Abstract
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Objectives: Thyroid cancer is a common endocrine tumor, according to ATA published guidelines for the treatment of adult thyroid nodules and DTC, the DTC standardized treatment regimen is surgical treatment of 131I and/or focal therapy + thyroid hormone therapy.Reported in the literature, in 131I removal of residual thyroid tissue and/or removal of metastatic foci for the treatment , because of the salivary gland tissue can also highly 131I uptake caused by salivary gland function damage. At present, there are a variety of methods to protect the salivary gland function, but the protective effect is still controversial. In this paper, the protective effect of vitamin C, amifostine to salivary gland function of patients with DTC in 131I therapy, was studied by radionuclide salivary gland dynamic imaging.
Methods: Sixty patients with DTC who underwent 131I therapy for the first time from May 2015 to February 2016 were enrolled in this study. All patients underwent surgical total thyroidectomy or subtotal resection. The pathologic diagnosis was DTC. Patients without autoimmune diseases, no head and neck radiation history, no hypotension and other diseases. The subjects were randomly divided into A(vitamin C group), B(amifostine group) and C(the combination of the two group ) three groups, each group of 20 patients. Group A was treated with Vit C for several days from the day before the 131I treatment to the end of the sixth day after treatment. In group B, 400mg amifostine was infused 30min before 131I, and blood pressure was monitored after 15min. Group C while the use of these two drugs, the method above.The salivary gland function was quantitatively analyzed before and after 131I treatment with salivary gland dynamic imaging. (UR30), excretion fraction (EF), excretion time (EP) and excretion rate (ER) after acid stimulation were calculated. Using SPSS 22.0 statistical software for the analysis of the data, compared with paired t test, the comparison between groups using non parametric test.
Results: 1.A group, the difference of UR30 between pre-and post-submandibular glands was 0.02 ± 0.03; the difference of EF was 2.48 ± 1.29; the difference of EP was -0.46 ± 0.16; the difference of ER was 2.69 ± 1.04. B group, pre-and post-submandibular gland UR30 difference was 0.01 ± 0.01; EF difference was 1.46 ± 2.76; EP -0.42 ± 0.11; ER difference of 2.03 ± 1.14. There was no significant difference between the two groups (P> 0.05).2.C group,the difference between pre-and post-submandibular gland UR30 was 0.01 ± 0.01; the difference of EF was 0.98 ± 0.45; the difference of EP was -0.13 ± 0.05; the difference of ER was 0.98 ± 0.35. Respectively, compared with A and B group, the difference was statistically significant (P <0.05).3.A group before and after treatment the parotid difference of UR30 was 0.04 ± 0.03; the difference of EF was 3.07 ± 1.77; the difference of EP was -0.79 ± 0.20; the difference of ER was 5.20 ± 1.63.B group,the difference of UR30 was 0.02 ± 0.01; the difference of EF was 1.77 ± 1.11; the difference of EP was -0.31 ± 0.08; the difference of ER was 2.09 ± 0.73. There was no significant difference between the two groups (P> 0.05)4. C groups,the difference between pre-and post-parotid UR30 was 0.02 ± 0.01; the difference of EF was 0.93 ± 0.83; the difference of EP was -0.23 ± 0.24; the difference of ER was 1.53 ± 1.16. Respectively, compared with A and B group, the difference was statistically significant (P <0.05).
Conclusion: 1. For the first time in the DTC patients with 131I treated, submandibular gland and parotid uptake and excretion function was damaged; 2.Vitamin C and amifostine can reduce the intake of salivary gland to 131I, reduce the damage of 131I on salivary gland, but there are no significant differences between the two; 3.The combined use of vitamin C and amifostine can improve the protective effect of the salivary gland, compared with the use of a single. Research Support: No