Amifostine for salivary glands in high-dose radioactive iodine treated differentiated thyroid cancer

Department of Nuclear Medicine, Affiliated Hospital of Medical College Qingdao University, Jiangsu Road 16, Qingdao, Shandong Province, China, 266003.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 07/2009; 4(4):CD007956. DOI: 10.1002/14651858.CD007956.pub2
Source: PubMed


Radioactive iodine treatment for differentiated thyroid cancer possibly results in xerostomia. Amifostine has been used to prevent the effects of irradiation to salivary glands. To date, the effects of amifostine on salivary glands in radioactive iodine treated differentiated thyroid cancer remain uncertain.
To assess the effects of amifostine on salivary glands in high-dose radioactive iodine treated differentiated thyroid cancer.
Studies were obtained from computerized searches of MEDLINE, EMBASE, The Cochrane Library and paper collections of conferences held in Chinese.
Randomised controlled clinical trials and quasi-randomised controlled clinical trials comparing the effects of amifostine on salivary glands after radioactive iodine treatment for differentiated thyroid cancer with placebo and a duration of follow up of at least three months.
Two authors independently assessed risk of bias and extracted data.
Two trials with 130 patients (67 and 63 patients randomised to intervention versus control) were included. Both studies had a low risk of bias. Amifostine versus placebo showed no statistically significant differences in the incidence of xerostomia (130 patients, two studies), the decrease of scintigraphically measured uptake of technetium-99m by salivary or submandibular glands at twelve months (80 patients, one study), and the reduction of blood pressure (130 patients, two studies). Two patients in one study collapsed after initiation of amifostine therapy and had to be treated by withdrawing the infusion and volume substitution. Both patients recovered without sequelae. Meta-analysis was not performed on the function of salivary glands measured by technetium-99m scintigraphy at three months after high dose radioactive iodine treatment due to the highly inconsistent findings across studies (I(2) statistic 99%). None of the included trials investigated death from any cause, morbidity, health-related quality of life or costs.
Results from two randomised controlled clinical trials suggest that the amifostine has no significant radioprotective effects on salivary glands in high-dose radioactive iodine treated differentiated thyroid cancer patients. Moreover, no health-related quality of life and other patient-oriented outcomes were evaluated in the two included trials. Randomised controlled clinical trials with low risk of bias investigating patient-oriented outcomes are needed to guide treatment choice.

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    • "Between 300 000 and 500 000 patients undergo radiation therapy each year worldwide,1 and as a consequence, most of these patients will experience severe salivary gland hypofunction. Neither the prophylactic use of amifostine2 to prevent radiation-induced xerostomia nor symptomatic treatment strategies, such as pilocarpine, have offered satisfactory relief from symptoms. Intensity-modulated radiation therapy holds great promise in reducing xerostomia;3 however, it is neither available nor applicable in the majority of cancer patients. "
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