nebenwirkungen - Xerostomie - differenziertes
Schilddrüsenkarzinom - Dosimetrie -
124Iod
Key words
salivary glands - radioiodine therapy - side effects - xerostomia - differentiated
thyroid carcinoma - dosimetry -
124iodine
Literatur
- 1
Ariji R, Yuasa H, Ariji E.
High-frequency color Doppler sonography of the submandibular gland.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
1998;
86
476-481
- 2
Arita T, Fujita T, Yoneshiro S. et al .
Usefulness of color Doppler flow imaging for blood flow in salivary gland.
Nippon Igaku Hoshasen Gakkai Zasshi.
1993;
53
865-877
- 3
Bice AN, Eary JF, Nelp WB.
Quantification of iodine-131 distribution by gamma camera imaging.
Eur J Nucl Med.
1991;
18
142-144
- 4
Bohuslavizki KH, Brenner W, Lassmann S. et al .
Quantitative salivary gland scintigraphy in the diagnosis of parenchymal damage after
treatment with radioiodine.
Nucl Med Commun.
1996;
17
681-686
- 5
Bohuslavizki KH, Brenner W, Lassmann S. et al .
Quantitative salivary gland scintigraphy – a recommended examination prior to and
after radioiodine therapy.
Nuklearmedizin.
1997;
36
103-109
- 6
Bohuslavizki KH, Klutmann S, Brenner W. et al .
Salivary gland protection by amifostine in high-dose radioiodine treatment: results
of a double-blind placebo-controlled study.
J Clin Oncol.
1998;
16
3542-3549
- 7
Brown-Grant K.
Extrathyroidal iodide concentrating mechanisms.
Physiol Rev.
1961;
41
189-213
- 8
Caglar M, Tuncel M, Alpar R.
Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer
after radioiodine treatment.
Clin Nucl Med.
2002;
27
767-771
- 9
Carotti M, Salaffi F, Manganelli P. et al .
Ultrasonography and colour Doppler sonography of salivary glands in primary Sjogren's
syndrome.
Clin Rheumatol.
2001;
20
213-219
- 10
Cohen B, Logothetopoulos JH, Myant NB.
Autoradiographic localization of iodine-131 in the salivary glands of the hamster.
Nature.
1955;
176
1268-1269
- 11
Cooper DS, Doherty GM, Haugen BR. et al .
Management guidelines for patients with thyroid nodules and differentiated thyroid
cancer.
Thyroid.
2006;
16
1-33
- 12
De la Vieja A, Dohan O, Levy O. et al .
Molecular analysis of the sodium/iodide symporter: impact on thyroid and extrathyroid
pathophysiology.
Physiol Rev.
2000;
80
1083-1105
- 13
Dietlein M, Dressler J, Eschner W. et al .
Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version
3).
Nuklearmedizin.
2007;
46
213-219
- 14
Dodds MWJ, Johnson DA, Yeh CK.
Health benefits of saliva: a review.
J Dent.
2005;
33
223-233
- 15 Edgar M, Dawes C, O’Mullane D. Hrsg Saliva and Oral Health. 3. Auflage. London.
British Dental Association; 2004
- 16
Ernst H, Kopenhagen K, Ziegast J.
Strahlenreaktion und Strahlenfolgen an den Kopfspeicheldrüsen.
Strahlentherapie.
1977;
153
9-12
- 17
Filetti S, Bidart JM, Arturi F. et al .
Sodium/iodide symporter: a key transport system in thyroid cancer cell metabolism.
Eur J Endocrinol.
1999;
141
443-457
- 18
Flux G, Bardies M, Monsieurs M. et al .
The impact of PET and SPECT on dosimetry for targeted radionuclide therapy.
Z Med Phys.
2006;
16
47-59
- 19
Franzen L, Funegard U, Ericson T. et al .
Parotid gland function during and following radiotherapy of malignancies in the head
and neck, a consecutive study of salivary flow and patient discomfort.
Eur J Cancer.
1992;
28
457-462
- 20
Freitas JE, Gross MD, Ripley S. et al .
Radionuclide diagnosis and therapy of thyroid cancer: current status report.
Semin Nucl Med.
1985;
5
106-131
- 21
Freudenberg LS, Jentzen W, Brandau W.
124I-PET(/CT) bei differenzierten Schilddrüsenkarzinomen.
Nuklearmediziner.
2009;
32
149-153
- 22
Hyer S, Kong A, Pratt B. et al .
Salivary gland toxicity after radioiodine therapy for thyroid cancer.
Clin Oncol (R Coll Radiol).
2007;
19
83-86
- 23
Hyer SL, Newbold K, Hamer CL.
Early and Late Toxicity of Radioiodine: Detection and Management.
Endocr Pract.
2010;
14
1-20
- 24 Ship JA. Xerostomia: aetiology, diagnosis, management and clinical implications.
In:, Edgar M, Dawes C, O’Mullane D, Hrsg Saliva and Oral Health. 3. Auflage. London.
British Dental Association; 2004: 50-70
- 25
Jentzen W, Balschuweit D, Schmitz J. et al .
The influence of saliva flow stimulation on the absorbed radiation dose to the salivary
glands during radioiodine therapy of thyroid cancer using 124I PET(/CT) imaging.
Eur J Nucl Med Mol Imaging.
2010;
online publiziert am 13.07.2010
- 26
Jentzen W, Freudenberg L, Eising EG. et al .
Optimized 124I PET dosimetry protocol for radioiodine therapy of differentiated thyroid cancer.
J Nucl Med.
2008;
49
1017-1023
- 27
Jentzen W, Hobbs RF, Stahl A. et al .
Pre-therapeutic 124I PET(/CT) dosimetry confirms low average absorbed doses per administered (131)I activity
to the salivary glands in radioiodine therapy of differentiated thyroid cancer.
Eur J Nucl Med Mol Imaging.
2010;
37
884-895
- 28
Jentzen W, Schneider E, Freudenberg L. et al .
Relationship between cumulative radiation dose and salivary gland uptake associated
with radioiodine therapy of thyroid cancer.
Nucl Med Commun.
2006;
27
669-676
- 29
Jentzen W.
Experimental investigation of factors affecting the absolute recovery coefficients
in iodine-124 PET lesion imaging.
Phys Med Biol.
2010;
55
2365-2398
- 30
Jentzen W.
Prätherapeutische 124I PET(/CT)-Speicheldrüsendosimetrie bei der Radioiodtherapie differenzierter Schilddrüsenkarzinome
und Untersuchung von wichtigen Einflussfaktoren auf die 124I-Quantifizierung.
Universität Duisburg-Essen, Dissertation.
2010;
- 31
Jhiang SM, Cho JY, Ryu KY. et al .
An immunohistochemical study of Na+/I– symporter in human thyroid tissues and salivary gland tissues.
Endocrinology.
1998;
139
4416-4419
- 32
Kolbert KS, Pentlow KS, Pearson JR. et al .
Prediction of absorbed dose to normal organs in thyroid cancer patients treated with
131I by use of 124I PET and 3-dimensional internal dosimetry software.
J Nucl Med.
2007;
48
143-149
- 33
Lassmann M, Reiners C, Luster M.
Dosimetry and thyroid cancer: the individual dosage of radioiodine.
Endocr Relat Cancer.
2010;
17
R161-R172
- 34
Liu B, Kuang A, Huang R. et al .
Influence of vitamin C on salivary absorbed dose of 131I in thyroid cancer patients: a prospective, randomized, single-blind, controlled
trial.
J Nucl Med.
2010;
51
618-623
- 35
Logothetopoulos JH, Myant NB.
Concentration of radio-iodide and 32-S-thocyanate by the salivary gland.
J Physiol.
1956;
134
189-194
- 36
Luster M, Clarke SE, Dietlein M. et al .
Guidelines for radioiodine therapy of differentiated thyroid cancer.
Eur J Nucl Med Mol Imaging.
2008;
35
1941-1959
- 37
Ma C, Xie J, Jiang Z. et al .
Does amifostine have radioprotective effects on salivary glands in high-dose radioactive
iodine-treated differentiated thyroid cancer?.
Eur J Nucl Med Mol Imaging.
2010;
37
1778-1785
- 38
Mandel SJ, Mandel L.
Radioactive iodine and the salivary glands.
Thyroid.
2003;
13
265-271
- 39
Martinoli C, Derchi LE, Solbiati L. et al .
Color Doppler sonography of salivary glands.
AJR.
1994;
163
933-941
- 40
Nakada K, Ishibashi T, Takei T. et al .
Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid
cancer?.
J Nucl Med.
2005;
46
261-266
- 41
Nieuw Amerongen AV, Veerman ECI.
Saliva – the defender of the oral cavity.
Oral Dis.
2002;
8
12-22
- 42
Percival RS, Challacombe SJ, Marsh PD.
Flow rates of resting whole and stimulated parotid saliva in relation to age and gender.
J Dent Res.
1994;
73
1416-1420
- 43 Putz R, Pabst R. Hrsg Sobotta – Atlas der Anatomie des Menschen. Band 1. 20. Auflage.
München, Wien, Baltimore: Urban & Schwarzenberg; 1993
- 44
Robbins RJ, Schlumberger MJ.
The Evolving Role of 131I for the Treatment of Differentiated Thyroid Carcinoma.
J Nucl Med.
2005;
46
28S-37S
- 45
Schneider E.
Die Beziehung zwischen kumulativer Energiedosis und iod-131-Uptake von Speicheldrüsen
bei Radioiodtherapien des differenzierten Schilddrüsenkarzinoms.
Universität Duisburg-Essen, Dissertation.
2006;
- 46
Siedek V, Zengel P, Berghaus A.
Ursachen und Diagnostik der Xerostomie.
MMW Fortschr Med.
2008;
150
27-30
- 47
Siedek V, Zengel P, Berghaus A.
Chronische Mundtrockenheit.
MMW Fortschr Med.
2008;
150
31-33
- 48
Spiegel W, Reiners C, Börner W.
Einschränkung der Speicheldrüsenfunktion nach hochdosierter Radioiodtherapie.
Nuklearmediziner.
1986;
9
159-166
- 49
Sreebny LM.
Saliva in health and disease: an appraisal and update.
Int Dent J.
2000;
50
146-161
- 50 Taurog A. Hormone synthesis: thyroid iodine metabolism. In: Braverman LE, Utiger
RD, Hrsg. Werner & Ingbar's the thyroid Philadelphia: JB Lippincott Company; 1991:
51-97
- 51
Valdez IH, Atkinson JC, Ship JA. et al .
Major salivary gland function in patients with radiation-induced xerostomia: flow
rates and sialochemistry.
Int J Radiat Oncol Biol Phys.
1993;
25
41-47
- 52
Vayre L, Sabourin JC, Caillou B. et al .
Immunohistochemical analysis of Na/I symporter distribution in human extra-thyroidal
tissues.
Eur J Endocrinol.
1999;
141
382-386
- 53
Walter MA, Turtschi CP, Schindler C. et al .
The dental safety profile of high-dose radioiodine therapy for thyroid cancer: long-term
results of a longitudinal cohort study.
J Nucl Med.
2007;
48
1620-1625
Korrespondenzadresse
PD Dr. med. Dr. rer. medic. Lutz S. FreudenbergMA, MBA
Klinik für Nuklearmedizin
Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
Telefon: +49/201/723 2032
Fax: +49/201/723 5964
eMail: lutz.freudenberg@uni-duisburg-essen.de
