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Reducing the Incidence of ¹³¹I-Induced Sialadenitis: The Role of Pilocarpine

Department of Nuclear Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio

Correspondence: For correspondence or reprints contact: Edward B. Silberstein, MD, University of Cincinnati Medical Center, 234 Goodman St., Room G026, Mont Reid Pavilion, Cincinnati, OH 45219. E-mail: silbereb{at}healthall.com

The goal of this study was to reduce the salivary symptoms of pain and xerostomia caused by ¹³¹I therapy for papillary and follicular thyroid carcinoma. Methods: In a single-blind controlled prospective study of 60 patients, we investigated whether pilocarpine, 5 mg orally every 8 h for 1 wk after ¹³¹I therapy, would reduce salivary symptoms. All patients received 8 mg of dexamethasone and 100 mg of dolasetron mesylate orally 2 h before therapy and every 12 h for another 5 doses after ¹³¹I ingestion. In addition, for a week after therapy all drank 2,400 mL of nondairy liquid per day and had sugar-free gum or candy in their mouths at all times when awake for a week and, for the first 3 nights, every 3 h after retiring. All brushed their mouths out every 3 h while awake and also for the first 3 nights after ¹³¹I therapy. Symptoms and signs were followed by frequent telephone calls over the first week and every 8–12 wk thereafter, a physical examination within the first 10 d after therapy, and a clinic visit 6–8 mo after therapy. Statistical comparisons were by ² analysis. Results: The 2 patient groups were not statistically different in age, sex, type of thyroid cancer, or ¹³¹I activity administered (P > 0.05). There were no statistical differences between the groups in the prevalence of sialadenitis, stomatitis, xerostomia, or dysgeusia over the next 6 mo (P > 0.05). Conclusion: Under the conditions of the study, pilocarpine did not reduce the occurrence of radiation sialadenitis or stomatitis. The occurrence, however, was lower than had previously been reported in the literature, possibly because of the concurrent stringent application of physiologic sialogogues (candy, gum, fluids), dexamethasone, and dolasetron mesylate, a serotonin receptor antagonist.

Key Words: ¹³¹I • radiation sialadenitis • pilocarpine • serotonin receptor antagonist

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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