Elsevier

Clinical Oncology

Volume 19, Issue 1, February 2007, Pages 83-86
Clinical Oncology

Original article
Salivary Gland Toxicity after Radioiodine Therapy for Thyroid Cancer

https://doi.org/10.1016/j.clon.2006.11.005Get rights and content

Abstract

Aims

Salivary gland toxicity is a common, but not widely appreciated, adverse effect of high-dose radioiodine (131I). This study was carried out to determine the incidence of symptoms of salivary gland damage after 131I treatment for differentiated thyroid cancer.

Materials and methods

This was a prospective study of 76 consecutive patients attending thyroid cancer treatment. Symptoms of salivary gland damage (dry mouth, pain and swelling) were assessed during hospital admission and at follow-up visits. Additionally, a retrospective analysis was carried out of patients recorded in our database as having chronic salivary gland swelling after 131I ablation.

Results

Twenty patients (26%) developed salivary gland toxicity, 11 (15%) had symptoms within the first 48 h, continuing for 12 months in seven of these patients. The onset of toxicity in a further nine (12%) patients with persistent symptoms did not occur until 3 months after therapy. In total, 16 (21%) patients had evidence of chronic toxicity, typically xerostomia, at 12 months. Toxicity was more common after repeated 131I administration. After searching our thyroid cancer database, we identified an additional five patients to have chronic salivary gland swelling (chronic sialadenitis or pleomorphic adenoma) 20 months to 23 years after 131I.

Conclusions

Pain, swelling and dry mouth occurred frequently after 131I, with some developing symptoms months or years after administration. Early recognition of salivary gland complications may help to reduce morbidity in these patients.

Introduction

Clinicians treating patients with radioiodine (131I) are aware that the salivary glands have the ability to selectively take up and concentrate iodine. However, there seems to be little recognition of the potential for salivary gland toxicity, particularly when large doses of 131I are used, such as in the treatment of differentiated thyroid cancer (DTC). Soon after 131I therapy, patients may experience acute salivary gland swelling and pain, which usually subsides over a few days. Some patients will develop a slower onset of symptoms and others may progress to a chronic radiation sialadenitis. The frequency of these complications after 131I therapy is uncertain, but is probably clinically significant in 11%–30% of patients 1, 2. We report our experience of salivary gland toxicity in order to highlight these problems and emphasise the importance of early recognition to minimise morbidity.

Section snippets

Materials and Methods

We carried out a prospective cohort study of all patients with DTC treated with 131I at the Royal Marsden Hospital over a 12-month period. There were 76 patients in this cohort and they were followed for a minimum of 48 months. All patients underwent total or near-total thyroidectomy before 131I ablation. An ablative dose of 3 GBq was given 4–6 weeks after surgery and a further therapy dose of 5.5 GBq was given if residual disease was demonstrated by abnormal post-ablative 131I whole body scans

Results

The cohort of 76 patients undergoing 131I ablation consisted of 19 men and 57 women, mean age 50.9 years (range 17–89). Fifty-six patients had papillary cancer, 18 had follicular cancer and two had Hürthle cell cancer. Lymph node metastases were present in 29 patients and eight had distant metastases. Twenty patients (26%) developed salivary gland toxicity with a median time of onset of 48 h from the timing of the 131I dose. The median duration of toxicity symptoms was 12 months. In the 11

Discussion

The overall frequency of symptomatic salivary gland damage after 131I in this study is 26% keeping with that reported previously 1, 2. Unusually, in this series, the submandibular glands seemed to be most frequently affected, although it was noticeable that the parotids were principally affected in all five patients in the cohort with chronic persistent swelling. It is possible that submandibular salivary gland involvement is under-reported and that swelling in these glands is confused with

Conclusion

In summary, clinicians, as well as patients receiving 131I, need to be aware of the possibility of salivary gland toxicity. Patients should be warned of the possibility of a dry mouth, pain or swelling in the salivary glands and told to report any symptoms to their nurse or doctor during their admission or at follow-up visits. Although in most cases this is a transient side-effect, it may persist for months or appear as a late complication. Early recognition is important so that further damage

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